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Forum Name: Miscellaneous Nephrology Topics

Question: kidney cyst


 Tony - Mon Oct 18, 2004 12:04 am

I was just told by a doctor at a health center that they found a 7 cm kidney cyst in me while doing ultrasound to check my liver this month (October 2004). I'm a 41 y/o male, work out regularly for 7.5 years and a health nuts. I've always been very proud of my good health and a much younger looks than my real age that I've been able to maintain through a healthy lifestyle. So when hearing this news, I was not just shocked but also angry and worried. I felt angry because the doctor who told me this ultrasound result said a 7 cm kidney cyst is very large. About 5 years ago when I was taking my physical exam, I told the doctor that I urinate VERY frequently and the urine looked yellow. The doctor said it's normal without any hesitation and reservation. Since then I did another two physicals. During both exams, I brought up the same issue and both doctors responded exactly the same way as the first one. I don't understand why. If the doctor 5 years ago had ordered an ultrasound for my kidney, maybe the cyst wouldn't have grown to such a large one. And I could have dealt with it much earlier. So can any doctors here please advise me why all those 3 doctors would respond to me that way? Is it really normal to urinate very frequently ? Can I hold them responsible for anything?

Another question is I really didn't know anything about kidney cyst when the doctor at the health center told me about this result. And he didn't really explained much about it to me either except scare the hell out of me, emphasizing 7 cm kidney cyst is very large (he's a very young-looking doctor and so is the way he talks.) I then search in the Interent and found some basic information about kidney cyst. He ordered a CT scan for me and it'll be done in November. While waiting for the CT scan, I'm still very worried about two things. One - if a 7 cm kidney cyst is considered very large, will it be more likely to be a tumor or even cancer? Two - I don't have insurance, which is why I'd have gone to the city health center for physical exam. If this cyst is only a cyst with water inside, for a 7 cm size cyst, will it be a costly procedure to remove it? Do I have to have my abdomen cut open? What kind of treatment will I receive?

Thank you very much for reading.

Tony
 Dr. Tamer Fouad - Wed Oct 20, 2004 12:46 pm

User avatar Dear Tony,
I cannot comment on your previous clinical experiences as the clinical situation is a complex one which involves a lot of factors. I am not with or against your doctors. What do you define as urinary frequency?

You should note that most renal cysts do not present with any symptoms whatsoever. Cystic diseases of the kidney are grouped into congenital and aquired cysts. This is resolved with the patient's history.

Aquired renal cystic disease is either associated with a systemic disease (such as Tuberous sclerosis and Von Hippel-Lindau Syndrome). If not associated with a systemic disease then there are several hypotheses for the cause of these cysts. Some say they are secondary to obstruction of the tubules by fibrosis or oxalate crystals. Another hypothesis is that, with nephron loss, compensatory hypertrophy of the relatively normal nephrons occurs leading to cyst formation.

Once cysts are observed sonographically, further evaluation with contrast-enhanced CT scan is indicated to rule out carcinoma. Contrast-enhanced helical CT scanning has 96% sensitivity and 95% specificity in detecting carcinoma.

Treatment of simple cysts rarely requires surgery. Surgery may be indicated in the case of complications such as obstruction, pain or infection. Treatment options are many and include aspiration, open resection, sclerosis, endoscopy, percutaneous resection, and laparoscopy.

For your particular case, I would say you get the CT done as soon as possible. Your ultrasound should give you an idea however, whether the threat of cancer is probable. Sonographic features supporting the diagnosis of simple cyst are an anechoic round mass with a smooth and sharply demarcated wall and through-transmission with strong posterior wall echo. A large size and a slow progression are with the diagnosis of a simple cyst rather than against it.

Best regards,

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