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Kidney Diseases

5mm Cyst on Right Kidney and Flank Pain

05/08/2009

Question:

I went to the doctor complaining of right flank pain. They said it may be a UTI or stones. They ruled both out. When they did urine test, they discovered micro hematuria. Then sent me to urologist who also did urine test. Nothing showed then. Next they sent me back to get a ultrasound. After the ultrasound I had gross hematuria. I went back to urologist and had cystoscopy. All clear. I still have flank pain so went for CT scan with contrast. They found 5 mm cyst on right kidney. So I went back to ultrasound and nothing found. I`m getting tired of running around. What could this be?

Answer:

I am not sure how to explain your symptoms, but one possibility is that your flank pain has nothing to do with your kidneys.  See our article about "Kidney Pain" for a description of the location and quality of pain that comes from the kidneys.  You seem to have had all of the tests that would detect a kidney stone, tumor, or bladder problem as the cause of hematuria.  

It would be helpful to know your age and gender.  If you are a woman, it's possible that the blood could be coming from the vagina.  There is also a possibility that you have blood coming from the kidney itself, for instance from a disease called "IgA nephropathy," which can be diagnosed only by kidney biopsy (and not from imaging or cystoscopy).  IgA nephropathy is more common among people of western European (especially France, Belgium, Netherlands) or Asian origin. 

There are also small structural problems in the kidney, ureters, or bladder (such as duplicated collecting systems or bladder diverticulae) that may be better seen on a study called an IVP (intravenous pyelogram), which would give greater detail than either an ultrasound or a CT scan.  It sounds like the best thing at this time would be for your doctor to refer you to a nephrologist (medical kidney doctor), who can go over all your studies and try to decide whether you need an IVP, kidney biopsy, or other tests at this time.  Another possibility would be for the nephrologist simply to follow you closely over the next few months to see if you develop any further symptoms or problems, since it doesn't seem like you have a stone, malignancy, or infection -- and there are people with hematuria for which a cause is never found, but who seem to do perfectly well anyway.

Related Resources:

Kidney Pain

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Response by:

Mildred   Lam, MD Mildred Lam, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University