Hi all, I got this kidneys from a 8yo MN maltese x with weight loss, vomiting, off colour and PU/PD. Bloods elev BUN,Creat, Lip, Amyl. Both kidneys presented enlargement and an anechoic elongated type of cyst attached to the caudal pole with same shape (almost looks tubular to me, but was neither ureter nor vessel) centesis showed pure transudate (have never seen this before). Also what is your opinion on the periphery of the kidneys (looks like subcapsular fluid? but with striations, could it be hypoechoic tissue?) Thanks. Veronica
Hi all, I got this kidneys from a 8yo MN maltese x with weight loss, vomiting, off colour and PU/PD. Bloods elev BUN,Creat, Lip, Amyl. Both kidneys presented enlargement and an anechoic elongated type of cyst attached to the caudal pole with same shape (almost looks tubular to me, but was neither ureter nor vessel) centesis showed pure transudate (have never seen this before). Also what is your opinion on the periphery of the kidneys (looks like subcapsular fluid? but with striations, could it be hypoechoic tissue?) Thanks. Veronica
Comments
I see subcapsular fluid occur
I see subcapsular fluid occur in any aggressive nephritis (toxic, infectious, autoimmune) and also neoplasia but this is different than the subcapsular capping that you get with lsa or otehr neoplasia for example (see image from path CD in thread large arrow). Think of your presentation as a renal blowout. Something aggressive enough is present to cause swelling and deviation of that fibrous capsule s we know its aggressive. I saw this the other day and did an fna (images in thread) and came back aggressive mixed inflammation. Infectious (lepto for example) or toxic likely. You can fna the cortex looking for mixed population of inflammation vs monopopulation like lsa and get a quick direction. The renal pelvis is dilated on the third image as well so pyelocentesis and culture as well as cortical fna and run a lepto titer and start iv ampi for lepto if you have it in your area. The general pattern of uniform cortical thickening is most consistent with interstitial nephrosis.
I see subcapsular fluid occur
I see subcapsular fluid occur in any aggressive nephritis (toxic, infectious, autoimmune) and also neoplasia but this is different than the subcapsular capping that you get with lsa or otehr neoplasia for example (see image from path CD in thread large arrow). Think of your presentation as a renal blowout. Something aggressive enough is present to cause swelling and deviation of that fibrous capsule s we know its aggressive. I saw this the other day and did an fna (images in thread) and came back aggressive mixed inflammation. Infectious (lepto for example) or toxic likely. You can fna the cortex looking for mixed population of inflammation vs monopopulation like lsa and get a quick direction. The renal pelvis is dilated on the third image as well so pyelocentesis and culture as well as cortical fna and run a lepto titer and start iv ampi for lepto if you have it in your area. The general pattern of uniform cortical thickening is most consistent with interstitial nephrosis.
Aggressive nephritis of
Aggressive nephritis of unknown source suspect lepto given the presentation and endemic region here in NJ. FNA came back mixed neutrophilic inflammation. You can see the fluid accumulating subcapsully…before the fna of course. Used 25 g because these are bloody samples so use a smaller needle to avoid blood artifact.
Aggressive nephritis of
Aggressive nephritis of unknown source suspect lepto given the presentation and endemic region here in NJ. FNA came back mixed neutrophilic inflammation. You can see the fluid accumulating subcapsully…before the fna of course. Used 25 g because these are bloody samples so use a smaller needle to avoid blood artifact.
Great! Thanks Eric, I’ll
Great! Thanks Eric, I’ll check what came back from cytology as we did fna on the kidney and we also sampled the fluid from the cystic structure on photo 3. We used a 23g and no bleeding 🙂 Ill try to tack this one. Thanks for the photos.
In regards to the cystic structure on photo No.3 why it looks so tubular and so out of the renal parenchyma?, exaclty the same image in both kidneys and fluid was completely translucent (cystic type), no urine.
Great! Thanks Eric, I’ll
Great! Thanks Eric, I’ll check what came back from cytology as we did fna on the kidney and we also sampled the fluid from the cystic structure on photo 3. We used a 23g and no bleeding 🙂 Ill try to tack this one. Thanks for the photos.
In regards to the cystic structure on photo No.3 why it looks so tubular and so out of the renal parenchyma?, exaclty the same image in both kidneys and fluid was completely translucent (cystic type), no urine.
That’s just the way the fluid
That’s just the way the fluid is pushing on the capsule….like a partially filled balloon.
That’s just the way the fluid
That’s just the way the fluid is pushing on the capsule….like a partially filled balloon.