Diabetes is the single most common reason for development of renal failure. Even if you are not diabetic, if diabetes runs in your family or if you are …
Discharge Instructions: Partial Nephrectomy
Activities and Pain Control:
Your incision will take at least six weeks to heal, therefore you
should not lift anything heavier than 10 lbs for at least 6 weeks After
this, you may gradually increase your activities over the course of another
3-4 weeks until you have reached your baseline normal routine Initially
you may require narcotic analgesics to help control the incisional pain
These medications are often constipating and therefore, I recommend that
while you are taking them you should also take an over the counter stool
softener eg, Colace In addition to the pain medication, you should
take an iron supplement for 3-4 weeks after the surgery to help your body
reconstitute your red blood cells Blood loss is an expected part of this
type of surgery and iron helps the body to rebuild new red blood cells
Since the iron supplements can be constipating as well, you should continue
the stool softeners until you have stopped taking both the pain medication
and the iron pills
Incision care:
Before you leave the hospital, the staples on your incision line will
be removed and replaced with a special adhesive tape
referred to as steri-
strips These adhesive strips should be allowed to stay on the skin for at
least another week It is best to let them fall off themselves If you
want to take a shower, you may simply cover the incision with saran wrap
and tape The incision itself can be cleaned with hydrogen peroxide for
any encrusted blood, and with dilute soap and water as necessary The
steri-strips can get a little wet without falling off, however, try not to
let the area get too wet, as this will loosen the adhesive and facilitate
the strips coming off prematurely The incision should be cleaned once a
day and kept dry by allowing it to be open to the air Placing too much
bandages over it will let sweat accumulate If the incision becomes warm
and red and painful, a local infection may be developing and you should
call the office
Diet:
Certain dietary changes should be followed to minimize the likelihood
of damage to the normal remaining kidney tissue The most important of
these is to try to avoid a high protein diet Diets that are high in
protein ie, meat tofu can result in hyperfiltration injury to the
remaining kidney If the remaining kidney has particularly poor
function,
then modifications in the salt and potassium intake may be required If
this is necessary, a nutritionist will provide you with information on how
this is accomplished
Precautions for the remaining normal kidney:
Since there is less normal remaining kidney tissue, there are certain
precautions one should take to avoid unnecessary loss of function These
include:
1 High blood pressure control The single most important cause of
progression of kidney failure in patients with a single remaining
kidney is uncontrolled high blood pressure You must maintain a close
relationship with your internist with frequent blood pressure checks
and modification of the diet, sodium intake, and medication changes as
necessary
2 Diabetes control If you have diabetes, you must maintain tight
control of your glucose Diabetes is the single most common reason
for development of renal failure Even if you are not diabetic, if
diabetes runs in your family or if you are significantly overweight,
you should have your blood sugars checked at least once a year by your
internist
3 Avoidance of drugs, which may
cause kidney damage The most common of
these are certain antibiotics such as Gentamicin, vancomycin and
others In certain circumstances the use of these particular
antibiotics may be life saving; however, their indiscriminant use may
put you at unnecessarily high risk for kidney injury Whenever you
are receiving intravenous antibiotics, make sure you remind your
physician that you only have one kidney, so that they are sure to re-
assess whether this is the best antibiotic for your circumstance
Other over the counter agents which may cause kidney damage over time
include NSAIDS, such as aspirin, Motrin, Orudis, Aleve, etc The
only painkiller, which is available over the counter that does not
have significant kidney toxicity, is Tylenol acetomenaphen Finally
certain over the counter medications can worsen your blood pressure
control and may impact on your kidney function indirectly eg,
Sudafed
3 IV Contrast exposure IV contrast can cause injury to the kidney
when the overall kidney function is already poor Typically, I
prefer not to give IV contrast to patients with a serum
creatinine of
18 If your creatinine is persistently elevated above this point
and you require frequent imaging for follow-up for the primary renal
mass, then an MRI with gadolineum enhancement would be preferred
since the risk of renal injury from MRI contrast is insignificant
Since MRI is expensive, tedious and uncomfortable for the patient, it
may be possible to alternate MRI and non-contrast CT scans for
surveillance of high risk patients
Expectations from the surgery:
Removal of kidney tissue for a renal mass requires incision through
multiple muscle layers and often across certain nerves As a result, it is
not uncommon for there to be some numbness around and frequently below the
suture line This is expected and gradually improves with time Soreness
for the incision also takes time to improve Finally, the muscles may tend
to become a little relaxed as their tone will no longer be as good as it
was prior to cutting those muscles This is rarely of any consequence to
the patient, but occasionally there may be a noticeable bulge or
asymmetry when looking directly into a mirror
Follow-up:
When I accepted you as a
patient, I also accepted responsibility for
your continued follow-up If you should experience a problem related to
your surgery you should contact me not your internist or family
physician I can be contacted as follows:
1 Office: 410 614-6662
2 Clinic Desk: 410 955-6101
3 Emergencies: 410 955-6070 this will reach the urologist on
call 24hrs a day
If you are unable to reach anyone through the numbers listed above
and it is truly an emergency, my home phone number is 410 489-5054 I
only ask that you reserve my home number for true emergencies when you are
unable to reach anyone through the normal routes and not for convenience
Removal of the renal mass is just the first step in your care Once
that mass has been analyzed and staged, you must begin a lifelong process
of continued follow-up and surveillance for any potential recurrence
Since the most common sites of recurrence include the other kidney and
adrenal, lung, brain and bone, special emphasis is given to these areas
Every follow-up visit should consist of a CXR and certain blood tests
complete metabolic panel This approach screens for spread to the bone
or lung Every other visit
should also include a CT scan or MRI of the
abdomen and pelvis, looking for local recurrence or spread to the other
kidney or adrenal gland If for any reason you develop frequent headaches
or a seizure, you should undergo a brain MRI If you should develop
persistent bone pain or if the blood-work done with each visit indicates an
abnormality consistent with a bone problem eg, elevated alkaline
phosphatase or calcium then a bone scan should also be done The
frequency of follow-up visits varies with the likelihood of recurrence and
will be discussed with you prior to discharge The primary therapy for a
renal malignancy is surgery Chemotherapy and immuno-therapy is only
reserved for those patients who either have failed surgery, or for whom
surgery is not possible Thus, if a recurrence is ever found, you will be
referred to a medical oncologist for evaluation for additional therapy
Experimental Therapies:
At Johns Hopkins we are very active in trying to develop new and
effective therapies for patients who have failed treatment of their renal
mass by surgery alone At any given moment we may have 2-3 experimental
therapies under use in clinical protocols and an equal
number of therapies
in development in laboratory settings If you should qualify for such a
protocol, you will be notified
Source:hooah4health.com
