Diagnostic Tests for Kidney Cancer
Kidney Cancer: Diagnostic Tests
The list of diagnostic tests
mentioned in various sources as
used in the diagnosis of Kidney Cancer
includes:
Kidney Cancer Tests: Book Excerpts
Home Diagnostic Testing
These home medical tests may be relevant to Kidney Cancer:
- Colon & Rectal Cancer: Home Testing
- Bladder & Urinary Health: Home Testing:
- Kidney Health: Home Testing:
- Cancer-Related Home Testing:
Kidney Cancer Diagnosis: Book Excerpts
Tests and diagnosis discussion for Kidney Cancer:
To find the cause of symptoms, the doctor asks about the
patient's medical history and does a physical exam. In
addition to checking for general signs of health, the doctor
may perform blood and urine tests. The doctor may also
carefully feel the abdomen
for lumps or irregular masses.
The doctor usually orders tests that produce pictures of
the kidneys and nearby organs. These pictures can often show
changes in the kidney and surrounding tissue. For example, an
IVP
(intravenous pyelogram) is a series of x-rays
of the kidneys, ureters, and bladder after the injection of a
dye. The dye may be placed in the body through a needle or a
narrow tube called a catheter .
The pictures produced can show changes in the shape of these
organs and nearby lymph nodes.
Another test, arteriography ,
is a series of x-rays of the blood vessels. Dye is injected
into a large blood vessel through a catheter. X-rays show the
dye as it moves through the network of smaller blood vessels
in and around the kidney.
Other imaging tests may include CT
scan , MRI ,
and ultrasonography ,
which can show the difference between diseased and healthy
tissues.
If test results suggest that kidney cancer may be present,
a biopsy
may be performed; it is the only sure way to diagnose cancer.
During a biopsy for kidney cancer, a thin needle is inserted
into the tumor and a sample of tissue is withdrawn. A pathologist
then examines the tissue under a microscope to check for
cancer cells.
Once kidney cancer is diagnosed, the doctor will want to
learn the stage ,
or extent, of the disease. Staging is a careful attempt to
find out whether the cancer has spread and, if so, what parts
of the body are affected. This information is needed to plan a
patient's treatment.
To stage kidney cancer, the doctor may use additional MRI
and x-ray studies of the tissues and blood vessels in and
around the kidney. The doctor can check for swollen lymph
nodes in the chest and abdomen through CT scans. Chest x-rays
can often show whether cancer has spread to the lungs. Bone
scans reveal changes that may be a sign that the cancer has
spread to the bones. (Source: excerpt from What You Need To Know About Kidney Cancer: NCI)
Diagnosis of Kidney Cancer: medical news summaries:
The following medical news items
are relevant to diagnosis of Kidney Cancer:
Diagnostic Tests for Kidney Cancer: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the diagnostic tests for Kidney Cancer.
HEMATURIA:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
The workup begins with a urinalysis and microscopic examination of the urinary sediment. The physician can easily do this in his office. If there is proteinuria, granular cast, and red cell cast, glomerulonephritis or collagen disease should be suspected. A culture and sensitivity and colony count should be done if a UTI is suspected. A three-glass test may be done. If there is blood in the initial specimen, the cause is most likely in the urethra or male genitalia. If it is in the final specimen, the cause is most likely a bladder lesion. Phase-contrast microscopy may also be helpful in identifying hematuria from a glomerular lesion. If this is negative, an anaerobic culture should be done also and then an AFB smear and culture and guinea pig inoculation to rule out tuberculosis. An intravenous pyelogram will also usually have to be done. A CBC, sedimentation rate, chemistry panel, coagulation profile, and ANA test will help rule out blood dyscrasias, collagen diseases, and other systemic diseases. Ultrasonography may help diagnose a renal cyst.
If the above are not revealing, referral to a urologist is indicated. He will probably do a cystoscopy and retrograde pyelography. He may also want to order a CT scan of the abdomen and pelvis and a renal biopsy. Renal angiography and aortography may be necessary to evaluate renovascular hypertension and renal embolism.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Hematuria:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
After detecting hematuria, take a pertinent health history. If hematuria is macroscopic, ask the patient when he first noticed blood in his urine. Does it vary in severity between voidings? Is it worse at the beginning, middle, or end of urination? Has it occurred before? Is the patient passing clots? To rule out artifactitious hematuria, ask about bleeding hemorrhoids or the onset of menses, if appropriate. Ask if there’s pain or burning with hematuria episodes.
Ask about recent abdominal or flank trauma. Has the patient been exercising strenuously? Note a history of renal, urinary, prostatic, or coagulation disorders. Then obtain a drug history, noting anticoagulants or aspirin.
Begin the physical examination by palpating and percussing the abdomen and flanks. Next, percuss the costovertebral angle (CVA) to elicit tenderness. Check the urinary meatus for bleeding or other abnormalities. Using a chemical reagent strip, test a urine specimen for protein. A vaginal or digital rectal examination may be necessary.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Introduction: Renal and Urologic Disorders:
Clinical assessment
(Professional Guide to Diseases (Eighth Edition))
Assessment of the renal and urologic systems begins with an accurate patient history and requires a thorough physical examination and certain laboratory data and test results from invasive and noninvasive procedures. When obtaining a patient history, ask about symptoms that pertain specifically to the pathology of the renal and urologic systems, such as frequency or urgency, and about the presence of any systemic diseases that can produce renal or urologic dysfunction, such as hypertension, diabetes mellitus, or bladder infections. Family history may also suggest a genetic predisposition to certain renal diseases, such as glomerulonephritis or polycystic kidney disease. Also, ask what medications the patient has been taking; abuse of analgesics or antibiotics may cause nephrotoxicity.
Physical examination for renal disease
The first step in physical examination is careful observation of the patient’s overall appearance, because renal disease affects all body systems. Examine the patient’s skin for color, turgor, intactness, and texture; mucous membranes for color, secretions, odor, and intactness; eyes for periorbital edema and vision; general activity for motion, gait, and posture; muscle movement for motor function and general strength; and mental status for level of consciousness, orientation, and response to stimuli. (See Common renal symptoms.)
Renal disease causes distinctive changes in vital signs: hypertension due to fluid and electrolyte imbalances and hyperactivity of the renin-angiotensin system; a strong, fast, irregular pulse due to fluid and electrolyte imbalances; hyperventilation to compensate for metabolic acidosis; and an increased susceptibility to infection due to overall decreased resistance. Palpation and percussion may reveal little because the kidneys and bladder are difficult to palpate unless they are enlarged or distended.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Hematuria:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
After detecting hematuria, take a pertinent health history. If hematuria is macroscopic, ask the patient when he first noticed blood in his urine. Does it vary in severity between voidings? Is it worse at the beginning, middle, or end of urination? Has it occurred before? Is the patient passing any clots? To rule out artifactual hematuria, ask about bleeding hemorrhoids or the onset of menses, if appropriate. Ask if pain or burning accompanies the episodes of hematuria.
Ask about recent abdominal or flank trauma. Has the patient been exercising strenuously? Note a history of renal, urinary, prostatic, or coagulation disorders. Then obtain a drug history, noting the use of anticoagulants or aspirin.
Begin the physical examination by palpating and percussing the abdomen and flanks. Next, percuss the costovertebral angle (CVA) to elicit tenderness. Check the urinary meatus for bleeding or other abnormalities. Using a chemical reagent strip, test a urine specimen for protein. A vaginal or digital rectal examination may be necessary.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Hematuria:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
should focus on signs of systemic disease (fever, rash, lymphadenopathy, joint swelling, and abdominal or pelvic mass), and underlying medical or renal disease (hypertension, edema). Multiple telangiectasias and mucous membrane lesions indicate hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber disease). An abdominal mass in children requires exclusion of Wilms tumor.
Testing
A. Initial evaluation. Hematuria is usually detected by dipstick or microscopic examination. The dipstick test relies on detecting hemoglobin and should always be confirmed by microscopic examination of the urine sediment. Some controversy exists about the abnormal number of red blood cells in urine. Most clinicians consider more than three to five red blood cells per high power field (40 × lens) as definitely abnormal. When dipstick testing is positive for blood but urine microscopy reveals no red blood cells, hemoglobinuria or myoglobinuria should be considered. The next step is a urine culture. Baseline blood tests include a renal panel, complete blood count with differential, sedimentation rate, prothrombin time, and partial thromboplastin time.
B. Further evaluation is highly dependent on the suspected cause. Further blood tests can include serum complement titer (significant if low), antistreptolysin-O titer (high), antinuclear antibody and extended panels with anti-deoxyribonuclease B titer (high), and hemoglobin electrophoresis. A tuberculin skin test or chest x-ray study can be done to detect tuberculosis. Further tests can include imaging studies and cytology. Intravenous pyelogram and abdominal and pelvic ultrasound or computed tomography scanning may detect malignancies of the various anatomic areas as well as benign conditions such as urolithiasis, obstructive uropathy, renal cysts, parenchymal abnormalities, and nonurinary tract lesions. To complete the workup, send the urine for cytology study and proceed with cystoscopy looking for abnormalities of the urethra and bladder. Biopsies of various areas, including kidney and bladder, and invasive vascular studies may be needed. Unless a diagnosis is made, patients will need referral to subspecialists.
Diagnostic assessment
The key to the diagnosis of hematuria is the clinical history and physical examination. Laboratory and imaging studies only confirm or rule out initial suspicions. The goal is to diagnose a variety of serious illnesses, including malignancies and renal parenchymal diseases. In general, keep in mind that transient hematuria, especially in a young person, is quite common and rarely indicative of significant pathology (4). When present in patients aged more than 50 years, however, transient hematuria always warrants a comprehensive evaluation to rule out malignancy. Similarly, a diagnostic workup should be performed when persistent hematuria is found in patients of any age.
References
1. Froom P, Ribak J, Benbassat J. The significance of microhematuria in young adults. BMJ 1984;288:20–28.
2. Mariani AJ, Mariani MC. The significance of adult hematuria: 1000 hematuria evaluations including a risk-benefit and cost-effectiveness analysis. J Urol 1989;
141:350–355.
3. Messing EM, Young TB, Hunt VB, et al. Hematuria home screening: repeat testing results. J Urol 1995;154(1):57–61.
4. Murakami S, Igarashi T, Hara S, et al. Strategies for asymptomatic microscopic hematuria: a prospective study of 1034 patients. J Urol 1990;144:99–106.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Hematuria:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
A reasonable cutoff for discriminating benign from serious causes of hematuria is 10 RBCs/HPF. The urine dipstick detects as few as 1 to 2 RBCs/HPF. Analysis of the urine sediment is crucial. White cells and bacteria are indicative of cystitis whereas white cell casts are seen in pyelonephritis. Red cell casts and dipstick proteinuria indicate glomerulonephritis. Red cells from a glomerular source tend to be distorted. A positive dipstick for hemoglobin but no RBCs in the urinalysis suggests the presence of myoglobin or free hemoglobin derived from intravascular hemolysis. Menstrual blood contamination needs to be considered in the differential of microscopic hematuria.
Initial hematuria suggests a urethral source; terminal hematuria, the prostatic urethra, trigone, or base; and total hematuria, the kidney, ureter, or bladder. Massive hematuria is usually associated with bladder neoplasm, benign prostatic hypertrophy, or trauma. Bright red urine suggests a lower urinary source. Passage of bulky disc-like or fragmented clots implies the bladder as source, long shoestring clots suggest a ureteral origin, and pyramidal clots are from the renal pelvis. Glomerular sources virtually never produce clots (due to the presence of tissue plasminogen activators in the glomeruli and tubules). With a presentation of painless total hematuria, a urinary tract cancer is found in 20%.
Flank pain associated with hematuria may result from the passage of stones or clots. Hypertension suggests renal disease. Rash, fever, arthralgia/arthritis, or hemoptysis suggests a connective tissue disease or vasculitis. Beets, blackberries, and rhubarb, as well as pyridium, rifampin, phenothiazines, and anthracyclines, can produce red urine without blood.
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Source: Field Guide to Bedside Diagnosis, 2007
Hematuria:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Begin the physical examination by palpating and percussing the abdomen and flanks. Next, percuss the costovertebral angle (CVA) to elicit tenderness. Check the urinary meatus for bleeding or other abnormalities. Using a chemical reagent strip, test a urine specimen for protein. A vaginal or digital rectal examination may be necessary.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Hematuria:
Diagnostic Approach
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
First stepin diagnosis is to determine whether there is blood in urine. Althoughblood may produce pink, red, or brownish color of the urine, othersubstances also may produce same type of urinary discoloration.Urine dipstick detects hemoglobin containedin red cells as well as free Hgb. It can detect as few as 1 or 2red cells per high-power field in uncentrifuged specimen. Microscopydetermines whether red cells are in urine and thus the presenceof hematuria.Urine sample that tests positive ondipstick but negative on microscopy indicates presence of hemoglobinor myoglobin. Serum is pink in color with hemoglobinuria and normalin color with myoglobinuria.Best way to distinguish myoglobin fromHgb is immunochemically. Red, orange, or brownish urine that isdipstick negative for blood indicates that certain foods (blackberries,beets), food dyes, urate crystals, or drugs (pyridium, desferoximine)are coloring urine. Urine containing porphyrin initially has normalcolor but changes to red on standing; dipstick is negative, andno red cells are seen on microscopy. Hematuria without Proteinuria
Microscopichematuria without proteinuria is most commonly due to urinary tractinfection, trauma, acute postinfectious glomerulonephritis, immunoglobulinA nephropathy, familial benign hematuria, or nonfamilial benignhematuria.Following history and physical exam,these tests should be performed initially: UA of child and familymembers (to diagnose familial benign hematuria), urine culture,serum creatinine, blood urea nitrogen, C3, calcium:creatinine ratio,and renal U/S. If results of these tests are normal, andproteinuria is consistently absent, most causes of hematuria havebeen excluded and further diagnostic studies (e.g., cystoscopy andrenal biopsy) are usually unnecessary.Children categorized as having nonfamilialbenign hematuria because they have normal evaluation and no recognizablerenal disease may prove to have transient hematuria, but as longas hematuria occurs, these children should be followed for possibleoccurrence of proteinuria. Those with familial benign hematuriaalso should be followed.In addition to above tests, diagnosticevaluation of gross hematuria should include CBC, platelet count,antistreptolysin O or streptozyme titer, and Hgb electrophoresis(in African-American children). Renal angiography may be necessaryif vascular malformation is suspected. If proteinuria occurs whenhematuria subsides, renal biopsy may be indicated. Hematuria with Proteinuria
Glomerulonephritisshould be suspected in every child with hematuria and proteinuria.Presence of red cell casts indicatesglomerular bleeding.Results of tests for urinary protein(urine dipstick, sulfosalicylic acid test) are usually positivewith gross hematuria. Although dipstick protein reading of 3+ to4+ may signify glomerular disease with gross hematuria,lower reading may have diagnostic significance. See Chap. 50, Proteinuria, forprotein concentrations corresponding to dipstick readings.To more reliably detect proteinuriaassociated with glomerular disease, urine should be tested whengross hematuria subsides.Renal biopsy is required for specificdiagnosis unless there is evidence of unequivocal acute postinfectiousglomerulonephritis or family history of Alport syndrome. Biopsymay be necessary with acute postinfectious glomerulonephritis ifserum C3 level does not become normal within 2 mos, if proteinuriapersists for >6 mos, or to distinguish it from idiopathicrapidly progressive glomerulonephritis if presentation is that ofacute renal failure.
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Hematuria:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
After detecting hematuria, take a pertinent health history. If hematuria is macroscopic, ask the patient when he first noticed blood in his urine. Does it vary in severity between voidings? Is it worse at the beginning, middle, or end of urination? Has it occurred before? Is the patient passing clots? To rule out artifactitious hematuria, ask about bleeding hemorrhoids or the onset of menses, if appropriate. Ask if there's pain or burning with hematuria episodes.
Ask about recent abdominal or flank trauma. Has the patient been exercising strenuously? Note a history of renal, urinary, prostatic, or coagulation disorders. Then obtain a drug history, noting anticoagulants or aspirin.
Begin the physical examination by palpating and percussing the abdomen and flanks. Next, percuss the costovertebral angle (CVA) to elicit tenderness. Check the urinary meatus for bleeding or other abnormalities. Using a chemical reagent strip, test a urine specimen for protein. A vaginal or digital rectal examination may be necessary.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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