Kidney Issues: Insights on Proteinuria and Cysts

Q: Kidney Issues: Insights on Proteinuria and Cysts

Question 1： With normal urine and blood reports but abnormal ultrasound indicating bilateral parenchymal kidney disease, does this indicate Stage 1 CKD or has kidney function already been gradually impaired? (The physician only mentioned to return in six months for urine testing

Kidney problems

Hello, Doctor! Last year, I visited the hospital due to a urinary tract infection.
After reviewing my urinalysis report, the urologist indicated that my proteinuria was elevated and recommended follow-up with a nephrologist.
Since then, I have had five urinalysis tests by June of this year, with some results showing high values and others normal.
In January, the nephrologist scheduled me for urinalysis, blood tests, and a renal ultrasound in June.
The urinalysis and blood test results in June were normal, but the renal ultrasound showed abnormalities.
During the follow-up, the doctor mentioned a renal cyst on the right side that needs monitoring but did not explain whether there are other kidney issues.
I was also scheduled for another urinalysis and follow-up on the cyst in six months.
However, the report indicated bilateral parenchymal kidney disease (I will attach the ultrasound report below).
I have three questions that I hope you can help clarify.
Thank you, Doctor.
Question 1: Given that the urinalysis and blood test results are normal, but the ultrasound is abnormal and shows bilateral parenchymal kidney disease, does this indicate stage 1 CKD or that kidney function is gradually deteriorating? (The doctor only mentioned that I need to return in six months for urinalysis and monitoring of the cyst, which has made me anxious about possibly having kidney disease.)
Question 2: The ultrasound report describes the right renal cyst as complex, but the doctor's diagnosis states it is an acquired renal cyst.
What is the difference between these two terms?
Question 3: If there is no family history of kidney disease, is there a concern regarding the right renal cyst, or is regular monitoring sufficient?
I appreciate your assistance in answering these questions.
Thank you, Doctor! Here is the renal ultrasound report:
Proteinuria Right Left
Size 11.4 cm Size 11.3 cm
Reference range 9-12 cm Reference range 9-12 cm
Shape irregular Shape regular
Margin Irregular Margin Smooth
Cortical echogenicity increased increased
Cortical thickness cm Reference range >0.7 cm
Parenchymal thickness 1.1 cm Parenchymal thickness 1.6 cm
Reference range >1.2 cm Reference range >1.2 cm
Central echo normal normal
Cystic lesions 1 cysts Cystic lesions 0 cysts
One 1.0 cm anechoic lesion in the middle portion with septum
Solid lesions nil nil
BLADDER not well distended
OTHERS nil
IMPRESSION
1.
Bilateral parenchymal renal disease
2.
Complex renal cyst right

Yū, 10~19 year old female. Ask Date: 2023/06/26

Dr. Wu Hongjie reply Internal Medicine

Question 1: With normal urine and blood reports but abnormal ultrasound indicating bilateral parenchymal kidney disease, does this indicate Stage 1 CKD or has kidney function already been gradually impaired? (The physician only mentioned to return in six months for urine testing and follow-up on the renal cyst, which makes me anxious about having kidney disease.)
Question 2: The ultrasound report for the right renal cyst indicates a complex renal cyst, but the physician's diagnosis states it is an acquired renal cyst.
What is the difference between these two terms?
Question 3: If there is no family history of kidney disease, is there a concern regarding the right renal cyst, or is regular follow-up sufficient?
1.
Persistent proteinuria >0.15g per day for more than three months can be diagnosed as Stage 1 Chronic Kidney Disease; otherwise, it is not.

2.
A complex cyst refers to a cyst with irregular, heterogeneous margins, containing debris or septations, and with indistinct walls.
An acquired cyst means that the cyst did not exist at birth or during fetal development; one describes the timing of the cyst's formation, while the other describes its characteristics.

3.
If there is only a single cyst in one kidney, regular follow-up is sufficient.
For other concerns, it is advisable to seek the physician's opinion in the outpatient clinic.
Thank you.

Reply Date: 2023/06/26

More Info

Hello! Thank you for your detailed inquiry regarding your kidney health, particularly concerning proteinuria and the findings from your ultrasound. Let's address your questions one by one.

Question 1: Understanding the Implications of Normal Urine and Blood Tests with Abnormal Ultrasound Findings
The fact that your urine and blood tests are normal while the ultrasound indicates bilateral parenchymal renal disease can be concerning. Chronic kidney disease (CKD) is classified into stages based on the glomerular filtration rate (GFR) and other markers. If your urine and blood tests are normal, it is possible that you are in the early stages of CKD, but this cannot be definitively diagnosed without further testing. The ultrasound findings suggest some structural changes in the kidneys, which may indicate early kidney damage. It is essential to continue monitoring your kidney function through regular check-ups, as your healthcare provider has recommended.

Question 2: Differentiating Between Complex Renal Cysts and Acquired Renal Cysts
A complex renal cyst is characterized by the presence of septations, irregularities, or solid components within the cyst, which can raise concerns about potential malignancy. In contrast, an acquired renal cyst is typically a simple cyst that develops due to various factors, including age, kidney disease, or prior kidney injury. The term "acquired" suggests that the cyst is not congenital but rather developed over time. Your healthcare provider's diagnosis of a complex renal cyst means that it requires careful monitoring to ensure it does not change in nature or size, which could indicate a need for further evaluation or intervention.

Question 3: The Significance of a Right Renal Cyst Without Family History
The presence of a renal cyst, particularly if it is complex, should be monitored, even in the absence of a family history of kidney disease. While many renal cysts are benign and do not require treatment, complex cysts have the potential for complications. Regular follow-ups, as your doctor has advised, are crucial. These follow-ups typically involve repeat ultrasounds and possibly additional imaging studies to assess any changes in the cyst's characteristics. If the cyst remains stable and there are no concerning features, it is often safe to continue with routine monitoring.

Additional Considerations
Given your history of proteinuria, it is essential to maintain a healthy lifestyle to support kidney health. This includes:
1. Dietary Management: A balanced diet low in sodium and protein can help reduce the workload on your kidneys. Consult with a dietitian specializing in renal nutrition for personalized advice.

2. Hydration: Staying well-hydrated is crucial for kidney function. Aim for adequate fluid intake unless otherwise advised by your healthcare provider.

3. Regular Monitoring: Keep up with your scheduled appointments for urine tests and ultrasounds. This will help track any changes in your kidney function or the characteristics of the cyst.

4. Blood Pressure Control: High blood pressure can exacerbate kidney issues. Regular monitoring and management of blood pressure are vital.

5. Avoiding Nephrotoxic Substances: Limit the use of medications that can harm the kidneys, such as non-steroidal anti-inflammatory drugs (NSAIDs), unless prescribed by your doctor.

In conclusion, while your current test results are reassuring, the ultrasound findings warrant ongoing vigilance. Regular follow-ups and lifestyle modifications will be key in managing your kidney health. If you have further concerns or notice any changes in your symptoms, do not hesitate to reach out to your healthcare provider for guidance. Thank you for your questions, and I hope this information helps clarify your situation!

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