These images are from a 6 year old British Short Hair cat. Creatinine prior to dental work was 6.0. Urine sg was isosthenuric and a culture was negative. Both kidneys show the same findings. The blood flow seemed to be diminished on color flow. I made a tentaive diagnosis of renal dysplasia since infection and neoplasia seem to be ruled out. What do other people think? The ureters were not visible and I did not see any uteroliths.
Comments
Hello Jeff, these kidneys
Hello Jeff, these kidneys have mild/moderate hydronephrosis which can be caused by a number of things including congenital hydro, which would by my primary suspicion given that both are this way. Proximal ureteral stricture owing to stone passage or similar, and chronic pyelonephritis. The increased cortical echogenicity and diminished doppler signals suggest fibrosis and likely interstitial nephrosis pattern. I know that culture ws negative but this is often the case because of washout from isosthenuria and cultures are imperfect by nature. What I would do is do a pyelocentesis with a 25g needle and culture that. I have pulled frank pus out of these things with negative cultures. These are island of pathology that may not be felt downstream in the bladder. If the pyelocenstesis gives relatively clean urine then its likely congenital. Could bx the cortex as well for more definitive dx of congenital and see where the parenchyma stands but px is poor. I dont think its a stent case if you cant get it out of renal failure and poor color would suggest these arent coming back soon. If they wanted to be heroic then dialysis and referral for potential stents would be the direction. Best regards,
Hello Jeff, these kidneys
Hello Jeff, these kidneys have mild/moderate hydronephrosis which can be caused by a number of things including congenital hydro, which would by my primary suspicion given that both are this way. Proximal ureteral stricture owing to stone passage or similar, and chronic pyelonephritis. The increased cortical echogenicity and diminished doppler signals suggest fibrosis and likely interstitial nephrosis pattern. I know that culture ws negative but this is often the case because of washout from isosthenuria and cultures are imperfect by nature. What I would do is do a pyelocentesis with a 25g needle and culture that. I have pulled frank pus out of these things with negative cultures. These are island of pathology that may not be felt downstream in the bladder. If the pyelocenstesis gives relatively clean urine then its likely congenital. Could bx the cortex as well for more definitive dx of congenital and see where the parenchyma stands but px is poor. I dont think its a stent case if you cant get it out of renal failure and poor color would suggest these arent coming back soon. If they wanted to be heroic then dialysis and referral for potential stents would be the direction. Best regards,
My bet is congenital
My bet is congenital dysplasia given the bilateral presentation and being a pure bred.
Marty
My bet is congenital
My bet is congenital dysplasia given the bilateral presentation and being a pure bred.
Marty