Case Study

Polycystic kidney disease in a 7 year old MN German Shepherd Dog with a history of prostatic disease

A 7-year-old neutered male German Shepherd with history of prostatitis, prostatic hypertrophy, pyelonephritis, renal cysts, and recent neutering was presented for follow-up visit to check renal values. He was currently eating the K/D diet. Physical examination and CBC were both within normal limits. The urine was cloudy and red in appearance, and revealed isosthenuria, 3+ proteinuria, 3+ hematuria, and leukocyturia on analysis. Urine culture yielded no growth. The only abnormality on blood chemistry was elevated creatinine. Blood pressure measurement was 161/106.

DX

Polycystic kidney disease with moderate to end stage degenerative changes. Corticomedullary calculi.

Sonographic Differential Diagnosis

Polycystic kidney disease with moderate to end stage degenerative changes. Corticomedullary calculi.

Image Interpretation

The kidneys bilaterally presented multiple, anechoic cystic cortical changes with corticomedullary calculi and disrupted renal pelvises. The kidneys were significantly enlarged at 9-10 cm overall length. Power Doppler signals were significantly subnormal bilaterally. Subjectively, there was minimal functional parenchyma in the left kidney. The right kidney presented similar cortical cystic changes with moderate degenerative residual parenchyma. Corticomedullary calculi were also present. These changes are most consistent with congenital progressive polycystic kidney disease and secondary degenerative disease. The cortical cysts presented some echogenic content, which is suggestive of residual inflammation and potential suppurative cavitation.

Outcome

Renal biopsies were discussed to obtain a definitive diagnosis. Blood pressure monitoring, low dose aspirin, broad-spectrum and pulse antibiotics, as well as ace inhibitor therapy were all suggested as treatments. A guarded long-term prognosis was given.

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Clinical Differential Diagnosis

Renal disease – pyelonephritis, neoplasia, urolith, early chronic kidney disease. Unresolved prostatic disease – abscess, chronic prostatitis, neoplasia. Bladder pathology – neoplasia, urolith.