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What Does Multiple Lesions In Kidneys In A CT Scan Indicate?

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Posted on Sat, 8 Nov 2014
Question: Hello,

I'm a 31 year old male. I just had an abdominal cat scan to help diagnose lower left abdominal pain. In the radiology report the radiologist mentioned that there were multiple well-circumscribed hypodense lesions in kidneys that could suggest polycystic kidney disease. There wasn't any mention of my kidneys being enlarged, my blood pressure was normal, and both blood and urine work came back normal. There is no one in my family with PKD.

My question is what could those lesions on my Kidney be and should I be worried. I'm freaking out. Please help.
doctor
Answered by Dr. Divakara (1 hour later)
Brief Answer:
It's Polycystic kidney disease

Detailed Answer:
HI

Greetings from Dr.Divakara.P
Thanks for choosing your Query.

It could still be Polycystic Kidney disease, though it is an inherited disorder it might have not manifested in your family members or they might have not checked it.

It seems like the disease is in it's milder variant so no need to worry. You just need to get Ultrasound Abdomen Scan or CAT Abdomen scan every year and Serum Creatinine test every 6 months .

If still you want more confirmation you can do test for Mutation in PKD1 or PKD2 gene.

Other possibilities are : Acquired Cystic disease, Simple Renal Cyst, Renal Cystic Neoplasm , Medullary Sponge Kidney. ( These are other diseases of kidney where cysts can be found )

Hope this answers your query.
Any clarification feel free to ask .

Regards.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Divakara (21 minutes later)
Dr. Divakara,

Thank you for your response. You said it is in its milder variant. What does that mean? Are there different levels of this illness? How do I go about getting diagnosed? Do I have to worry about kidney failure in the future?

I spoke with my father who said that no one in the family, both my mom and dad side have this or have kidney problems. My father has problems with kidney stones but doesn't have cysts on his Kidneys.
doctor
Answered by Dr. Divakara (9 minutes later)
Brief Answer:
You need to monitor creatinine

Detailed Answer:
Hi

Welcome back.

Polycystic kidney disease will progress in some people as the cyst starts enlarging it will compress and destroy the normal kidney tissue ultimately leading to kidney failure over years.

The severity of the disease is different in different people. In some it becomes fatal within few years of diagnosis but in some it will not cause any significant kidney problem. Since your blood reports are showing that your kidney function is normal it deduce from that as you have milder variant.

Yes there is a possibility of kidney failure but the risk is slightly higher than a normal person. That's why i advised you to get serum creatinine test every 6 months.

For definitive diagnosis of inherited polycystic kidney disease you need to get tested for PKD1 and PKD2 gene

Hope this answers your query.

Any clarifications feel free to ask.

Regards.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Divakara (1 hour later)
Dr.

Thanks for your response.

So you're saying that in many cases of PKD there isn't much damage to the kidneys? Why is that? So for some PKD isn't a death sentence?

What kind of doctor does the PKD test? Also, a doctor can't diagnose PKD just by using a CT Scan?
doctor
Answered by Dr. Divakara (4 hours later)
Brief Answer:
No it's not death sentence

Detailed Answer:
Hi

Polycystic kidney disease could be due to inheritance or it could be acquired. A CT scan will just say that there are multiple cysts in the kidney , it will not say whether it is inherted or Acquired.

You need to get the test I advised in my previous reply. You can consult a Nephrologist and ask for the test.

In inherited diseases there are some parameters called Gene Penetrance and Gene expressibility. The severity of the disease varies on this factor. It is too technical to explain. Just know that if two different persons are having same genetic then both will have different severity and different course of disease.

PKD is not death sentence keep getting tested as advised previously.

Hope this answers your query.

Regards

Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Divakara (7 hours later)
Dr.

Thanks for the response.

So there is a difference between inherited and acquired? The doctor will be able to tell how the disease will progress by knowing the defective gene? Is the inherited worse than than acquired?

I read that 60% of people by age 70 will reach kidney failure. Is that number accurate? What happens to the other 40%. Do their kidneys still enlarge due to the cysts or does the disease not progress fast enough to become a problem?

I also read that there are several treatments in 2nd and 3rd clinical stages. Is this true? If so, do you foresee treatments in 5 years that will slow the progression of the disease?
doctor
Answered by Dr. Divakara (3 hours later)
Brief Answer:
Acquired is usually milder.

Detailed Answer:
HI

Yes it's Renal Insufficiency not Kidney failure . Renal Insufficiency means there is will reduction in the functioning of kidney which can range from mild reduction causing no noticeable problems to kidney failure . The number is 70%.

In rest the cyst will enlarge but at very slow rate so that it doesn't hinder the functioning of Normal Kidney tissue. There are many people who lived throughout like with this disease and had no problems.

Yes if it is Inherited it's relatively worse than Acquired. And yes knowing what gene is affected we will be able to tell the progression of the disease to some extent. That's why I advised for PKD1 and PKD2 gene mutation test.

Present treatment is only directed to control the complications that might arise out of the disease . Other option is Surgical removal of Cyst if they are compromising the normal kidney tissue.

Yes certain medications are undergoing trial, but I will not comment of any experimental things . Once it becomes approved I will be very happy to use it and advise it .

Hope this answers your query.

Feel free to ask anything .

Regards.
Note: For further queries related to kidney problems and comprehensive renal care, talk to a Nephrologist. Click here to Book a Consultation.

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
doctor
Answered by
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Dr. Divakara

Internal Medicine Specialist

Practicing since :2006

Answered : 2358 Questions

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What Does Multiple Lesions In Kidneys In A CT Scan Indicate?

Brief Answer: It's Polycystic kidney disease Detailed Answer: HI Greetings from Dr.Divakara.P Thanks for choosing your Query. It could still be Polycystic Kidney disease, though it is an inherited disorder it might have not manifested in your family members or they might have not checked it. It seems like the disease is in it's milder variant so no need to worry. You just need to get Ultrasound Abdomen Scan or CAT Abdomen scan every year and Serum Creatinine test every 6 months . If still you want more confirmation you can do test for Mutation in PKD1 or PKD2 gene. Other possibilities are : Acquired Cystic disease, Simple Renal Cyst, Renal Cystic Neoplasm , Medullary Sponge Kidney. ( These are other diseases of kidney where cysts can be found ) Hope this answers your query. Any clarification feel free to ask . Regards.