Hello,
-This is a 12 years old Yorkie M/N that presented with anorexia and vomiting. Both kidneys present with marked pelvic dilation, decrease corticomedullary definition, hyperechoic cortex with cyst. This dog was treated with iv fluids for 3-4 days.
-I was wondering if this presentation fits with Pyelonephritis ( fluids alone would not dilate pelvis to this extent, right?).
-Ureters were not seen and bladder/trigone was normal with no neoplastic changes or uroliths. This dog also has pancreatitis.
Thank you
Hello,
-This is a 12 years old Yorkie M/N that presented with anorexia and vomiting. Both kidneys present with marked pelvic dilation, decrease corticomedullary definition, hyperechoic cortex with cyst. This dog was treated with iv fluids for 3-4 days.
-I was wondering if this presentation fits with Pyelonephritis ( fluids alone would not dilate pelvis to this extent, right?).
-Ureters were not seen and bladder/trigone was normal with no neoplastic changes or uroliths. This dog also has pancreatitis.
Thank you
Comments
Fluid therapy should not
Fluid therapy should not dilate the pelvis to that extent. Is the evidence of renal failure on bloods? Pyelonephritis should give a positive urine culture/bacteria on sediment examination and ideally from a sample collected by pyelocentesis.
Yes definatelly evidence of
Yes definatelly evidence of CRF on blood. Slight improvment on fluid therapy.
Q: if there is evidence of advance renal disease would you still advicate for pyelocentesis? Isn t that to risky?
Pyleocentesis not a risky
Pyleocentesis not a risky proceedure and is able to diagnosis pyelonephritis and a culture can give specific antibiotic therapy. Untreated pyelonephritis will cause progressive renal damage.
Thank you. Good to know
Thank you. Good to know
The parenchyma is chronic
The parenchyma is chronic interstitial pattern and the pyelectasia may be from pelvic scarring like when a stone passes in the the past, or pyeleneprhitis or fluid tx up to 0.3 cm dilation. This is much more than fluid tx as Remo says.Pyelecentesis use a 25g needle and push the body wall down to the renal pelvis. The tendency for pyelonephritis is that the pelvic fluid is somewhat echogenic and the pelvic fat is ill-defined. This case doesn’t show that so you may just get relatively clear urine back but will be a mroe sensitive culture than a bladder sample from downstream wiht a cystocentesis.
Here’s an ugly pyelonephritis in a stone mover to show the typical pus filled renal pelvis compared to th eanechoic urine in your case but there are variable degrees and presentations.
http://sonopath.com/members/case-studies/cases/obstructive-urolithiasis-pyelonephritis-nephritis-and-bladder-stones-10-y
I would pyelocentesis your case and may help wiht temporary decompression. Allyson Berent this year at IVUSS meeting in NYC poo poo’d pyelocentesis before she did SUB on the obstructed kidneys because she has seen a couple of damaged kidneys. But if you can handle a needle well I think this risk is minimal and is a glorified cysto in the end and obtains very useful information in culture even when the cultures are negative downstream. Just use a 25g or 27g needle. Tough to do any damage with that.
Thank you EL
Thank you EL