Kidney Cysts: Diagnosis, Monitoring, and Management

Kidney cyst issues?

Due to hematuria, the patient visited the urology department at a medical center.
A CT scan of the urinary system revealed several tiny cysts in both kidneys.
One of them appears hyperdense on non-contrast CT, suggesting a complicated cyst, classified as Bosniak type II.
The bilateral adrenal glands appear normal.

I would like to ask the following questions:
1.
How often should renal cysts be monitored?
2.
Is it more appropriate to follow up with urology or nephrology? What are the differences between the two specialties?
3.
When it states that the bilateral adrenal glands are not unusual, does that indicate any issues?
4.
What is the likelihood of this type of renal cyst worsening?
5.
Are there any other specific concerns that should be noted? Thank you, doctor!

murusita, 50~59 year old female. Ask Date: 2020/08/14

Dr. Wu Jiyu reply Internal Medicine

According to your inquiry, Bosniak type II refers to a classification of renal cysts based on computed tomography, which theoretically does not require intervention, and the percentage of it becoming malignant is zero.
If you are still concerned, you may consider follow-up imaging in six months, and you can consult either a urologist or a nephrologist.
The statement "Bil.
adrenal glands are not unusual" indicates that the bilateral adrenal glands appear normal.
Additionally, I would like to remind you to discuss with your physician the possibility of polycystic kidney disease, which is a hereditary condition.
Currently, genetic testing is available at your own expense.
Thank you for your inquiry; the Nephrology Department at Changhua Hospital cares about your health.

Reply Date: 2020/08/14

More Info

Understanding kidney cysts is crucial for both diagnosis and management, especially when they are discovered incidentally during imaging studies such as CT scans. In your case, the findings indicate several tiny cysts in both kidneys, with one cyst showing hyperdensity, which suggests it may be a complicated cyst classified as Bosniak type II. This classification is important as it helps guide the monitoring and management of these cysts.

1. Follow-Up Frequency for Kidney Cysts: The follow-up for kidney cysts largely depends on their classification. Bosniak type II cysts are generally considered benign and have a low risk of malignancy. Current guidelines suggest that follow-up imaging may not be necessary for Bosniak type II cysts unless there are changes in symptoms or characteristics of the cysts. However, some clinicians may recommend follow-up imaging every 6 to 12 months for the first couple of years to ensure stability. Ultimately, the specific follow-up schedule should be determined by your healthcare provider based on individual circumstances.

2. Urology vs. Nephrology for Follow-Up: Both urology and nephrology are involved in the management of kidney-related issues, but they focus on different aspects. Urology is a surgical specialty that deals with diseases of the urinary tract and male reproductive organs, including the surgical management of kidney tumors and cysts. Nephrology, on the other hand, is an internal medicine specialty that focuses on kidney function and diseases, including chronic kidney disease and electrolyte imbalances. For monitoring a simple cyst like a Bosniak type II, either specialty could be appropriate, but if there are concerns about kidney function or systemic issues, nephrology may be more suitable.

3. Bilateral Adrenal Glands Not Unusual: The statement that "bilateral adrenal glands are not unusual" indicates that there are no abnormalities detected in the adrenal glands. This is a reassuring finding, as it suggests that there are no masses or other issues in the adrenal glands that could complicate the clinical picture.

4. Risk of Malignancy for Bosniak Type II Cysts: The risk of malignancy for Bosniak type II cysts is relatively low, estimated at around 6%. This means that while there is a small chance that a Bosniak type II cyst could become malignant, the vast majority remain benign. Regular monitoring and imaging can help detect any changes that may warrant further investigation.

5. Additional Considerations: While Bosniak type II cysts are generally benign, it is essential to monitor for any new symptoms, such as changes in urinary habits, pain, or blood in the urine, which could indicate complications. Additionally, maintaining a healthy lifestyle, including proper hydration and avoiding nephrotoxic substances, can help support kidney health. If there are any changes in the characteristics of the cysts during follow-up imaging, further evaluation may be necessary, potentially including a biopsy or surgical intervention.

In summary, while the discovery of kidney cysts can be concerning, understanding their classification and the associated risks can help guide appropriate follow-up and management. Regular communication with your healthcare provider is essential to ensure that any changes in your condition are promptly addressed.

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