9 year old MN Siamese 3 days anorexia and vomiting, hiding. Blood work shows severe azotemia. INitially unable to get urine, now UA pending (small bladder, urine appears dilute). Left kidney large, bright with surrounding edema and some minerlized areas that look like uroliths without causing renal pelvis obstruction; right kidnye atrophied w/ minimal blood flow on doppler. Suspect chronic stone passing…other rule outs pyelonephritis, lymphoma….? Can you please comment on what you see at the end of the arrow?
9 year old MN Siamese 3 days anorexia and vomiting, hiding. Blood work shows severe azotemia. INitially unable to get urine, now UA pending (small bladder, urine appears dilute). Left kidney large, bright with surrounding edema and some minerlized areas that look like uroliths without causing renal pelvis obstruction; right kidnye atrophied w/ minimal blood flow on doppler. Suspect chronic stone passing…other rule outs pyelonephritis, lymphoma….? Can you please comment on what you see at the end of the arrow?
Comments
I cannot speak to pathology
I cannot speak to pathology as I am not a DVM, but I see kidneys like this with FIP being a possible ddx as well. Is the unlabeled video of the RK or the LK in transverse? I’ll ping a SonoPath specialist to get an opinion on here for you!
It is the LK in transverse.
It is the LK in transverse. THank you for your input!
When I see a hypoechoic rim
When I see a hypoechoic rim around the kidney, especially with that history, my top two rule outs are renal lymphoma and FIP. I would check systemic blood pressure, PCV/TP, platelet count and FNA that kidney.
“Fluffy” kidneys like this
“Fluffy” kidneys like this are concerning for neoplasia vs. other. See this case with it’s own set of “fluffy” kidneys for comparison: https://sonopath.com/members/case-studies/cases/suspected-multicentric-lymphoma-12-year-old-mn-dsh-cat
You can get the subcapsular
You can get the subcapsular halo wiht obstructive disease and acute nephritis but its fluid and p doppler negative while that with fip and lsa the halo is vascularized. 25g fna of the cortex will help here.
In dogs you will see similar fluid with acute insults like lepto
Unfortunately the owner
Unfortunately the owner euthanized. The halo was p doppler negative during ultrasound. Post-mortem, I did an FNA of the cortex – there were some large degenerate cells that may have been lymphocytes, but were too degenerate to tell. They did not look like renal cells. I also took a sample from the renal pelvis that did not show infection. Apparently a related cat is also having azotemia. Wish owner would have approved necropsy/histo. What would your instinct be with what I’ve described, including the atrophied right kidney?
stone passer acute on
stone passer acute on chronic… the big kidney little kidney scenario is usually that… swollen grape to raisin progression and obstructive related dystrophy and degenerative atrphopy over time … The opposite kidney was likely the end stage version of prior insult similar to what you see in the left one here. Just once both are smoked beyond 60-% funciton threshold then you have renal failure. Was likely running on this kidney funciton til this stone and inflammatory issue started.
This is very common in cats and for sonographers its like “Oh heres another stone passer. Save the good kidney!” Keeps the interventionalists busy.
Tough gig for these cats.