Living with One Kidney? 5 Things to Know

Dr. Molina and Dan R.
With many types of kidney cancer, surgical removal of the cancerous part of the kidney is part of treatment. This is also known as a “nephrectomy.” Depending on the size and location of your tumor, you may have had all or part of the kidney removed. People only need one kidney, but it’s very important to protect your remaining kidney function since the kidneys are responsible for filtering your blood and removing wastes from your body.

March is Kidney Cancer Awareness Month and the second Thursday in March is World Kidney Day. After you’ve had all or part of your kidney resected in order to remove a tumor, there are certain things to keep in mind in order to preserve your remaining kidney function. Here are five things you should know:

  1. Certain medications may need to be adjusted or avoided. Medications should be dosed according to your level of remaining kidney function. This is called “renal dosing” and pertains to all medications filtered by the kidneys (which covers a diverse group ranging from certain medications for cholesterol, heart disease, blood pressure, diabetes, infections and pain). A medical oncologist who specializes in kidney cancer should take this into account when prescribing medications, including dosing for cancer treatments. Some over-the-counter drugs are also “nephro-toxic” or harmful to the kidneys. These include non-steroidal anti-inflammatory drugs (NSAIDs), a type of pain medication that includes ibuprofen (Advil®), aspirin and naproxen (Aleve®).
  2. Speak up before imaging tests. Certain imaging tests that might be necessary to see what’s going on in your body and determine whether your cancer has spread, require the injection of contrast dyes. It’s critical to tell the imaging technician that you only have one kidney before undergoing these tests or any procedures. You should also hydrate before and after the test, and you may need to stop taking certain medications beforehand, such as metformin for diabetes. It’s important to discuss your specific situation with your healthcare team before you undergo any procedures.
  3. Drink up! Drinking plenty of water and staying hydrated is important on an ongoing basis, not just when undergoing imaging tests. Being hydrated helps your kidneys filter the wastes and toxins out of your blood so that they can leave your body as urine. Aim for your urine to be clear or pale yellow. Staying hydrated also helps prevent kidney stones.
  4. Watch the sugar and hold the salt. Diabetes and high blood pressure can damage the kidneys, so it’s important to monitor your sugar and salt/sodium intake. People with only one kidney should consume less than 2300mg sodium each day. This is approximately one teaspoon of salt. Those with diabetes should regularly check blood sugar levels. Additionally, maintaining a healthy weight and incorporating physical activity can help prevent developing type II diabetes.
  5. Know your numbers. There are certain blood and urine tests that you’ll want to monitor for changes in your level of kidney function over time. These include your estimated glomerular filtration rate (eGFR) which indicates how well your kidneys are filtering the wastes from your blood, the albumin to creatinine (A:C) ratio which indicates the level of protein in your urine, as well as tests for blood and infection. Work with your primary care physician to make sure you’re receiving these tests on an annual basis and you should see a nephrologist (kidney function specialist) if your eGFR is less than 30 milliliters per minute (ml/min) or if you have large amounts of blood or protein in the urine.

Kidney Cancer – It Takes a Team

By Ana M. Molina, M.D.

Each year, about 63,000 people in the United States are newly diagnosed with kidney cancer. Whether you’re still undergoing testing to determine whether you have kidney cancer or have already been diagnosed, you may be wondering where to turn next and who to trust.

Kidney cancer requires a multidisciplinary, team-based approach to treatment and that includes you as a key member of the team. For advanced cancers, your medical oncologist should act as your quarterback to help you navigate your next play. Your medical oncologist will work with you and recommend treatments and next steps based on your wishes and goals for treatment. The oncologist will account for factors such as the type of kidney cancer you have, the size and placement of the tumor and whether the cancer has spread to other organs throughout your body. This can also be referred to as the process of cancer staging and management.

From the time of your diagnosis and throughout the course of your treatment, you will be meeting with a variety of specialists who all provide different expertise.

Kidney Cancer_It Takes a Team

In honor of March being National Kidney Cancer Awareness Month, here’s an overview of all the players:

Urologist: Urologists specialize in diseases of the urinary tract, including the kidneys, and the male reproductive organs. Within this field, there are sub-specialists who specifically focus on urological cancers. A urologic surgeon who specializes in oncology will be the one who determines whether the tumor can be surgically removed. Based on the size and placement of the tumor, all or part of the kidney may be removed. If only the cancerous part of the kidney is removed, it is called a partial nephrectomy. If the entire kidney is removed, the procedure is called a radical nephrectomy. Whenever possible, it is advantageous to have a partial nephrectomy in order to save nephrons – the kidneys’ filtering units—and preserve kidney function. Following surgery, you will meet with the urologist to review the pathology results and discuss next steps.

Medical Oncologist: This doctor specializes in monitoring and treating your kidney cancer using medical intervention. A medical oncologist can recommend a wide-range of treatment options such as clinical trials, chemotherapy, immunotherapy, combination therapies and targeted therapies. At the Weill Cornell Genitourinary (GU) Oncology Program, we also offer personalized care in the form of precision medicine. This involves tumor profiling to analyze the genetic makeup of your kidney cancer. Based on the results of this analysis, we’re able to select treatment choices that most closely match the vulnerabilities of your specific tumor(s). The medical oncologist will refer you to a urologic surgeon or radiation oncologist if these interventions will offer the best course of treatment for your specific situation.

Radiation Oncologist: This specialist delivers cancer treatment using x-rays and other forms of radiation to treat metastatic kidney cancers. At Weill Cornell, we currently offer clinical trials that combine immunotherapy and radiation which has been shown to have an abscopal effect, meaning that this combined treatment has been able to activate the body’s immune system in order to eliminate tumors that weren’t directly targeted by the radiation.

Radiologist and Interventional Radiologist: Radiologists are the doctors who review imaging tests ordered by your urologist or medical oncologist to determine the location of your cancer and whether it has spread. Imaging tests you may receive include: computed tomography (CT) scans, magnetic resonance imaging (MRI), positron emission tomography (PET), ultrasonography and x-rays. A sub-specialty within radiology, the interventional radiologist is the person who will use image-guided tests to conduct minimally invasive procedures. For example, the interventional radiologist will biopsy organs and tissue in order to collect samples from your tumor. These samples will be examined by pathologists and may ultimately be used for precision medicine and to test out which treatments may be most beneficial to your specific cancer.

Nephrologist: This is the doctor who specializes in treating kidney disease and preserving your remaining kidney function. Nephrologists also work with your healthcare team to help manage other risk factors for kidney failure such as diabetes and hypertension, and to ensure you’re on a kidney-protective regimen. Since many medications are “cleared” by the kidneys, this may involve changing your medications to reduce the stress on the kidneys to filter these medications out of your body as waste.

Palliative Care Physician and Social Worker: Palliative care is often wrongly interpreted as a synonym for end-of-life care and hospice. The field of palliative care, or supportive medicine, is more accurately described as the services that help improve quality of life. It is beneficial for this team to get involved early, as these experts help alleviate some of the symptoms of kidney cancer and its treatment, while even helping to extend life. A palliative care physician can help manage pain and help to reduce uncomfortable side effects such as diarrhea and nausea. They also provide counseling and other therapeutic interventions to help people cope with the emotional impact a cancer diagnosis can have on patients and their loved ones.

At the Weill Cornell GU Oncology Program, we have weekly tumor board meetings in which many of the specialists listed above all meet together to discuss our patients’ care. This close collaboration with experts across kidney cancer sub-specialty areas helps ensure that our patients are receiving the best, most comprehensive and cutting-edge treatment. Because we have a shared system of medical records across the Weill Cornell Medicine healthcare network, communication between our physicians is integrated and seamless.

We understand that it’s not only your medical team that provides support and care during the course of cancer treatment. Our Kidney Cancer Support Group brings together other patients, caregivers and loved ones so that you’re part of a community that “has been there” and understands what you’re going through.

USPSTF Panel Announces Final Recommendation Against PSA Screening for Prostate Cancer

The  U.S. Preventive Services Task Force (USPSTF), a government panel, has issued a recommendation that men should not get routinely screened for prostate cancer using the PSA test. The panel found there is little evidence that testing for PSA, or prostate-specific antigen, saves men’s lives, and that it causes too much unnecessary harm from the treatment of tumors that would never have killed them. The panel concluded that the benefit of screening was outweighed by the potential risks, which include pain, fever, bleeding, infection and problems urinating, resulting from biopsies as well as incontinence and impotence associated with the treatment of tumors that would not have otherwise caused harm. Click here to read more about this on the Prostate Cancer Foundation website, including a dissenting opinion and comments from the Prostate Cancer Foundation.

The American Urological Association, one of the most significant professional associations for urologists, oncologists, and radiation oncologists focusing on prostate cancer has provided helpful information, primarily aimed at primary care physicians.

The USPSTF recommendations in no way affects men who have already been diagnosed with prostate cancer and have received or are currently receiving treatment.  PSA remains one of the important tools to follow the results of treatment.  We suggest that you discuss your PSA results with your physician.