blood in urine with low back pain

[dona__0__0]

  About a year ago I was feeling tired and bruising easily. Abnormally high white cell count. Leukemia test, anemic test both negative. At the same time microscopic blood
  found in urine. urologist did cystscostomy
   IVP, ultra sound with negative results. Another urologist sent me for a CT scan. A small cst was found on my right kidney about a month ago. Doctor was not concerned. Three days ago I started having severe pain in the right side of my back with pressure radiating lower and around to my groin area. My personal Dr. said possible kidney stones. I have an appointment with an urologist today.
   Shoud I be concerned with the cyst? My brother was diagnosed with IGA nerophothy 15 years ago. Should I be tested for this?  

[HFHS M.D.-JJ]

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Dear Donna:
Hematuria is a condition where blood is detected in the urine.  It may be “microscopic” (blood cells only seen under a microscope, or “gross” where the blood can be seen with the naked eye.  Some problems that can lead to hematuria may include a urinary tract infection, stone in the urinary tract, mass (cancer?) or lesion in the urinary tract, or many other etiological lesions some of which may be benign. The typical urological work-up includes cystoscopy and an intravenous peylogram (IVP) to rule out any problems in the upper urinary tract (kidneys and ureters) or lower urinary tract (bladder and urethra).  Some urologists will order a renal ultrasound instead of an IVP if there is any contraindication to IV contrast administration.  Renal ultrasound is more sensitive at detection of kidney cysts.  Ct scans are very sensitive at detection of both kidney stones and any possible larger lesions or masses.  
Flank and abdominal pain may be associated with hematuria in a variety of situations.  This includes kidney stones or any mass (cancerous or benign) in the kidney or ureter.  It would be difficult to say exactly what the cause of hematuria and pain would be until a lesion or stone is detected on a diagnostic study.  On the other hand pyelonephritis (an infection of the kidney) is unlikely as it usually involves fevers in addition to the above mentioned symptoms.
I can not evaluate your specific situation.  However, it sounds like you have undergone a variety of tests and work-up (certainly more than the usual for hematuria alone, but appropriate in the setting of pain, etc.) without any specific finding except this possible renal cyst.  I would suspect that the cyst should have shown up on the ultrasound if it were there, or may be too small to see.  In any case, most cysts are considered “simple cysts” which are benign.  Therefore, most likely, you do not need to worry.  However, your urologist who can evaluate you in person, would be the best person to make that judgment.  A nephrologist (kidney specialist) would be the best person to evaluate any kidney problems such as IgA nephropathy which could also be a cause for blood in the urine.  I hope this sheds some light on your situation.  Wish you the best.
This information is provided for general medical education purposes only.  Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653 6568).
Sincerely,
HFHS M.D.-JJ
*Keyword: hematuria, renal calculus disease, kidney cancer