Case Study

Ureteral calculus and hydroureter in an 8 year old FS DMH cat

An 8-year-old female spayed DMH cat with a history of possible urinary bladder stones and/or kidney stones was presented for evaluation. The clinical examination was uneventful. Urinalysis showed an inappropriate specific gravity, proteinuria, and hematuria. CBC was normal.

DX

Right hydroureter, ureteral and bladder calculi. Mild hydronephrosis.

Sonographic Differential Diagnosis

Right hydroureter and passing calculus. Mild hydronephrosis 1 x 0.5 cm. Chronic interstitial nephrosis pattern in both kidneys.

Image Interpretation

The urinary bladder presented slight concretions without shadowing. Two small bladder calculi, the largest of which measured 0.56 cm, were noted in this patient. They presented minor shadowing. There was also a calculus within the right ureter with similar minor shadowing. The kidneys demonstrated renal fibrosis and a chronic interstitial pattern. The right kidney presented mild to moderate pyelectasia and contained a calculus within the medulla. The right kidney measured 2.57 cm. The left kidney measured 2.8 cm. Right hydroureter was also noted with a 0.14 cm concretion at the level of L4. Secondary hydroureter stricture may be an issue in this patient as well. Right kidney pelvic dilation measured 0.5 x 1.0 cm.

Outcome

72 hour IV fluid protocol would be recommended or potential interventional radiology and stent placement. The calculus in the right ureter may be small enough to pass into the urinary bladder. Alternatively, fluoroscopy-guided stent placement can be considered at Animal Medical Center with Dr. Allyson Berent in order to maintain urine flow within the right kidney. Blood pressure measurements would also be warranted. A recheck sonogram after 72 hours of fluid therapy would be ideal in order to assess if the stones have passed into the urinary bladder and if pyelectasia is still present in the right kidney.

Comments

No further outcome provided.

Clinical Differential Diagnosis

Bladder pathology (interstitial cystitis, uroliths, bacterial cystitis, neoplasia), ureter pathology (urolith), renal pathology (renolith, neoplasia, pyelonephritis).