Image posted is an example of a cat kidney with calculi, dystrophic mineralization and a caudal pole infarction. This is not the exact image of the case discussed below.
My client is not sure why this cat is losing weight. No definitive diagnosis. now–still waiting for colbal and folate levels. If these are abnormal, suspect IBD or lymphoma. If these are normal, cause is still open–may very well be renal insufficiency. Ultrasound did not reveal definitive cause. started benazepril and pepcid on 12/09, owner stopped benazepril because patient wasn’t eating well
>> BUN 78 15 – 34 mg/dL HIGH
>> CREATININE 4.4 0.8 – 2.3 mg/dL HIGH
Ultrasound interpretation from other company: The small size of the left and right kidney suggest the presence of chronic renal disease bilaterally. The flattening of the cranial pole the left kidney is thought likely a result of chronic renal infarction. Chronic renal disease may be responsible for the weight loss described in the history;
>The rDVM client wants to do an abdominal US & possible biopsy of the
>kidneys. I am unsure whether FNA or Biopsy would be appropriate. ( I
>think BX as structure is probably needed) I think also that full
>anesthesia is needed either way. Can you advise?
EL: Yes Tomie, full anesthesia with propofol and iso is likely necessary but with that clinical profile and it being a cat, I am concerned that the results will not likely give any tTx direction. It really depends on the sonographic presentation. If the kidneys are slightly altered with this profile the bx is recommended to rule out toxin, infectious, amyloid or other structural disease that may respond to treatment.
However, if the kidneys are small dystrophic kidneys with little blood flow 1) Bx will be necessary for the Dx 2) You won’t likely be able to do anything with the results unless a renal transplant is a potential.
If the kidneys are big then 4 possibilities are present 1) hydronephrosis-congenital, stricture, stone or other obstruction +/- pyelonephritis. 2) pkd 3) lsa in which fna is fine 4) FIP need Bx for dx
Based on the probabilities for this particular case, this is likely a CRF cat with small dystrophic chronic kidneys and bx will not likely change the outcome and may exacerbate the renal failure if the patient is hypertensive. you have to hope for chronic pyelo nephritis and potentially hypertension ironically because at least you can treat those 2 things. I would suggest send doing the ultrasound for interpretation first and then set up for biopsy based on “end justifying means scenario.”
Best regards,
Eric Lindquist DMV (Italy) DABVP
Cert. IVUSS Director SE NJ Mobile Associates,
Founder/CEO SonoPath.com
“Make every obstacle an opportunity.” — Lance Armstrong