"Woman Says Hospital Removed Both of Her Kidneys By Mistake"

[W19]

Woman Says Hospital Removed Both of Her Kidneys By Mistake

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[Matthew9Thirtyfive]

 

[libertyyne]

So is it common practice to remove both kidneys without biopsy? I would think they would want to know what they are dealing with before opting to put an old lady on dialysis for the rest of her life.

 

[W19]

So is it common practice to remove both kidneys without biopsy? I would think they would want to know what they are dealing with before opting to put an old lady on dialysis for the rest of her life.

Maybe it is at the University of Colorado Medical Center...

 

[libertyyne]

Maybe it is at the University of Colorado Medical Center...

Seems like paying out settlements is also part of the standard of care then.

 

[Matthew9Thirtyfive]

Seems like paying out settlements is also part of the standard of care then.

Or there's more to the story than just the patient's side.

 

[libertyyne]

Or there's more to the story than just the patient's side.

Thats true. I am just trying to run the differential in my head on what would lead to this result.
Wrong patient imaging
Abscess- Cysts from long standing upper uti and pylo seem like a possibility.
What are the odds of bilateral benign tumors?
Wrong patient surgery.

 

[evilbooyaa]

While things that are highly suspicious for renal cell carcinoma are routinely removed without biopsy (if they have radiological features highly suggestive about RCC), due to concern about peritoneal or retroperitoneal (depending on angle of biopsy) spillage of tumor contents from a biopsy.

Never heard of an elective bilateral nephrectomy though. I've seen cases where there was radiographical concern for bilateral RCC, but usually they'd take out one and then take a look at the other one or do a partial nephrectomy or something, or go with surgery on one and chemo/ablation for the other one.

Not a common clinical scenario of course to have bilateral RCC, but I'll need to bring in the urologists for their opinions on the actual medical indications for this as they have more experience with kidney tumors.

@cpants @DoctwoB

 

[Matthew9Thirtyfive]

Thats true. I am just trying to run the differential in my head on what would lead to this result.
Wrong patient imaging
Abscess- Cysts from long standing upper uti and pylo seem like a possibility.
What are the odds of bilateral benign tumors?
Wrong patient surgery.

Yeah, I'm wondering if she was appropriately consented and really understood what was happening and the chances of it not being tumor.

 

[NotAProgDirector]

It's certainly possible this is just a huge screw up.

But it's also possible she had bilateral renal oncocytomas. These are rapidly growing masses that although benign are often very difficult to differentiate on imaging from RCC. Even if a needle biopsy is done (which is controversial, as above), it is difficult to exclude malignancy as these tumors have have both benign and malignant portions.

 

[libertyyne]

It's certainly possible this is just a huge screw up.

But it's also possible she had bilateral renal oncocytomas. These are rapidly growing masses that although benign are often very difficult to differentiate on imaging from RCC. Even if a needle biopsy is done (which is controversial, as above), it is difficult to exclude malignancy as these tumors have have both benign and malignant portions.

do you think that the standard of care would have been a staged procedure? Or one shot , i suppose we dont know what her risk profile was with anesthesia.

 

[nimbus]

Similar cases have happened before. Wrong site nephrectomy of normal kidney followed by removal of cancerous kidney leading to anephric patient.

 

[docnyc14]

It's certainly possible this is just a huge screw up.

But it's also possible she had bilateral renal oncocytomas. These are rapidly growing masses that although benign are often very difficult to differentiate on imaging from RCC. Even if a needle biopsy is done (which is controversial, as above), it is difficult to exclude malignancy as these tumors have have both benign and malignant portions.

Agreed, could just be a massive screw up!


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[mistafab]

100% you cannot reverse-doctor a case from a news story.

Stop trying. If you weren’t the doctor, you can’t know.

Just like I don’t know anything.

 

[alprazoslam]

Only thing for sure is the news attempt to demonize modern medicine with this occuranxe. At least the video I watched did.

 

[libertyyne]

100% you cannot reverse-doctor a case from a news story.

Stop trying. If you weren’t the doctor, you can’t know.

Just like I don’t know anything.

Obviously , since we dont have all the information. But its still fun in hypothesizing.

 

[cpants]

Synchronous bilateral RCC is more common than you think, approximately 2% in published series. We frequently do nephrectomies and partial nephrectomies without a biopsy prior for several reasons. First, CT/MR characteristics are pretty specific for RCC. If it looks like RCC on the CT, it's about 80% chance it is. Biopsies carry risks including procedural risks, false negative risk, possibly making definitive surgery more difficult, and frequent nondiagnostic biopsies. It's pretty common to get a biopsy and the pathologist can't tell you what it is. There is no longer thought to be a real risk of tumor seeding from the biopsy. It has only been reported once or twice.

That said, synchronous lesions large enough to require bilateral nephrectomy is a pretty rare situation. Obviously, there was some screw up if there was no cancer in either kidney. Possibly the patient had large bilateral fat-poor AML's which can look pretty malignant. I find it a little hard to believe that only normal kidney tissue was found. My preference in these situations is almost always to treat one kidney at a time.

 

[DoctwoB]

Synchronous bilateral RCC is more common than you think, approximately 2% in published series. We frequently do nephrectomies and partial nephrectomies without a biopsy prior for several reasons. First, CT/MR characteristics are pretty specific for RCC. If it looks like RCC on the CT, it's about 80% chance it is. Biopsies carry risks including procedural risks, false negative risk, possibly making definitive surgery more difficult, and frequent nondiagnostic biopsies. It's pretty common to get a biopsy and the pathologist can't tell you what it is. There is no longer thought to be a real risk of tumor seeding from the biopsy. It has only been reported once or twice.

That said, synchronous lesions large enough to require bilateral nephrectomy is a pretty rare situation. Obviously, there was some screw up if there was no cancer in either kidney. Possibly the patient had large bilateral fat-poor AML's which can look pretty malignant. I find it a little hard to believe that only normal kidney tissue was found. My preference in these situations is almost always to treat one kidney at a time.

Agreed. Or if you do bilateral nephrectomies get a frozen on the one before going to the other. We’re only hearing one side here, but something seems fishy. I’m pretty anti biopsy for renal mass, because I find that it rarely alters management. The reason being that some RCC is extremely slow growing and indolent while some benign masses can grow quickly or hemorrhage, hence my decision to operate tends to be more based on size/growth rather then on benign/malignant. Biopsy is also ineffective at differentiating oncocytoma (benign) from chromophobe subtype RCC. I’ve taken our kidneys or parts of kidneys for benign disease before and will do it again, but I find current renal biopsy to be not especially helpful most of the time.

That being said, if I’m taking out two kidneys in a patient without ESRD you better believe i need a tissue diagnosis. Similarly you can do a whole lot to save kidneys even with huge or multiple tumors, for example get transplant involved and do a partial nephrectomy on ice on the back table and then an auto transplant.

We do bilateral nephrectomies not too infrequently, but usually in the setting of ESRD with bilateral renal masses or symptomatic giant ADPCKD kidneys, or bladder cancer with proven bilateral upper tract TCC (even then will try like hell to spare at least one kidney).

 

[MSTP18]

Synchronous bilateral RCC is more common than you think, approximately 2% in published series. We frequently do nephrectomies and partial nephrectomies without a biopsy prior for several reasons. First, CT/MR characteristics are pretty specific for RCC. If it looks like RCC on the CT, it's about 80% chance it is. Biopsies carry risks including procedural risks, false negative risk, possibly making definitive surgery more difficult, and frequent nondiagnostic biopsies. It's pretty common to get a biopsy and the pathologist can't tell you what it is. There is no longer thought to be a real risk of tumor seeding from the biopsy. It has only been reported once or twice.

That said, synchronous lesions large enough to require bilateral nephrectomy is a pretty rare situation. Obviously, there was some screw up if there was no cancer in either kidney. Possibly the patient had large bilateral fat-poor AML's which can look pretty malignant. I find it a little hard to believe that only normal kidney tissue was found. My preference in these situations is almost always to treat one kidney at a time.

I can't get the video to load but this is a really good point that I doubt would have been made in the video. Just because the permanent sections ended up being "benign" by no means means they were "normal."

 

[sunshinefl]

Found this gem in the comments...

 

[libertyyne]

This story was used as a springboard by my favorite HS classmate who drives the anti-vaccine train. He loves homeopath too. He also thinks that thc is the cure for almost everything. And, in case anyone is wondering, yes he smells like patchouli

So much to educate so little time to do it in. Now I just sip my drink and move on.