Micro blood in urine

[carkosh10]

I am a 60 yr old female.  Several yrs ago I was dx'd with 2 renal simple cysts (1 ea kidney) about 9mm each.  I went to a well known medical campus close to my home town because the drs in my small town couldn't agree about the cysts being simple or complex.  An Assoc Prof of Urology was the one who dx'd them as simple after a couple of CT scans at that facility.  There was also found a small non-obstructing stone in my left kidney.  This dr & I didn't discuss the stone much as he is a urology cancer specialist & I was at that time much more worried about the cysts.

In my early 20's I did develop 2 renal stones, one I passed without much difficulty; the other with typical horrible pain.  My dad had many stones so there is family history concerning stones.  Until this stone found on CT a few yrs ago I haven't had another one.  I don't know if I ever passed that stone; it was, thankfully asymptomatic.

Last week I had my yearly physical &  micro blood was found in the urinalysis.   My dr ordered a culture & it is negative for infection. I did have some right flank pain start last night through today, although its not horrible so I have no idea if its just a muscle problem or is related to any stone I might have.  My bladder feels a little uncomfortable but I've had no trouble urinating & its not unduly frequent.

My dr. has now ordered a renal US & a referral to a Nephrologist.  My questions are: (1) is the US the correct test instead of CT (2) is a Nephrologist the correct specialist vs a Urologist; (3) can simple cysts cause micro blood?

Thank you for any info.

[carkosh10]

Hello Sir,  I have another question.  I had the renal US first (my dr was out of town, couldn't discuss with him about having the Ct scan so I went ahead with the US).  It showed a 3.4 cm hypoechoic to slightly isoechoic lesion in left kidney.hilum area.  A .04x.06 cm stone was found in right kidney.

I then had renal CT scan with contrast.  It reads "a 5mm hypodensity is seen on initial contrast enhanced phases within the left kidney is not seen on subsequent slices and statistically favors cyst.". I have known about the cyst for several years.  At bottom of page under Impression it says: " Liver & kidneys without significant abnormality".  It also showed some gallstones which I believe should have nothing to do with the urinary system unless these stones can cause micro blood.

I'm a little confused about which test to believe although I tend to trust CT scans vs US but I'm definitely not a medical expert.  I certainly want to go with the CT results as the report is much better than the US report.

My question to you is what should be my next step if any.

I again appreciate your time.

[carkosh10]

Thank you for taking the time to answer my questions.  I thought stones might be the issue; will have to see.  But I think your advice is the way to go about this; will be talking to my dr today..  Again, thanks so much!

[Rajiv Goel, MD]

Dear carkosh10,

Thanks for posting your query.

Your areas of concern are simple cysts, renal stone, pain and the microscopic hematuria.

1. A computerised tomography scan (CT scan) of the kidney-ureter-bladder region, or even a contrast study will be a better investigation than an ultrasonography of this region.
2. An urologist rather than a nephrologist would be a better person to see.
3. Simple cysts shall not cause microscopic hematuria. In all probability, the renal stone you have had is creating trouble. It is the cause of your pain, slight urinary difficulty and the microscopic hematuria. I would suggest that you should be started on alpha blockers under the care of your physician.

Hope that this information helps and hope that you will get better soon.

Thank you for using MedHelp's "Ask an Expert" Service, where we feature some of world's renowned medical experts in their fields. Millions have benefitted from our service to get personalized advice for them and for their loved ones.

Best Regards,
Dr. Rajiv Goel