Friday, April 29, 2016
Calcification on left kidney
Thank you for "listening" I am writing this e- mail from Greece. After several cases of urinary tract infection since childhood, 2 diagnosed pyelonephrities,nephrolithiasis, non specific lymphadenopathy (surgical removal of neck lymph node for biopsy) and suspicion of SLE I am as confused as can be. I need your opinion for my CT results refering to an "insection" and calcification in the outline layer of my left kidney. Additionally CT results for the lung refer to the presence of calcification on left lung (several calcified lymph nodes) whereas my lymph node biopsy was positive for CD68, CD1aS100 and revealed focal hyperplasia. My medical record is full of unexplained quite strange incidents and test results. However, since I am really tired of abdominal pain and pain on my left kidney lasting for more than three years I am searching for your medical advice on line because it is rather difficult for me to visit your country. Thank you in advance and pardon me for any mistranslations of my CT results.
I am sorry that I cannot be of very much assistance in your complicated case. Here are a few observations that may help:
Calcification of the outer lining (I assume that you mean the outermost layer, or "capsule" of the kidney) can be caused by several disorders, including: bleeding around the kidney (for instance, from trauma); infection; and malignancy. There are several types of tumors, both benign and malignant ones, that can cause calcification of various areas of the kidney, including the capsule.
The cell markers that you mention (CD 68, CD 1a, and S100) can all be found in normal cells and in lymph nodes. However, they can also be found in abnormal lymph nodes and in various types of tumors. The calcified lymph nodes that you mention in your lung may merely indicate previous exposure to a substance such as silica, or previous exposure to a disease such as tuberculosis or histoplasmosis (which does not necessarily mean that such an infection is currently active in your body).
Probably the best thing for you to do is to sit down with the doctor who ordered all these tests and biopsies and ask them to try to put things together and explain the various findings and possibilities. Do not hesitate to ask questions like: do you think I have any type of cancer (of the lymph nodes or of the kidney)? or TB or other infection in the lungs or in the kidneys? I would also ask whether your kidney function is normal, since calcification in the kidney may mean that damage and loss of functioning tissue has occurred in the past. Your doctor may need to refer you to a urologist (surgical kidney specialist) for more help with the left-sided pain, or to a lung doctor. I hope that everything works out well for you, and that you are able to get the information and treatment that you need.
Mildred Lam, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University