Benefits of being followed by a nephrologist vs. a urologist?

icemantoo said:

Follow up

Talmid,

 

It is best to be followed by both as each serves a distictly different purpose. A urologist surgeon is concerned about mets and the state of your other Kidney. The Nephrologist is concerned about your lower Kidney function as a result of the Neph. He also addresses other issues outside your Cancer which affect your Kidney such as high blood pressure, diabities weight etc. Depending on your age many of us older dudes are classified as Stage 3 CKC (Chronic Kidney Disease). Many things cause reduced Kidney function including but not limited to the loss of a kidney. One observation my Nephrologist shared was that those losing a Kidney to Cancer do better than others with the same low kidney function numbers from other causes.

 

Icemantoo

Talmidah, I think you should get a second opinion. Mine was also the same size as yours and I had a partial nephrectomy that save 85 percent of my kidney. Of course a lot depends on the location, and it's possible that yours will have to be a radical one, but I think it's important to get another point of view before allowing a whole kidney to be taken. Another poster here, Positive_Mental was also told he needed a full one yet ended up having a partial by the same surgeon that I had, who saved 95 percent of his kidney. If possible to preserve your kidney, definitely go with the partial. There's always the risk it will have to convert to a full nephrectomy but at least you start out with the hope of preserving most of your kidney.

Talmidah said:

Thanks for your suggestions

APny - I really appreciate your response.  I have actually seen 3 urologists so I have a second, second opinion.  The one who is doing the surgery is going in with the goal of doing a partial nephrectomy and preserving as much of the kidney as possible.  However, the tumor is in the middle of the kidney and is "sitting" on the artery.  But he can't tell if it grown into the artery - which I know would change the whole trajectory.  We have discussed the potential need to convert to an open procedure and a complete nephrectomy.  In the meantime, I am going to find a nephrologist - does anyone have any suggestions for a nephrologist in DC or the Maryland suburbs of DC? 

Yes, location makes all the difference as well as whether it has grown into the vein. Hopefully not, and they can do the partial, but if not, at least it'll be gone. I'm sure you'll find a good nephrologist. Wishing you the best!

I am also in the DC area, but on the other side of the river from you.  

As Icemantoo said, Urologist is the surgeon and plumber....Nephrologist is concerned about the kidney function, but no the cancer per se.

You might not need a nephologist; I would wait to see how your kidney function is after the surgery.  I started seeing my nephrologist when my creatinine went high, to 1.8.  He does very little, except makes sure when medical procedures such as cardiac cath need to be done that my kidneys are treated properly.  He is affiliated with Inova fairfax hospital, where my cardiologist practices. 

If the tumor goes into to vein, you might want to consult with a medical oncologist.  I am/was stage four, with a lung met.  For the oncoligist, I see Dr. Hans Hammers at John's Hopkins.  There is no one in DC at his level (except for NIH, but they will only see you in a trial).

Bonzy said:

Nephrologist vs urologist

My mass was a 9.5 cm x 7.5 cm in  the center of my left kidney. It had extended into the rental vein with LVI present . Had a open radical nephrectomy . My counts were all off and is starting to come back normal 6 months later , except for my GFR . It's still only 58. My urologist said he would take care of everything and make my appointments for all my scans. I already had my three month scan in March and no other date  has been planned yet. Little worried about that. Have a nodule in lung they are also watching. My urologist said nephrologist is if my other kidney goes into failure .good luck with your appointment and surgery in june 

Talmud,

The Nephrologist is going to look at all of your kidney function numbers as well as other medical issues which negatinely effect yoy kidney such as high blood pressure, smoking, diet  diabites, weight and exercise. The negative effect of low kidney function first and most offten appears in heart and stroke risk rather than loss of kidney function. As you get older your kidney function goes down as well. Part of your GFR is age related. While a gfr of 60 may be good for someone in their 50's with one kidney, those of us like me approaching 72 will not reach that number. The other downer is that a gfr under 60 (31-59) which most of us one kidney guys have is classified as Stage 3 CKD (Chronic Kidney Disease). The name is worse tham the bite.

Icemantoo

Sorry, I just popped in and didn't really read all the replies thoroughly, but skimmed them.

Are you having a partial or radical nephrectomy?

If your kidney function is abnormal after your surgery (creatinine above 1.4 I'd say), then I'd want to see a nephrologist periodically. You want to take good care of your kidneys and watch your blood pressure (which can damage kidneys).

The followup with the urologist is for making sure you catch any mets if it comes back. Personally, I would rather be followed by an oncologist with RCC experience. My second choice is urologic oncologist (a urologist with specialized training in kidney masses). I would not want to be followed by a urologist, unless I thought he was particularly interested and thorough. Most run-of-the-mill urologists really don't know metastatic kidney cancer that well. A medical oncologist with RCC experience is the best choice. They are the ones that will manage your care should your cancer return (heaven forbid).

Best wishes,

Todd