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Kidney cancer, also known as renal cell carcinoma (RCC), accounts for 3% of all cancers in adults.
Certain lifestyles and environmental exposures can increase the risk of having kidney cancer such as cigarette smoking, obesity and high blood pressure (hypertension). Genetic syndromes and a family history of kidney cancer is a significant risk factor.
These genetic syndromes include von-Hippel Lindau (VHL) syndrome and tuberous sclerosis among others.
The classic triad of pain, blood in the urine (haematuria) and an abdominal mass only occurs in less than 10% of patients and most kidney cancers are detected incidentally in this day and age.
Surgical treatment has good results when the cancer is detected early while new medications are being developed to treat disease in advanced disease.
In this "Ask the Specialist" forum, Dr Kenneth Chen, Consultant from the Department of Urology at Singapore General Hospital (SGH), answers your questions on kidney cancer. SGH is a member of the SingHealth group.
This Q&A forum is open from 1 Aug to 26 August 2022.
To post your question, please log in as a member. If you are not a member, you can register for a FREE membership here.
If you have problems posting your questions, please email your questions to marcom@healthxchange.com.sg
Kindly note: Your question will only go live / appear on this page after the doctor answers it
I went for a medical check-up. And my result shows that there is high sodium in my kidney. 148mmol/L. Is it a concern? What will happen if there is a high sodium in kidney? How to reduce it?
Answered by Dr Kenneth Chen, Consultant, Department of Urology, Singapore General Hospital (SGH)
Thank you for your question.
I believe it is a blood test showing the sodium levels in your blood rather than the kidney. At 148mmol/L, the levels are not critically high and should not be a concern. In severe cases of high sodium, patients can experience thirst or even lethargy. I would suggest a repeat check first as most times it may be due to benign causes such as dehydration. Do further consult your GP to see if a referral is warranted.
I am a female 66 year old. Had microscopic blood in urine and had some tiny calcium crystalized particles in 2019. Had yearly 24-hrs urine test in 2020 and 2021 there were no more traces of blood. In 2022, I had spotting. Had kidney ultrasound and there was a few tiny cysts. Everything else were normal. No history of high blood, diabetes or anything. Two Pap smear tests were normal. Please advise if I need to be concerned.
Microscopic blood in the urine is one of the most common referrals urologists get from the primary healthcare. Very often this is detected upon a health screening. The good news is that for the majority of people, this is benign and not something that is concerning. It can happen to both the young and the elderly.
After further investigations, only about 5% of patients have an underlying cause detected such as urinary tract infection, kidney stones or even cancer. For the majority of people, the traces of blood in the urine is temporary and may disappear with repeat testing.
Spotting is different from blood in the urine. Spotting refers to blood that originates from the vagina and points to a gynaecological cause. Post-menopausal bleeding should be investigated. Do further consult your gynaecologist with regards to this.
If you have completed investigations both with the urologist and gynaecologist for both issues above and nothing significant is found then there is no cause for concern.
Doctor, it has been consistently all these years (more than 20 years) that I always have blood in my urine each time I take a urine test. How can I tell it is time to take a deeper look - is it when the blood in my urine test exceed a certain mark? Thank you for your advice.
Yes, persistent traces of blood detected in the urine (microscopic hematuria) can be frustrating especially when the urine looks normal to the naked eye and tests have repeatedly come back negative.
There are many factors to microscopic hematuria and these range from simple issues with sample collection for example during menstruation (for females) or after vigorous exercise, when some degree of blood in the urine might be naturally expected, to more sinister causes such as bladder cancer or kidney cancer.
Nonetheless, when you are seen by a Urologist for investigation, a thorough check would have ruled out significant causes like infection, stones and cancer of the urinary tract. Through special urine tests, we can also tell if the red blood cells (RBCs) found in the urine are actually from microscopic bleeding along the urinary tract as seen in the case of infection, stones and cancer or the red blood cells have gotten there by "leaking" into the urine during the normal filtration process of the kidney. If these red blood cells are found to be due to "leaky" kidneys, this could signify a different set of problems with the internal health of the kidneys instead. A further consult with the renal physician or nephrologist will be arranged if that is the case.
There is no threshold for the amount of RBCs to determine if one needs more attention, however generally speaking, the higher the number of RBCs the more likely an underlying cause is present. If you have undergone a thorough detailed check by the Urologists and none of the above has been found, then there should not be any cause for concern.
Doctor, besides red blood cells in my urine, I also consistently have white blood cells in my urine too. It is assymatic ie no symptoms. Occasionally, I get burning sensation after urination, but the burning sensation would always go off after some time (like 10-15 minutes). Do I need to worry? Thank you for your advice.
This is not an uncommon scenario from patients. White blood cells indicate some element of inflammation which can arise from the lower urinary tract especially if accompanied by burning sensation either in the lower abdomen or along the urethra (where urine exits the bladder).
This burning sensation is also known as dysuria. Dysuria along with white blood cells found in the urine would point towards inflammation and infection. This should be further confirmed with a urine culture which can help isolate the bacteria responsible. It is important to have your urine culture taken before starting any antibiotics as once antibiotics is started, the bacteria counts will drop and the culture may be negative. Knowing the bacteria responsible is confirmatory of an infection and also helps guide appropriate use of an effective antibiotic.
Although urinary tract infection is the most common cause for the above scenario that you have described, there are other less common causes that can account for persistent white blood cells in the urine and these include gynaecological infections (for females), inflammation due to previous radiation treatment in the pelvic area, cancer of the urinary tract and even tuberculosis infection of the urinary tract which is rare.
Do seek further consult with your Urologist.
Question posted by Jeff
Hi Dr Chen, I have the following questions:
Thank you for your advice.
Thank you for the questions.
