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Monday, June 18, 2012

K is for Kidney/Bladder

By Laura Corio, MD

Woman in pain

Many women experience a bladder infection, also known as a urinary tract infection or UTI, at some point in their lives. A UTI can occur alone or along with an infection of the kidney (pyelonephritis). UTIs are caused by bacteria (commonly e coli) that ascend from the vagina and rectum into the urethra and then up into the bladder. Risk factors include sexual intercourse, spermicide use, and a history of UTIs. Woman with an infection often experience pain on urination, increased frequency of urination, greater urgency (the feeling of having to continually go to the bathroom), supra pubic pain, and/or blood in the urine. Urine analysis and a sterile urine culture need to be examined to make the diagnosis, and treatment typically involves antibiotics. Cranberry pills, yogurt, blueberries, probiotics all decrease the incidence for recurrent UTIs.

Recurrent UTI’s are defined as more than two infections in six months or more than three infections in one year. Urologic evaluation of women with recurrent cystitis is not warranted, but if structural or functional abnormalities of the genitourinary tract are suspected, then a work up is reasonable. Continuous treatment with antibiotics, post-coital treatment with antibiotics, or intermittent self-treatment are all effective ways to deal with recurrent bladder infections.

A kidney infection presents with the symptoms of a UTI along with fever, chills, nausea and vomiting, and upper back pain. Treatment consists of antibiotics and bladder analgesics, with follow-up cultures to make sure that the infection has been treated and cured.

Hematuria, or blood in the urine, is very common. In young adults, it can be transient and not worrisome but after 40 years of age, it can be a sign of kidney or bladder cancer. When blood first appears, a urine culture should be sent off to rule out a UTI. A workup by a urologist is the next step if the hematuria persists and a bladder infection has been ruled out. The urologist is looking for a stone or a cancer either in the bladder or in the collecting system to the kidney, or the kidney itself.

Kidney stones or nephrolithiasis are a common problem. Patients may present with renal colic (pain) and hematuria. Calcium stones are the most common. Risk factors include a family history of stones, previous history of stones, and patients with histories of previous gastric bypass procedures, bariatric surgery, or short bowel surgery. High blood pressure increases the risk twofold for renal colic. Diabetes, obesity, gout, and marathon running with low intake of fluids are also risk factors. Presentation of a stone can be subtle or very pronounced. Acute, one-sided flank pain, hematuria, and an X-ray showing a stone can be seen in 90% of patients. It’s important to diagnose a stone before it causes persistent kidney obstruction, which can lead to permanent kidney damage. Treatment can be conservative: management with pain meds and hydration until the stone passes.  If this fails, then the stone needs to be removed by lithotripsy (SWL). Once the acute episode is over, the patient needs to be evaluated; prevention of further stones is required and therapy must be instituted.

Kidney cancer has been on the rise in the U.S. Risk factors include smoking, obesity, high blood pressure, diabetes, chronic hepatitis C infection, and childhood chemotherapy. The good news is that we are picking up these tumors earlier and therefore five-year survival rate has doubled over the last fifty years.

Bladder cancer is the most common cancer of the urinary tract. Hematuria is the most common symptom, and if a woman is over 40 years of age, she needs to have an evaluation by a urologist to rule out bladder cancer. Men are more at risk, and smoking and chemical carcinogens increase the risk for bladder cancer. However, symptoms mimicking a UTI or difficulty with emptying your bladder could also be signs of bladder cancer. The problem with this is that it makes it difficult to diagnose bladder cancer and, therefore, the cancer may be fairly advanced when it is finally picked up. A cystoscopy can diagnose and manage this disease. Treatment always involves removing the tumor, and based on the stage of the tumor, chemotherapy, BCG, and other treatments may be needed.

I hope this has helped you understand a little bit about the urinary system

Stay tuned for L is for liver: hepatitis C infection.

Photo: Polka Dot

Posted by: Laura Corio, MD at 6:02 am


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