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Q. Was suggested kidney removal for tumor. Can the organ be saved?

Answered by
Dr. Arshad Hussain Shah
and medically reviewed by Dr.Sowmiya
This is a premium question & answer published on Feb 06, 2018 and last reviewed on: Jan 25, 2022

Hi doctor,

This is about a tumor in the kidney case as follows.

Before ten days, the patient found bloodstain in the urine. No pain, no other symptoms. On the next day, after drinking two glasses of water, he developed pain in the lower abdomen and back. Got an ultrasound done. Ultrasound showed a tumor in the left kidney (report attached). The following day, we got a CT scan done, and it showed a big mass arising from the lower pole of the left kidney of size 8.8(AP)*6.9(TR)*7.4(SI) cm, and the doctor suggested surgery which involves removal of the kidney to save from spreading. Let me know if the kidney can be saved and the disease eradicated and controlled from spreading further.

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#

Hello,

Welcome to icliniq.com.

It looks like a large tumor in the left kidney. The reports (attachment removed to protect patient identity) show that the disease is localized and not spread to other parts. The only curative treatment for this tumor is surgery (removal of affected kidney along with the whole tumor). It is difficult to save the kidney because of the large tumor size, but the surgeon will review the CT scan films with the radiologist to decide finally regarding any chance of saving the kidney.

After surgery (removal of the tumor), the pathological report will be available, which will show the type of tumor and pathological stage. That will guide us whether further treatment is needed or not. You have not attached kidney function test or liver function test, serum chemistry, LDH (lactate dehydrogenase), alkaline phosphate blood test reports so that I can tell you whether further tests are needed or not, like isotope bone scan, etc.

After surgery usually prognosis is good depending on the pathological report.

Hello doctor,

Thanks for your detailed reply. Please find attached LFT/KFT/alkaline and renal DTPA reports. A bone scan has also been done today. The report is expected by tomorrow morning. The doctor has advised surgery on Monday. I have two questions - a) Is there any remote chance of saving the kidneythrough some miraculous medical advances? b) What is the life expectancy of the survivor with one kidney at age 43? Are there any 'special' medical/lifestyle advice/precautions to be taken to maintain surviving kidneys in good health and protected from the same thing to reoccur?

Thank you and regards.

#

Hello,

Welcome back to icliniq.com.

I have gone through the reports. They are almost normal. I am very much hopeful that the bone scan will be normal. I appreciate your decision to go for surgery on Monday. The earlier, the better. After surgery, the histopathological report will guide us for further follow-up and any possible treatment. It will also show us the type of tumor, pathological stage, and prognostic factors. There are still some slim chances of saving a kidney by removing only the partial kidney. But more chances are that the whole kidney will be removed. That is a pure surgical decision. But nothing to worry about if you do not have hypertension and diabetes. That can put an extra burden on the kidneys. One can live with one kidney typically for long years. I have had patients on follow-up for the last 15 years with one kidney after their kidney was removed because of the tumor. They are doing fine.

After surgery, you have to take some precautions lifelong like:

  1. Stay hydrated always. Drink plenty of water during hot weather.
  2. Keep a regular follow-up every three months for two years, then six-monthly. Monitor KFT electrolytes, LDH, ALP, etc., occasionally. Abdominal scans need to be done six-monthly or yearly for a few years, depending on the histopathological report, which will show how aggressive the tumor is.
  3. Do exercise daily (to prevent diabetes, hypertension, obesity and improve blood circulation to the whole body. Just a brisk walk for 45 minutes is acceptable.
  4. Avoid some medicines which can harm kidneys most painkillers. Also, avoid herbal medicine.

After the bone scan, revert to me again and anytime in the future.

Thank you doctor,

Here is the renal bone scan report. Please tell me that when you say slim chances of saving a kidney is a purely surgical decision, how and based on what factors it will be decided as we are done with all tests and scheduled for surgery on Monday. Let me put it this way. If you were the doctor to operate what would be your decision or how will you decide if it is to be decided on operation day? Tell me what would you do, if you were the doctor? Also, please note that we are ready to go to any extent if there are any chances of saving the organ. Awaiting your response ASAP. Thanks and regards.

#

Hello,

Welcome back to icliniq.com.

I am a medical oncologist. So, once we diagnose the patient with a kidney tumor, we refer him to a surgical oncologist for surgery. He will investigate and assess the patient if he is fit for surgery or not and decide about partial or whole kidney removal.

It depends on many factors:

Usually ideal indication for partial removal of the kidney (also called nephron-sparing surgery) is:If the tumor size is less than 4 cm but some surgeons may remove even up to less than 7 cm. It also depends on many other factors (peripheral vs central, exophytic vs endophytic).

In some cases, we need to preserve the function of the kidneys. So, the whole kidney cannot be removed. We must save the kidney. For example, if there is a pre-existing disease of the other kidney like chronic kidney infections, some vascular kidney disease, long standing diabetes and poor kidney function. Personally, in this case, I will recommend removal of whole kidney because the tumor size is large. So, if we remove only half there is increased risk of recurrence compared to whole kidney removal.

For more information consult a medical oncologist online --> https://www.icliniq.com/ask-a-doctor-online/medical-oncologist

Dear Doctor, Here I am again with an update of the above case. As advised by all, we got the surgery done on 22 Jan. Today we received the histopathology report of biopsy and I would like to seek your opinion or your fellow doctor in surgery oncology (as you said you are medical oncologist and surgery one may know better) on next course of action/ treatment recommended for a better and healthy life. Am attaching the report here. Looking forward to hear detailed treatment suggestions from you soon. Thanks and regards.
# Thanks for sharing histopath reports I have seen the histopathological report . The tumour was removed successfully and it was limited to left kidney only and the pathological subtype found is clear cell type Kidney cancer ( which is better than other type of kidney cancers ) . THey have removed whole tumour including near by lymph nodes . All lymph nodes resected are free of Tumour invasion . It looks a stage 2 Renal Cell cancer ( clear cell type )
Regarding further management since many decades the only treatment for this kind of localized tumour was surgical excision of the tumour along with kidney ( Nephrectomy ) which has been done already
But according to latest international treatment guidelines 2017 some medicine ( target therapy ) is recommended after surgery for upto one year period But only for those who are at high risk for recurrence .
According to Histopath details he is not in the high risk group . So i don't think there is need for further treatment now But he must follow up regularly every three months to Medical Oncologist or Surgical Oncologist
It is better to discuss with the Medical Oncologist regarding any role of adjuvant treatment ( after surgery treatment )
As he can examine him physically , review his surgical details , and all scans and lab tests . So for me little difficult to give final opinion with out clinical examination etc

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