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Wednesday, June 19, 2013
Kidney and Hepatic Cysts
Hello, I am a 54 year old male, few weeks ago I complained from abdominal pain, and some back pain (in place of kidneys). I went to the doctor, and he ordered an ultrasound and kidney function tests. The tests were all fine, but the ultrasound showed kidney and liver cysts, so the doctor ordered an axial tomography. It showed 3 liver cysts and two kidney cysts, one in each kidney.. they all are smaller than 2 cm. the doctor also made me blood tests for liver function and to exclude cancer, and they were all fine. Should I worried about these cysts? I know that simple cysts are common, but is it common to have them both in kidnys and liver?? Please help me.
Your cysts are all small, and it is unlikely that they are causing pain. Kidney cysts are not uncommon, and are found in as many as 15% of males in your age group. Liver cysts are not as common and are seen in about 1% of adults. Most kidney and liver cysts will not enlarge and will not cause any problem. Occasionally, a cyst may be -- or may become -- malignant. Also, liver cysts can sometimes be seen in parasitic disease, particularly echinococcus infection; so keep this in mind, especially if you live in a country where echinococcus is found.
It is very important for the radiologist who reads the ultrasound and CT to note whether the cysts have any worrisome or suspicious characteristics. Benign cysts are usually round and well-defined, and contain clear fluid (that appears black on an ultrasound or a CT scan). If a cyst is not round, has fuzzy or thick borders, or contains any fluid that is not black on ultrasound or CT, further study may be needed. Sometimes this consists of simply repeating the study in 3-6 months to see if the cyst has grown or if anything has changed; sometimes it may require doing an MRI, or even putting a needle into the cyst and sampling the fluid. So the radiologist's reading is very helpful in deciding the likelihood of malignancy and in determining what further studies (if any) should be done.
One other consideration is a disease called "polycystic kidney disease," or PKD. This results in formation of innumerable cysts in the kidneys and liver, ultimately leading to kidney failure and the need for dialysis. However, PKD typically first becomes evident when a person is under the age of 30, and typically leads to kidney failure in the 50's or 60's. Since it is a hereditary disease (with dominant inheritance), a person who has PKD usually has one parent with it, and half of their siblings will have it as well. Since you are already in your 50's and have only a few cysts, and apparently no one in your family with the disease, it is unlikely that you have PKD. Be sure to ask your doctor exactly what the radiologist said on reading the ultrasound and CT scan, and whether any further studies were advised at this time.
Mildred Lam, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University