Understanding your Kidneys

When do you know you need a transplant?

The symptoms of kidney failure vary widely by cause of the kidney failure, severity of the condition, and the other body systems that are affected.Most people have no symptoms at all in the early stages of the disease, because the kidneys are able to compensate so well for the early impairments in their function. Others have symptoms that are mild, subtle, or vague. Generally, obvious symptoms appear only when the condition has become severe or even critical.

Kidney failure is not painful, even when severe, although there may be pain from damage to other systems.Some types of kidney failure cause fluid retention. However, severe dehydration (fluid deficiency) can also cause kidney failure.
Fluid retention – Puffiness, swelling of arms and legs, shortness of breath (due to fluid collection in the lungs, called pulmonary edema) Dehydration – Thirst, rapid heart rate (tachycardia), dry mucous membranes (such as inside the mouth and nose), feeling weak or lethargic

Other common symptoms of kidney failure and end-stage renal disease include the following:

Urinating less than usual
Urinary problems – Frequency, urgency
Bleeding – Due to impaired clotting, from any site
Easy bruising
Fatigue & Confusion
Nausea, vomiting
Loss of appétit
Pain – In the muscles, joints, flanks, chest
Bone pain or fractures
Pale skin (from anaemia

Fortis Hospitals cures a 71 year old patient of kidney tumor through ‘Radiofrequency Ablation’ technique

-       a novel micro invasive treatment that melts kidney cancers

Kolkata, 10th January, 2012 – A team of doctors at Fortis Hospitals cured a 71 year old patient suffering from kidney tumor through a novel technique called ‘Radiofrequency Ablation’. Mr. Arun Kanti Roy first reported to Dr. Gopalakrishna, Consultant Urologist, Fortis Hospitals Kolkata with severe abdominal pain.A CT scan revealed a 3 cm tumor in the middle of the patient’s left kidney. The standard treatment for these tumors is either removal of the whole kidney or removing part of the kidney. However, Mr. Roy was apprised of a new method called ‘Radiofrequency Ablation’ (RFA) wherein a special electrode is inserted in the skin through a pinhole and the tumor is then heated till the tumor cells are killed.

Opting for RFA, the patient came to Dr Shuvro Roy Choudhury, Consultant Interventional Radiologist,FortisHospitals. To make a definite histological diagnosis, Dr Shuvro Roy Choudhury performed two biopsy cores (examination of cells and tissues) from the tumor prior to starting the ablation. The procedure of RFA was performed under a short general anesthetic lasting around 35 minutes. Under CT guidance a thin electrode was inserted into the centre of the tumor and the treatment was continued according to a set algorithm for 12 minutes. A second ablation zone was also performed to ensure that there was enough margin around the tumor to prevent any recurrence.

Dr Shuvro Roy Choudhury (Consultant Interventional Radiologist Fortis Hospitals) says, “Mr. Roy’s case was a complex one since his colon was very close to the tumor, raising the possibility of inadvertent heat injury to the colon. This was prevented by placing a needle between the kidney tumor and the colon and inserting a layer of dextrose saline to form a buffer between the heated tumor and the colon. This procedure is known as Hydrodissection and was done for the first time in India. On a post-operative round the patient was sitting up after two hours. He had normal dinner and was ready for discharge the following morning.”

Subsequent to this, after 1 month the patient had a follow up CT and a subsequent MRI performed at one and four months confirmed that no residual tumor is left in the kidney. The patient was delighted with the outcome and is completely fit now. Dr Shuvro Roy Choudhury says, “Tumors can nowadays be successfully treated using pinhole surgery with minimum side effects and without scars. These ‘new age’ treatments save the whole organ from being taken out of the body. Hence interventional or pinhole surgeries are the treatments of future. As there is lack of recognition the awareness has to be spread.”

Dr. R K Gopalakrishna (Consultant Urologist Fortis Hospitals) says, “Radiofrequency Ablation is a relatively new method of treating kidney cancers which restores the renal function to its best. It solves the problem without damaging the kidney and least disturbances in the body system. Usually patients make a very rapid recovery and are sent home the following day after surgery. There are no scars and only a Band-Aid is sufficient to cover the operation site.

Ms. Richa S. Debgupta (Facility Director Fortis Hospitals) says “There is a lack of recognition or awareness for minimally invasive techniques like RFA. Hence it is not usually done in our country especially in the eastern part. Interventional radiology or pinhole surgery can deal with a number of problems throughout the body. These include tumors, fibroids, varicose veins of the leg, blocked arteries are or veins, to name only a few. An advanced laboratory to perform these procedures has been set up at Fortis Hospitals in Kolkata.”

Mr Roy Says, “After I got back to my senses I could not believe that the surgery was already over. I asked my doctor when will he operate on me and he said its already over while I could feel no pain or discomfort. I just hope proper awareness is spread about this treatment so that more people are saved from painful surgeries.”

Master Akilesh a 14 years old boy was was admitted in the FORTIS Nagarbhavi with a complex condition of Non-functional kidney. His left kidney was almost non functional kidney with only 6 % of the left  kidney being functional. On expert advice from our Urologist Dr L.N.Raju  he was advised to undergo NEPHROURETECTOMY.

He was hospitalized on 20^th of April 2011 in the hospital for the procedure, considering the age and other benefits of Laproscopic Nephrouretectomy , it was decided to undertake Laproscopic  way of getting the procedure done

Surgery lasted for two hours and patient recovery was good, he was discharged in stable condition in two days. I

This procedure is an advancement over the traditional Nephrouretectomy as the surgical time and the recovery time both are much lesser than the traditional way.

This way of conducting Nephrouretectomy had several advantages like

• Surgical time required is almost half compared to open procedure( procedure lasted for two hours compared to four and half hour required for open procedure
• Patient recovery is fast and could be discharged in 1/4^th of the time required for open procedure, in this case patient was discharged on the 2^nd day of admission ,wherin open procedure requires 8 days
• The residual scar tissue is minimal
• Comparative cost to the patient is minimal

This  advancement in the traditional procedure of Nephrouretectomy not only saves time and reduces complexities of a surgery but also reduces the cost incurred by the patient.

Dr. Mohan Keshavamurthy

MS (General Surgery), M Ch (Urology), FRCS(C), FASTS
Consultant Urologist and Transplant Surgeon

Dr. Mohan Keshavamurthy is an eminent urologist and transplant surgeon with over 16 years of extensive surgical experience. He is a pioneer in laser Urology as well as an expert in complex reconstruction of the urinary tract and major uro-oncological procedures in both adult and paediatric age groups.

He has performed over 250 Laser enabled Transurethral prostate Vaporization procedures (LASER TURP), 1500 laser fragmentation of kidney(RIRS) and ureteric stones(URS), 1600 kidney transplants, and 75 pancreas transplant. He is an acknowledged expert in implantation of flexible and inflatable penile prosthesis & penile lengthening procedures.

Professional qualification

A meritorious and award-winning student, Dr. Mohan, after completing his MS in general surgery finished his M Ch urology from the prestigious KEM Hospital, Mumbai. He then completed his fellowship in urogynaec-oncology from Tata Memorial Hospital, Mumbai. Besides these, he has done advanced training leading to a Fellowship in solid organ transplantation from QE II HSC, Halifax, Canada and Fellowship of American Society of Transplantation thereafter.

Dr. Mohan has contributed more than 100 articles in various peer reviewed journals like Transplantation Proceedings, The Canadian Journal of Urology, British Journal of Urology International to name a few. Apart from being the Chief Investigator-Middle East for Neoral MOST study, he contributed significantly to the medical fraternity by presenting on various topics at different international conferences like Congress of the International Pediatric Transplant Association, American Transplant Congress, Transplant Odyssey, etc.

By Dr Avishek Mukherjee Consultant Uro surgeon, Fortis Hospital & Kidney Institute,Kolkata

Kidney cancer is one of the most common cancers affecting males in the middle age group, especially those who sm ke. Smoking is one of the most important causative factors. These cancers are best treated with surgery wherein the cancer bearing organ is removed along with the cancer and the surrounding layers so that cancer recurrence can be reduced maximally. However this also means that the unaffected portion of the kidney also has to be sacrificed with the cancer. Nephron sparing surgery allows the surgeon to remove the cancer bearing area of the kidney while at the same time preserving the rest of the unaffected parts of the kidney thereby preserving as many functioning nephron units as possible.

This surgery can be performed by laparoscopic approach which the additional advantage of rapid recovery and rapid return to work. At the Fortis Kidney Hospital we have performed many such procedures to remove the cancer bearing tissue and at the same time preserve the rest of the kidney.

This surgery can however be only offered to those who present in the earlier stage of the cancer, and the tumor has as yet not affected the main blood supply of the kidney. These cancers can easily be detected in early stage by a simple abdominal ultrasound evaluation and can routinely be done in individuals above the age of 50 years. After the tumor is suspected then the surgeon will usually advise for CT angiography to assess the relationship of the blood vessels of the kidney with the tumor. Once it is detected that the cancer is in the early stage and has not yet attacked the main central vessels then the uro-surgeon can decide in favor of removal of the main tumor while at the same time preserve the rest of the nephrons.

This surgery performed by minimal invasive technique at Fortis Kidney hospitals. The patient needs to be admitted for five to six days and can return to work after two weeks of rest.

This treatment can be offered to most patients if the cancer is detected in the early stage of the disease and therefore the importance of regular kidney check up and ultrasound examination after age pf 50 years.