Renal mineralization vs. renolithiasis

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Renal mineralization vs. renolithiasis

  • 10 year old mn DSH presented for urethral obstruction 3 days ago.
  • Small stones were flushed out of the bladder and stone analysis is pending.
  • Abdominal radiographs abnormal kidney size, shape, and renolithiasis.
  • Abdominal US was done to look for any obstructive renal stones.
  • The left kidney shows multiple, small stones with minor renal pelvic dilation.
  • Both kidneys are normal in size (4.0-4.4cm) but both have scalloped renal capsules.

    • 10 year old mn DSH presented for urethral obstruction 3 days ago.
    • Small stones were flushed out of the bladder and stone analysis is pending.
    • Abdominal radiographs abnormal kidney size, shape, and renolithiasis.
    • Abdominal US was done to look for any obstructive renal stones.
    • The left kidney shows multiple, small stones with minor renal pelvic dilation.
    • Both kidneys are normal in size (4.0-4.4cm) but both have scalloped renal capsules.
    • The right kidney shows a nonshadowing echogenic density in the renal crest. What is this? Renal crest mineralization? fibrosis? stone?

Comments

EL
December 15, 2014 at 10:28 pm -

The left kidney has focal

The left kidney has focal pinpoint mineralization that could be fibrosis to start but you see it so often I just call it dystrophic mineralization-non obstructive but could describe it in many ways and you never know when these are going to  travel into the pelvis>ureters>bladder.

The RK pelvis has an overt stone in position to move into the ureter. Up to 0.3-0.4 cm stones will move through the ureter if the ureter is healthy and then into the u-pap and into the bladder but may lump things up along the way, cause temprorary hydronephrosis, ischemic necrosis, infections and so you get what I call the grape to raisin kidney scenario and big kidney little kidney thing escpecially in cats. Interstitial nephrosis and infarcts are the usual sequelae.

Here’s what I have seen over an dover and over ad nauseum through the years:

Scan one day the stone is in the CM junction, then another day its in the pelvis, then the cat goes anorexic because of ureteral passage (making the vet think pancreatitis or neoplasia) and you come in for the scan and the stone is now in the bladder. The vet does the cystotomy stone analysis…. then you scan again in a month and another stone is there making the vet think he/she missed one when its likely another stone moved down the pipe from the kidney…. Long hypothetical scenario and many variations but you get the idea. If you search calculi in the general search you will see tons of variations of this story along with biliary calculi.

http://sonopath.com/members/case-studies/search?text=calculi&species=All

EL
December 15, 2014 at 10:28 pm -

The left kidney has focal

The left kidney has focal pinpoint mineralization that could be fibrosis to start but you see it so often I just call it dystrophic mineralization-non obstructive but could describe it in many ways and you never know when these are going to  travel into the pelvis>ureters>bladder.

The RK pelvis has an overt stone in position to move into the ureter. Up to 0.3-0.4 cm stones will move through the ureter if the ureter is healthy and then into the u-pap and into the bladder but may lump things up along the way, cause temprorary hydronephrosis, ischemic necrosis, infections and so you get what I call the grape to raisin kidney scenario and big kidney little kidney thing escpecially in cats. Interstitial nephrosis and infarcts are the usual sequelae.

Here’s what I have seen over an dover and over ad nauseum through the years:

Scan one day the stone is in the CM junction, then another day its in the pelvis, then the cat goes anorexic because of ureteral passage (making the vet think pancreatitis or neoplasia) and you come in for the scan and the stone is now in the bladder. The vet does the cystotomy stone analysis…. then you scan again in a month and another stone is there making the vet think he/she missed one when its likely another stone moved down the pipe from the kidney…. Long hypothetical scenario and many variations but you get the idea. If you search calculi in the general search you will see tons of variations of this story along with biliary calculi.

http://sonopath.com/members/case-studies/search?text=calculi&species=All

Electrocute
December 16, 2014 at 2:07 am -

Thanks Eric.  All of the

Thanks Eric.  All of the above pics are of the right kidney.  The cat has been in the hospital for urethral obstruction and the rDVM wants to prepare the client for what may be coming next down the pipes…..no pun intended!  The tiny bladder stones that passed from the urethra have been submitted for stone analysis.  If it looks like CaOxalate, anything else to do other than prescription diet and increase fluid intake (and referral to AMC)?

Electrocute
December 16, 2014 at 2:07 am -

Thanks Eric.  All of the

Thanks Eric.  All of the above pics are of the right kidney.  The cat has been in the hospital for urethral obstruction and the rDVM wants to prepare the client for what may be coming next down the pipes…..no pun intended!  The tiny bladder stones that passed from the urethra have been submitted for stone analysis.  If it looks like CaOxalate, anything else to do other than prescription diet and increase fluid intake (and referral to AMC)?

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