RENAL TUMORS
Renal tumors may arise from the renal capsule, parenchyma (renal cell carcinoma), connective tissue (sarcomas), or fatty tissue or they may be neurogenic or vascular. Almost 90% of all tumors are adenocarcinomas. Occur more frequently in inhales and may metastasize early to the lungs, bone, liver, brain and contralateral kidney.
Causes
Exact cause is unknown
Clinical Manifestations
1. Many renal tumors produce no symptoms and 'are discovered on routine physical examination ad a palpable abdominal mass.
2. Weight loss, fever and night sweats - [from systemic effects of renal cancer]
3. Classic trial (late symptoms).
a Haematuria intermittent or continuous, microscopic or gross.
b. Flank pain [from distention of renal capsule, invasion of surrounding structures].
C. Palpable mass in flank.
Diagnostic Evaluation
1. Ultrasonography - [helpful in differentiating renal cyst from renal tumor.]
2 CT or MRI - [for Patients with urographic findings suggesting tumor, useful for detecting, categorizing, and staging a renal mass]
3. Intra venous Pilogram. IVP. fused as a screening procedure, IVP alone may fail to detect some renal tumors]
Others cystoscopic examination sectional radiographic examination of kidney nephrotomograms, renal angiograms.
4. Renal Biopsy - to confirm the Carcinoma.
Medical Management
1. A radical nephrectomy- removal of the kidney and associated tumor, adrenal gland, surrounding perinephric fat and gerota's fascia and lymph nodes. Radiation therapy may be used adjunctively with surgery. Chemotherapy or hormonal therapy may be tried.
Immunotherapy may be helpful.
2. Renal artery embolization this cuts off the blood supply to the tumor and thus cause the death of the tumor cells.
Catheter is advanced into renal artery.
Embolizing material (gelfoam, steel coils, blood clot) is injected into artery and carried with arterial blood flow to occlude the tumor vessels.
This decreases tumor vascularity and minimizes blood loss, relieves pain and devitalizes the tumor pre operatively, making removal of the kidney easier [and theoretically stimulates an immune response. The concept infraction of renal cell carcinoma will release tumor Patient's response to metastatic lesions.] associated Ags that will enhance the [It may also reduce the no. of tumor cells entering the venous circulation during surgical manipulation.
Monitor for post infarction syndrome (lasts 2-3 days)
Severe abdominal Pain, nausea, vomiting, diarrhoea, fever. [pain is treated with parenteral analgesics while aspirin controls fever, antiemetics, restriction of oral intake and maintenance with IVF are used to treat the G.I. complaints].
Complication arterial obstruction, bleeding, diminution of renal function.
Complications
Metastasis to the lungs, bone, liver, brain and other areas.
Nursing Management
1. Explain each diagnostic test, its purpose and adverse reactions
2. Answer questions and assess Patient's understanding about diagnosis and treatment options.
3. Encourage Patient to discuss fear and feelings.
4 Administer Analgesics as prescribed to control flank and abdominal Pain.
5. Encourage Rest and assist with positioning for 2-3 days until syndrome subsides.
6. Obtain temperature every 4 Hrs. administer Antipyretics as indicated.
7. Restrict oral intake and provide IVF while Patient is nauseated.
8. Administer Antiemetics as ordered.
9. Advise patient with, one kidney to wear a medic-alert bracelet and notify all health care providers. Because potentially nephrotoxic medications and procedures must be avoided.
