Bladder Cancer

Bladder cancer usually surfaces in the lining of the bladder (transitional cells )and later spreads to other areas. Cases of bladder cancer are mostly noticed in persons over 60 years. Bladder cancer is often hereditary. Smoking and exposure to toxic chemicals increase the risk of bladder cancer. Men are more likely to develop bladder cancer than women. Persons who have repeated instances of urinary infection or have been using catheters for long are at increased risk for bladder cancer. Superficial bladder cancer in the initial stages indicates that the cancer is restricted to the surface of the inner lining of the bladder. Later it spreads to the inner lining and invades the wall of the bladder. The surrounding tissues, lymph nodes and other organs are the next to get affected by the cancerous cells.

Symptoms of bladder cancer include pain during urination and increased frequency of urination. The patient suffering from bladder cancer is likely to have pelvic pain. Blood is noticed in the urine. Blood clots are also sometimes noticed in the urine. Often there are no symptoms during the early stages of bladder cancer. A urologist will check the functioning of the kidneys and conduct a physical examination. IVU (Intravenous Urogram) is a diagnostic imaging tool that allows the doctor to examine the kidneys, ureters and bladder. Blood tests and chest x-ray aids in diagnosis of bladder cancer. The urologist might use a cystoscope to examine inside the bladder. A biopsy is often conducted.

Surgery, chemotherapy or radiation therapy are resorted to while treating bladder cancer. The treatment is based on the stage of bladder cancer. Drinking plenty of water and increasing the consumption of cruciferous vegetables such as cabbage and broccoli can minimize the chances of developing bladder cancer.

Uremia

Uremia is regarded as the end stage of Kidney Failure. Uremia is also called the 'second cancer'. Uremia is related to the second point filtering blood. The kidney is impaired and does not filter the waste products that result from the body's metabolism. When this function fails, the waste products and blood urea nitrogen accumulate in the bloodstream. This build-up is Azotaemia. Mild levels of azotaemia may not show symptoms. But continued kidney failure to filter the waste result in symptoms and this condition is called uremia.

Uremic patients show varied signs and symptoms collectively called as uremic syndrome.

Gastrointestinal tract: Loss of appetite, discomfort in the abdomen, nausea, vomiting, diarrhea, severe dehydration, oral ulcer, Glossitis (inflammation of the tongue) and urine taste in breath.

Nerves related: Headache, dizziness, lethargy, drowsiness, weakness, fatigue. In advanced stage symptoms such as irritability, muscle trembling, seizures and convulsions may be experienced.

Cardiovascular system: Hypertension and arrhythmia and in the advanced stage heart failure can happen.

Blood forming or hematopoietic system: Serious anemia and in the advanced stage bleeding can happen.

Respiratory system: Shortness of breath, difficulty breathing, chronic cough, respiratory disorders such as pleural effusion (fluid accumulation in the lungs), pneumonia, uremic bronchitis, pleurisy.

To decide on the course of treatment the cause of Uremia is of great significance. As Uremia can be life-threatening, quick and proper treatment may reverse the illness condition. The chief cause is of course, kidney failure or damage to kidneys.

Diseases that affect kidney function:

• Bright disease - Glomerulonephritis
  
  
• Chronic hypertension
  
  
• Diabetes mellitus
  
  
• Kidney diseases (Kidney failure, Kidney anomalies)
  
  
• Bladder cancer
  

Body conditions:

• Urinary stones that block flow of urine
  
  
• Enlarged prostate glands (in males)
  
  
• Injury to kidney
  
  
• Renal artery occlusion or embolism
  
  
• Cardio vascular problems (excessive bleeding, congestive heart failure)
  
  
• Gastro-metabolic disorder (diarrhea, vomiting, severe dehydration)
  
  
• Burns
  
  
• Lupus
  

How is Uremia diagnosed?

Most renal disease including Uremia do not cause symptoms in the early stages. Uremia is likely to be noticed incidentally from blood or urine tests done for other health issues. Urinalysis is done to detect protein and blood in urine. Blood clotting test, kidney biopsy and stool culture to ascertain presence of a certain type of E.coli bacteria or other bacteria.

• A normal hemoglobin level is below 80g/L. In persons with symptoms of Uremia, the level may decline to 40-60g/L. Also, the platelets or leukocyte levels may be high.
  
  
• In persons with symptoms of Uremia, BUN increases from its normal value of less than 20 mg/dL to approximately 80-100.
  
  
• A 24-hour urine sample for creatinine clearance is taken. If the test result shows below the normal of less than 1.0 mg/dL to approximately 10, there is a high possibility of renal failure.
  
  
• Estimated Glomerular Filtration Rate or eGFR is a measure that filtering and waste removal function of the kidneys. eGFR falls to less than 10-15 ml/1.73 m2.
  
  
• Calcium, phosphate, parathyroid hormone, albumin, potassium and Bicarbone- abnormalities prevalent in these are also observed as part of blood tests.

How is Uremia treated?

If the diagnosis is confirmed, the patient would be hospitalized for observation and treatment. The cause determines the treatment.

• Patients with diarrhea require intravenous fluids or re hydration and rebalancing of electrolytes like sodium and potassium which is lost with diarrhea. This is the immediate supportive care.
  
  
• Severely anemic patients are given blood transfusion when the hemoglobin falls below 6 or 7 gdL.
  
  
• Plasma exchange or plasmapherisis is usually for adults patients who are likely to have an abnormal chemical in the plasma stimulating abnormal clot formation. To rectify and balance, the plasma is removed and replaced with donor plasma.
  
  
• is done to filter the waste out of the blood while the kidneys recover.
  
  
• Kidney transplant is another choice.
  
  
• Eculizumab (Soliris) is an intravenous infusion approved by the FDA for the treatment of pediatric and adult patients with atypical hemolytic uremic syndrome (aHUS). Atypical Hemolytic-uremic syndrome is a syndrome characterized by three major problem areas, progressive renal failure, problems associated with red blood cell and platelet counts and problems that occur in the vascular system.