S Related Menu
|
| | Title: | Kidney cancer. Part 2. | | Article: | Kidney cancer. Part 2.
It is 1:30 AM. Pager goes off.
A nurse calls (they just had shift, fresh nurse came in).
Doctor, Patient so and so made just 100 ml of urine in last shift (8 hours). What are you going todo?
Ms. X had colon resection last afternoon.
Does patient had history of CHF or renal failure?
Not, that I know of.
OK, give her bolus 500 ml of Normal saline and call me again in an hour
At 2:30. Dr patient so and so still puts just 15 ml of urine an hour.
OK. Lets give her 500 more of NS and check it in an hour.
At 3:30. Doctor, Patient did not make the urine .
Now you really need to evaluate patient carefully.
Any surgery is a trauma. As any trauma the fluid is going out of blood vessels and into damagedtissue . This sort of natural protective mechanism - to keep spreading of infection from thedamaged area around the rest of your body. But that protective mechanism removes the fluid from bloodvessels. Blood becomes partially more concentrated. Yet worse: there are lees blood goingthrough the kidneys.
Kidneys require certain amount of blood to work. You know that to filtrate the fluid into urine youneed pressure. Like if you filtrate something through a paper. The more is pressure, the more isfiltration.
No blood - no pressure. This is why you give normal saline.
But let say you are wrong and there is enough blood in vessels, enough pressure, the fluid isreplaced.
Just kidneys do not work well.
Patient have 5 liters of blood , you give 1 more liter of fluid. Where does it all go?
If there is 5 liter bottle and you pour one more litter. Here are now 6 liters. Where does it go?
It goes everywhere.
Apparently it filtrates into tissue.
I am so puffy, doctor - complains the patient
If kidneys work well it is not a big deal. Sooner or later- usually at day 3 - fluid from tissue willreturn back to vessels and your kidneys filtrate excess of fluid into your urine.
In realilty patient is usually not a 20 year-old Hollywood beach boy. Real patient is usually 70years old bed-ridden chronically ill patient with CHF (heart does not pump the blood wellthrough the kidneys ) and Diabetes (kidney are damage in the first place). Besides, there are other15 diagnosis, and list of 30 different medications including steroids and colchicine for her rheumatoid arthritis and gout.
Colchicine certainly relives gout.
Sure. But it can also damage kidney when overdosed.
OK, where does the fluid go now?
It goes where it is easier to go. Lungs.
Right here and right now at 3 AM you have a problem with fluid overload. You listen patent's lungs.
Plop-Plop. There are small bubbles. Crackles. Patient almost drowns in his own fluid. You needto boost oxygen to help him to breath easier. Then try to rid off the fluid.Maybe kidney will respond to diuretics (medication that increase production of urine).
Or maybe they will not, because the patient has the history of diabetes, hypertension andrheumatoid arthritis. Now she develops acute renal failure (kidneys are shut down and do notreact to diuretics).
Then you really have a problem. You try this, you try that.
Several methods exist. Everything fails.
Eventually (fortunately it is rare) you call Nephrologist (doctor who looks for kidneys) and ask ifhe can schedule emergent dialysis. Right here , right now.
Obviously, Nephrologist, the guy who left hospital yesterday at 9 PM, kissed his children at 11 -bye-bye, good night - and was going back at 7 a.m. today, is not very happy that you wake himup at 4 AM.
But what could we do? This is life.
All this is just to illustrate how important kidneys are.
Not surprising is that kidneys consume huge amount energy, require a lot of blood and lot of oxygen.This is a super efficient waste removal plant. Maybe couple of other organs could be compared as working the same hard. Brain and heart.
Liver also cleans some toxic wast. Though, the liver way is different. Also liver removes less waste than kidneys.
You can replace kidneys with dialysis. However, dialysis is not exactly the same kidney.
Dialysis allows just to filtrate fluid. It does not filtrate so efficiently as kidneys (because kidneyshave some additional mechanisms to remove waste) .
Dialysis does not concentrate back.
You rapidly loose good stuff on dialysis too.
Besides there are problems with access. Infections at the site of access plague the care for dialysis patients.
The machine consits of complicated mechanism, that artificial kidney outside of your body. The machine wheighs half ton, binds you to the bed for three hours every couple days etc, etc.
It is good when kidneys work well.
Kidneys may develop cancer too (as any other organ).
| | Author: | Aleksandr Kavokin, MD, PhD | | System: | Kidney | | Subject: | Cancer | | Abstract: | It is good when kidneys work well.
Kidneys may develop cancer too (as any other organ).
| | Website: | http://www.kavokin.com | | Time: | 19:09 | | Reference: | http://www.rdoctor.com | | Reference 2: | http://www.symptomat.com |
|
|
Pain? Discomfort? Sickness? Some vague symptoms?
Afraid that you have Cancer, Diabetes or Heart Disease?
Need a second opinion or online diagnosis?
Confused with your current medical condition?
The Diagnostic Tool is designed to help individuals to learn about themselves, and to help health
professionals give good health care.
Understand the cause of your symptoms.
Educate yourself. Understanding your symptoms helps to obtain the right diagnosis. Right diagnosis
allows prompt and correct treatment.
Go to:
Some potentially dangerous diseases may look falsely innocent. If in any doubt, please contact your
physician.
©2006 Kavokin.com
...
powered in 0.03s by baseportal.com
Get your own Web Database - for FREE!
|
|
Home
New users
FAQ
Articles
About Us
Testimonials
Tell-A-Friend!
Discount Pharmacies
Articles by Aleksandr Kavokin, MD, PhD
Doctor-Robot (Free section)