09/25/2003
Personal Images
You may be too young to remember the days when medical imaging consisted essentially of just the plain old X-ray images of your chest, your teeth or that broken bone. Today we have invasive procedures for viewing directly one’s innards such as the colonoscopy, the cystoscopy, the sigmoidoscopy and the endoscopy. Then there are the more exotic noninvasive procedures such as MRI (magnetic resonance imaging) and ultrasound imaging to name just a couple. If you aren’t familiar with all these imaging techniques, you may have been lucky enough not to have needed them. Over the past decade or so, my wife and I have had experiences with all of them.
Occasionally, a particular set of images focuses your attention on a part of your anatomy that you’ve taken for granted. You may not even know an organ’s location or function, at least not in detail. A set of ultrasound and MRI images has suddenly focused my attention on the kidney. Every so often there’s an item in the paper or on the news about some brave and generous soul who has donated one of his or her kidneys, sometimes to a total stranger. Most of us are endowed with two kidneys at birth, although occasionally a baby is born with only one and is none the worse for it. Obviously, Nature has given us the ability to operate rather well with a solo kidney.
A few weeks ago, I met a fellow who said that 13 years ago he had all but a quarter of one kidney removed. The fellow looked to be in good shape and he has lived all these years with that small fraction of a kidney! For those like myself who haven’t paid much attention to their kidneys, let’s see what a kidney is good for. A friend wondered if the kidney is hollow? The answer is no, far from it. It contains a million or so little units known as nephrons, whose function is to remove waste products from the blood. These waste products are passed to the bladder in the form of urine. The bladder is indeed essentially hollow, serving as a retainer for the urine until it is excreted through the urethra.
Each nephron is a rather complex arrangement of a bunch of various types of fine capillaries and connects to the main blood stream through veins and arteries feeding and extracting the blood for and after purification. I won’t go into detail except to mention the glomerulus, which is a tuft of capillaries. The glomerulus filters water and other materials from the blood for passing along to the bladder. Each nephron has a little collection tube for the urine that feeds into the ureter, which feeds the total output of the kidney into the bladder. My 1962 World Book Encyclopedia, from which much of this material was obtained, says that the ureter is “about as large as the quill of a crow’s feather”. I don’t know about you but I don’t recall ever having examined a crow’s feather. There must have been a different sort of audience for the World Book in 1962.
I imagine that the word nephron shares the same origin as the term “nephrectomy”. When any medical term ends in “ectomy”, it’s an ominous sign that something is going to be removed. Sure enough, a nephrectomy is the removal of a kidney. By this time you probably suspect that I have more than just an academic interest in the kidney. You’re right. If this column appears on schedule, it means that I have had the experience of undergoing a partial nephrectomy, the removal of part of a kidney. At least that was the intended surgery.
The surgery was prompted by my routine annual physical exam with a new young doctor, Dr. Craig (first name). Dr. Craig was the doctor who, earlier this year, diagnosed our Lamb guy, Harry Trumbore, with Guillain-Barre Syndrome, a difficult diagnosis. In my case, the young doctor scored again when he found subtle changes in my blood chemistry and prescribed ultrasound and MRI tests. They showed a 2 cm diameter tumor in my right kidney. This seemed pretty large to me but I was assured by other medical personnel that it was small and that such tumors are typically substantially larger when detected. Now, if Dr. Carl (first name) has performed his skilled surgery, the tumor is history and I have at least one kidney and, hopefully, part of another purifying my blood.
All this was written before going to the hospital. If I feel as washed out as I expect to, next week’s column may be a rerun of an earlier one. Otherwise, be prepared, doesn’t everyone want to talk about his or her operation?
Allen F. Bortrum
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