* Lilly is an 8 year old Cavalier King Charles Spaniel that has a history of chronic kidney disease that came in recently with renal numbers that were much worse and with signs of vomiting.
*Pertinent labs: Albumin 2.2 g/dl, BUN 157 mg/dl, Creat 4.1 mg/dl, Phosp 19.2 mg/dl, SDMA 30
Urinalysis: pH 1.011, 3+ Blood, pH 5, 2-5 WBC/HPF, RBC 10-15/HPF, Moderate bacteria (urine MIC started), No crystals noted.
CBC: Low RBC numbers: RBC 5.12, HGB 9.2, HCT 28.4- non regenerative anemia, mild monocytosis.
* Lilly is an 8 year old Cavalier King Charles Spaniel that has a history of chronic kidney disease that came in recently with renal numbers that were much worse and with signs of vomiting.
*Pertinent labs: Albumin 2.2 g/dl, BUN 157 mg/dl, Creat 4.1 mg/dl, Phosp 19.2 mg/dl, SDMA 30
Urinalysis: pH 1.011, 3+ Blood, pH 5, 2-5 WBC/HPF, RBC 10-15/HPF, Moderate bacteria (urine MIC started), No crystals noted.
CBC: Low RBC numbers: RBC 5.12, HGB 9.2, HCT 28.4- non regenerative anemia, mild monocytosis.
* Currently on IV fluids, enrofloxacin and SQ Cerenia
My questions:
I suspect we are dealing with Renal Dysplasia here. I was wondering if I can get some feedback on the morphological appearance of these kidneys.
Lilly is normo-tensive
Thanks
Comments
Some ugly pyelonephritis
Some ugly pyelonephritis pattern in the Lk and minor in the Rk and an interstitial nephritis pattern. Never just one patholoigy in a kidney but tret the treatable and play it out over 72 hours and ensure BP is not a player. Pyuria with isosthenuria is key here.
Clinical picture and blood
Clinical picture and blood work points towards chronic kidney disease. The UTI is most likely secondary to the low SG and renal changes but needs to be treated to hopefully preserve renal function. Renal dysplasia is a possible underlying cause but can only be confirmed on histopath but will not change management – renal diet, controlling hyperphosphatemia, gastric protectants, EPO.
Thank you EL and Remo.
What
Thank you EL and Remo.
What specifically are you seeing morphologically in the kidneys that make you believe this is pyelonephritits- although I do believe that is what we are dealing with.
The key here is the
The key here is the pyelectasia thats more dramatic in the first video is too much to be simple fluids and the pelvic fat is ill defined suggesting inflammation (see attached image). The kidneys are pretty uniform so I doubt primary dysplasia and there is an increased cortical echogenicity and cm band so largely and interstitial pattern but would need bx to confirm.
The isosthenuria with 2-5 wbc is pyuria because thats a lot of wbc wiht a significant washout factior. Medullary washout likely the cause of pupd which you will see with UTpyelonephritis. In other words if usg were 1030 the wbc would be in the 20-50 range.
I have also attached a more typical primary renal dysplasia case here with thick irregular crushed grape cortex and disrupted irregular pelvis.
Thanks EL- that is exactly
Thanks EL- that is exactly what I wanted to know.
So far the urine MIC is coming out no growth. Surprising since
moderate bacteria was seen in the urine sediment.