Tumors of the kidneys and urinary tract

Tumors of the renal parenchyma. Benign neoplasms of the kidney: lipoma, fibroma, fibroids, angiomas and chondroma - are very rare, they are characterized by small size and asymptomatic. They are discovered by chance during kidney surgery or autopsy. Fibroma, lipoma, adenoma size to cherries are located on the surface of the kidney (adenomas sometimes grow to significant size and then can take a malignant nature, metastasize and investirovat renal parenchyma). Angioma the size of a pinhead found on the tops of the renal papillae, they sometimes alarming renal bleeding requiring nephrectomy; are recognized only to the remote kidney.
Malignant tumors of the kidney are adults 1-2%, and the children about 25-30% of all tumors. Compared to other surgical diseases of the kidneys they meet in 5-7% of cases. This disease affects people of all ages, including infants. In 3/4 of the cases, tumors of the kidney are found in people aged 40-60 years, men find it in 2-3 times more often than women. As a rule, the tumor affects one kidney, right and left equally often. Tumor involvement of both kidneys occurs only rarely.
In adults 80-90% of tumors is Gipernefroidnyi cancer (renal cell cancer), much less meet other forms of cancer (5-10%) and sarcoma of the kidney (3-5%). Most tumors of the kidneys in children refers to embryonic mixed tumors.

Sarcoma of the kidney may consist of spindle-shaped, round or polymorphic cells. Macroscopically, and histologically, it is often difficult to differentiate from renal cell carcinoma of the kidney.
Malignant tumors of renal parenchymal manifested three main symptoms: hematuria, apparently swelling or pain in the kidneys.
Hematuria occurs in 70-90% of patients suffering from kidney tumors, appears for no apparent reason, not accompanied by pain or functional disorders. This kind of "asymptomatic" or "painless" hematuria in most cases, very rich, kept short (1-2 days) and disappear as suddenly as they appear. Often bleeding so profusely that in the urine, densely saturated crimson blood, blood clots form, which, stuck in the ureter, can cause an attack of renal colic. Accumulate in the bubble, clots can lead to a delay of urine. Blood clots in the kidney tumor is sometimes form like an impression of the lumen of the ureter and become worm-like form.
Bleeding in the kidney tumors arise from the violation of the integrity of the vessel tumors, sprouted in the pelvis, or congestive veins kidneys, compressed tumor.
Profuse total "asymptomatic" hematuria should always call the suspected tumor in one of the urinary system, including in the kidney.
Apparently the tumor. In most cases be felt tumor that has reached a considerable size, often sprouted in surrounding tissue and organs. Only when flaccid the wall of the abdomen with thin patients can sometimes be felt small tumors that originate from the front wall or the lower pole of the kidney.
Pain in the kidney after tumors have been observed in about half of cases. Dull pain depend on pressure kidney tumors to adjacent organs and nervous sites, and also from stretching fibrous capsules kidneys, rich sensitive nerve endings. Pain that depend on the germination of the nerves, can irrationality in different directions. Acute pain can arise due to the obstruction of the ureter blood clots or massive bleeding in the kidney, causing a rapid increase of its volume.
For tumours of kidneys, clenching v. spermatica germinating or her, there is sometimes a dilatation of the spermatic cord. Varicocele can be explained by pressure on the seminal vein lymph nodes, infiltrated by the tumor. Unlike idiopathic varicocele, observed mainly among young people on the left, by tumors of the kidneys varicocele is their right and their left and disappears in the supine position of the patient. Therefore any expansion of veins of the spermatic cord, which the man of middle and old age, should raise suspicion of the kidney tumor and to encourage the appropriate examination of the patient. The same applies to the expansion of subcutaneous veins of the abdomen on one side (right or left) or around the navel (head of Medusa), associated with the outflow of blood from the buds on collaterals due to compression tumor venous trunks kidneys.
The General condition of patients may long remain undisturbed, in some cases, rapidly developing General weakness, loss of appetite, weight loss, cachexia, analizatze.
Often the only symptom of kidney tumor is resistant hectic temperature. If you cannot determine the cause fever, patients will be detailed urological examination to detect or exclude a tumor of the kidney.
Diagnostics of tumors of kidney simple and typically occurring cases and difficult in the absence of the above characteristic features.
Even one of these symptoms, especially hematuria, may be suspicious of the kidney tumor. The same applies to every occasion sudden varicocele, unexplained fever, no cause weight loss, anemizatsii, pathological bone fractures (metastasis of tumor).
Palpation of the abdomen kidney tumors are presented bumpy, knotty; only sarcoma sometimes have a smooth surface. Easier felt tumors of the lower pole, harder - the middle part of the kidney and very hard - tumor top of the pole.
Often, patients with tumors of the kidneys is celebrated polycythemia is the number of red blood cells exceeds 5 000 000, hemoglobin above 100%. The reason for this is contained in the tissues of renal cell carcinoma erythropoietin that stimulates blood in the bone marrow.
Often seen rapid ROHE, but it is not permanent or characteristic.
When macroscopic hematuria cystoscopy should not be postponed until the termination of her, as during bleeding can establish where the stands out the blood of the bladder or kidneys, and what it is.
Unlike hydronephrosis, stones and tuberculosis of the kidneys, in which the allocation of Indigo Carmine on the side of the disease is delayed or missing, when renal tumors, even at large, the paint can be allocated on time or with a slight lag, if you still have at least a small area of normal tissue.
On the overview radiograph often have shadows of the kidneys, which allows you to set enlarged and irregular contours of a kidney-affected by the tumor. Crucial retrograde pyelography. If the tumor grows or squeezes renal glasses, on the retrograde pyelogram visible corresponding changes them (Fig. 101 and 102). If the cancer has grown into the renal pelvis, found filling defect. The contrast agent may not penetrate into the sack, if sprouted tumor fill her cavity. Tumors that originate from the lower pole, often push the upper section of the ureter to the side of the spine in the form of an arc, is convex in the medial side (see Fig. 102). An important symptom is asymmetric location of the renal pelvis against the kidney. If a tumor is coming from the pole of the kidney pelvis moves to the opposite pole (Fig. 103).
When excretory urography found the same changes, but not always as clear.

Fig. 101. A tumor of the left kidney, originating from the inferolateral the edges of her. The lower and middle cups crushed and moved away from each other. Retrograde pyelogram.

Fig. 102. Swelling of the lower pole of the left kidney, pushing back the left ureter to the side of the spine. The lower Cup amputated, middle pushed upwards. Retrograde panoretrograph.

Fig. 103. A tumor of the upper pole of the left kidney. The pelvis is located asymmetrically, closer to the lower pole. Retrograde pyelogram in combination with Pnevmostroimashina.

Fig. 104. Swelling of the lower pole of the right kidney. Angiogram.

The tumor growing to the periphery of the kidneys and not changing contours of the pelvis and cups can be discovered using Pnevmostroimashina or pneumonia (see Fig. 41). In differential detection of the tumor and solitary cysts in the kidneys can help renal angiography. Sign tumors are excessive branching of small vessels in tumors and small clusters of contrast fluid in the form of "lakes" or "puddles" on the ground of tumor lysis (Fig. 104). For cysts characteristic avascular area (see Fig. 60). As with other diseases of the kidneys, for example, hydronephrosis, omitted kidney stones or tuberculosis kidney, polycystic kidney disease, the contrast of the kidney tumor is as follows:
1. When hydronephrosis kidney function sharply broken pelvis and cups symmetrically extended, but not deformed.
2. If omitted kidney last not enlarged, its normal function. Pielografia standing precise diagnosis.
3. At stones of kidneys hematuria small it follows renal colic, and not precedes it, as it is observed in tumor when colic occurs when the obstruction of the ureter a blood clot.
4. Tuberculosis of the kidneys observed dysuric disorders that when kidney tumors are missing. Excessive bleeding from the veins of renal papilla in the early stages of renal tuberculosis cause profuse asymptomatic hematuria, but in the early stages of tuberculosis in the Deposit urine can detect leukocytes and Mycobacterium tuberculosis.
5. In polycystic increased bumpy kidney felt on both sides. Often marked phenomena renal failure. Retrograde pyelography finds in both kidneys are typical for polycystic changes (take long and too branchy Cup).
Pielografia should not be performed during hematuria and earlier 5-7 days after its termination, as blood clots in the Cup pyelocaliceal system can cause defects of filling and lead to misdiagnosis.
Untreated kidney cancer inevitably leads to death from cachexia and violations of vital functions because of tumor invasion and metastasis.
The only method of treatment is the removal of a kidney. Than before the operation took place, the greater the chances for a lasting recovery. Unfortunately, the disease is detected in most cases too late. Therefore, the results nephrectomy unsatisfactory. Within 2 years after surgery more than half of patients die from the relapses and metastases. Only 1/3 of patients still alive after 3 years after surgery.
The kidney are removed through vnebrachnyi oblique lumbar section. When uninstalling, you must avoid breaking the tumor and hit her particles in the wound, seek to remove together with the tumor and perinephral fiber, as early as possible to bandage vascular leg to prevent tumor cells into the bloodstream when allocating kidneys. For this purpose use razbrosannye nephrectomy, which manages before bandaging vascular leg buds.
After healing the wounds you can apply deep x-ray treatments, but the benefit of its questionable, except mixed renal tumors (tumors Villmsa) in children under which it is effective. Radiotherapy can be used in children before the operation for very large tumors to reduce their volume.
Tumors of the kidneys in children are found mainly in the age from 3 to 7 years. Histological structure is extremely patchy. In them you can find fat, bone, cartilage, glandular education and brain ganglia, smooth and striated muscle fiber (Wilms tumor).
For tumors of the kidneys in children differs in many respects from the disease in adults. Hematuria and pain occur much less frequently. The main symptom is rapidly growing in hypochondrium large, rough tumor, often visible to the eye, causing swelling and deformation of the abdomen. The pressure of the tumor on the diaphragm, intestine, biliary tract and veins causing shortness of breath, constipation, diarrhea, jaundice, edema of the lower extremities. Children die more often from cachexia.
Operative treatment - removal of the kidney. Early operation gives some chance of a full recovery. In the coming months after surgery more than half of the operated dies of relapses and metastases.