- 15 year old mn indoor only cat with a history of chronic weight loss (from 8 to 6 lbs) despite good appetite.
- CBC and chemistry profile done 6 weeks ago were both wnl.
- Ultrasound done yesterday showed bilateral medullary rim sign, increased medullary echogenicity, decreased corticomedullary definition, nonobstructive mineralization, and pyelectasia. Both kidneys measured 3.4cm in length.
- The GI tract was mostly normal except for one short segment of jejunem with an increased muscularis to mucosal ratio.
- 15 year old mn indoor only cat with a history of chronic weight loss (from 8 to 6 lbs) despite good appetite.
- CBC and chemistry profile done 6 weeks ago were both wnl.
- Ultrasound done yesterday showed bilateral medullary rim sign, increased medullary echogenicity, decreased corticomedullary definition, nonobstructive mineralization, and pyelectasia. Both kidneys measured 3.4cm in length.
- The GI tract was mostly normal except for one short segment of jejunem with an increased muscularis to mucosal ratio.
- Ultrasound guided cystocentesis was performed and the urine was sumbitted for urinalysis and culture. The results are pending. The urine grossly appeared quite dilute.
- My primary differentials are bilateral pyelonephritis, chronic interstitial nephritis/glomerulonephritis, LSA, and FIP.
- If U/A and urine culture are negative for bacterial infection, would you cover with anitibiotics anyways or go straight to renal biopsy?
- I am also recommending blood pressure measurements.
Comments
I assume that
I assume that hyperthryroidism has been r/o and that there is no hypercalcemia. Although the kidneys look very abnormal on US, there is no azotemia but with the description of the urine would expect that there is early chronic kidney disease. FIP with no other signs not likley but your other differentials all valid. If urine culture negative can consider doing an US guided aspirate of the pyelectasia as may show more in line of infection. if cultures are negative and no white cell response on CBC, would not use antibiotics. FNA of kidney is a quick and easy diagnostic test to exclude lymphoma. Jejejum most likely IBD but consider an emerging lymphoma
I assume that
I assume that hyperthryroidism has been r/o and that there is no hypercalcemia. Although the kidneys look very abnormal on US, there is no azotemia but with the description of the urine would expect that there is early chronic kidney disease. FIP with no other signs not likley but your other differentials all valid. If urine culture negative can consider doing an US guided aspirate of the pyelectasia as may show more in line of infection. if cultures are negative and no white cell response on CBC, would not use antibiotics. FNA of kidney is a quick and easy diagnostic test to exclude lymphoma. Jejejum most likely IBD but consider an emerging lymphoma
Med rim is idiopathic and the
Med rim is idiopathic and the rest of the kidney looks like interstitial nephrosis. FNA rules out the big stuff (LSA which I doubt becaus eno ca=psular or cm distortion) and if mixed inflammation dry FIP possible but I would chase other causes and do a maldigestion panel, full cns exam, chest rads…. maybe even a pred b12 +/- zithromaz trial…Kidneys here may be most dramatic sonographically but the big picture may be somethign else entirely. Maybe check a BP at times hypertension starts before renal failure and the juxtoglomerular apparatus is harmed with sectorial disease int he kidney.
Med rim is idiopathic and the
Med rim is idiopathic and the rest of the kidney looks like interstitial nephrosis. FNA rules out the big stuff (LSA which I doubt becaus eno ca=psular or cm distortion) and if mixed inflammation dry FIP possible but I would chase other causes and do a maldigestion panel, full cns exam, chest rads…. maybe even a pred b12 +/- zithromaz trial…Kidneys here may be most dramatic sonographically but the big picture may be somethign else entirely. Maybe check a BP at times hypertension starts before renal failure and the juxtoglomerular apparatus is harmed with sectorial disease int he kidney.
Great, thanks. That is all
Great, thanks. That is all very helpful. Yes, the thyroid level was normal. I have pyelonephritis high on the list because of the bilateral pylectasia which I really can’t explain because there are no obvious ureteral obstructions and the bladder/trigone region is normal.
Great, thanks. That is all
Great, thanks. That is all very helpful. Yes, the thyroid level was normal. I have pyelonephritis high on the list because of the bilateral pylectasia which I really can’t explain because there are no obvious ureteral obstructions and the bladder/trigone region is normal.