7 yr FS DSH (tortie) w/ BUN 74, creat 7.6, phos mild inc., normal K, HCT 32, normal T4. UA inactive w/ isosthenuria and ph = 6. No crystals. Bladder has small hyperechoic non-shadowing speckles throughout. Renoliths in both kidneys w/ irregular border L>R. No ureteral obstruction. Considering renal diet w/ added citrate to prevent further Ca oxylate (suspected based on pH). Any other guidance? Thoughts on why BUN not higher? Pre-disposing factors?
7 yr FS DSH (tortie) w/ BUN 74, creat 7.6, phos mild inc., normal K, HCT 32, normal T4. UA inactive w/ isosthenuria and ph = 6. No crystals. Bladder has small hyperechoic non-shadowing speckles throughout. Renoliths in both kidneys w/ irregular border L>R. No ureteral obstruction. Considering renal diet w/ added citrate to prevent further Ca oxylate (suspected based on pH). Any other guidance? Thoughts on why BUN not higher? Pre-disposing factors?
Comments
BUN is highly variable in
BUN is highly variable in cats in my experience… any BUN over 50 I just consider high.. creat is more of an issue and steady state marker an d7 is a problem:(. This looks like an interstitial nephrosis case and stone mover thats making things worse. There are small cortical infarcts that follow the stones as they move. I have hence coined the term comet tail infarct to describe this issue. I labeled one for you. When they are aold infarcts like in this case there is no adjacent inflammtory pattern but when active they are mixed echogenicity and have hyperechoic ill defined fat adjacent to the infarct. If you havent treated yet with these numbers then try pushing the ARF fluid protocol for 72 hours and reassess as these kidneys may not be end stage and just moving stones and what we see is the side effect of an acute on chronic episode. BP and culture of course as well… I havent heard of much diet help with oxalates on these guys but I dont manage them myself any more. Maybe there is someone more active in that task out there than me.
Thank you – very helpful. Is
Thank you – very helpful. Is the evidence of chronic infarcts in this case the irregular border? Would you recommend serial ultrasounds to be sure not an early ureteral obstruction?
yes the irregular border and
yes the irregular border and hyperechoic cortical changes with adjacent indentation.
Here is one with small infarcts
http://sonopath.com/members/case-studies/cases/0600317-peanut-g-acute-chronic-renal-disease-bladder-and-urethral-sand
Here is one with larger infarct and cortical collapse… and some stents.
http://sonopath.com/members/case-studies/cases/bilateral-ureteral-obstruction-stent-placement-8-year-old-fs-dlh-cat
Its hit or miss on when you catch a stone moving through or not but they have “ADR” panreatitis type signs and then you see the stone obstruction on US but often they have already moved to the bladder if < 0.4 cm and solid ureteral funciton according to Berent et al… 3-4 mm is a good parameter to judge by in my experience as far as what size stones will pass in a cat or small dog… up to 1/2 cm in bigger dogs assuming good ureteral function and hydration.
Dietary therapy for bladder
Dietary therapy for bladder stones works well but poorly effective for renal or ureteral stones as the stone has to “sit” in the urine for a period of time for dissolution to occur.