– older intact male in renal failure
– not responding to typical treatment.
His kidneys are significantly hyperechoic (note teaser image compared with liver) with reduced corticomedullary differentiation and mild pyelectasia. He also incompletely empties his bladder. I don’t believe his history is consistent with ethylene glycol.
What ddx are most likely?
Thanks!
– older intact male in renal failure
– not responding to typical treatment.
His kidneys are significantly hyperechoic (note teaser image compared with liver) with reduced corticomedullary differentiation and mild pyelectasia. He also incompletely empties his bladder. I don’t believe his history is consistent with ethylene glycol.
What ddx are most likely?
Thanks!
Comments
I am incluiding a slide from
I am incluiding a slide from one of my training modules which can help with differentiation. I think your kidney is larger than you are measuring. I hope this helps.
Thx for that Randy. This is a
Thx for that Randy. This is a chronic interstitial nephrosis pattern and some pyelectasia which can be from fluid tx (< 0.3 cm), scarring, or infection. Try putting some power doppler over the cortex if not lighting up then that fits with chronic, if hypervascular that fits with acute. Often I see these cats come in acute with these chronic kidneys but its as if something just sends them over the edge when they have significant parenchyma loss for some time… its usually infection, hypertension, prerenal disease, triaditis or some acute phase disease, hyperthyroidism that gets treated and drops the GFR… something just pushes the chronic kidney over that 60-70% threshiold to maintain metabolic need and boom acute on chronic renal failure…. Then other cats stay in stage 2 IRIS for a long time.
Sorry, I should have
Sorry, I should have clarified. This is a dog. I’m not sure if that changes anything. I do have better measurements on the kidney but it had the best image quality to post.
I do like the table above, it is very concise -thanks!
Thanks!
LOl ok:) wel that makes me
LOl ok:) wel that makes me think in a dog this may be a certain level of primary renal dysplasia that is not end stage degenerative or th edog thinks he’s a cat
Its still an intersttitial nephrosis pattern but the irregular cortical/medullary pattern is mildly reminiscent of primary renal dysplasia. Sometimes minor renal dysplasia forms hang in there for some time and just fail later. Needs a bx to know more.