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Severe hydronephrosis; ureteral lithiasis in an 18 year old FS DSH cat

Case Study

Case Study

Severe hydronephrosis; ureteral lithiasis in an 18 year old FS DSH cat

An 18-year-old FS DSH was presented for decreased appetite, weight loss, and polyuria/polydipsia. Abnormalities on physical examination were possibly deafness, unkempt haircoat, weight loss, nuclear sclerosis and iris atrophy in both eyes, thickened bowel loops on abdominal palpation, and palpable thyroid enlargement on the right side. Bacterial UTI was present on urinalysis and blood work showed moderate azotemia and elevated thyroid (T4). Patient was treated with methimazole and antibiotics pending abdominal ultrasound.

An 18-year-old FS DSH was presented for decreased appetite, weight loss, and polyuria/polydipsia. Abnormalities on physical examination were possibly deafness, unkempt haircoat, weight loss, nuclear sclerosis and iris atrophy in both eyes, thickened bowel loops on abdominal palpation, and palpable thyroid enlargement on the right side. Bacterial UTI was present on urinalysis and blood work showed moderate azotemia and elevated thyroid (T4). Patient was treated with methimazole and antibiotics pending abdominal ultrasound.

Sonographic Differential Diagnosis

Left hydronephrosis ureteral lithiasis. Right renal pyelonephritis pattern. Stress adrenal hyperplasia.

Image Interpretation

The left kidney demonstrates severe hydronephrosis with mid ureteral calculi. Mild uniform left adrenal enlargement is also noted likely owing to metabolic stress. This is a common finding in older diseased cats. No overt evidence of a rent is noted. The right kidney presents chronic interstitial cortical changes and mild/moderate pyelectasia without evidence of calculi. Pyelonephritis is probable. ureteral stricture can also present in this manner from potential prior stone passage.

DX

renal failure, obstructive nephrolithiasis, ureteral calculi, pyelonephritis

Outcome

Surgical versus medical therapy of the hyperthyroidism was discussed with the owner, who elected home treatment with renal diet and subcutaneous fluid therapy. A few days later the patient was re-presented for ongoing vomiting, which had initially stopped after offering smaller meals more frequently. On physical examination tachycardia and weight gain was present. Thyroid assay showed an improvement but was still high. The methimazole dose was increased. Several days later the patient was re-presented for lethargy after being left alone at home for 2 days without medication. On physical examination the patient was in lateral recumbency, unable to stand, pupils were dilated, there was no menace reflex, mucous membranes were pale pink and tacky, and the pulse was poor. Owner elected for euthanasia.

Clinical Differential Diagnosis

Renal clinical signs- chronic renal failure, pyelonephritis, bacterial cystitis. Hyperthyroidism.

Sampling

None taken.

Video

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Video Player

Patient Information

Patient Name : Chandon G
Gender : Female, Spayed
Species : Feline
Type of Imaging : Ultrasound
Book : yes
Status : Complete
Liz Wuz Here : Yes
Code : 06_00006

Clinical Signs

  • Anorexia
  • PU-PD
  • Weight loss

History

  • Decreased appetite
  • PU-PD
  • Weight Loss

Exam Finding

  • Ocular abnormality
  • Poor or unkempt coat
  • Thickened Intestines
  • Thyroid enlargement
  • Weight loss

Images

01090203151504_06242010070553

Blood Chemistry

  • Azotemia
  • Hyperthyroidism

Clinical Signs

  • Anorexia
  • PU-PD
  • Weight loss

Urinalysi

  • Bacteria Present