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Kidney Problems - Treatment

Overview | Diagnosis | Treatment | Prevention | FAQ

Kidney Infection

The doctor can determine if you have a kidney infection by examining your urine for bacteria and pus cells. A kidney infection is usually treated by plenty of fluids and antibiotics. If the infection is severe, you may need to be hospitalized to receive intravenous antibiotics and fluids.

Kidney Stones

Sometimes drinking lots of water and taking pain medication will help you pass the stone. The success of this treatment depends mainly on stone size and location. Smaller stones have an excellent chance of passing themselves. Other times, kidney stones can be broken up with an ultrasonic shock wave technique called a lithotripsy. This grinds the stones into a powder to be passed more easily. This technique does not require an incision and can usually be carried out without anesthesia.

Sometimes the lithotripsy is not an option for patients with large or complex kidney stones. In these cases, the doctor would apply a laser or more powerful ultrasonic form of energy directly to the kidney stone. This is also a procedure that usually requires no incision.

In a few cases, surgical removal of the stone is needed.

Click here to download a PDF with more information about treatment options for kidney stones, new window will open.

Kidney Failure

• Acute kidney failure - This is sometimes a reversible condition. The disease that is causing the failure must be treated. Examples of this are controlling diabetes, better control of blood pressure, and intravenous fluids and transfusions for kidney failure associated with severe blood loss. If the failure is a result of an enlarged prostate or a kidney stone, then surgery may be required to remove the obstruction.

• Chronic kidney failure - Possible treatments include better control of disease causing the failure, intravenous fluids, transfusions, surgery, or transplant.

• End-stage kidney failure or renal disease - Permanent damage cannot be reversed. Dialysis or a kidney transplant is required.

  • Dialysis is an artificial means of removing wastes in the blood when the kidneys can not do it anymore.
  • Kidney transplants are another option. The United Network for Organ Sharing reported that as of June 2, 1999 there were 42,071 people waiting for a kidney transplant. In 1998, there were 11,990 kidney transplants done in the United States. Of these 11,990 transplants, 4,016 of the transplants were performed with living donors. The living donors are usually relatives of the patient who volunteer to donate one of their own kidneys. The chance of the body rejecting a kidney from a relative is less than with an unrelated donor.

Kidney Cancer

For localized kidney cancer, it was previously believed that the only curative therapy was radical removal of the kidney. While complete removal of the kidney has long been the standard of care, increasing attention is being paid to nephron-sparing procedures such as partial nephrectomy, removal of the tumor only, cryotherapy (freezing) of the tumor, or radio frequency ablation of the tumor are now viable alternatives in selected cases. For small tumors which are peripherally located, this may provide a result as good as radical nephrectomy. The tendency for renal cell carcinoma to be multifocal and metachronous demands careful long-term scrutiny in those patients treated with nephron-sparing techniques.

Our AUNC surgeons take advantage of innovations in the management of renal tumors. Depending upon the type, size, and location of the tumor, our talented surgeons are able to tailor the surgery to offer the best outcome. In addition to removing complex renal tumors through an open operation, our AUNC surgeons also offer our patients a the option less invasive options such as hand-assisted or da Vinci® robot-assisted laparoscopic partial or radical (total) nephrectomy. Potential benefits of laparoscopic surgery versus open surgery include:

	©2011 Intuitive Surgical, Inc.

• Less postoperative pain

• Less bleeding

• Lower risk of infection

• Less scarring

• Shorter hospital stay

• Quicker recovery time

Whenever possible, our surgeons strive to preserve maximal renal function by only removing the tumor and sparing the rest of the involved kidney. A frozen section of the tissue margins of the resected tissue is examined at the time of surgery to make sure that the entire tumor has been removed. Periodic follow up imaging studies are performed to evaluate the remaining kidney. If a tumor should ever recur locally, it is still possible to salvage a cure by removing the remaining kidney. If you wish to learn more about da Vinci® robot-assisted laparoscopic renal surgery, click here, a new window will open.

When kidney cancer has spread to elsewhere in the body, multiple types of chemotherapy are often utilized. Although the results of chemotherapy have been disappointing, there is reason for hope. There have been significant advances in the treatment of metastatic kidney cancer. For further information, click here.

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The cause and degree of obstruction plus the severity of symptoms dictate the type and immediacy of treatment. If hydronephrosis is caused by a stone that is small enough to pass, the situation is usually treated expectantly; that is, with medication, plenty of fluids, and a tincture of time. Similarly, if a UPJ obstruction is asymptomatic , especially if it is mild, it may not require treatment. On the other hand, if there is a severe obstruction of the urinary tract, intervention is usually required. Treatment of a symptomatic stone in the kidney or ureter is discussed elsewhere under the heading of stone disease. Treatment of other types of ureteral and bladder obstruction is beyond the scope of this brief discussion.

©2011 Intuitive Surgical, Inc.

The remainder of this section will focus on management of UPJ obstruction. If a UPJ obstruction causes pain, high blood pressure, reduced kidney function, kidney stones, or kidney infection, treatment is recommended.

UPJ repair (pyeloplasty)

Dismembered Pyeloplasty

Traditionally, a symptomatic UPJ obstruction is repaired with open surgery by dismembering (excising) the obstructed area where the ureter enters the renal pelvis. A plastic surgical type of repair is performed to reconnect the severed end of the ureter to the renal pelvis. The success rate of this procedure, which is called a dismembered pyeloplasty, is 95%.

In addition to an open surgical repair, AUNC surgeons also ultilize the da Vinci®robot to perform a laparoscopic dismembered pyeloplasty. Both an open and laparoscopic dismembered pyeloplasty are more successful than endopyelotomy procedures (discussed below).

The advantages of performing a da Vinci®robot-assisted dismembered pyeloplasty versus an open pyeloplasty repair include:

• Less postoperative pain

  	©2011 Intuitive Surgical, Inc.

• Less bleeding

• Lower risk of infection

• Less scarring

• Shorter hospital stay

• Quicker recovery time

Endoscopic Pyeloplasty

If the UPJ obstruction is caused by a crossing vessel, or if the point where the ureter inserts into the renal pelvis is difficult to access, an open or laparoscopic dismembered pyeloplasty is usually recommended. Otherwise, a minimally invasive procedure, called an endopyelotomy, may be a consideration. Although a variety of techniques and types of medical devises can be used, the common denominator for an endo/pyelo/tomy is dilation and incision (‘otomy’) of the UPJ (‘pyelo’) obstruction.

The first step is to pass a specially designed instrument called an endoscope thru the urethra into the bladder. Sterile fluid is used to fill the urinary tract, and a series of mirrors inside the endoscope reflect brilliant light the tip of the instrument, which allows the surgeon to view the inside of the urinary tract. A flexible guide wire is then threaded up the ureter, through the UPJ obstruction, and into the kidney. Correct positioning is confirmed with x-ray guidance. Next a balloon dilation catheter is slid over a guide wire, through the UPJ obstruction, and into the kidney. The balloon portion near the tip of the catheter has markers that can be seen with x-ray; as can the type of fluid that is used to fill the balloon. The initial endoscope is switched out for a tinier version that is called a ureteroscope. A ureterscope is negotiated up the ureter to the level of the UPJ obstruction. Under direct vision, the balloon is carefully positioned so that a wire that is located on the surface of the balloon is directed away from any vessels that may lie outside the ureter. Once everything is properly positioned, electric current is used to create a ‘hot wire’ on the balloon’s surface that incises the narrowed UPJ. Alternatively, a laser fiber can be used to incise the UPJ obstruction.

An endopyelotomy can also be performed from above (antegrade), by passing a wire, with x-ray guidance, through a tiny incision in the skin, into the kidney , through the UPJ obstruction, and down the ureter into the bladder. A larger type of balloon catheter is then threaded over the wire into the kidney collecting system. The larger balloon catheter is then inflated with fluid under x-ray guidance, which dilates a tract from the level of the skin into the renal collecting system. Next special sheath is slid over the balloon into the kidney. The endopyelotomy balloon catheter is then positioned through the UPJ. Finally, an endoscope that is inserted through the sheath and into the renal collecting system is used to directly monitor the endopyelotomy procedure.

Following an endopyelotomy, a special catheter is temporarily left ‘indwelling’ (inside the urinary system), that extends from inside the bladder, up the ureter, and through the incised UPJ. A catheter may also be positioned from outside the body, through the kidney and UPJ, down the ureter, and into the bladder if an antegrade procedure was performed. Either way, the stent usually remains in place for 6 weeks or so, which allows the ureter time to heal. The success rate of this procedure is around 80-85%.

For further information about an endopyelotomy procedure, click here.

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