– 16 year MN DSH with history of chronic lower urinary tract signs, abdominal pain

– urine culture resistant E.Coli but sensitive to Convenia; mild azotemia

– has had 3 Convenia injections

– u/s shows bilateral pylectasia – worse on the left side, thickened, hyperechoic renal cortices

– left kidney has a hyperechoic, non-shadowing structure in the renal pelvis (mucus, blood clot?)

– ureters not seen and no evidence of obstruction, no renoltihs, uroliths seen – UB small amount of hyperechoic debris but otherwise normal

– 16 year MN DSH with history of chronic lower urinary tract signs, abdominal pain

– urine culture resistant E.Coli but sensitive to Convenia; mild azotemia

– has had 3 Convenia injections

– u/s shows bilateral pylectasia – worse on the left side, thickened, hyperechoic renal cortices

– left kidney has a hyperechoic, non-shadowing structure in the renal pelvis (mucus, blood clot?)

– ureters not seen and no evidence of obstruction, no renoltihs, uroliths seen – UB small amount of hyperechoic debris but otherwise normal

– recommended abdominal rads in case a stone in the ureter that I did not see on u/s

DDx: chronic pyelonephritis and interstial nephritis, lymphoma?

Couple of questions:

1. Should pyelocentesis be performed and when – wait 1 week after Convenia wears off?

2. Will the renal pelvis shrink down when the infection is under control or will it remain dilated?