Kidney

Kidney stones are a widespread condition: they are more common in men than in women, and how common they are varies from region to region. Stones reduce quality of life and can cause severe pain and infection and impair kidney function. In some people, however, they progress silently without any symptoms — which is why a stone found by chance should also be evaluated.

Not every kidney stone needs surgery. Surgery is considered for stones that do not pass or dissolve despite drinking plenty of fluids and taking medication.

Situations in which surgery is definitely needed: severe pain or infection; a stone that does not pass with treatment; bleeding; a threat of losing kidney function; complete blockage; a stone in a solitary kidney.

Like any surgical procedure, stone operations carry risks — bleeding, infection, anesthesia-related complications; the technique is chosen individually for each patient after an examination.

Kidney pain accompanied by fever and chills may be a sign of infection in a blocked kidney and needs to be evaluated without delay.

RIRS is closed (flexible) kidney stone surgery: no incision is made; a flexible endoscope is passed through the urethra and ureter into the kidney, and stones can be removed from the various calyces of the kidney — including the lower calyx. Patients are usually discharged the next day and can return to their daily activities within a short time.

The main indications are kidney stones up to about 1–1.5 cm, and in some cases up to 2–3 cm; stones in both the kidney and the ureter at the same time; stones in both kidneys; multiple small stones in the kidney. For stones larger than 2 cm, the procedure may need to be done in several stages, and in such cases percutaneous nephrolithotomy (PCNL) is often considered the more suitable option.

Stone size is not the only criterion: the number of stones, the calyx in which they sit, the structure of the kidney and the patient’s general health are assessed together, and the technique is chosen separately for each patient.

RIRS also has limitations: with a large stone burden, the operation takes longer, scattered stone fragments can cause problems and the risk of infection increases; general anesthesia is required; any existing urinary tract infection must be treated beforehand. RIRS is not suitable for every stone.

Stone size is not the only criterion; the choice of technique is made individually for each patient after an examination.

The main limiting factor is stone size. With large stones, the operation takes a long time, which increases the risk of infection and sepsis; general anesthesia is required, and any existing urinary tract infection must be treated beforehand. In such cases, percutaneous nephrolithotomy is chosen.

Percutaneous nephrolithotomy is performed through a small incision in the skin that gives direct access to the kidney, and with a large stone burden it may be more suitable than the closed endoscopic approach.

This technique also requires anesthesia, involves an incision — albeit a small one — and is not suitable for every patient; the choice depends on the size and location of the stone, the anatomy of the kidney and any other health conditions. Like any surgery, it carries a risk of bleeding and infection.

Yes, stone disease can recur — especially in people with a family history of stones, those who developed stones at a young age, or those who have had stones several times before. That is why the composition of a removed or passed stone is analyzed; in patients at high risk of recurrence, an additional (metabolic) evaluation with blood and urine tests is carried out.

General recommendations: drinking enough fluids throughout the day (for people with heart or kidney failure, the amount is agreed with the doctor), limiting salt and animal protein, and maintaining a healthy weight. Sharply cutting back on calcium on your own is not advisable.

Depending on the type of stone, dietary or medication-based prevention is prescribed individually; self-prescribed diets and supplements can be useless and sometimes even harmful.

Hydronephrosis is dilation of the collecting system (the calyces and renal pelvis) of one or both kidneys as a result of impaired urine flow. It can occur at any age and may be congenital or acquired. Its cause must be identified and eliminated.

Causes include: a narrowing where the renal pelvis joins the ureter (including one caused by a crossing accessory blood vessel); a blockage further down — a stone, a tumor, a blood clot; ureteral stricture; vesicoureteral reflux (urine flowing back up from the bladder). Acute or chronic urinary retention — for example, when an enlarged prostate prevents the bladder from emptying — can also lead to hydronephrosis.

For example, a stone may block the passage, or an enlarged prostate may cause the bladder to fill up, and this leads to hydronephrosis — dilation of the kidney. All of these are postrenal, urological causes.

Hydronephrosis that persists for a long time can lead to irreversible loss of kidney function; that is why early diagnosis and early treatment are important. Treatment targets the cause: the stone is removed, the narrowing is repaired, the cause of urinary retention is treated.

The degree and duration of hydronephrosis determine the outcome — in a kidney that has been blocked for a very long time, function may not fully recover after treatment. Repairing a narrowing is a surgical procedure and, like any operation, carries risks; the technique is chosen individually.

Kidney cysts are evaluated using the Bosniak classification. This classification determines whether a cyst is simple or suspicious, and whether it should be monitored or requires surgery.

Kidney cysts are more common after age 40, and most of them are benign. The classification is based mainly on contrast-enhanced CT or MRI images (a cyst that does not look simple on ultrasound is clarified with these scans), and it helps in choosing the right course of action.

Type I — a simple cyst with a smooth wall; it is not considered malignant and needs no treatment. Type II — a benign cyst with a few thin internal walls (septa) or fine calcifications; the likelihood of malignancy is very low, and it usually needs no treatment. Type IIF — a cyst with thickened walls or septa and calcifications; the likelihood of malignancy is low, but because it cannot be completely ruled out, the cyst is monitored with imaging at set intervals. Type III — a cyst with thicker walls and septa that partially enhance with contrast; because the likelihood of malignancy is considerably higher, surgery is usually recommended, although in some patients close monitoring may also be discussed as an individual decision. Type IV — a cyst with enhancing tissue components; it is treated as a kidney tumor, and surgery is planned.

At the same time, a simple cyst does not need to be treated “just in case” — unnecessary intervention carries its own risks. Conversely, missing checkups for a cyst that requires monitoring delays the diagnosis. Only a specialist can determine the type of cyst, based on imaging; when surgery is needed, it carries risks like any operation, and the technique is chosen individually.

The likelihood of malignancy differs by cyst type; for a cyst that requires monitoring, it is important to keep to the follow-up intervals set by your doctor.

When the size and location of the tumor allow it, an organ-sparing approach — removing only the tumor (resection) — is preferred. When this is not possible, a radical nephrectomy (removal of the entire kidney) is performed laparoscopically or with a robot.

In the laparoscopic approach, no large incision is made: thin instruments and a camera are inserted through tubes (trocars) placed through several small openings in the abdominal wall, and all the steps of open surgery are carried out in the same way. This is a technique that causes little trauma (minimally invasive).

Masses that develop in the kidney can be benign or malignant. A specific diagnosis can be made using modern methods — CT, MRI or ultrasound. If the mass is malignant, surgical treatment is needed.

The laparoscopic approach is used only for suitable tumors and suitably located masses; if the size, location or extent of spread of the tumor does not allow it, open surgery may be needed. Every surgical procedure carries risks related to bleeding, infection and anesthesia.

Kidney cancer usually occurs in people over 40 and is more common in men than in women.

Factors that increase the risk: smoking; obesity; long-term use of certain pain relievers; long-term dialysis; kidney cancer in the family — especially in siblings — and certain hereditary conditions; long-term exposure to chemicals such as asbestos, cadmium, benzene and certain pesticides.

Having a risk factor does not mean the disease will definitely develop; however, kidney-related symptoms should be evaluated more carefully in people with these factors.

Blood in the urine (dark red or rust-colored urine); a dull, persistent pain in the flank; a lump in the abdomen or kidney area that can be felt by hand; loss of appetite and weight loss; high fever; excessive tiredness and weakness.

None of these symptoms is specific to cancer — stones, infections and other conditions can cause similar complaints. That is why, when symptoms appear, you should not draw conclusions on your own but get examined.

Visible blood in the urine always requires investigation — even if it is painless and happens only once. Even if the ultrasound is normal, a camera examination of the bladder (cystoscopy) and imaging of the upper urinary tract (CT) may be needed; a tumor cannot be ruled out with ultrasound and a urine test alone.

Controlling blood pressure, controlling blood sugar if you have diabetes, and cutting down on salt are crucial. Salt consumption in Azerbaijan is considerably higher than in European countries; excessive salt intake can lead to high blood pressure, edema and harmful effects on the kidneys. Early diagnosis helps preserve kidney function.

Kidney failure has a prerenal form — caused by high blood pressure, diabetes, or disease or narrowing of the blood vessels that supply the kidney. There are also diseases of the kidney itself — glomerulonephritis or collagen diseases, which damage the structure of the kidney. Finally, there is the postrenal form, which counts as the urological form: some kind of obstruction in the pathways that drain the kidney.

Urological (postrenal) causes — a stone blocking the urinary tract, an enlarged prostate preventing the bladder from emptying — need to be checked separately. If the stones are cleared and kidney function improves, this can prevent kidney failure.

That is why, in every patient diagnosed with kidney failure, it must be determined whether the cause is prerenal, renal or postrenal; if a blockage is found, timely urological treatment can help protect the kidney. Diseases of the kidney itself, however, require treatment by a nephrologist.

Preventive measures do not restore function that has already been lost; the outcome depends on how early the cause is detected.

If you have been diagnosed with kidney failure, a urological evaluation to rule out a blockage in the urinary tract should not be delayed.

Another kidney condition is pyelonephritis — an inflammation of the collecting system. It has chronic and acute forms; the cause needs to be investigated, because it never happens without a reason.

Pyelonephritis often comes with fever, chills and pain in the kidney area — below the ribs, on the side — and sometimes nausea and vomiting. For a urologist, the key question is whether there is a blockage behind the inflammation — a stone, a narrowing, urine flowing backward: in a blocked kidney, infection can worsen rapidly and may require urgent intervention.

Timely treatment based on a correct diagnosis helps prevent the condition from progressing to kidney failure. However, unless the cause is eliminated, antibiotic treatment alone may not be fully effective, and the inflammation may come back.

Kidney pain with fever and chills — especially if a stone or blockage is known — needs to be evaluated without delay; the cause of the inflammation is always investigated separately, although in some cases no clear cause may be found.

Glomerulonephritis is an inflammation of the kidney’s filters (nephrons) and requires follow-up by a nephrologist rather than a urologist — but changes in urine tests are often first detected during a urological examination.

If there are signs such as swelling (edema), high blood pressure, a sharp drop in the amount of urine, cloudy urine and fever, and a urological cause — a stone, a blockage, an infection — has been ruled out, the patient is referred to a nephrologist. These signs may sometimes be accompanied by pain in the abdomen or around the kidneys, nausea and vomiting; how often you need to urinate may also change. The complaints are sometimes temporary, but the disease process may continue. That is why, if you notice signs such as swelling, a reduced amount of urine, a change in urine color or high blood pressure, it is important to see a doctor without delay and have urine and blood tests — even if the complaints have gone away. A kidney biopsy may be needed for diagnosis; treatment (including hormone therapy) falls within nephrology, is long-term and requires patience.

Treating glomerulonephritis is the responsibility of a nephrologist; the purpose of the urological examination is to rule out causes such as blockage and infection.