Case Study

Obstructive urolithiasis, pyelonephritis, nephritis, and bladder stones in a 10 year old FS Schnauzer

The patient is a 10 year old spayed female Schnauzer dog with a history of bladder stones about 1 year ago. Patient was placed on S/O diet and was able to pass stones according to owner. She began vomiting this week. Bloodwork shows azotemia, and urinalysis reveals a bacterial infection. The patient was given Convenia and Metronidazole 3 days ago, then started Maropitant and Famotidine 2 days ago with IV fluids. The patient was admitted for continued diuresis 2 days ago when radiographs show marked bladder stones, calcifications/stones in kidney, and concern for possible ureterolith. The patient has been urinating a good stream though still has a painful abdomen. Physical examination revealed a cardiac murmur. Blood work showed creatinine 6.9, cholesterol 397, BUN 102, and globulins 4.8. Urinalysis revealed occult blood, 1+ protein, pH 7.5, white cells and bacteria.

Sonographic Differential Diagnosis

Obstructive urolithiasis, pyelonephritis, aggressive nephritis in the right kidney. Right ureteral calculus and bladder calculi. Renal pelvic calculi, nonobstructive in the left kidney. Concurrent nephritis. Regional mesenteric inflammation. This patient has likely been passing large calculi periodically as well as forming them in situ in the bladder.

Image Interpretation

Multiple bladder calculi were noted; each measured approximately 2.0 cm. Urinary debris was also noted. The left kidney (3.67 cm) had a swollen contour with hyperechoic surrounding fat and a pelvic calculus that measured 1.4 cm. The right kidney presented swollen, irregular contour with moderate pyelectasia (3 cm x 2 cm) and hydroureter with echogenic debris. The distal right ureter revealed a 0.53 cm calculus. The right kidney presented a pericapsular, hypoechoic fluid accumulation. There were also multiple pelvic calculi noted in the right kidney. Regional mesenteric inflammation was noted associated with both kidneys and the ureter.

DX

Obstructive urolithiasis, pyelonephritis, nephritis, and bladder stones

Outcome

None

Comments

Recommend aggressive therapy for acute renal failure in this patient with surgical intervention with cystotomy, right nephrotomy and ureteral stent placement. A right nephrectomy may be necessary in this patient. However, I do recommend attempt at conserving the function of the right kidney as the left kidney appears significantly compromised from a chronic degenerative standpoint. Very guarded prognosis. Coverage for aggressive urinary tract infection would be warranted. Culture of the renal pelvis as well as calculi analysis would be recommended.

Clinical Differential Diagnosis

Urinary obstruction, renal failure, neoplasia, UTI.

UA PH

7.5

UA PH

7.5

Sampling

None