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Friday, March 24, 2017
My 16 yr old son has had gross amounts of blood in his urine. The test showed: UR Creat 143.0 Sodium 140 Potassium 4.2 Chloride 102 Glucose 94 CO2 31 Bun 19 Creatinine 0.90 Calcium 9.4 Total Protein 7.0 Albumin Level 4.3 Bili total 0.8 Alk Phos 99 ALT 68 AST 36 AGAP 7 UR Calcium 3.2
Could you please tell me what these results mean? He does not go back to the doctor for one month. A renal ultra sound today showed a 3.5 cm septated cystic mass in the upper pole of the left kidney.
The blood results all seem to be normal, except for one of the liver tests (ALT), which may be a little high (normal values vary from place to place, so if you have the actual lab report, check the normal values, which should be listed). The kidney tests (BUN and creatinine) are normal for a 16 y.o. boy. It is hard to help with the interpretation of the ultrasound without actually seeing the films.
Cysts are common in adults, but uncommon in kids. A cyst is like a thin, fluid-filled balloon, and is usually benign (not cancerous). However, the one that your son has is apparently a "mass" (which sounds solid, and partly fluid-filled), and is "septated," meaning that it is divided into at least two compartments. This cystic mass could indeed be responsible for the blood in his urine, and could be either benign or malignant.
The next steps in his workup will depend a lot on what the radiologist says about the cystic mass, how solid it looks, and whether it has any characteristics of malignancy. Then depending on the radiologist's interpretation, the next steps will probably be either:
- Watch and wait, repeating the ultrasound in 3-6 months to see if there's been any change.
- Put a needle into the cyst and take out some of the fluid to see whether it contains blood or malignant (or premalignant) cells.
- Do surgery to take a direct look at the kidney and the mass, and perhaps remove the mass, while leaving the rest of the kidney in.
Here are some less likely possibilites:
There is a disease called "polycystic kidney disease," which can cause cysts and blood in the urine. This disease is not present at birth, but usually shows up with development of kidney cysts by age 30. However, if this is the case with your son, other people in the family should have the same disease, because it is genetic.
Finally, there are other causes of blood in the urine that may have nothing to do with the cystic mass. These include (in kids) diseases such as IgA nephropathy, thin basement membrane disease, and Henoch-Schonlein purpura (unlikely unless he also has a rash on his legs). There can also be bladder tumors and "AV malformations" (abnormal blood vessels, not malignant) within the kidney.
Good luck with the tests, and please feel free to write back and let us know what the outcome was.
Mildred Lam, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University