Bilateral hydronephrosis in a chronically vomiting cat

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Bilateral hydronephrosis in a chronically vomiting cat

  • 18 year old MN Siamese with history of chronic vomiting, chronic renal failure, HCM, and hyperthyroidism.
  • Owner feels that the vomiting has become worse.
  • Abdominal US shows bilateral renal pelvic dilation/hydronephrosis with dilation of the proximal ureters as well.  The right kidney was normal in renal length at 3.9cm.  The left kidney was slightly decreased in size at 3.25cm. There were no visible ureteral stones.  The bladder/trigone/proximal urethra all appear normal with no visible masses or stones.

    • 18 year old MN Siamese with history of chronic vomiting, chronic renal failure, HCM, and hyperthyroidism.
    • Owner feels that the vomiting has become worse.
    • Abdominal US shows bilateral renal pelvic dilation/hydronephrosis with dilation of the proximal ureters as well.  The right kidney was normal in renal length at 3.9cm.  The left kidney was slightly decreased in size at 3.25cm. There were no visible ureteral stones.  The bladder/trigone/proximal urethra all appear normal with no visible masses or stones.
    • Other ultrasound findings included a small to normal size gallbladder with a slightly thickened wall, and mild cystic and common bile duct dilation (4.6mm) with increased tortuosity.  The GI and pancreas appeared normal.
    • Ultrasound guided cystocentesis was performed and the urine submitted for culture. 
    • I have also recommended abdominal radiographs to better evaluate the mid ureters.
    • My differential diagnosis list for the bilateral renal pelvic dilation/hydronephrosis includes bilateral ureteral obstruction (stricture or stones), pyelonephritis, previous renal insult (obstruction), and neoplasia (LSA).
    • Just wondering what your thoughts were on the possiblity of lymphoma, especially since the kidneys are not enlarged (and decreased on the left side).

Comments

rlobetti
January 4, 2018 at 9:37 am -

Kidneys not typical for

Kidneys not typical for lymphoma but for chronic kidney disease. Spot on with your differential diagnosis list.

Electrocute
January 4, 2018 at 2:14 pm -

Thank you, Dr. Lobetti.

Thank you, Dr. Lobetti.

EL
January 4, 2018 at 8:33 pm -

yes LSA not the right pattern

yes LSA not the right pattern here. Renal pelvic scarring from stone passage or other insults likely here. Can do a 25g centesis of the pelvis for culture as well but likely a permanent issue owing to scarring of th eprox ureter/pelvic outlet.

Here are more typical renal lsa patterns from the basic search

https://sonopath.com/members/case-studies/cases/0600330-sebastian-d-renal-lsa-presumro

https://sonopath.com/members/case-studies/cases/renal-lymphoma-14-year-old-fs-dsh-cat

 

Electrocute
January 5, 2018 at 4:12 am -

Thanks, Eric.  I didn’t think

Thanks, Eric.  I didn’t think so either, but just wanted to be sure.  I appreciate the case links.

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