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Kidney Diseases

Kidney cysts

04/09/2008

Question:

Hello, I need help in determining if I should follow up on my recent CT Scan / MRI. I was sent to a Urology from my regular MD and he acted as if, "What are you doing here?" The CT Scan showed 1. The left and right kidneys demonstrate syminetic enhancement. Multiple low attenuation lesions are pressent within the renal cortex bilaterally. These lesions measure higher than fluid density and DO NOT meet criteria for simple cysts. The largest measuring a 2.5 cm at the upper pole of the right kidney appears to demonstrate a suble low attenuation junction with the bordering right kidney. There is midle prominence of the right uteter and suble enhancement of the uretheliem extending to the level of the urinary bladder. A follow up MRI should be done with particular attention to the largest lesion at the upper pole of the right kidney which appears to demonstrate an infulrative or edematous border with surrounding renal parenchyma. This could represent an infection provess.

MRI was done several days later and the finding were 1. Multiple bilateral exoplytic renal cortical cysts are present The largest cyst on the right previous demonstrated a halo of relative low attenuation of the surrounding renal parenchyma. The raised concern for a possible infectious process. However, on the currect examination, the halo is not definitely identified on pre or post contrast sequences. The cyst deomstrates mildly increased signal intensity on T1 weighted sequences suggesting proteinaceous contents. There is no appreciable enhancement following contrast administration. 2. A 5.mm cyst within the left kideny demonstrates high signal intensity on T1 weighted sequences and low sigal intensity on T2 weighted sequences most likely representing a hemorrhagic cyst. This lesion becomes obscured when intravenous contrast is administered. No definite suspicious lesions are appreciated. A follow up mri in one year. Also I would like to mention that I have had one the last year high Wbc counts and no sign of infections. Resently my whc was high my platelets 441 high. Weight loss of 30 pounds without dieting. Now this is the question.

The regular MD sent me to a ulrologist. He did no test except urine which he say was fine. He told me that kidneys do not cause kidney pain that my pain has to be something else. He also said that he could not review my images at this time but would on Thursday at his other office and to call him if I do not hear from him. I felt he does not want to even want to have anything to do with me. What should I do? Should I see another ulrologist? My regular MD sent me there becasue he had a concern that something could be wrong. Help answer some of my questions. Please respond soon for I`m worried about myself. Thank You

Answer:

I would give your regular MD and the Urologist time to evaluate and discuss the results. Then you need to return to your regular MD and have a frank discussion which addresses the test results and what they mean for you.

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Response by:

Thomas   Zipp, MD Thomas Zipp, MD
Assistant Professor of Medicine
School of Medicine
Case Western Reserve University