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  Thursday, 18 January 2024
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Hello, sorry if this is a long post. I appreciate any experts taking time to read this, I have been severely stressed recently regarding this and it has began to impact my day to day life.

I'm a 25 year old Male. No known health conditions pre existing and nothing of note in my family history on both sides.

At age 24 I was sent to A&E with pain, this turned out to be a 5mm stone leaving my left kidney on non contrast CT. Before this I was drinking an average of 3 to 4 Pepsi Max's a day, maybe even 1 large redbull energy drink or monster energy per day. Very little water.

I suddenly stopped drinking this rubbish and to this day drink 3 LTRs of water a day approx. Soon after this stone due to my career plans I had to go get an ultrasound to show I had no stone left. The ultrasound however detected a kidney Cyst. This was called somewhat complex and I was told to have an MRI.

Fast forward a few months I have a Contrast MRI. This MRI was done using gadolinium. The results were basically calling the cyst on my right kidney a 1.8cm bosniak 2F cyst. It added I also had a 1.2cm Bosniak 2 cyst on my left kidney. The report was very vague and when I spoke to the urologist he said it was perhaps rushed over. But he was happy that I should get another MRI in 6 months to check this cyst on my right kidney only.

Fast forward 6 months.

I go get my MRI, this time it was also contrast and the report came back in a very detailed and thorough layout.

[b] Right kidney: Normal in size, simple Bosniak 2 cyst noted on mid interpolar region, this is unchanged in size (1.8cm) and has thin slightly enhancing wall with no nodular on the preceding CT scan R.E renal stone past. Thin septation with slight enhancement, this is consistent with a Bosniak 2 cyst.

Left kidney: Normal in size, again in comparison to the previous scan for comparison there is a 1.2cm cyst on left mid pole. Thin slightly enhancing wall and thin septation.This is consistent with a Bosniak 2 cyst. Tiny Bosniak 1 cyst noted.

Liver: Normal

Impression: 1.8cm simple Bosniak 2 cyst in the right kidney, 1.2cm simple Bosniak 2 cyst in the left kidney. Both unchanged and very much stable.

So after getting this result I was discharged from the urology clinic and told I was good. However I have pretty anxious mind and one part concerned me. The part where the radiologist said "tiny Bosniak 1 cyst noted". Why would that be so vague and not mentioned in the impression. Is it a mistake or a typo, did the last radiologist not see it?, is it new? I try to tell myself it was probably just not seen and is maybe insignificant?

My worry is the following and I'd really appreciate anyone taking time to assist me here.

I'm 25 (24/25 at scans) and I am terrified I could have ADPKD? It would literally stop my career and I would lose alot. I have read mixed things, some say if someone has less than 5 cysts after 20 (MRI SCAN) they don't have PKD and others saying to PKD using an MRI you would have at least 20 cysts greater than 5mm.

But I just would like to hear what a neph thinks. I obviously am a worrier and perhaps to some seem silly, but in my mind I'm wondering could 2 or 3 cysts detected on an contrast MRI at age 25 be PKD? or am I being silly.

Note that I have no family history of diseases like kidney failure etc, I also have blood pressure of about 125/80 or sometimes less.

If it is of any relevance I used to take tetracycline, lymecyline for acne in teenage years. I also took Roaacutane/isotretinoin for acne. I heard links between kidney problems and this? Other than that I used to binge on energy drinks and wonder would this cause damage.

Thanks for anyone who read and takes time to give me a chance at understanding more.

Appreciate it.:)
4 months ago

A Bosniak 1 cyst is considered simple with no malignant potential. That is probably why the radiologist glossed over it. It is a very incidental finding. Stable Bosniak 2 cysts are also very low malignant potential and it is reassuring that they have not changed in size and appearance for the most part. Out of an abundance of caution you could have periodic reimaging of these cysts but my prediction is they will never bother you.

As for ADPKD, without a family history of this disease, it is exceedingly unlikely that these cysts represent ADPKD. There is no comment on the size of the kidneys but I imagine if they seemed inappropriately large, they may have commented on that. With that said, it would be very unlikely for the kidneys to be enlarged on the basis of so few cysts. therefore, I think these are sporadic acquired cysts that are not related to an underlying kidney disease per se. I am assuming you have normal kidney function?

Dr. Jordan Weinstein
4 months ago
Hello Dr,

Thank you firstly for such a swift and thorough response.

Apologies, I forgot to add. The ultrasound said my left and right kidneys were : 11.2cm and 11.3cm respectively. I am 6ft 2 and have a BMI of 20 if that makes any difference size wise.

I appreciate you giving me information on these cysts, I am glad to hear that they were benign and the urology doctor expressed similar view.

Would you say these cysts could be linked to lifestyle, medication, infection etc? Or sporadic in the sense they just have always been there? Thank you.

In terms of bloods, I was told my kidney function was normal, all the ranges were normal.

The only thing I forgot to mention was I once did have a blood test for another matter that detected abnormal TSH and T4 which made the Doctor suspect possible hyperthyroidism. This was checked and a scan revealed a few tiny thyroid nodules. The TSH and T4 returned to normal soon after and this was put down to transient causes.

I read thyroid can sometimes effect kidney. Could the cysts even be related to some kind of thyroid imbalance or something, I was also once deficient in Folic Acid. My diet and health is much better now.

Thanks so much, I am glad to hear an expert such as yourself feels this is not ADPKD.
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