Inside Kidney Health: Bhaskar Lakshman Reddy on Cancer, Early Detection & More! (Part-2)

Bhaskar Lakshman Reddy: You can do ultrasound through—what do you call the contrast—because what happens through the ultrasound or MRI, the contrast, the metals, it can light up when they capture the tumor within the kidneys. So sometimes, you know, there is no other option, you have to use such chemicals, such contrast for some patients. So what normally they do is, whether you give IV fluids to increase the fluids—because the reason why they give IV fluid before contrast is it will flush out through the urine, so all those harmful chemicals will be washed out, the contrast will be washed out. Or asking the patient to drink extra water, so that makes sure no dilates and it is passed through the urine actually, that is the whole idea. I think even hydration—these things are dependent on patients, the percentage of renal functions. Again, I would recommend seeking nephrologists' advice as the ideal thing.

Bhaskar Lakshman Reddy: I believe this issue is a global pandemic, affecting both developed and developing countries, regardless of their wealth. Diabetes and hypertension can impact anyone, regardless of gender. My message, based on over three decades of experience in this field, is that high blood pressure should be controlled from the very beginning to prevent complications, such as renal failure. It is eminently preventable.

While it may not seem easy, it is essential for people to see a family doctor. At the very least, if someone has diabetes or high blood pressure, they should get checked early. Everyone, irrespective of age, gender, or religion, should know their health numbers—what their blood pressure and sugar levels are. If any results are abnormal, numerous lifestyle changes can help.

For instance, if someone is obese, they can address their weight through exercise and healthy eating, and medication can be considered if necessary. A healthy lifestyle is the ideal option, with focusing on maintaining a healthy weight and proper nutrition being the first steps. Medication should be the last resort. The same applies to diabetes—having diabetes is not the end of the world. If diabetes is controlled from the beginning, it can prevent further complications affecting the eyes, heart, blood vessels, and kidneys. This protection can be achieved through the same strategies: healthy eating, regular exercise, and, if necessary, medication to control blood sugar at an optimal level.

It is crucial that individuals put in the effort. Just as you take your car for annual service, you need to pay attention to your body and understand what is happening within it. I recommend that everyone get checked at least once a year to know their health numbers. From there, if any abnormalities are found, it's important to follow the recommendations of your family physician or specialist.

In India, the public health system is quite robust; I know that every village has access to public health services, with approximately one public health clinic for every 25,000 people. However, many people in rural areas often have to walk long distances to reach these clinics, sometimes facing challenges such as poor road access. Typically, they only seek medical attention for high fevers or severe pain, neglecting the silent threats of diabetes and hypertension until the situation becomes critical.

Thus, it is vital for everyone to have regular check-ups—at least once a year. For those already diagnosed with diabetes and hypertension, more frequent check-ups, ideally every three months, are crucial to monitor their numbers and adjust medications as needed. By doing this, individuals can lead longer, healthier lives and protect their kidneys, hearts, eyes, and brains. Ultimately, managing these health conditions can safeguard not just the kidneys, but other organs as well.

Bhaskar Lakshman Reddy: Yes, I have been in this field for more than 30 years. Some of my patients' families captured kidney cancer as genetically it runs in the families. One patient was investigated—luckily, the tumour was at the beginning stage, about 4 cm small, recommended for ablation, that is treatment without surgical intervention. They freeze or burn it without disturbing kidney function. Before two or three decades ago, there was no alternative option for kidney cancer except nephrectomy—removing the total kidney. But nowadays, cancer issues can be treated without surgical intervention and continue to follow up. Sometimes it can recur for the same patient.

Bhaskar Lakshman Reddy: We have small test strips to check blood sugar, hemoglobin, cholesterol, protein—and these tests are 98% accurate these days, and within minutes you get results. That’s amazing. Electronic blood pressure monitors and blood sugar test strips are available to common people. Modern machines and dialysis are amazing. They give quality treatment for patients.

Bhaskar Lakshman Reddy: I had an interesting guy a couple of years ago. I was in New Zealand. He asked, “Does drinking tea prevent or reduce kidney cancer?” It’s a myth, definitely. If you are fitter, healthier, regularly exercise, you can take care of a lot of things like obesity, diabetes, and hypertension—obviously minimizing the risk of cancer. The important thing is hydrating your body, not necessarily drinking tea.

Bhaskar Lakshman Reddy: You know, people tend to believe in Ayurvedic and homeopathy medicines. I won’t dispute that because I have never tested that, so I cannot comment on it. But my experience is that cancer is lethal—why would you take chances? You need to see a specialist when you have cancer. If you leave it, it can go from stage one to stage four quickly. You must act before it’s too late.

Bhaskar Lakshman Reddy: In kidney cancer, when a patient is confirmed having kidney cancer, the team has to be multidisciplinary, which includes a nephrologist, medical oncologist, surgeon, urologist, and nutritionist. The nephrologist plays a key role in deciding what kind of medication the patient should be on. The medical oncologist will decide what is the best treatment for cancer—whether the patient goes for surgical intervention, non-surgical intervention, or any therapy. It depends on the stage of cancer. Robotic surgery is also there.

If the tumour is big and has killed most of the kidney, then there’s no point in keeping the kidney, and the ideal option is to undergo nephrectomy. But sometimes what happens is, if these cancer cells develop within the kidneys and spread outside the kidney—for instance, it goes to the bones, lungs, and the brain—it becomes more complicated. So the patient has to be on regular monitoring—it’s called active surveillance.

Bhaskar Lakshman Reddy: Generally, experts believe it can grow 1 cm yearly. If it goes beyond 7 cm, it’s an alarm—meaning it has gone from stage 1 to 2 to maybe 3 or 4. That’s a critical time. The team has to decide whether to remove it. Then you go for chemotherapy or maybe immunotherapy—depends on the condition of the patient.

It can spread to other vital body parts, so close monitoring is needed.

Bhaskar Lakshman Reddy: For the treatment of kidney disease, hemodialysis is a noteworthy option. There are several methods, including hemodialysis, peritoneal dialysis, and continuous ambulatory peritoneal dialysis. Peritoneal dialysis utilizes the patient's natural peritoneal cavity. In this method, fluid is filled into the cavity overnight, allowing waste products to pass into the fluid, which is then drained the next morning. The choice of treatment depends on the patient’s condition.

In hemodialysis, patients typically visit center-based units in hospitals or community centers. However, home dialysis has become increasingly popular due to its cost-effectiveness and convenience. Unlike 20 years ago, when cost reduction was a significant concern, home dialysis allows patients to dialyze more frequently—up to four or five times a week, or even daily. This is important, as our kidneys function continuously, while traditional hospital dialysis usually occurs only three times a week. As a result, conventional scheduling may not be sufficient to adequately support patients' health.

With home dialysis, patients often experience an improved quality of life. They may reduce their intake of anti-inflammatory medications, keep their phosphate levels under control, achieve better hemoglobin levels, and enjoy improved nutrition and sleep. Overall, their quality of life tends to be better than that of patients who receive hospital-based dialysis.

Technological advancements have significantly enhanced safety in dialysis. For instance, state-of-the-art blood pressure monitoring and volumetric control systems have replaced outdated methods, allowing for precise fluid removal—such as setting a target of three liters over four hours. Additionally, air bubble detection technology is critical to prevent air embolism, which can be life-threatening.

Improvements in water treatment have also elevated the quality of dialysis care. Since ultra-pure water is essential for effective dialysis, these advancements in technology continue to evolve, ensuring better outcomes for patients.