The most common form is kidney cancer is called Renal Cell Carcinoma (RCC). RCC is a disease in which malignant cells are found in the lining of tubes within the kidney. Kidney Cancer is a highly treatable disease, but like most cancers, it is difficult to treat once it has spread to the surrounding tissues and organs. If you are exhibiting the symptoms below, you increase your chances of survival by seeing a physician for evaluation.

Symptoms
There are few symptoms that are strong indicators of the early stages of kidney cancer; however, some possible symptoms include:

• Blood in the urine
• Lower back pain
• A mass or lump in the abdomen
• Fatigue
• Weight loss
• Fever that persists for a few weeks
• Swelling of ankles and legs

Treatment Options
The standard treatments for kidney cancer include surgery, radiation therapy, chemotherapy and biotherapy or immunotherapy.  

• Surgery involves removing part or all of the kidney, and in some cases the adrenal gland, lymph nodes and surrounding tissue.  
• Radiation therapy uses x-rays or radiation to kill cancer cells.
• Chemotherapy uses pharmaceutical drugs to stop the growth of malignant cells.  
• Biotherapy is a treatment that uses substances produced by the body's immune system to fight cancer.  

Read "Kidney Cancer Surgical Treatments" for detailed information.

Possible Causes and Prevention
The following may increase the risk of developing kidney cancer: 

• Smoking
• Obesity
• High blood pressure
• Unhealthy diet
• Family history of kidney cancer
• Genetic conditions such as von Hippel Lindau disease
• Exposure to asbestos and/or industrial chemicals

Cigarette smoking is responsible for a large number of kidney cancer cases, and cessation can help to reduce your risk. Maintaining a healthy weight, managing high blood pressure, eating a healthy, well-balanced diet and exercising regularly may also help to reduce your chances of developing kidney cancer.

Urinary stones, or calculi, are caused by the crystallization of one or more substances normally found within the urine. These calculi can be found anywhere within the urinary tract, including the kidneys, ureters, and bladder. Most often these stones are formed within the kidney and cause a sudden, sharp, intense pain along the back, which radiates towards the groin as they travel down the ureter towards the bladder.

Symptoms
Some symptoms you may experience with kidney stones include:

• Intense pain in the back, side, abdomen, groin or genitals
• Bloody, cloudy or foul-smelling urine
• Nausea and vomiting
• Frequent and/or painful urination
• Fever

Stones can present without any symptoms, in which case blood in the urine may be the only sign.

Evaluation

History and Physical Examination
Initial evaluation of an individual suspected of having a kidney stone consists of a complete history and physical examination. A review of medications is important as certain ones including steroids, antacids, water pills, colchicine, and chemotherapeutic agents may predispose to stone formation. Past medical history including hyperparathyroidism, renal tubular acidosis, recurrent urinary infections, gastrointestinal diseases, diarrhea, prior stones, and prior urologic surgeries should be elicited during the history. On physical examination the patient often appears restless, unable to find a comfortable position. The abdomen may be slightly distended and pain is often elicited by gently tapping on the flank region. 

Laboratory Tests 
Initial laboratory tests include: 

• Urinalysis to assess for the presence of blood in the urine 
• Blood tests to determine kidney function, blood count, and concentrations of calcium, phosphate and uric acid 
• Urine culture to assess for the presence of urinary infection

For patients who are considered high-risk stone formers (e.g. genetic predisposition, cystine or uric acid stones, infection stones, recurrent or bilateral stones, stones in children) a more complete evaluation is performed. This includes a 24-hour collection of urine to test for various minerals. In addition, further blood tests, including a test to rule out hyperparathyroidism, may be performed. Ideally, all stones that are passed spontaneously should be collected and analyzed to determine the precise stone composition.

Radiologic Evaluation
All individuals with stones should undergo radiologic evaluation. An entire battery of radiologic procedures exist and are aimed at confirming the presence of a kidney stone, pinpointing the precise location of the stone within the urinary tract, assessing for the presence of urinary obstruction, and determining the number and approximate size of the stone(s). Each of the radiologic modalities will be discussed individually. 

• Plain Abdominal X-ray ("KUB" or Kidney-Ureter-Bladder X-ray)
  The first radiologic test that is performed is the plain abdominal X-ray or KUB. Because the majority of stones (90%) are radiopaque, these can be easily identified on X-rays. The number, size, and approximate location of the stone can also be assessed. Some stones, however, including uric acid and some cystine stones, may not appear on plan X-rays and a CT scan will be required.
• Intravenous Pyelogram (IVP)
  An intravenous pyelogram is a series of four to six plain abdominal X-rays that are taken after the administration of intravenous contrast material, which is excreted by the kidneys into the urinary tract. This provides anatomic detail of the entire urinary system from the kidneys, ureters, and bladder. Urologists use this as a "road map" to identify and pinpoint the precise location of the stone along the urinary tract. This also allows for the identification of urinary obstruction from an impacted stone.
• Computed Tomography ("flank" CT scan)
  A CT scan of the abdomen and pelvis has become the imaging modality of choice for the localization of kidney stones. Unlike the IVP, intravenous contrast is not used. All stones, including uric acid stones will appear on a CT scan. 
• Sonogram (Ultrasound)
  Sonograms provide excellent assessments of the kidneys and bladder, but are inferior to the IVP and CT scan in evaluation of the ureters. The presence of all stones types within the kidney can be identified by sonography. The advantage of ultrasonography is that it avoids the exposure to radiation and may be used in special situations.

Treatment Options
Most small kidney stones move out of your body with the help of drinking extra fluids. This is called Natural Progression Passing kidney stones isn't a pleasant experience, and pain medication is often perscriped. Physicians Urology also offers conservative therapy and surgical options for more advanced cases.

Read "Kidney Stone Treatment Options" for more information.

Possible Causes and Prevention
Kidney stones are most often caused when your urine contains too much calcium, oxalate, or uric acid. They can also be caused by low levels of citrate and magnesium, or if your urine becomes too concentrated or is too acidic or too alkaline.

The primary known causes are:

• Dehydration
• Dietary imbalance
• Urinary infections
• Use of diuretics or medications known to increase levels of uric acid
• Imbalance in hormone production in the parathyroid gland

You can prevent kidney stones by making a few lifestyle changes. This includes drinking adequate amounts of fluid and making a few dietary changes. In some cases medication is required.

Resources
National Kidney and Urologic Diseases Information Clearinghouse: http://kidney.niddk.nih.gov/index.htm
The Kidney & Urology Foundation of America: http://www.kidneyurology.org

When Is a Kidney Transplant Necessary?
The diseases that most often create a need for kidney transplantation are glomerulonephritis (inflammation of the kidneys), diabetes, hypertension and cystic kidney failure. People with these diseases who have failing kidneys must undergo regular treatment with an artificial kidney (hemodialysis). However, dialysis can only replace about 5% of the function of two healthy kidneys and, for many people, the quality of life on dialysis is very poor. Additionally, life expectancy is lower for people on dialysis than for the normal population. Kidney transplantation offers an excellent alternative for these patients. It can dramatically improve quality of life and increases life expectancy.

Types of Kidney Transplants
There are two donor sources possible for transplantation. The first and preferable source is from a living donor. A living donor can be someone who is either genetically or emotionally related to the transplant candidate. A living donor is preferred because of the statistically higher success rate. Living donors must have a compatible blood type and undergo medical and psychological evaluations to ensure they are in good health and are mentally prepared for donation. The other source for transplantation is from a cadaveric donor. A cadaveric donor is a person whose family, at the time of his or her death, has consented to organ donation.

Laparoscopic Kidney Removal
Dr. Wegryn of Physicians Urology is involved in the living donor program and offers his patients the newest and most advanced method of organ retrieval from living donors, laparoscopic donor nephrectomy. Using this minimally invasive approach, a 7 cm midline abdominal incision and two to three smaller incisions are made in the abdominal wall. Video equipment and instruments are inserted through these punctures to perform the operation. Once the kidney is freed from its attachments, it is extracted from the abdomen through the abdominal incision, and cooled. It is then prepared for immediate implantation into the recipient, following the donor surgery. The donor operation takes 3-4 hours and the recipient operation lasts about 3 hours. In addition, the time necessary for anesthesia before and after operation will be an additional 30-60 minutes. Dr. Wegryn and his team will call your waiting relatives as soon as the surgery is finished to report on your progress.

Benefits to the Donor 
The advantages of laparoscopic surgery come from minimizing the trauma of access to internal organs. By avoiding a long incision through the muscles, many post-operative problems are eliminated and pain is markedly reduced. This enables the donor to breathe and cough better. Use of strong pain medications is drastically reduced so the drowsiness, fatigue and unsteadiness they cause is minimized. The patient is discharged sooner and resumes normal activity in a much shorter amount of time.

Risks for the Donor
All operations carry some risk. Those that are the most important for you to know are mentioned here.

Most of the laparoscopic procedures that we perform require full general anesthesia. This allows enough relaxation of the muscles of the abdominal wall to ensure that the operative space is large enough. Modern anesthesia is very safe and the anesthesiologists are all highly skilled, board certified physicians; however, general anesthesia does have risks including heart attack, stroke, and respiratory failure. Your anesthesiologist will review these risks with you prior to your procedure.

Bleeding and infection are other potential complications. Deep vein thrombosis and pulmonary embolus (clots to the lungs) are also an ever-present risk. It has been our experience that these complications are much less frequent after laparoscopic than conventional surgery because the patient is able to ambulate sooner postoperatively. A complete review of potential complications will be reviewed with you at your preoperative evaluation.

Occasionally, difficulties are encountered during surgery that cannot be safely managed laparoscopically. This may be suspected before the operation and confirmed with the laparoscope. If so, conversion to a conventional open procedure is done for your safety.

Alternatives
Most live donors come to Dr. Wegryn for laparoscopic surgery, although he has an extensive background in traditional surgery. If he feels that your best interests will not be served by laparoscopic surgery, he will tell you and suggest an appropriate alternative.

Conclusion
Successful kidney transplantation, an alternative to dialysis treatments, can provide a new life for those patients diagnosed with end stage renal disease. If you are considering kidney transplantation, it will be important for you to obtain as much information as possible so that, with your physician's guidance, a decision can be made as to which treatment option may be best for you.