A 5-year-old NM DSH was presented for evaluation of weight loss and a 5-day history of decreased appetite and lethargy. On physical examination 8% dehydration, pale mucosa, and a full but easily expressible bladder were present. Abnormalities on CBC and serum biochemistry were mild lymphopenia and neutrophilia, azotemia (BUN >180, creatinine >20), and hypoproteinemia. Survey radiographs showed irregular kidneys with opacities and possible opacities within the urethra.
Bladder and urethral sand.
Renal calculi. Chronic end stage interstitial nephrosis pattern with cortical infarcts and calculi. Minor free fluid was noted around the right kidney. No obstructive disease was noted at this time.
This is a combination of chronic degenerative process with calculi movement with secondary comet tail infarcts and acute on chronic nephritis. 72-hour IV fluid protocol, pain management, culture and blood pressure measurements would all be warranted. Very guarded prognosis.
The urinary bladder presented a small, non-shadowing concretion that measured 0.07 cm. Urethral sand was also noted.
The kidneys presented end stage interstitial nephrosis pattern with calculi. The right kidney measured 3.44 cm. A minor amount of free fluid was noted around the right kidney as well. The left kidney was subnormal in size and measured 2.74 cm with calculi. A cortical infarct was noted in the left kidney. A recent, comet tail infarct was noted in the dorsal cranial aspect of the left kidney with a focal inflammatory pattern. This is likely owing to calculi movement.
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Chronic kidney disease, renoliths, obstructive uropathy, pyelonephritis, bacterial nephritis, neoplasia, Leptospirosis
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