Diseases Treatment

Techniques for studying the functions of the kidney and visualizing the structures and processes of the urinary tract have been highly developed in recent years. Very exact knowledge of urological conditions can be obtained with the assistance of highly refined instruments, chemical analyses, x-ray visualization, and tests of function.
Urinalysis

Diagnosis of disease by inspection of the urine is an ancient and honorable practice, pursued centuries ago by Babylonian magi and Chinese, Hindu, Greek and Roman physicians of the time. In medieval days, the flask of urine was held in high esteem by patients and by practitioners who made diagnoses merely by looking at the portentous fluid.

Today, a properly analyzed urine specimen can tell many precise tales about conditions of the body. A complete urinalysis is not always necessary; it depends on what the doctor wants to learn about a particular patient’s condition. The mere volume of urine passed in 24 hours may, for instance, be significant. Odor and color are gross qualities, and frightening color does not always have frightening significance, as when reddish urine is traced to eating too many beets. Tests for sugar, albumin, specific gravity and acid-alkaline reaction are more or less routine, but more sophisticated tests may be ordered to determine the presence of specific kinds of inorganic crystals, bile, pus, blood cells, bacteria, proteins and other elements. Cultures may be necessary to identify the particular germs responsible for a urinary tract infection, so that effective anti microbial drugs may be used against them. Urine tests alone of course do not tell the whole story about a patient’s condition.
Cystoscopy

From the catheter, the beginning of instrumentation of the urinary tract, it was a tremendous leap to the modern cystoscope. This remarkable instrument consists essentially of a hollow tube with a tiny electric light bulb at its tip, which can be passed into the bladder. Various systems of viewing lenses are then introduced. Thus the interior of the bladder, the tubes leading into it, and the urethra can be inspected visually.

Modern cystoscopes embodying refined improvements are exceedingly versatile instruments. Forms of the cystoscope can be used as operating instruments for destruction of tumors and removal of stones and foreign bodies from the bladder. Recent improvements in the light systems have made it possible to see in the ureter and kidney pelvis, and it is likely that excellent instruments for inspecting the urine-collecting chambers of the kidney’s interior will be developed.
X Rays

Developments in x-ray apparatus have tremendously improved the study of the urinary tract and kidney function. Plain films can now be made which show the outlines of urinary tract structures. Other details can be visualized by injecting radio-opaque substances and making an x-ray film an excretory pyelogram. This enables the entire urinary tract to be visualized and shows any distortions or disturbances associated with disease processes. It is also possible to introduce such substances into particular regions through cystoscopes and catheters. Recent developments in cinefluorography make it possible to take motion pictures of the urinary tract in action, following the introduction of opaque media.

Since the main function of the kidney is to clear certain substances -from the blood, its ability to do so is a measure of kidney function. Highly specialized studies of the chemical constituents of the blood and ability of the kidneys to clear dyes or other substances give important information about how well the organs are doing their job.

Infections of the kidney and its pelvis (pyelonephritis) are quite common. They are of extreme importance because chronic and recurring infections tend to induce changes which in time may interfere seriously with kidney function. In many ways the conditions seem to be related to high blood pressure. Some cases, particularly if untreated or neglected, progress to renal insufficiency­ incapacity of the kidneys to filter toxins adequately from the blood. Retention of these infectious wastes leads to uremia or “uremic poisoning.”

Infections can reach the kidney by various routes: direct ascent of infecting organisms from the bladder; spread from infections in surrounding tissues; and via the bloodstream and lymphatic channels. Acute infections manifest them­selves by pain in the kidney region, fever and chills, and changes in composition of the urine. Chronic and recurrent infections tend to manifest themselves more insidiously in symptoms such as head­ache, nausea or vomiting.

Symptoms Of Kidney Infections

The urine may contain pus (pyuria), colonies of micro-organisms, many white blood cells, and other products of inflammation. Identification of the infecting organisms enables effective antibiotics or other drugs to be given to destroy the organisms. Many acute and chronic infections respond to proper chemotherapy, rest, and general care in the form of fluids and other measures.

However, many kidney infections are complicated by obstructions and conditions which prevent free drainage of the urinary tract. Infected teeth and other foci may introduce infecting organisms into the bloodstream and thence the kidneys, in continuous supply. Extrarenal sources of infection must be recognized and cleared up, and there is need for urological investigation to recognize and correct abnormalities which impede good drainage and perpetuate low-grade infectious organisms. Early diagnosis and treatment is important and neglect may lead to kidney damage that is difficult if not impossible to reverse.

Some stones thrive in acid urine, others in alkaline. Medicines and special diets, such as an acid ash diet, may help to maintain desired balances and deter future stone formation. There are other medical measures which a doctor can institute from his special knowledge of the patient’s body chemistry and physical condition. It is of immediate importance to remove stones that are causing serious trouble, and this generally requires surgery . Sometimes it is desirable to remove the entire kidney, if its function has been markedly impaired by a large stone or stones, and if the remaining kidney is healthy and quite capable of continuing the labors that it has shouldered anyhow. Naturally, it is far more desirable for a person who is susceptible to stone formation to cooperate with his doctor in regular checkups, with x-rays and other measures, which may keep trouble from progressing and do everything possible to avert eventual surgical removal of a kidney.

Symptoms Of Kidney Stones

Some stones cause no symptoms, at least for a long time. Fine crystals, no larger than grains of sand, may pass down the ureter and to the outside world without the patient’s being aware of it. Some “silent” stones are too large to enter or obstruct the ureter, but they may move about in the kidney and do quiet injury to delicate tissues. Some stones may practically fill the kidney pelvis and take on the irregular shape of the cavity, like a cast. These are called “stag horn” calculi from their antler like appearance. person who experiences it. The agony is caused by a stone which enters the ureter and works its way down, gouging as it goes. The pain is not necessarily felt in the mid-back, in the area memorialized by old-time advertisements for kidney nostrums, but may be referred to the pelvic region. Indeed, pain is not invariably excruciating, and the immediate symptoms may be nausea, vomiting, chills and fever.

Kidney Stones Treatment

If the stone gets stuck in the ureter, and medical measures can do little more than relieve pain, surgery will probably be necessary to remove an obstruction which can cause urine to back up, distend, and injure the tract above it most gravely. Stone-harried kidneys generally are more prone to infections; modern antibacterial drugs afford potent measures of control.

Often a stone passes into the bladder and acute pain subsides. Bladder stones are relatively easy to remove with instruments which leave no operative scar. The surgical instrument is inserted through the urethra, the stone grasped and crushed, and the particles withdrawn. Occasionally, a stone will lodge in the urethra and prevent urination. Its removal is comparatively easy and always an immense relief to the patient.

Kidney Tumors are not uncommon. They may be benign, or they may be malignant that is, cancerous, with ability to spread to other parts of the body (metastasize). The benign tumors are essentially cysts of the kidney, fluid­filled sacs. These may occur in one kidney or both, and may produce a large mass in the abdomen of the patient.

Malignant tumors practically always affect only one kidney. They arise in functioning tissue of the kidney. In general, kidney malignancies occur in two periods of life, in infancy, and in mid-adult life. Broadly speaking, there are two types: the so-called Wilms’ tumor of childhood, and the malignancy of the adult; the so­called hypernephroma, which occurs primarily in persons over the age of 40. There are other malignant tumors which need not be discussed, because they are extremely rare and their effects are quite similar to those of Wilms’ and hypernephroma tumors.
Kidney Tumor Symptoms

Evidences of such kidney tumors are primarily pain in one side or the other, bloody urine, or appearance of a mass in the abdomen in the region of the kidney. The symptom of bloody urine may not be accompanied by pain. There may be periods when there is no blood in the urine, and precious time may be lost in hope that the symptom will “go away.” It is always a symptom that calls for immediate investigation, although it may originate from quite another cause than cancer.
Kidney Tumor Cure

As with all cancers, the best hope of cure lies in early treatment.A mother is often the first to discover a Wilms’ tumor, as an abdominal mass, in the course of caring for her baby. The tumor usually occurs before the age of seven. A mass that can be felt in the abdomen is not necessarily a Wilms’ tumor. A very large hydronephrosis, which we will discuss later, can also produce a mass and is much more common than Wilms’ tumor. Congenital cysts of the kidney also may produce a large abdominal mass. Every child who has a palpable mass in the abdomen should be investigated promptly. The treatment for Wilms’ tumor and hypernephroma is removal.

Obstructions

The most common abnormalities involving the infections of urinary tract, and the most important from the point of view of kidney damage, are obstructions. Obstructions can occur in the area where the urine-collecting pelvis of the kidney merges with the narrow ureter, or they may occur anywhere along the ureter. For example, a stone or congenital stricture may obstruct the ureter any­where along its course. Or obstruction can occur within the bladder from a tumor which blocks the openings of both ureters into the bladder, or it can occur at the bladder neck from congenital lesions, tumors, stones, or strictures.

Obstruction anywhere along the line causes urine to back up, as a river backs up behind a dam. Back pressure produces hydronephrosis, a swelling of the kidney pelvis, and the ureter becomes distended and swollen above the level of obstruction. Hydraulic pressure squeezes kidney tissue which begins to atrophy. Functioning capacity is gradually lost and the inflated kidney is at risk of becoming totally useless. When destruction of any nature is discovered, it must be removed by appropriate therapy to prevent irreparable harm.
Ureters

Injuries which tear, puncture, or otherwise disrupt a ureter permit urine to seep into surrounding tissues like water from a burst pipe. Repair is surgical. Strictures and stones may cause obstruction. Tumors may produce obstruction and gross bleeding into the bladder. The most important single difference between lesions of the ureter and the kidney itself is that ureteral obstruction invariably produces pain, but lesions of the kidney frequently do not. The pain warning generally leads to early diagnosis and removal of an obstruction which can do untold harm to the kidney above it.

Cancer of the Bladder

It is extremely important that persons who have any difficulty or abnormality of urination be carefully examined to ascertain whether any lesions are present in the bladder.

Cancer of the bladder is one of the most common in this country. It is almost as common as cancer of the lungs, although it has not received as much publicity. At the University Hospitals in Iowa City, more than 75 new patients with cancer of the bladder are seen yearly.

The most common evidence of cancer of the bladder is grossly bloody urine, but frequency of urination and cloudy urine may also be important symptoms. When detected early, the outlook is good, when late, poor. Treatment consists of destruction of the tumor by a combination of surgical removal and irradiation therapy. Small tumors may be removed through the urethra with an instrument called the resectoscope. Larger lesions require more radical sur

The term is quite simple. Renal Insufficiency means that the kidneys are unable to filter all the wastes and poisons from the blood. Thus, various amounts of toxic materials remain harmfully in the body. If the kidneys fail completely, death results in a few days, from uremia “uremic poisoning “. This ia a damming-up of toxins which is fatal unless corrected.

There are degrees of uremia. Early symptoms are headache, loginess, itching, muscle discomfort, with or followed by nausea and vomiting. The patient becomes drowsy, perhaps has convulsions, and lapses into coma and death.

Insufficiency is relative to the capabilities of a particular pair of kidneys. Insufficiency may result from some acute, repairable condition, or from gradual and irreversible damage and destruction of kidney tissue over a period of years. A major purpose of good urological care is to prevent insidious kidney injury and whenever possible to eradicate causes of insufficiency by such measures as clearing up infections and removing or by­passing obstructions.

Great advances in treatment of renal insufficiency have been made in recent years. One of the mechanisms artfully employed by the kidneys is dialysis. This is the separation of substances in solution, having different diffusibilities, by passing them through a porous membrane, such as membranes of the kidney filters. Similar filtration can be achieved by techniques of peritoneal dialysis, in which membranes of the abdominal cavity do the work of the diseased kidneys temporarily. Blood passed through peritoneal membranes is cleansed and returned to the body. The technique has proved very successful in treatment. Absorptive resins placed in the gastrointestinal tract are useful adjuncts.