ABSTRACT
Objective: To study the pattern of presentation of patients with renal cell carcinoma
Methodology: This descriptive study was conducted at Institute of Kidney Diseases, Hayatabad Medical Complex Peshawar-Pakistan from January to December 2012. All patients who were diagnosed as renal masses on ultrasound were admitted. Detailed history and physical examination was performed on all patients. Relevant investigations were done on all patients
Results: A total of 65 patients with renal cell carcinoma were included in the study. Patients presented with flank pain [n=30, 46%]; hematuria [n=14, 22%]; flank mass [n=2, 3%]; both hematuria and flank pain [n=3, 5%]; incidental tumors [n=10, 15%]; and with metastasis [n=6, 9%]. The tumors were located on right side in 39 [60%] cases and 26 [40%] on left side with 80% of the tumors involving the upper pole of the kidney. Twenty six patients [40%] were cigarettes smokers. No patient was found to have positive family history of renal cell carcinoma or any other cancer in the close family. Fifty nine patients with renal tumors underwent radical nephrectomy and histopathology was done of every specimen. In six patients of renal tumor with metastasis, needle biopsy was taken. The histopathology of the specimen showed that 61 [94%] were clear cell type and 4 [6%] were papillary cell carcinoma
Conclusion: Renal cell carcinoma presents with a variety of symptoms. It can also present incidentally during investigation for non-specific symptoms. Ultrasonography is encouraged for nonspecific abdominal symptoms to detect renal cell carcinoma at earlier stage
ABSTRACT
To evaluate the efficacy of Percutaneous Nephrostomy [PCN] for the management of pyonephrosis. This descriptive study of 78 cases of pyonephrosis was conducted at Institute of Kidney Diseases Hayatabad Medical Complex, Peshawar Pakistan from July 2010 to December 2011. Ultrasound guided percutaneous nephrostomy was performed and pus was sent for culture and sensitivity. Urine output in the PCN was monitored. Patients were clinically observed. Blood chemistry was analyzed. Patients were put on antibiotics based on culture and sensitivity. Efficacy was defined as the symptomatic relief of a patient in respect to pain and fever and biochemical improvement in terms of decreased TLC count and improved RFTs in early post PCN period. Data was collected on a structured proforma and was analyzed on SPSS version 10. Out of 78 patients who underwent percutaneous nephrostomy for pyonephrosis, 42[53.84%] were male and 36[46.15%] were female. The majority, 69[88.46%] patients had underlying obstructing urinary calculi. Other causes of obstruction included, benign strictures 5[6.41%]; pelviureteric junction obstruction 3[3.84%] and malignant stricture 1[1.2%]. Culture of the drained pus was positive in 73[93.58%] patients. After 2 to 3 weeks of PCN, 53[69%] patients underwent minimally invasive procedures as definitive treatment of the obstructing lesion whereas 23[31%] patients required major surgery after 4 to 6 weeks. Percutaneous drainage for pyonephrosis is an effective diagnostic and therapeutic method, decompressing the obstructed and infected pelvicaliceal system and rapidly stabilizes the patient's clinical condition and makes him fit for definitive treatment