Treatment & Management of Renal Diseases
Once the disorder has been diagnosed, a multi-disciplinary team will decide on the best therapy option.
Early stages of kidney disease may be reversed by diet & lifestyle changes, however advanced CKD would require the patient to have regular dialysis or at the latest stage, a kidney transplant.
Dialysis is a procedure to remove waste products & excess fluid from the blood when the kidneys stop working properly. It often involves diverting blood via a percutaneous dialysis catheter to a machine to be cleaned. Dialysis patients will be usually on diuretics increase the production of urine to help expel excess toxins from the body.
Hydronephrosis is a comorbidity associated with other renal diseases therefore it is often treated by addressing the underlying disease or cause, such as a kidney stone or infection.
Treatment of hydronephrosis may involve a nephrostomy procedure which will usually be carried out by an interventional radiologist. A nephrostomy is an artificial opening created between the kidney and the skin which allows the urinary diversion directly from the renal pelvis of the kidney. A percutaneous nephrostomy catheter is inserted to act as a drain & may be short or long-term.
Severe cases of urinary blockage and hydronephrosis can damage the kidneys and lead to kidney failure. If kidney failure occurs, treatment will be needed with either dialysis or a kidney transplant. However, most people can recover from hydronephrosis if treated promptly.
Urostomy (ileal Conduit)
Sometimes urinary diversion will happen lower down the urinary tract at the ureters, this would normally be the case post removal of the bladder due to bladder cancer.
- The urology surgeon removes a small piece of bowel (ileum). They join then ends of the ileum back together.
- The surgeon then uses this piece of ileum to form the urostomy. They sew the ureters into one end of the piece of ileum.
- Next, the surgeon cuts a small hole in the surface of the abdomen. They then bring the other open end of the piece of ileum out through this hole.
- This makes a stoma. The stoma is usually put to the right of the navel. Post procedure, urine will run down the ureters, through the piece of ileum and out through the stoma.
- The ureters can be quite fragile & collapse easily under the pressure of subcutaneous tissue so a urinary stent can be used to keep the urostomy patent.
Kidney stones can cause several further complications depending on the severity & location of the stone. Some larger stones may require surgical removal but the most common procedure for kidney stone treatment is non-invasive, Extracorporeal Shock Wave Lithotripsy (ESWL).
Lithotripsy is a medical procedure involving the physical destruction of hardened masses like kidney stones & gallstones using targeted shock waves which causes the stones to break up into smaller pieces which can be passed naturally.
A urinary stent may be placed prior to a lithotripsy procedure to prevent larger pieces of stone migrating down the ureters causing further blockage. Gallstones can also be treated using ESWL.
Percutaneous Nephrolithotomy (PCNL)
PCNL is a minimally invasive procedure to remove stones from the kidney by a small puncture wound (up to about 1cm) through the skin. It is most suitable to remove stones of more than 2cm in size and which are present near the pelvic region. It is usually done under general anaesthesia or spinal anaesthesia. Recovery time can take several days.
Kidney cancer is managed in the same way as most other cancers of the human body, with either surgery, medication, targeted radiotherapy, or chemotherapy. Depending on the cancer, the tumour may cause blockages along the urinary tract, particularly if it is TCC. A urinary stent may be used here to help keep the ureters patent.