Kidney Function

Renal cell carcinoma is a malignant tumor of the kidneys resulting from tubular epithelium.

Renal cell carcinoma accounts for about 90% of kidney cancers. It is estimated that in 1989, 23,000 cases were diagnosed, and out of those 23k, 10,000 people died as a result of the disorder. Renal cell carcinoma occurs most frequently in adult men, with the peak occruence in the sixth decade of life. The life expectancy of a patient with metastases at the time of diagnosis is poor; only 5%-20% are alive at the end of the first year. The disorder is usually unilateral, with equal incidence in the right and left kidneys. There is little evidence for specific carcinogens, although tobacco use appears to be associated with development of the tumor.

Pathophysiology

The tumor may appear anywhere in the kidney, and its increasing mass may compress surrounding tissue, causing ischemia, necrosis, and hemorrhage. The tumor may invade the collecting system and branches of the renal vein, even extending in the the inferior vena cava. Although the tumor grows somewhat slowly, metastases can occur at any stage. Primary sites of metastases are the lungs, lymph nodes, liver, and bones. Renal cell carcinoma metastasizes to all visceral organs. Such involvement may be discovered first, an metastases may occur long after the original tumor has been removed.

Treatment

When a patient is diagnosed with renal cell carcinoma, efforts are made to stage the tumor’s development. No radiation or chemotherapy has been found to effect a cure.

A radical extrafascial nephrectomy may be attempted, which is a surgery that involves removing the kidney and tumor, neural and vascular structures at the kidney’s hilum, surrounding perinephric fat, Gerota’s fascia, and the ipsilateral adrenal gland. The prognosis is poor if there is involvement of the renal vein or extension through Gerota’s fascia, extension to the renal lymph nodes or contiguous organs, or distant metastases. The need for nephrectomy depends on the severity of symptoms. Radical nephrectomy is not indicated if there is preoperative evidence of local node involvement or advanced disease. A partial nephrectomy is done if the patient has only one kidney. Staging involves examining local nodes and identifying distant metastases.

In the body, blood serves as a liquid transport system. It carries important substances to all cells in the body. It also carries waste materials away from cells.

Blood is made up of fluid (plasma or serum) and contains many different kinds of cells. Red cells, which are called erythrocytes, are the most common type. The average person has over thirty-five trillion erythrocytes. If a person has anemia, they have a reduced number of red blood cells. A doctor can tell how many red blood cells a person has by doing a blood test of the hematocrit or a red blood cell count. The hematocrit tells what percent of the blood is red cells. A normal hematocrit level is between 38% and 48%, but a level of 24 to 30 is still satisfactory for a dialysis patient. The doctor may also measure the hemoglobin level. Hemoglobin is the molecule that carries oxygen in red blood cells. A normal hemoglobin level is between 12 grams and 16 grams per deciliter. A normal red blood cell count is between 4.4-5.8 million per microliter.

Purpose of Red Blood Cells
Hemoglobin in the red blood cells carries oxygern to all parts of the body. The red cells are the oxygen transport system. The body uses oxygen as a fuel or source of energy. When a person is anemic, and does not ahve enough red blood cells, parts of the body do not get enough oxygen to work properly and the person may feel exhausted and out of breath. People with anemia may feel like they have no energy. The hemoglobin in red blood cells also serves to transport carbon dioxide, a waste product from the cells or tissues throughout the body to the lungs where carbon dioxide is excreted.

Symptoms of Anemia
Along with lack of energy, other symptoms of anemia include fatigue, depression, and inability to concentrate or exercise normally. Shortness of breath, palpitations (rapid or irregular heart beat), impotence (failure to achieve adequate penile erection), dizziness, light-headedness and constantly feeling cold are also symptoms of anemia.

Can Dialysis Help with Anemia?
Normally, the kidneys remove fluids and toxins from the blood stream. For people with kidney disease, dialysis does much of this work for the kidneys. However, dialysis cannot replace erythropoietin. Nevertheless, some dialysis patients are not anemic, even without being given erythropoietin.

How can Anemia be Treated?
Dialysis patients may receive blood transfusions if they are anemic. When patients are transfused, they receive red blood cells from a blood donor. They might also receive anabolic male-type (androgenic) hormones, such as decadurabolin. These substances may help raise the hematocrit to some degree.

Now there is an effective way to treat anemia in people with kidney failure. Scientists have found a way to produce erythropoietin in a laboratory using recombinant DNA technology. This erythropoietin is called recombinant human erythropoetin, or simply “EPO”.

Blood studies are generally performed to determine if you are maintaining your diet and medication properly and also to evaluate the effectiveness of your dialysis treatment. A group of blood tests is usually done monthly as a monitoring method to keep an eye on your blood chemistries. Blood may be drawn from the blood tubing at the beginning of a dialysis treatment for laboratory studies and sometimes during and at the end of dialysis. These tests include creatinine, blood urea nitrogen and hematocrit. Other blood tests are performed to determine the levels of potassium, sodium, bicarbonate, calcium and phosphate in the bloodstream.

Why is Fluid a Problem?

Properly functioning kidneys prevent the fluid in the body from building up by removing the excess body fluid as urine. When your kidneys are not functioning, fluid may accumulate in your bloodstream. A large amount of fluid in your blood can cause high blood pressure and it also places a strain on your heart. Although fluid can also collect in your lungs, making it difficult to breathe properly, this can be controlled by bringing the body to a dry weight or a weight at which the blood pressure is normal and no swelling is present. You should achieve proper fluid balance by watching your diet and fluid intake between dialysis treatments.

Will I Experience Muscle Cramps?

Muscle cramps are most likely to occur if you are overweight due to the excess fluid in your body. A major cause of muscle cramps is the removal of a large amount of fluid during treatment. The best way to avoid muscle cramps is to limit salt and fluid intake.

Will Itching be a Problem?

You may experience some itching as a result of kidney failure (uremia), the level of phosphorus in the body or allergies to medications you may be taking. If the itching symptoms are related to uremia, your doctor may increase dialysis or prescribe medications, and, in some cases, recommend ultraviolet light treatments. Your physician adjusts the intake of phosphorus through diet and medication if the itching is related to phosphorus. Your medications may be adjusted if the itching is a result of an allergic reaction to medications.