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Specialities

Kidney Abscess

A renal abscess can be caused by bacteria from an infection that’s gotten to the kidneys. The bacteria can travel through the blood or in urine backing up into the kidney. In the kidney, the bacteria can spread to the kidney tissue.

A renal abscess is not a common disease. It often occurs as a result of common problems such as:

  • Kidney inflammation
  • Stone disease
  • Urine flowing backwards into the kidney from the bladder (“vesicoureteral reflux”)

A renal abscess can sometimes form from infection in other parts of the body. Abscesses in the skin and intravenous drug abuse can also lead to renal abscess.

Some symptoms of a renal abscess are:

  • Fever
  • Chills
  • Pain in the belly
  • Weight loss
  • Vague feeling of bodily discomfort

You might also have pain when passing urine and the urine may be bloody.

DIAGNOSIS OF RENAL ABSCESS.

It can sometimes take a while to notice a renal abscess. This is because the symptoms are vague and the disease isn’t common.

Lab Tests

A blood test may show a higher white blood cell count and bacteria. Bacteria are often found in the urine as well.

Imaging Tests

X-ray findings depend on how bad the infection is and how long it’s been there. Small renal abscesses can be hard to notice on an x-ray.

Ultrasound and computerized tomography (CT) scans are most helpful in recognizing a renal abscess.

Complicated urinary tract infections can also put a person at risk for renal abscess if linked to:

  • Stones
  • Pregnancy
  • Neurogenic bladder
  • diabetes mellitus
  • Vague feeling of bodily discomfort

You can help prevent renal abscess by having any bacterial or urinary tract infections (UTI) treated right away.

TREATMENT OF RENAL ABSCESS

Renal abscess is treated with antibiotics given through the blood by IV (“intravenously”) and/or by draining the pus from the abscess.

The draining can be done with surgery or by putting a tube (“catheter”) through a needle in the skin over the kidney (“percutaneous drainage”). X-rays are used to help see that the needle is in the kidney. Percutaneous drainage is a recent technique and is the method being used more often.

Hypertensive Kidney Disease

Hypertensive kidney disease is a medical condition referring to damage to the kidney due to chronic high blood pressure.

Signs and symptoms of chronic kidney disease, including loss of appetite, nausea, vomiting, itching, sleepiness or confusion, weight loss, and an unpleasant taste in the mouth, may develop.

"Hypertensive" refers to high blood pressure and "nephropathy" means damage to the kidney; hence this condition is where chronic high blood pressure causes damages to kidney tissue; this includes the small blood vessels, glomeruli, kidney tubules and interstitial tissues. The tissue hardens and thickens which is known as nephrosclerosis. The narrowing of the blood vessels means less blood is going to the tissue and so less oxygen is reaching the tissue resulting in tissue death (ischemia).

Diagnosis of HN is made from a clinical history and biochemical investigations. Chronic hypertension with progressive kidney disease progresses over a long period of time. Damage to the glomeruli allows proteins that are usually too large to pass into the nephronto be filtered. This leads to an elevated concentration of albumin in the urine (albuminuria). This albuminuria usually does not cause symptoms but can be indicative of many kidney disorders. Protein in the urine (proteinuria) is best identified from a 24-hour urine collection.

The aim of the medical treatment is to slow the progression of chronic kidney disease by reducing blood pressure and albumin levels.

ACE inhibitors, angiotensin receptor blockers, direct renin inhibitors and aldosterone antagonists, are pharmacological treatments that can be used to lower BP to target levels; hence reducing neuropathy and proteinuria progression.

Diabetic nephropathy

Diabetic nephropathy (or diabetic kidney disease) is a progressive kidney disease caused by damageto the capillaries in the kidneys' glomeruli.It is characterized by nephrotic syndrome and diffuse scarring of the glomeruli. It is due to longstanding diabetes mellitus, and is a prime reason for dialysis in many developed countries. It is classified as a small blood vessel complication of diabetes.

Signs and symptoms

During its early course, diabetic nephropathy often has no symptoms. Symptoms can take 5 to 10 years to appear after the kidney damage begins.These late symptoms include severe tiredness, headaches, a general feeling of illness, nausea, vomiting, frequent voiding, lack of appetite, itchy skin, and leg swelling.

Causes

The cause of diabetic nephropathy is not well understood, but it is thought that high blood sugar, advanced glycation end productformation, and cytokines may be involved in the development of diabetic nephropathy.

Kidney damage is likely if one or more of the following is present:

DIAGNOSIS

Diagnosis is usually based on the measurement of high levels of albumin in the urine or evidence of reduced kidney function. Albumin measurements are defined as follows:

  • Normal albuminuria: urinary albumin excretion <30 mg/24h;
  • Microalbuminuria: urinary albumin excretion in the range of 30–299 mg/24h;
  • Clinical (overt) albuminuria: urinary albumin excretion ≥300 mg/24h.

People with diabetes are recommended to have their albumin levels checked annually, beginning immediately after diagnosis for type 2 diabetics, and five years after diagnosis for type 1 diabetics. To test kidney function, the person's estimated glomerular filtration rate (eGFR) is measured from a blood sample. Normal eGFR ranges from 90 to 120 ml/min/1.73 m

Treatment

The goals of treatment are to slow the progression of kidney damage and control related complications. The main treatment, once proteinuria is established, is ACE inhibitor medications, which usually reduce proteinuria levels and slow the progression of diabetic nephropathy. Other issues that are important in the management of this condition include control of high blood pressure and blood sugar levels, as well as the reduction of dietary salt intake.

PROGNOSIS

Diabetic nephropathy in type 2 diabetes can be more difficult to predict because the onset of diabetes is not usually well established. Without intervention, 20-40 percent of patients with type 2 diabetes/microalbuminuria, will evolve to macroalbuminuria.

Diabetic nephropathy is the most common cause of end-stage kidney disease, which may require hemodialysis or even kidney transplantation. It is associated with an increased risk of death in general, particularly from cardiovascular disease.

Kidney Stones

What Is It?

Kidney stones are abnormal, hard, chemical deposits that form inside the kidneys. This condition also is called nephrolithiasis or urolithiasis.

Kidney stones are often as small as grains of sand. They pass out of the body in urine without causing discomfort.

However, the deposits can be much larger—the size of a pea, a marble or even larger. Some of these larger stones are too big to be flushed from the kidney.

Some kidney stones manage to travel into the ureter. This is the narrow tube between the kidney and bladder. The stones may become trapped in the ureter. Trapped kidney stones can cause many different symptoms. These include:

  • Extreme pain
  • Blocked urine flow
  • Bleeding from the walls of the urinary tract

There are several different types of stones. They form for a variety of reasons. Kidney stones are grouped into four different categories, based on their chemical composition:

  • Calcium oxalate stones

    These stones account for most kidney stones. Several factors increase the risk of calcium oxalate stone formation in the kidney:

    • Low urinary volume
    • High concentrations of calcium in the urine
    • High concentrations of oxalate in the urine
    • Low amounts of citrate in the urine (citrate acts to inhibit stone formation)

    Medical conditions that increase the risk of calcium oxalate kidney stones include:

    • Extra parathyroid hormone (hyperparathyroidism)
    • High uric acid levels in the blood (as in people who have gout)
    • Bowel disease
    • Surgery for obesity
    • Kidney problems
  • Struvite stones - These stones are made of magnesium and ammonia (a waste product). They are related to urinary tract infections caused by certain bacteria. Struvite stones are less common now that urinary tract infections are better recognized and treated. Struvite stones are more common in women than in men. They develop frequently in people who have long-term bladder catheters.
  • Uric acid stones - Uric acid stones form because of an abnormally high concentration of uric acid in the urine. They are more likely to occur in people who have gout because of an over production of uric acid. Gout is a disorder in which uric acid builds up in the blood and gets deposited in joints.
  • Cystine stones - These rare stones are the least common type of kidney stones. They are composed of the amino acid cystine. Cystine is a building block of proteins. Cystine stones are caused by an inherited defect.

Symptoms

Very small kidney stones may pass out of the body in the urine without causing symptoms.

Larger stones may become trapped in the narrow ureter. This can cause:

  • Severe pain in the back or side
  • Nausea and vomiting
  • Blood in the urine (urine may look pink, red, or brown)

The location of pain may shift downward, closer to the groin. This usually indicates that the stone has traveled downward in the ureter and is now closer to the bladder. As the stone approaches the bladder, you may feel:

  • A stronger urge to urinate
  • A burning sensation when urinating

When stones pass out of your body in your urine, you may see the stones exit

Diagnosis

Your doctor will ask you about your symptoms. He or she will ask about any change in the colour of your urine. Your doctor will want to know about your family history of kidney stones, and whether you have had gout.

Your doctor will check your urine for red blood cells. He or she may order a X-Ray KUB(Kidney,Ureter,Bladder), Computed tomography (CT) scan or Ultrasound. The CT scan can show an actual stone. The Ultrasound usually cannot detect the actual stone. But an ultrasound can show swelling of the kidney and/or ureter which indicates that the stone is obstructing urine flow.

If you are able to collect a stone that you passed from your urine, your doctor will send the stone to a laboratory for chemical analysis. Blood and urine tests may be done to identify a treatable cause of the stone.

Expected Duration

When a kidney stone becomes trapped in the ureter, it may remain there until your doctor removes it. Or, it eventually may move downward and pass on its own. It can take hours, days or weeks for a stone to pass.

As a rule, the smaller the stone, the more likely it is to pass on its own. The larger the stone, the greater the risk that it will remain trapped in the ureter. A trapped stone can significantly obstruct the flow of urine.

Prevention

In general, you can help to prevent kidney stones by drinking plenty of fluids and avoiding dehydration. This dilutes your urine and decreases the chance that chemicals will combine to form stones.

You can prevent calcium oxalate stones by eating low-fat dairy products and other calcium-rich foods. Taking calcium supplements, however, can increase the risk of stone formation.

People who excrete too much oxalate into their urine should avoid eating foods high in oxalate. These foods include beets, spinach, chard and rhubarb. Tea, coffee, cola, chocolate and nuts also contain oxalate, but these can be used in moderation. Eating too much salt and meat can cause more kidney stones to form.

After your doctor receives an analysis of the chemical composition of your kidney stones, he or she can suggest medications or changes in your diet that will help to prevent stones from forming in the future.

Certain medications may increase the risk of stones. So your doctor may want to adjust your regular medications if you have had kidney stones.

Treatment

In many cases, a trapped kidney stone eventually flushes out of the urinary tract on its own, especially if you drink plenty of fluids. With a doctor’s supervision, it is likely that you can remain at home. You can take pain medicine as needed until the stone dislodges and flushes away.

In some cases, it is necessary to have your stone removed or broken into fragments that can pass more easily. This may be the case if:

  • The stone is too large to pass on its own
  • Your pain is severe
  • You have infection
  • You have significant bleeding

Doctors have several options for destroying stones lodged in the urinary tract:

  • Extracorporeal lithotripsy — Shock waves applied externally break kidney stones into smaller fragments. The fragments are then swept away in the urine stream.
  • Percutaneous Nephrolithotomy — A narrow, tube-like instrument is passed through a small incision in the back to the kidney. There, ultrasound breaks up the kidney stones. The stone fragments are then removed.
  • Laser lithotripsy — A laser breaks up stones in the ureter. The stones then pass on their own.
  • Ureteroscopy — A very small telescope is inserted into the urethra as it makes its way to the bladder. The doctor finds the opening of the affected and guides the scope up the ureter until it reaches the stone. The stone is then either fragmented or removed.

Once a kidney stone has been removed, you can sometimes prevent new stones from forming with medications or changes in diet.

When To Call A Professional

Call your doctor whenever you have:

  • Severe pain in your back or side, with or without nausea and vomiting.
  • Unusually frequent urination or a persistent urge to urinate.
  • A burning and discomfort when urinating.
  • Urine that is colored pink or tinged with blood.

Trapped kidney stones can lead to a urinary tract infection. Call your doctor if you have fever and chills, or if your urine becomes cloudy or foul smelling.

Prognosis

The prognosis varies from person to person. Up to half of people who pass a kidney stone will never pass a second. For people with a recurrent kidney stone, the prognosis depends on the cause of the kidney stones and the response to preventive therapies.

Urinary tract infections

What Is a Urinary Tract Infection?

About half of women will get a urinary tract infection, or UTI, at some point in life. It happens when germs infect the system that carries urine out of the body -- the kidneys, bladder, and the tubes that connect them. Bladder infections are common and usually not serious if treated promptly. But if the infection spreads to the kidneys, it can cause more serious illness.

UTI Symptoms: Bladder Infection

Most UTIs are bladder infections. Symptoms include:

  • Pain or burning sensation during urination.
  • The urge to urinate often.
  • Pain in the lower abdomen.
  • Urine that is cloudy or foul-smelling.
  • Some people may have no symptoms.

UTI Symptoms: Kidney Infection

An untreated bladder infection can spread to the kidneys. Signs of this include:

  • Pain on either side of the lower back.
  • Fever and chills.
  • Nausea and vomiting.

When to See Your Doctor

See your doctor right away if you have signs of a urinary tract infection. A bladder infection is generally not a medical emergency -- but some people have a higher risk for complications. This includes pregnant women, the elderly, and men, as well as people with diabetes, kidney problems, or a weakened immune system.

UTI Complications

The main danger associated with untreated UTIs is that the infection may spread from the bladder to one or both kidneys. When bacteria attack the kidneys, they can cause damage that will permanently reduce kidney function. In people who already have kidney problems, this can raise the risk of kidney failure. There's also a small chance that the infection may enter the bloodstream and spread to other organs.

What Boosts Your Risk?

UTIs are most common in sexually active women. Other factors that may increase your risk include:

  • Not drinking enough fluids.
  • Taking frequent baths.
  • Holding urine in the bladder too long.
  • Kidney stones.

UTIs and Pregnancy

During pregnancy, there are several factors that boost the risk of UTIs, especially a kidney infection. Hormones cause changes in the urinary tract, and the uterus may put pressure on the ureters or bladder or both -- making it more difficult for urine to pass from the kidneys to the bladder and out. Untreated UTIs can contribute to preterm labor, so be sure to alert your doctor if you suspect you have an infection.

UTIs and Diabetes

People with diabetes are more vulnerable to UTIs for several reasons. First, their immune systems tend to be weaker. Second, high blood sugar can spill into the urine and encourage the growth of bacteria. Also, nerve damage related to diabetes can prevent the bladder from fully emptying. People with diabetes should talk with their doctor at the first sign of a UTI.

UTIs in Infants

Babies occasionally develop UTIs, but they can’t tell you what they feel. Here are some signs to watch for:

  • An unexplained fever.
  • Strange-smelling urine.
  • Poor appetite or vomiting.
  • Fussy behavior.

It’s vital to treat a baby’s UTI quickly to prevent kidney damage. Promptly changing a dirty diaper can help prevent bladder infections. And of course, wipe from front to back whenever changing a baby's diaper.

UTIs in the Elderly

UTIs are among the most common infections in the elderly. But the symptoms may not follow the classic pattern. Agitation, delirium, or other behavioral changes may be the only sign of a UTI in elderly men and women. This age group is also more likely to develop serious complications as a result of UTIs.

Bladder cancer

What Is Bladder Cancer?

The bladder is a pouch in the urinary tract that stores urine after it is produced by the kidneys.

The bladder cancer spreads by penetrating bladder muscle, infiltrating surrounding fat and tissue, and -- if untreated -- spreads to lymph nodes and other organs, such as the liver, lungs, or bones.

The earlier the cancer is diagnosed, the more limited it will likely be and the more effective the treatment can be. Thanks to improved procedures for early detection and treatment, such as urine cytology, five-year survival rates for bladder cancer improved from 50% in the 1960s to over 70% in the 1990s. Although bladder cancers often recur, prompt detection means they can be treated while they are still superficial.

The average age of those diagnosed with bladder cancer is 73. Men are three times more susceptible to the disease than women, and whites are more susceptible than blacks and Hispanics.

Causes of Bladder Cancer

Many bladder tumors are not cancerous. Your doctor will help you understand what type of bladder tumor you have.

What Causes Bladder Cancer?

The exact cause of bladder cancer is unknown, but there are risk factors linked to the disease:

  • Bladder inflammation. Chronic inflammation of the bladder increases the risk of cancer. People with birth defects that affect the bladder, chronic bladder (urinary) infections, persistent cystitis, or bladder stones, are more susceptible, as are people with histories of benign bladder tumors..
  • Smoking and other chemical exposure. More than most cancers, bladder cancer is associated with exposure to cancer-promoting chemicals, or carcinogens. Cigarette smoking is the main cause of bladder cancer, with smokers at twice the risk of developing bladder cancer. People exposed to arylamines -- painters, leatherworkers, machinists, metalworkers, and rubber and textile workers -- are at increased risk for bladder cancer, as are those who have had radiation therapy.
  • Consumption of nitrates in smoked and cured meats may be associated with bladder cancer, as may consumption of caffeine and saccharin. However, the connections have not been scientifically proven.
  • Chemotherapy. Some drugs used to treat other cancers may increase the risk of bladder cancer. They include cyclophosphamide and ifosfamide.
  • Use of the herb Aristolochia fangchi. This Chinese herb, taken by some people for weight loss, has been linked to bladder cancer.
  • Some genetic and familial disorders, such as Lynch syndrome, may be predisposing causes of bladder cancer.

Prostate cancer

Prostate Cancer Overview

There are often no early prostate cancer symptoms. Prostate cancer treatment includes surgery, chemotherapy, cryotherapy, hormonal therapy, and/or radiation. In some instances, doctors recommend "watchful waiting."

Benign prostatic hyperplasia

What is benign prostatic hyperplasia (BPH)?

Benign prostatic hyperplasia (BPH) is an enlarged prostate gland . The prostate gland surrounds the urethra, the tube that carries urine from the bladder out of the body. As the prostate gets bigger, it may squeeze or partly block the urethra. This often causes problems with urinating.

BPH occurs in almost all men as they age. BPH is not cancer. An enlarged prostate can be a nuisance. But it is usually not a serious problem. About half of all men older than 75 have some symptoms.

Benign prostatic hyperplasia is also known as benign prostatic hypertrophy.

What causes BPH?

Benign prostatic hyperplasia is probably a normal part of the aging process in men, caused by changes in hormone balance and in cell growth.

What are the symptoms?

BPH causes urinary problems such as:

  • Trouble getting a urine stream started and completely stopped (dribbling).
  • Often feeling like you need to urinate. This feeling may even wake you up at night.
  • A weak urine stream.
  • A sense that your bladder is not completely empty after you urinate.

In a small number of cases, BPH may cause the bladder to be blocked, making it impossible or extremely hard to urinate. This problem may cause backed-up urine (urinary retention), leading to bladder infections or stones, or kidney damage.

BPH does not cause prostate cancer and does not affect a man's ability to father children. It does not cause erection problems.

How is BPH diagnosed?

Your doctor can diagnose BPH by asking questions about your symptoms and past health and by doing a physical examination. Tests may include a urine test (urinalysis) and a digital rectal examination, which lets your doctor feel the size of your prostate. In some cases, a prostate-specific antigen (PSA) test is done to help rule out prostate cancer. (Prostate cancer and BPH are not related, but they can cause some of the same symptoms.

Your doctor may ask you how often you have symptoms of BPH, how severe they are, and how much they affect your life. If your symptoms are mild to moderate and do not bother you much, home treatment may be all that you need to help keep them under control. Your doctor may want to see you regularly to check on your symptoms and make sure other problems haven't come up.

How is it treated?

As a rule, you don't need treatment for BPH unless the symptoms bother you or you have other problems such as backed-up urine, bladder infections, or bladder stones.

Although home treatment cannot stop your prostate from getting larger, it can help reduce or control your symptoms. Here are some things you can do that may help reduce your symptoms:

  • Practice "double voiding." Urinate as much as you can, relax for a few moments, and then urinate again.
  • caffeine and alcohol. They make your body try to get rid of water and can make you urinate more often.
  • possible, avoid medicines that can make urination difficult, such as over-the-counter antihistamines, decongestants (including nasal sprays), and allergy pills. Check with your doctor or pharmacist about the medicines you take.

If home treatment does not help, BPH can be treated with medicine. Medicine can reduce the symptoms, but it rarely gets rid of them. If you stop taking medicine, symptoms return.

If your symptoms are severe, your doctor may suggest surgery to remove part of your prostate. But few men have symptoms or other problems severe enough to need surgery.

Can BPH be prevented?

You cannot prevent BPH or the urination problems it may cause. Some people believe that regular ejaculations will help prevent prostate enlargement. But there is no scientific proof that ejaculation helps.

1. Urinary incontinence

Symptoms

The main symptom of urinary incontinence is a problem controlling urination.

  • Symptoms of stress incontinence:
    • Involuntary release of urine, especially when you cough, sneeze, or laugh
    • Leaking a small to moderate amount of urine
  • Symptoms of urge incontinence:
    • Frequent and sudden uncontrollable need to urinate
    • May leak a moderate to large amount of urine, although a small amount is possible

It is common for a woman to have symptoms of both types of incontinence. This is called mixed incontinence.

Erectile dysfunction

Erectile Dysfunction

Erectile dysfunction, is the inability to achieve or sustain an erection suitable for sexual intercourse. Causes include medications, chronic illnesses, poor blood flow to the penis, drinking too much alcohol, or being too tired.

What Can Cause Erectile Dysfunction?

A lot goes into achieving an erection. When you're turned on, nerves fire in your brain. Blood then flows into your penis. If all goes well, you’re ready for sex.

Sometimes, all does not go well. Occasional problems aren’t anything that need treatment. If issues happen more often, you may have erectile dysfunction.

Overview of congenital anomalies of the kidney and urinary tract

Congenital anomalies of the kidney and urinary tract (CAKUT) constitute approximately 20 to 30 percent of all anomalies identified in the prenatal period [1]. Defects can be bilateral or unilateral, and different defects often coexist in an individual child.

Because Congenital anomalies play a causative role in 30 to 50 percent of cases of end-stage renal disease (ESRD) in children, it is important to diagnose these anomalies and initiate therapy to minimize renal damage, prevent or delay the onset of ESRD, and provide supportive care to avoid complications of ESRD. Patients with malformations involving a reduction in kidney numbers or size are most likely to have a poor renal prognosis.

Assessment

  • Prenatal diagnosis may be possible.
  • Full clinical assessment, including family history and assessment of family members where appropriate.
  • Assessment of renal function.
  • Imaging of the urinary tract - eg, ultrasound, CT, MRI scanning.
  • Renal biops.
  • Genome testing.
  • Full evaluation for associated defects.

Management

  • The management will depend on the underlying disorder, degree of renal dysfunction and associated defects.
  • Genetic counselling is useful in patients and relatives where there is a defined autosomal dominant condition. However, where there is familial aggregation of congenital renal malformations with no defined genetic abnormality, genetic counselling may be of less benefit.
  • The role of prenatal interventions and postnatal therapies in cases of congenital kidney and urinary tract anomalies requires further research.

Renal cell carcinoma

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