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Recurrent burning senstaion while urinating, URINARY INFECTION.

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Case history:

Female 25 years, recurrent urinary tract infection initially for almost 6 months. Main problems: burning sensation while urinating and higher frequency of urination. Later on pain also developed on left side. She was treated with antibiotics for UTI during this period.

Later complete blood test, ct scan and ultrasound was done 5 months back as the problem was not going off.

CT scan showed focal lesion on left kidney and ESR was around 75 . Other parameters were fine. The doctor started TB treatment and she has een on it for past 4 months. The pain on left side has almost gone but burning sensation is still there an some time the increased frequency of urination as well.

The latest CT scan report shows:
right kidney shows normal attenuation , excretory function and corticomedullary distinction

left kidney :hypodense lesion seen at mid pole of left kidney measuring 3.1*2.6*4.3 cm in size following contrast the lesion shows hetrogenuos contrast enhancement
with few low denity non enhancing area
few enlarged left paratoric lymp nodes noted measuring upto 13 by 10mm in size

The ESR had reduced to 30 and then 25 in March.
Creatinine is 0.7 and Heamoglobin is 13.

We are worried about the lesion and why even after 4 months it is there. Please suggest.

Also attaching the blood test , urine and ct scan summary

Category: Nephrologist

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Category: Pediatric Nephrologist
 18 Doctors Online

Hello,
Thank you for your query at DoctorSpring.com
I understand your concern.
The hypodense lesion that has persisted, could also be a simple renal cyst which can be found in some adults and they do not cause any concern. Sometimes due to previous infections, there can be focal cysts or scarring. This needs every 6-12 monthly analysis and normally does not worsen. Since, she has been improving it is a positive sign. ESR has also reduced, so she has responded well to the TB medicines. What is her renal output now, or rather how is her urine now at present? Her latest urine report is also fine, so that is encouraging. For how many months has the doctor suggested treatment??
Kindly reply and I will get back to you,
Regards.


Patient replied :

Dear Sir,
Thanks for your response. The doctor has initially suggested 9 month of treatment. The main concern is that though clinically she seems to have improved with some weight gain and reduction in pain, the three CT scans which have happened in past 1 year are summarized below:
1. First CT scan was done almost a year back when UTI used to be the prime suspect based urine and culture test. That time it was mentioned that left kidney has some calcification
2. Later on for next six months multiple antibiotics were tried but the burning sensation continued and intermittent pain developed on left side. The second CT scan was done almost 5 months back and it showed some lesion on left kidney . The impression was written as focal nephritis and the size was given as 1.7cm x 2.1cm
3. The latest one which has been done showed bigger size that previous one though clinically she seems to have improved. I had attached the latest CT scan report in previous mail.
So the local doctor asked us to get the opinion of a nephrologist. The TB medication was started although the tests came out negative but the local doctor suggested that the success rate in TB identification has been limited and so as precautionary measure it was started in Jan 2015 .
Current urine reports are normal and even culture test are not showing any thing .
increase in lesion size has made us worry.
Please suggest.
Thanks & Regards Abhishek


Hello,
Sometimes, an a secondary formation can make the or symptomatic and prolongs the course of therapy. It looks like an abscess formation took place in the kidney locally and hence there appears to be increase in the size of the lesion. Mostly it disappears on its own or would require drainage of the abscess. Continue with ATT. Observe the lesion through ultrasound frequently, if it fails to decrease or increasing in size, it can be drained. Done times the lesion can be an unrelated entity and needs to be observed carefully. Can you send the original report of the last scan once as I couldn't find that out here.
Regards,
Dr. Raju


Patient replied :

Dear Sir ,
The local doctoe asked for more detailed report from Lab. They have provided upgraded report in which states the following
Impression:
1. Predominantly Exophytic solid enhancing lesion with areas of necrosis/liquefaction at mid pole
of left kidney-possibly Renal Cell Carcinoma
2.Enlarged Left Paraortic Lymph node-?Metastatic
3.No evidence of renal vein or IVC thrombus at the present scan
4.Cortical Scarring at mid pole of left kidney-likely chronic sequel infection
All other organs are fine.
The doctor is suggesting partial nephrectomy. Should we wait for another CT after 15 days or should be go with surgery straight away.
Please suggest.
Thanks
abhishek


RCC can be diagnosed by CT scan and if it were to be RCC, the treatment protocol should be implemented immediately. RCC treatment has become easier with the advent of newer drug therapies despite the case be being advanced and metastatic. You please plan for PET scan if possible and available in your locality and go ahead with surgery as early as possible. Please get back to me all reports as and when you get them including histopathology report later.
Regards.


Dr. Sree Bhushan Raju
Category: Pediatric Nephrologist
Experience: 
FISN : Fellowship of Indian Society of Nephrology(ISN), 2012
FIACM : Fellowship of Indian Association of Clinical Medicin(IACM), 2012
FICP: Indian College of Physicians Association of Physicians of India, 2012
Fellowship: DM, DNB, All India Institute of Medical Sciences, New Delhi, 2002
Residency: MD, General Medicine, Nizam's Institute of Medical Sciences, 1998
Medical School: MBBS, Gandhi Medical College, 1994
Dr. Sree Bhushan Raju and 4 other Medical Specialists are ready to help you

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