A 14-year-old MN DSH cat with a history of UTI’s, bladder calculi, and PU surgery 2 weeks prior, was presented at referral facility for ultrasound evaluation of ureteral stones. On physical examination a heart murmur and general muscle atrophy was present. Abnormalities on CBC and blood chemistry were leukocytosis, monocytosis, neutrophilia, elevated creatinine, hypoproteinemia, and hyperglobulinemia.
A 14-year-old MN DSH cat with a history of UTI’s, bladder calculi, and PU surgery 2 weeks prior, was presented at referral facility for ultrasound evaluation of ureteral stones. On physical examination a heart murmur and general muscle atrophy was present. Abnormalities on CBC and blood chemistry were leukocytosis, monocytosis, neutrophilia, elevated creatinine, hypoproteinemia, and hyperglobulinemia.
Case Study
06_00027 Fluffy W Renal and ureteral calculi *BK* ——NEEDS NVC—SEE C—
DX
Sonographic Differential Diagnosis
Severe left kidney hydronephrosis. Minimal residual functional parenchyma. Chronic ureteral obstruction. Chronic degenerative right kidney changes with mineralization. Chronic active pancreatitis. Urinary bladder sand and wall thickening with thickened urethra.
Image Interpretation
The left kidney presented severe hydronephrosis with 3 x 2 cm dilation of the left kidney. The left kidney measured 5.8 cm. The left ureter was dilated at 0.7 cm near the renal pelvis and 0.5 cm at the level of L4. Multiple calculi appeared to be embedded into the ureter. The thickening seemed chronic and polypoid, which is indicative of long term obstruction. The ureteral calculi measured 0.42 and 0.46 cm. The urinary bladder presented concentric thickening with a minor amount of bladder sand. The pelvic urethra appeared thickened with micropolypoid changes at the cystourethral junction.
Outcome
The patient presented 3 weeks post-operative and the owner reported him to be doing very well. Physical examination was within normal limits. Recheck urine culture one week after finishing the antibiotics was recommended
Comments
NVC of hydroneph
Clinical Differential Diagnosis
Urinary tract – bacterial infection, neoplasia, calculi, stenosis, trauma. Neoplasia, cardiomyopathy, peritonitis secondary to urinary tract disease.
Sampling
The patient was recommended for left nephrectomy, ureterectomy, culture and biopsy of the bladder wall, and antegrade flushing of the urethra with interventional radiology to place a urethra and ureteral stent given as an option. Instead, ureterotomy, left nephrotomy, and cystotomy were performed and the patient recovered uneventfully. Initially the urea and creatinine improved but began to worsen 24 hours post-operative. He was subsequently treated with Baytril and discharged two days later as the urea/creatinine was improving. Stone analysis: Calcium Oxalate 100%
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