### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
Female age 56, stage 4, diagnosed 10 yrs. ago. Runs genetically in the females of my family. Been to many different specialists including a study at Brigham/Womens, Boston. Finally found a younger MD, whom Im relieved to progress my issues with. My question is, had a rt kidney biopsy a week ago today, she said the preliminary patChatDoctore back with a lot of scarring of the tissues. Just to continue on wait and watch. I also have a complex cyst on that same kidney, that warranted an MRI but, cancelled due to lab work. What does the scarring suggest? Does that mean stage 5 or renal failure is rt. around the corner? What suggested sites should I be searching? Ty

### output:

Welcome to Chat Doctor dear. Thanks for the question. I would like to answer your question in two parts 1. Explanation of physical findings on biopsy -You may already know that each kidney contains about a million tiny filters (called nephrons). We all have damage to these filters after the age of 40 years due to normal aging process. Some of us have excess damage due to various different conditions (diabetes, high blood pressure, genetic kidney disease, etc.) The scarring (this is the term we use to explain to common man) that was seen on your kidney (I suspect it most likely means filters) is the end result of longstanding damage due to any cause. So, the scarring tells us that there is no active disease to treat now. The complex cyst in the kidney may/ may not be related to the general ongoing slow damage to your kidney and MRI is the right way to assess any complex cyst.2. Functional status of your kidney -The staging (Chronic Kidney Disease stage 1 to 5) is based on blood test (creatinine and EFR) and might not tally well with the physical findings of kidneys on scan or biopsy. Your nephrologist will monitor this regularly. Once EFR goes below 15 we class patients as CKD stage 5. Dialysis or transplant usually become necessary when EFR goes below 10. Hope the above clarifies your doubts.