Kidney Disease Treatment

Kidney diseases refer to all medical problems that impair the structure or function of these organs, which serve as the body’s natural filtration system, including stones, masses, cysts, infections, and reduced filtering capacity. These conditions, which prevent the maintenance of vital balances, appear with noticeable symptoms such as pain felt in the lower back area, changes in urine color, and differences in urination frequency. Current treatment methods are shaped according to the nature of the problem and offer a wide range of solutions extending from minimally invasive surgical operations to technological laser applications and medical support. Proper management of these structural and functional disorders that threaten kidney health is one of the most important steps in preventing permanent organ damage.

What are kidney diseases and how do they affect our body?

Our kidneys, located on both sides of the lower back area of our body, resemble beans, yet when their functions are considered, they operate like enormous factories. The microscopic filters within the system, known as nephrons, remove waste products and excess water from the blood to produce urine. However, structural disorders may develop in this system due to environmental factors, the habit of drinking insufficient water, or genetic predispositions. The collective term for these structural or functional problems is kidney diseases. A decline in filtering capacity, blockage of the urinary channels, or the appearance of cysts on the surface of the organ directly affects the general functioning of the body. When the system cannot function properly, toxins accumulate in the blood, fluid balance is disrupted, and blood pressure becomes difficult to control. Therefore, any obstruction that threatens the kidney structure profoundly affects not only the lower back area but the health of the entire body.

What are the main differences between nephrological and urological kidney diseases?

When kidney problems are examined in healthcare, two different perspectives come into play. Microscopic filtering problems of these organs, protein leakage into the urine, or failure caused by high blood pressure fall entirely within the field of internal medicine known as nephrology. However, when the issue is an anatomical problem that disrupts the physical structure of the organ, blocks the urinary tract system, or requires surgical intervention, urological medicine comes into play. A stone blocking the urinary tract, a tumor growing inside the organ, or a congenital narrowing of a channel obstructing urine flow are among the structural kidney diseases that must be resolved through urological methods. Since such physical obstacles significantly prevent the organ from performing its function, they generally require intervention with technological devices or surgical repair methods.

What are the most common symptoms of kidney diseases?

When the body’s filtration system malfunctions, it usually produces very mild signals at first that may easily be overlooked. However, especially when there is a condition blocking the urinary tract or causing pressure, these signals may suddenly become severe. The most basic warning signs of these diseases are noticeable changes in toilet habits and discomfort felt in the lower back areas of the body. Unexpected changes in urine volume and the need to wake up at night to urinate are among the most common complaints. One of the most dangerous situations is the complete cessation of urine output due to an obstruction. In general, the main complaints caused by these conditions in the body are as follows:

• Frequent urination (Pollakiuria)
• Waking up at night to urinate (Nocturia)
• Burning during urination (Dysuria)
• Blood in the urine (Hematuria)
• Flank pain
• Decrease in urine volume
• Pain radiating to the groin

How can we recognize pain caused by kidney diseases?

Pain is the body’s way of signaling that something is wrong, and kidney problems reveal themselves through highly characteristic pain patterns. These pains are generally felt in two different ways. The first type is severe, comes in waves, and makes it impossible for the person to remain still, occurring when the kidney suddenly swells because a stone has fallen into and blocked the urinary tract. During this pain, the person cannot find any comfortable position; it usually begins in the lower back and moves toward the groin. The second type of pain is subtle, continuous, and dull. This aching pain felt in the lower back occurs when a mass slowly growing inside the organ stretches the kidney capsule. Whether the pain began suddenly or gradually provides important clues about the source of the problem.

What does blood in the urine mean in terms of kidney diseases?

One of the most concerning situations observed during urination is the presence of blood in the urine, known as hematuria. Sometimes this condition is mild enough to be detected only under a microscope in laboratory analysis, which is called microscopic hematuria, while at other times it is obvious enough to visibly turn the urine red, which is called macroscopic hematuria. The pattern of bleeding provides important information about the possible underlying problem.

If the bleeding is accompanied by very severe flank pain, this usually indicates that a sharp-edged stone has scratched the urinary tract or that there is a severe infection. However, the main situation requiring attention is the silent presence of blood in the urine without any pain or discomfort. Painless bleeding may be one of the most important warning signs of unwanted masses or tumors growing within the organ.

The main conditions that can cause blood in the urine are as follows:

• Kidney stones
• Urinary tract infections
• Kidney tumors
• Bladder masses
• Kidney cysts
• Structural abnormalities

Which laboratory tests are used when diagnosing kidney diseases?

When a structural problem in the body is suspected, the first step is to create a chemical map of the body. This map is produced through laboratory tests that are simple yet provide extremely valuable information. The first test performed, a complete urinalysis, acts like a mirror of the urinary tract. Through this test, hidden bleeding in the urine that cannot be seen with the naked eye, white blood cells indicating the presence of infection, or crystals that predispose to stone formation can be detected. Blood tests are then performed using a sample taken from the arm to determine the actual filtering capacity of the organs. The levels of waste substances that accumulate in the blood and should normally be excreted through urine, such as urea and creatinine, are measured to understand how effectively the organs are performing their functions. Especially in conditions accompanied by fever, performing a urine culture to identify the type of bacteria is an indispensable step.

What are the modern imaging methods used in the diagnosis of kidney diseases?

After laboratory findings indicate the presence of a problem, imaging devices are used to determine where the problem is located and how extensive it is. These devices act as technological windows that allow the inside of the body to be viewed without surgery. In the first stage, devices that do not involve radiation and operate with sound waves, known as ultrasonography, are used to examine fluid accumulation or large stones. However, when more detailed mapping is required, especially to determine the location of millimeter-sized stones or the relationship of a mass with surrounding blood vessels, advanced cross-sectional imaging methods such as tomography are used. These technologies determine the entire strategy of the treatment to be applied. The main imaging methods used in diagnostic processes are as follows:

• Ultrasonography
• Non-contrast computed tomography (Stone protocol CT)
• Contrast-enhanced computed tomography (Contrast CT)
• Magnetic resonance imaging (MRI)
• Renal scintigraphy
• Contrast-enhanced kidney X-rays (IVP / Intravenous pyelogram)

Why and how do kidney diseases involving stone formation occur?

The urine produced by our body naturally contains many minerals and salts. In a healthy body, these substances remain completely dissolved in the fluid and are excreted without difficulty. However, when insufficient fluid is consumed, the concentration of urine increases. As the amount of fluid decreases, the minerals it contains can no longer remain dissolved and begin to precipitate. This precipitation process results in crystals combining and gradually turning into hard masses. Living in hot climates, failing to replace water lost through sweating, and consuming an excessively salty and high-protein diet greatly accelerate this process. In addition, a deficiency of certain protective substances in the urine that naturally prevent crystallization, such as citrate, is one of the factors that significantly increases the risk of stone formation.

What types of stones are seen in kidney diseases associated with stones?

Not every stone that forms in the body is the same; they differ considerably according to the chemical substances they contain and the mechanisms by which they form in the body. These structural differences directly affect how hard the stones are and the success rate of the treatment method to be applied. The most common stones generally develop as a result of excessive levels of calcium or oxalate in the urine. Some stones form when bacteria disrupt the urine balance due to recurrent persistent infections, known as struvite stones, and they can rapidly fill the inside of the kidney. There are also extremely hard stones that develop due to inherited disorders or diets heavily based on protein.

The main types of kidney stones encountered are as follows:

• Calcium oxalate stones (The most common hard stones)
• Calcium phosphate stones
• Infection stones (Struvite / Magnesium ammonium phosphate)
• Uric acid stones
• Cystine stones (Hereditary)

How are stone-related kidney diseases treated with non-surgical methods?

When a stone is detected in the urinary tract, surgery is not always performed immediately. The gentlest method is selected first by considering the size of the stone, its location in the tract, and the discomfort it causes. A significant proportion of small stones can leave the body spontaneously with only increased water consumption and physical activity. Medications that mildly relax the urinary tract may be used to facilitate this process. If the stone is too large to pass spontaneously but is located in a suitable area, technologies that turn the stone into sand using sound waves sent from outside the body, known as SWL, are used. This method allows sound waves to focus on the stone and break it apart without any instrument entering the body, and the resulting particles are gradually excreted through urine.

How are stone-related kidney diseases that require surgical intervention treated?

More advanced minimally invasive methods are used for masses that cannot be passed with sound waves or medication, are lodged in the urinary tract, stop urine flow and cause severe swelling of the organ, or have reached a very large size. Today, these procedures are performed through the body’s natural openings or through very small openings created in the back area. Methods in which thin, flexible, camera-equipped instruments are inserted through the urinary tract to reach the stone directly and turn it into dust with laser technology, known as RIRS or flexible URS, are extremely comfortable. In cases where the stone is very large, techniques known as PNL or percutaneous nephrolithotomy are applied by creating a small tunnel in the back approximately the thickness of a pencil and breaking and removing the stones. Modern surgical stone fragmentation procedures are as follows:

• Minimally invasive laser stone fragmentation (Retrograde Intrarenal Surgery – RIRS)
• Procedures performed by creating a tunnel through the back (Percutaneous Nephrolithotomy – PNL)
• Stone fragmentation with sound waves (SWL – Extracorporeal shock wave therapy)
• Stone surgeries performed with laparoscopic or robotic surgery (In very rare cases)

What symptoms do kidney diseases caused by tumor and cancer development produce?

Uncontrolled growth at the cellular level can lead to the formation of unwanted masses in the tissue of the organ. The most dangerous and surprising aspect of this condition is that it can grow silently for a very long time without causing almost any complaints. Most people discover these masses incidentally when they undergo an abdominal ultrasound for a completely different reason. When the mass grows considerably and begins to extend beyond its boundaries, a palpable feeling of fullness in the back area and persistent lower back pain may appear. The most obvious warning signal is visible bleeding in the urine without any pain or burning sensation. This silent progression once again highlights the importance of regular health check-ups.

Which modern surgical methods are used for cancer-related kidney diseases?

When unwanted masses are detected in the kidney, the primary aim is to completely remove this tissue from the patient while preserving as much healthy organ tissue as possible to prevent the future need for dialysis. If the mass is below a certain size, instead of sacrificing the entire organ, only the mass and a thin margin of surrounding healthy tissue are removed. The remaining healthy tissue is carefully repaired so that the organ can continue functioning. However, if the mass is very large, has approached the main blood vessels, or is located in the center of the organ, it may become necessary to remove the entire organ together with the surrounding membranes, known as radical nephrectomy. Today, the vast majority of these procedures are completed using minimally invasive technological methods, either laparoscopically or robotically, without large incisions.

How are robotic surgery systems used in the treatment of oncological kidney diseases?

Especially in surgeries where only the mass is removed and most of the organ is left in place, known as partial nephrectomy, speed and suturing precision are of vital importance. To prevent excessive bleeding while the mass is removed, the blood vessels supplying the organ are temporarily clamped. The duration during which the organ remains without oxygen must be kept as short as possible. At this point, robotic surgery systems provide an enormous advantage. Robotic arms controlled by the surgeon from a console perform movements that the human hand cannot make, without tremor. Thanks to this superior range of motion, the aim is to remove the mass quickly, carefully suture the open area, and restart blood flow. In this way, the procedure is completed without damaging the kidney cells.

What problems do kidney diseases caused by urinary tract narrowing create in the body?

For the waste fluid filtered by the organ to be transported continuously to the bladder, the urinary tract must be wide and unobstructed. However, in some people, congenital or acquired narrowing exists at the exact point where the urine-collecting basin of the kidney, known as the pelvis, joins the ureter, known as ureteropelvic junction obstruction.

Imagine trying to pour water rapidly through the mouth of a narrow funnel and seeing it flow backward; this is what happens in the body. Because urine cannot pass comfortably through the narrow point, it flows backward. This constant backflow and accumulation of fluid inside the organ causes it to swell under pressure and gradually compresses the delicate tissues responsible for filtration. Untreated narrowing may eventually lead to serious and permanent loss of function in the organ.

How are kidney diseases caused by anatomical narrowing corrected with surgical repair?

The solution to urinary tract narrowing is based on completely reshaping the narrowed area through physical repair. During the repair procedure, the nonfunctional and narrowed segment of the urinary tract causing the obstruction is safely cut out and removed. The fluid-collecting part of the organ is then reshaped to create a new and wide opening and reconnected to the healthy urinary tract. This procedure is called reconstruction of the urinary tract, or pyeloplasty surgery.

This repair procedure, which was previously performed through large incisions, can now be carried out through several small openings with high success rates thanks to laparoscopic and robotic technologies. The aim is to prevent fluid accumulation and relieve pressure through the newly created wide passage.

What are the healing stents used after kidney disease surgeries?

After obstructions are opened, narrowings are repaired, or minimally invasive kidney stone procedures are completed, soft tubes known as Double J or DJ stents are placed inside the urinary tract to protect the internal healing process. Because their ends are curled, these tubes do not move downward or upward. They remain inside like a temporary support to prevent tissue swelling that may develop in the surgical area or stone particles from blocking the tract again. During the short period they remain in the body, it is completely normal for the person to feel a constant urge to urinate or mild pressure in the lower abdomen. However, the most critical issue is that these support tubes must be removed from the body at the end of the period determined by the physician; if forgotten, they can calcify and cause serious damage.

Which lifestyle changes should be made to reduce the risk of kidney diseases?

Protecting this remarkable filtration system of the body is essentially related to how we treat our entire body. Very simple but effective decisions in daily life can greatly reduce the risk of serious problems that may occur in the future. The most basic rule is never to leave the body dehydrated so that the system can be continuously flushed. Drinking plenty of fluids prevents minerals from precipitating. Significantly reducing the amount of salt at the table prevents calcium from accumulating in dangerous amounts in the urine. Keeping blood pressure balanced and preventing blood sugar from rising sharply allow the microscopic filters to remain flexible and healthy for years. The habits that should be adopted to protect the kidneys are as follows:

• Drinking plenty of water
• Regular exercise
• Balanced nutrition
• Maintaining an ideal weight
• Restricting salt

Which foods should be avoided to reduce the risk of kidney disease caused by recurrent stones?

People who have experienced kidney stone pain once in their lives have a considerably high risk of experiencing the same problem again if they do not change their habits. For this reason, dietary habits must be reorganized. In particular, excessive consumption of red meat and animal protein, which makes the urine acidic, should be controlled. In addition, oxalate found in certain plant-based foods and beverages combines with substances in the urine and forms the basic material of the most common stones. Therefore, consuming such highly concentrated foods in strict moderation is the most practical way to keep the system clean from within. Foods that may trigger stone formation are as follows:

• Salty snacks
• Black tea
• Spinach
• Cocoa
• Hazelnuts
• Offal (Due to increased uric acid)

How can we prevent kidney diseases by protecting our general health?

These unique cleansing organs of the body are actually a reflection of how healthy our overall cardiovascular system is. The more flexible and healthy our blood vessels are, the longer this filtration system will remain functional. Blood sugar imbalances, uncontrolled high blood pressure, or excess weight begin to damage the structure of these delicate tubules without causing any symptoms. Therefore, it is extremely valuable to undergo simple check-ups not only when we feel pain but also during periods when we feel completely healthy. Providing our body with the clean water and balanced nutrition it needs is one of the most basic steps for maintaining healthy kidney functions for many years. The basic check-ups that can be performed to monitor general health are as follows:

• Annual urinalysis
• Blood pressure measurement
• Blood sugar test
• Kidney function tests (Urea, Creatinine)
• Annual ultrasonography

Frequently Asked Questions