Is it pyelonephritis

7-year-old DSH cat with previous history of CKD was presented with 3-week history of extreme hyporexia and 2kg of weight loss. Blood test showed renal azotemia, creatinie, 7mg/dL, urea 160mg/dL, amylase >4000. Phosphorus >20. USG of 1.015. FPLi levels were abnormal on snap test. Both kidneys show loss of corticomedullary distinction, are hyperechoic and fall in the lower end of the normal range. I am getting confused for the left kidney. In the longtitudinal view, is it pelvis which is dilated. For the right kidney, there is mild pyelectasia. I m considering pyelonephritis on top of the CKD. Urine test showed high WBC level and there is marked leukocytosis in hematology.Want an input for the left limb of  pancreas also. I think it is hpoechoic

2 responses to “Is it pyelonephritis”

  1. Pyelectasia, especially mild

    Pyelectasia, especially mild as it is here can be many things including pyeleonephritis. Need to pair with urinary sediment and culture. For example, fluid tx will dilate the pelvis to 3 mm or so. Pelvic scarring will also do this if prior insult like a stone passage. Also primary dysplasia will cause pyelectasia. Cats can get prerenal azotemia very easily with pancreatitis or neoplasia as well as from renal failure. When in doubt try to correct the azotemia over 3 days of fluids and look for comorbidities causing prerenal azotemia or casing a toxin shower to the kidneys like pancreatitis. I see this prerenal issue a lot in cats that respond well when the kidneys dont look that bad sonographically

  2. Hi, just wanted to add that

    Hi, just wanted to add that you mentioned high white cells in the urine – if this was just on a dipstick it may not be signficant, but if you looked at a sediment and there were many white blood cells in the urine, then pyelonephritis would jump up higher on my list – as mentioned, a culture can help confirm that suspicion and help guide you towards an antibiotic choice.   

    I also noticed you asked about the pancreas but I did not see an image of the pancreas, either I am missing it (I’m new to this), or you may want to try posting again?

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