Hello,
Hello,
This is a 9 years old DSH that has moderatelly high BUN/Creatinine, USG 1.025. Not clinical, gaining weight, doing well. Preanesth for dental raised questions about Kidneys. US findings : LK dystrophic mineralization, irregular capsule with indentation on cortex distal pole suspect from previous infarct. To me there are small nephroliths in the pelvis but no big pelvis dilation. RK is abnormal, not sure if functional, normal in length but only ” 1 cm tall” with mineralization, minor pelvic dilation and hyperechoic pelvis. MILN is also enlarged at 0.65 cm height. Urine ( bladder) culture is pending. Trace protein only, no active sediment PH 6.5 ( suspect oxalate)
My questions :
-beside renal insufficiency, mineralization, urolith should I suspect also Pyelonephritis based on RK appearance and MILN?
-RK US apppearance can say anything in terms of function? Does this look inherited or developed?
Thank you,
Comments
So this is a stone mover and
So this is a stone mover and stones < 0.3 mm typically can move south and be expelled as long as the system is funcitonal… bigger may have trouble. Scarred up pelvic or damaged ureters and u paps may not pass the small ones either. That number was pulled from Bartges, Allyson Berent et al article series Compendium 2013 Jan Feb March … great overview on that series on stonage..
So what I see on these is the ston moves from the cm junction to the pelvis and as it does it creates a cortical infarct. I named the infarct a “comet tail infarct” because the infarct follows the stone in traingular fashion and you get a cortical indentation in that spot like at the end of your video (stone not seen in the still (see image). Not sure if anyone has pubkished that term but I have to describe these all day on telemed so had to come up with a catchy phrase:)
I attached a cat kidney showing the stones and adjacent infarcts that fit this description.
Thank you for your
Thank you for your explanation. Makes sense. Any idea on the appearance of RK? Inherited?