17 year old MN DLH presented for vomiting, lethargy and anorexia. Painful on abdominal palpation. Marked azotemia with mild increase in K initially. Phosphorous elevated and HCT low normal with rehydration. Renal values have been coming down on IVF.
No uroliths seen in urinary bladder, one stone appreciated in left renal pelvis, but not obstructive. Could trace the ureter midway to urinary bladder. Wall thickened, but no ureterolith seen. Right kidney very small and irregular. There were also some hypoechoic and round lymph nodes and evidence of triaditis with some small hypoechoic nodules in the pancreas and mild muscularis layer thickening in the small bowel.
My primary rule outs are lymphoma and hydronephrosis secondary to a ureterolith not identified. The surrounding inflammation and sub capsular cuffing (am I using the right term for the hypoechoic rim?) have me concerned.
Owner was not interested in further dx, so along with IVF and GI support, also gave one dose of dexNaP……
Comments
acute nephritis and fresh infarct with hypertrophy and the other kidney is chronic dystrophy stones and pyelectasia older version of the acute phase kidney. Likely stone pusher can fna the larger kidney to ensure no lsa but usually lsa in kidneys is bilateral but not always. The 8 mm thing is that an adrenal and if so check conn;s syndrome. I would downplay neoplasia on these kidneys until fna says neoplasia.
side note we are still working on the forum format but made significant progress with new IT personnel on this updated platform that was a necessity. did you try to upload video or just the stills? We seem to have the video tested out ok so should be good to go with usual formats but mp4 is always best and most compatible nowadays with all formats.
Thank you, Eric. That was a lymph node by the left pancreatic limb, adrenals were 3 and 4.5 mm in size. I did not try the videos this time as it hadn’t worked for me on the last few posts. Good to know and I will definitely include video next time as I know much better for interpreting. This cat’s renal values are almost normal now, so very glad my concern about lymphoma must have been wrong!