Mitti is a 13 year old male neutered cat with a history of urinary bladder obstruction years ago. He has been on SO diet and not had other related urinary tract concerns. He also has a history of feline asthma and is currently on 2.5 mg prednisolone three times weekly.
Mitti stopped eating and had intermittent vomiting over the last week. Tender on palpation of the kidneys during PE. Current blood work shows a BUN in the 200’s, creat 14, phos 16, K is 5, no anemia. Blood work otherwise unremarkable.
Mitti is a 13 year old male neutered cat with a history of urinary bladder obstruction years ago. He has been on SO diet and not had other related urinary tract concerns. He also has a history of feline asthma and is currently on 2.5 mg prednisolone three times weekly.
Mitti stopped eating and had intermittent vomiting over the last week. Tender on palpation of the kidneys during PE. Current blood work shows a BUN in the 200’s, creat 14, phos 16, K is 5, no anemia. Blood work otherwise unremarkable.
I’m concerned that the right kidney looks like hydronephrosis, but is not enlarged (left is actually enlarged at 4.7 cm) and I could not find any distension of the mid and distal ureter (3 mm distension of proximal ureter w/o any stone found). There is a shadowing renolith in the right kidney and some mineralization on the left. The right kidney looks like it has a medullary rim sign and the left cortex looks very bright to me. He is indoor-outdoor, so toxin exposure is a potential. UA showed an active sediment with a pH of 6.5 and isosthenuria pre fluids. After 24 hours, he looks brighter and is more comfortable, but very concerned I am missing something (treating him as an acute infection on chronic renal disease with renoliths). He is currently very polyuric, urinating more than we have been giving intraveneously (and from images, showing evidence of some third spacing).
Comments
That’s an ugly kidney… I
That’s an ugly kidney… I see this when they pass a stone get bad hydro and has pericasular-retroperitoneal fluid from the damage/inflammation. The pelvic fat is ill-defined suggestive for pyelonephtiris. Ideally this is a SUB case. They used to do stents but found that IR Subcutaneous Ureteral Bypass is less invasive and more effective. Chick Weiss and Allyson Berent are the tops at this at AMC. Ideally needs dialysis and SUB and support ARF in the meantime… BP, Fluids, GI protect and you can do an us-guided pyelocentesis temporarily to decompress and culture the pelvis. 25g but do a BP first and coag as hypertensive kidneys can bleed and if he is septic then coag may be off as well…. usually doesnt stop me anyway on a 25g needle or ewven try a 27 but that wont pull pus if that what is in there. But have to cover bases. That renal pelvis needs decompression. Cool case
Thank you, Eric! Sorry to
Thank you, Eric! Sorry to ask this, but hasn’t amitryptiline been tried for passing ureteral stones if owners aren’t game for all of above? Any experience with this?
I do not know of that tx.
I do not know of that tx. Typically stones up to 0.3-0.4 cm can pass according to Berent et al but there is a lot going on in that kidney. have tpo hope the otehr can compensate. Have to play the renal numbers 72 hours of tx and lots of pain management and decompress and hope for the best. But the SUB etchnique was designed for these types of cases.
Maybe Remo knows of amytrip tx
Amitryptiline usually used
Amitryptiline usually used for interstitial cystitis and have not come across its use for ureteroliths.