American Medical Association Family Medical Guide - American Medical Association [538]
Diagnosis
Doctors use ultrasound imaging (see page 111), along with a family health history (see page 130), to diagnose both forms of inherited polycystic kidney disease. Kidney cysts are usually clearly visible on an ultrasound. Sometimes doctors detect the first signs of the disorder when an affected adult discovers blood in his or her urine or during a routine examination when high blood pressure is detected. Scientists are working on developing a genetic test (see page 953) that can screen for polycystic kidney disease before cysts begin to develop.
Treatment
Currently there is no cure for polycystic kidney disease, but treatment of the symptoms can relieve pain and prolong life. Over-the-counter pain medication may help reduce back or headache pain. Severe pain may require surgery to drain and remove the cysts that are causing the pain, but surgery cannot prevent the disease from getting worse. Doctors prescribe antibiotics to treat the frequent urinary tract infections that develop. High blood pressure can be controlled with medication, diet, and exercise. Eventually, if the kidneys fail, the person must begin dialysis or have a kidney transplant (see page 820).
Kidney transplantation is a relatively common and successful treatment for kidney failure caused by polycystic kidney disease. Healthy transplanted kidneys do not develop cysts, and donor kidneys are slightly more available than other organs because a person can donate one of his or her kidneys to an affected person and still function normally with the remaining kidney.
Kidney Tumors
A tumor is an abnormal mass of tissue that forms when cells reproduce at an increased rate. There are two major types of kidney tumors, both of which are cancerous. One type, called renal cell carcinoma, occurs only in adults. The other type, called Wilm’s tumor (see page 430), affects mainly children.
Renal cell carcinoma occurs most often in men over age 40. Renal cell carcinomas are highly malignant tumors whose cells can enter the bloodstream and spread to other parts of the body, particularly the lungs or bones. Because these tumors can grow for years without causing symptoms, they may go undetected until they are at an advanced stage. As the tumor enlarges, it can grow into healthy kidney tissue, gradually diminishing the ability of the kidney to filter blood.
Symptoms
A kidney tumor often causes symptoms such as pain in the side, loss of appetite, weight loss, anemia (see page 610), or blood in the urine, and can cause a variety of symptoms throughout the body.
Kidney tumor
A kidney tumor can grow for many years without causing symptoms. Doctors use diagnostic imaging techniques such as X-rays, ultrasound, CT, or MRI to detect kidney tumors that are too small to be felt during a physical examination.
For example, symptoms such as bone pain or a cough can develop if the tumor spreads to other organs, such as the bones or lungs. Your urine may appear reddish or cloudy because of bleeding from the tumor.
Diagnosis
If your urine looks reddish or cloudy, or if you have pain in your side, your doctor will order urine tests. If your doctor thinks you may have a kidney tumor, he or she will probably also recommend other diagnostic tests such as an ultrasound (see page 111), a CT scan (see page 112), or an MRI (see page 113) of the abdomen and pelvis, including the kidneys.
Treatment
If the diagnostic tests indicate that you have renal cell carcinoma, your doctor will perform tests to determine if the tumor has spread to other organs. Part or all of the affected kidney will be removed surgically in a procedure called nephrectomy. The remaining, healthy kidney will increase in size and level of function and do the work of both kidneys.
If cancerous cells have spread to other parts of the body (metastasized), your doctor may recommend treatment such as radiation therapy (see page 23),