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Nephrology/MCD and Blood in Urine

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Question
50 yr old male. I was diagnosed with MCD last spring and have been taking cyclosporine lately. I've had urine and blood tests every six weeks. The last three urine tests have shown microscopic amounts of blood. My neph sent me to a urologist to rule out other issues and the resulting CT scan showed a small simple cyst on the lower right kidney. Could this be the cause of the blood in the urine?

Urine test last week continued to show proteinuria and hematuria, but now trace ketones are present too. Renal function panel all came back in normal reference ranges. Not sure if the ketones are something to worry about now or if they help solve the puzzle.

Answer
Good morning, Dash,

I am going to assume (always a dangerous proposition) that by MCD you mean "minimal change disease". I call (as do all of my colleagues) this kidney disease "minimal change glomerulopathy". It is always best to use the full unabbreviated term when communicating medical information.  Mistakes are, then, less likely to happen.

Minimal change glomerulopathy is quite uncommon in adults but certainly and, obviously, does occur. Additionally, blood can often be seen under the microscope (microscopic hematuria) in this disease.  However, it is always wise to "cover the waterfront" and a urology consultation to investigate other causes of hamaturia is certainly appropriate, especially if you are a smoker.

The short answer to your question is "NO.". Simple renal cysts do NOT cause hematuria.  They are almost always benign (if they are, in fact, SIMPLE) and do not result in ant other abnormalities.  They are extremely common and require no further evaluation. I have one that was found forty years ago.

Hematuria is one of the two major red flags in kidney disease, the presence of proteinuria, being the other. Bladder, kidney and other urinary tract malignancies are causes of hematuria and, in your case, need to be excluded.  This is why you were sent to a urologist.  He/She is best qualified to exclude these conditions.

Cyclosporine can cause kidney disease but generally, it is not associated with hematuria.

You did not ask a question regarding the ketones in your urine (ketoneuria) but if the urine specimen was obtained during a fasting state or even just prior to your next meal, ketones are often present.  They are the result of the body's use of fats for nutrition.  You WANT to see them if you are on a diet because they signify that the body is burning fat.  It is common to see them and they have nothing to do with kidney disease.

I hope this is of some help to you.

Please, feel free to follow up if anything is unclear or you have any other questions.

Good luck.

Sincerely,

Dr Falkinburg

Nephrology

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Newell R. Falkinburg, M.D., FACP

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I am a board certified nephrologist and emeritus professor of medicine at a major medical school and past Director of Nephrology & Hypertension at a university affiliated hospital. I have expertise in all areas of clinical nephrology, dialysis, transplantation and plasmapheresis.

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Professor of medicine Director of Nephrology

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