Renal azotemia with inactive sediment in a 1 year FS DSH with some dec. appetite, intermittent V/D and systolic grade III heart murmur. BUN 36, creat 3.5, SpG 1.022, HCT 43 w/ normal K. Prev hypertension 194 systolic. Puzzled by the dilated renal pelvis on left without active sediment and no visible mineralization. Could trace proximal ureter, but lost it. Ureteral papilla is pronounced on that side. Right looks more like chronic infarcts with the hyperechoic wedges and I do appreciate mineralization there.
Renal azotemia with inactive sediment in a 1 year FS DSH with some dec. appetite, intermittent V/D and systolic grade III heart murmur. BUN 36, creat 3.5, SpG 1.022, HCT 43 w/ normal K. Prev hypertension 194 systolic. Puzzled by the dilated renal pelvis on left without active sediment and no visible mineralization. Could trace proximal ureter, but lost it. Ureteral papilla is pronounced on that side. Right looks more like chronic infarcts with the hyperechoic wedges and I do appreciate mineralization there. Quick peak at heart did not show hypertrophy, but didn’t do full echo. Thoughts? Antihypertensives, urine culture, antibiotic trial?
Comments
Sorry for the delayed
Sorry for the delayed response.
The kidneys have essential maintained architecture and appear to be within normal limits for size with the right kidney slightly subnormal in size compared to the left. The right kidney does appear to be more chronic than ther left with cortical infarcts and mineralization. There is some degree of increased echogenicity around the renal pelvis and sinus in both kidneys. I would put bilateral pyelonephritis at the top of the differentials with possible scarring or dysplasia possibly from calculi passage (although no signs of sediment or calculi in the bladder may make calculi passage less likely).
Antibiotic trial ideally based on C/S. The C/S may be negative on a sample from the bladder due to lower urinary washout. Pyelocentesis looks like it could be done to get a sample directly from the dilated renal pelvis for C/S.
Empirical treatment with a fluoroquinolone would be warranted in my opinion with monitoring of the azotemia. PRN fluid therapy and monitoring blood pressure. UPC may also be considered to assess for renal protein loss (>0.4 UPC value is considered significant in a cat).
Thank you for your input!
Thank you for your input!
This is likely a stone mover
This is likely a stone mover with resultant infarcts and renal pelvic scarring. Pyelectasia is not synonymus with pyelonephritis. You will see it in stone movers often likley the pelvis scars or strictures trying to move stones similar to why u paps get thick in stone movers as well.
Thanks, Eric. Any tips on
Thanks, Eric. Any tips on identifying the stone-ureter just tapered off? Do you ever try amitryptiline and fluids in these cases to see if can medically manage stone movers? Without crystaluria or significantly abnormal pH on UA, any long term management recommendations you’d have? The cat is hypertensive, so I think amlodipine couldn’t hurt.
Majority of stones are either
Majority of stones are either struvite or calcium oxolate. Dietary dissolution using either Royal Canin Urinary or Hills c/d can address the liths, however, the problem is that the amount of urine surrounding the urolith in the upper renal tract is too small for dietary dissolution to be effective.
Amilodipine is indicated. Has hyperthryoidism been excluded?
Yes, thyroid was WNL
Yes, thyroid was WNL