1. Kidney & testicular cancers and kidney transplantation

2. Kidney Cancer Renal cell carcinoma Commonest cancer of kidney From proximal tubular cell Fifth & sixth decade Male : Female = 2 : 1

3. Renal Cell Carcinoma Aetiology cigarette analgesic abuse cadmium, petroleum products, asbestos Von Hippel Lindau Syndrome adult polycystic kidney disease acquired cystic disease from chronic renal failure

4. Renal Cell Carcinoma Presentation Haematuria, the commonest Loin pain Loin mass Triad – haematuria, pain, mass – advanced disease Metastatic symptoms – bone pain, dyspnoea Incidental findings Paraneoplastic syndrome – erythrocystosis, hypercalcaemia, hypertension, hypoglycaemia, Cushing syndrome

5. Renal Cell Carcinoma Investigations Intravenous Urography – SOL classically with distortion and destruction of calyces Chest X-ray CT scan of abdomen – SOL enhanced with contrast (diagnostic of RCC), LNs, staging Bone scan Renal arteriogram – rarely done, neovascularity, arteriovenous fistula MRI, venography – IVC thrombus FNA, cytology – limited role US – if SOL in IVU suspected to be a cyst

6. Renal Cell Carcinoma Staging Stage I – tumour within kidney Stage II – invade capsule, within Gerota’s fascia Stage III – renal vein/IVC thrombus, LN Stage IV – adjacent organ(except adrenal), distant metastases (Fuhrman grading I, II, III, IV)

7. Renal Cell Carcinoma Treatment Surgery – only chance of cure Radiotherapy, Chemotherapy, Hormonotherapy – limited role Immunotherapy – rare chance of spontaneous regression, infiltration of tumour with lymphocytes triple therapy - interleukin 2, interferon, cytotoxic drug – some response

8. Testicular Tumour 95% germ cell tumour seminoma nonseminoma – teratoma, yolk sac tumour, choriocarcinoma, embryonal carcinoma Incidence - 1 in 100,000 20 to 40 years old Aetiology undescended testis – inguinal 1-2%, intraabdminal 5-10%

9. Testicular Tumour Presentation Painless enlargement Testicular pain Metastatic symptom – bone pain, chest symptoms Incidental finding after trauma/sexual partner

10. Testicular Tumour Investigation Scrotal ultrasonography Tumour markers alpha fetal protein – nonseminoma beta HCG – seminoma & nonseminoma LDH – seminoma & nonseminoma Inguinal exploration/orchidectomy

11. Testicular Tumour Staging Investigation Chest X-ray CT abdomen & pelvis Lymphangiogam – rarely done Stage I – tumour confined to testis Stage II – retroperitoneal lymph node Stage III – mediastinal lymph node/distant metastases

12. Testicular Tumour Treatment Stage I – post orchidectomy surveillance, chemotherapy, retoperitoneal LN resection Stage II – chemotherapy/retroperitoneal LN resection Stage III – chemotherapy, surgery for residual masses

13. Testicular Tumour Prognosis Before chemotherapy – overall 5 years survival rate 50% After chemotherapy – 5ysr to 70%, then to 90% with better chemotherapeutic drugs Stage I disease – 5ysr 95-100%

14. Kidney Transplantation Creatinine clearance normal80-120 ml/min mild renal impairment30-50 ml/min moderate renal impairment15-30 ml/min severe renal impairment5-15 ml/min end staged renal failure0-5 ml/min

15. End Staged Renal Failure Incidence – 10-20 per 100,000 Causes DM glomerulonephritis hypertension infection congenital

16. Functions of Kidney Excretion of metabolic waste Acid base balance Water & electrolytes Erythropoietin Vitamin D3 Renin-angiotensin

17. Renal Replacement Peritoneal dialysis Haemodialysis Kidney transplantation cost-effective & better quality of life

18. Kidney Transplantation First successful transplant between identical twins Allograft successful after immunotherapy Better graft survival – HLA typing, cyclosporin, brain death

19. Kidney Donor Living related careful work up, long term follow up showed no problem with single kidney Living unrelated Cadaveric – transplant co-ordinater

20. Graft Recipient Absolute contraindication – active infection, active malignancy Careful work up – ABO blood grouping, HLA typing, medical & mental fitness Low morbidity & mortality rates Good patient and graft survival rates half kidney grafts survive 10 years