– 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?
Comments
I dont think there are any
I dont think there are any rules but 1 week sounds reasonable.
There are other reasons for pyelectasia such as renal pelvic scarring so sometimes the pyelectasia stays despite treatment depends on the reason for th edilation. Pyelo + scarring/structyure from prior stone passage. I havent seent his issue addressed in the literature but would love if someone had a reference. Would have to correlate US findings to post mortem or surgical or IR findings.
With the infarcts that shrivel up the renal architecture Im thinking pelvic scarring may be the issue here and if you decompress the pelvis it may be clean urine there.
Here’s my chronic uti protocol that may help:
Chronic UTI Protocol
I recommend Enrofloxacin (5 mg/kg SID PO) in late pm after urination to maximize urinary concentrations overnight. This assumes that culture supports this use. Repeat culture at 3-4 weeks and continue treatment at least 7-10 days post negative urinary sediment and negative culture. Note: Negative culture does not necessarily mean lack of UTI. Other favorite antibiotics for chronic UTI include third generation Cefa (Ceftiafur or similar sid injectable) or Clavamox.