Nodule on my Kidney

[Recyclerz]

Hi Dr. Steve

I would appreciate your best guesstimate on this.

In response to tests showing microscopic levels of blood showing up in my urine for awhile, my primary care Dr. ordered a high contrast abdominal CT scan which showed this:
"A hyperdense nonenhancing nodule vs. cyst involving the midpole of the left kidney" measuring about 2.5 cm all around. Apparently the choices are solid neoplasm (tumor), hemorrhagic cyst or proteinaceous cyst. After poking around a bit on medical sites, I feel like I have a handle of what each of those scenarios will entail but I can't find anything on the likelihood of each being the reality. Here's my demographic profile which I assume will help you assess the odds - 47 y/o white guy, nonsmoker, overweight but not obese. I have HBP which is in the normal range with meds. I worked for many years (~15) in environmental remediation but did not have much real exposure to hazardous or industrial chemicals without protection, mostly office stuff with occasional trips to the field.

My questions are this: what is the ballpark estimate on the growth being cancer given the above? (I gotta admit that "hyperdense nodule" is sticking in my craw and making me consider whether I should start getting rid of my porn collection now.) My PCP seemed a little spooked and I didn't want to press him on the point at the time. Also, he recommended a visit to a urologist/surgeon (which I'll be setting up ASAP) but wouldn't it make sense to set one up with a nephrologist as well, or is this kind of thing in the wheelhouse of a urologist as a routine part of that job?


Anyway, thanks for any light you could bring to this for me.

[ToiletCrusher]

You'll be fine.

[Dr Steve]

Hi Dr. Steve

I would appreciate your best guesstimate on this.

In response to tests showing microscopic levels of blood showing up in my urine for awhile, my primary care Dr. ordered a high contrast abdominal CT scan which showed this:
"A hyperdense nonenhancing nodule vs. cyst involving the midpole of the left kidney" measuring about 2.5 cm all around. Apparently the choices are solid neoplasm (tumor), hemorrhagic cyst or proteinaceous cyst. After poking around a bit on medical sites, I feel like I have a handle of what each of those scenarios will entail but I can't find anything on the likelihood of each being the reality. Here's my demographic profile which I assume will help you assess the odds - 47 y/o white guy, nonsmoker, overweight but not obese. I have HBP which is in the normal range with meds. I worked for many years (~15) in environmental remediation but did not have much real exposure to hazardous or industrial chemicals without protection, mostly office stuff with occasional trips to the field.

My questions are this: what is the ballpark estimate on the growth being cancer given the above? (I gotta admit that "hyperdense nodule" is sticking in my craw and making me consider whether I should start getting rid of my porn collection now.) My PCP seemed a little spooked and I didn't want to press him on the point at the time. Also, he recommended a visit to a urologist/surgeon (which I'll be setting up ASAP) but wouldn't it make sense to set one up with a nephrologist as well, or is this kind of thing in the wheelhouse of a urologist as a routine part of that job?


Anyway, thanks for any light you could bring to this for me.



Ok, first off, I know this stuff is scary, so the first thing to know is that there IS A PLAN. So far, your doc seems to have done everything right...a little blood in the urine that doesn't go away warrants imaging of the urinary system. A nodule warrants further investigation.

Urologists are surgeons of the urinary system, Nephrologists are medical doctors of the urinary system. I think either one can order the definitive test for this, which would be a CT-directed needle biopsy of the nodule itself. This is a generally safe and minimally invasive test that will give all the information they need to proceed.

I can tell you that there are only 30,000 cases of Renal Cell Cancer in the US every year, and it's 2% of the total number of cancer cases. This means this nodule could very well be benign. If it's not, it's very treatable. 96% of people with early renal cell cancer are cured.

so either way, you run an overwhelmingly good chance of being ok. One route (the benign nodule) is easy, the other will require more pain in the ass but the eventual outcome is likely to be the same.

Get it checked out and let us know how you're doing, ok? You can email me anytime at drsteve202 at gmail dot com anytime.

your pal,



steve

[HBox]

Good luck Recyclerz. I know your own mind has to be driving you crazy at the moment.

[Recyclerz]

Thanks Buddays. I saw the urologist last week and he was leaning towards hemorrhagic cyst since the image on the CT scan didn't "light up" which may indicate that its not a tumor (since they have blood flow and the radioactive juice didn't seem to pass through.) I'm scheduled for another CT scan in a few months then, if it is still "suspicious", the biopsy is up next.

The main reason I'm bummed about this is that selling a kidney was my plan B for getting my retirement accounts back in shape. I don't think that rich and sick Asian guys are going to pay as much for a sub-prime organ*.


* Yes I'm talking about the kidney.