Hello all. One of my wonderful techs was blessed with “Special Sammy” 10 years ago. He is a DSH cat who has poor balance, a head tilt, and random “freak outs” since birth. Otherwise than asthma, he had been a pretty healthy until 2 years ago. Right before I went on maternity leave, he was xrayed and was found to have a gigantic kidney. His left kidney is essentially a bag of urine (no stricture/stone seen on u/s), while his right kidney had been holding its own (size, bloodwork-wise)…until the weekend.
Sammy is now in acute renal failure.
Hello all. One of my wonderful techs was blessed with “Special Sammy” 10 years ago. He is a DSH cat who has poor balance, a head tilt, and random “freak outs” since birth. Otherwise than asthma, he had been a pretty healthy until 2 years ago. Right before I went on maternity leave, he was xrayed and was found to have a gigantic kidney. His left kidney is essentially a bag of urine (no stricture/stone seen on u/s), while his right kidney had been holding its own (size, bloodwork-wise)…until the weekend.
Sammy is now in acute renal failure. His BUN and CREA are off the charts, and he is vomiting and anorexic. I ultrasounded his kidneys and found that his left one (the “abnormal one”) is essentially the same, while his right one is now enlarged (had been 4.47cm and is now 6cm). He is currently on famotidine, cerenia, and IV fluids. At time of ultrasound he had been on 2X maintenance IV fluids for 8hrs, but started showing signs of fluid overload so rate was decreased to maintenance and furosemide was started. At time of ultrasound, it was believed he had not urinated in 12 hours and I was a bit panicky that I couldn’t find a bladder…but he managed to urinate in his kennel under the bed?
Anywho – my questions:
– I found pelvic dilation in right kidney to be 0.24cm which I interpreted as normal for being in IV fluids, but is that amount normal given only 8 hours of IV fluids?
– I interpreted the ureter seen in this clip as normal. What else should I be looking for beside ureteral dilation/stone, etc?
– Based on X-ray, there appeared to possibly be 2 small stones? in left kidney area and left side (possibly ureteral area), but I could not find them on ultrasound (will look again tomorrow). These would be irrelevant given left kidney hasn’t changed, right?
Thanks for any suggestions/comments/ideas on this case.
Jennifer
Update from 4/5/13 “He is now peeing lots, but bun and creatinine hasn’t budged on IV 2x maintenance for 2 days”
[videoembed id=6972]
Comments
Well sounds like the LK is
Well sounds like the LK is shot but if the cortex is picking up any power doppler may still have some function. How is the right kidney structure? Can you load some images even stills for subjective analysis? if the LK has nor decent cortex then may be harboring infection and left nephrectomy may help if the right has function to it. IVP would be ideal. If the LK has cortex then a stent would be ideal. if a $ case and adopted cat then tx acute rf, rule out systemic hypertension and work to left nephrectomy depending on what they look like on ultrasound. Sounds like a stone passer lodged a stone in the left ureter and hydronephrosed. Happens a lot but can define further with the images. The right pelvic dilation could be fluids but even if on fluids could be pyelonephritis too if the urine suggests so.
Well sounds like the LK is
Well sounds like the LK is shot but if the cortex is picking up any power doppler may still have some function. How is the right kidney structure? Can you load some images even stills for subjective analysis? if the LK has nor decent cortex then may be harboring infection and left nephrectomy may help if the right has function to it. IVP would be ideal. If the LK has cortex then a stent would be ideal. if a $ case and adopted cat then tx acute rf, rule out systemic hypertension and work to left nephrectomy depending on what they look like on ultrasound. Sounds like a stone passer lodged a stone in the left ureter and hydronephrosed. Happens a lot but can define further with the images. The right pelvic dilation could be fluids but even if on fluids could be pyelonephritis too if the urine suggests so.
Hi there! I did upload a clip
Hi there! I did upload a clip of the right kidney – please let me know if it doesn’t work. Structure is normal as far as I can tell. We have started cat on 2.5mg/kg baytril SID in case of pyelonephritis. Pelvic dilation today – still 0.25cm.
Left kidney still has some doppler flow and hasn’t been changing so was just left (and monitored over the last year).
Hi there! I did upload a clip
Hi there! I did upload a clip of the right kidney – please let me know if it doesn’t work. Structure is normal as far as I can tell. We have started cat on 2.5mg/kg baytril SID in case of pyelonephritis. Pelvic dilation today – still 0.25cm.
Left kidney still has some doppler flow and hasn’t been changing so was just left (and monitored over the last year).
yes i see the clip now and
yes i see the clip now and with that pelvic dilation pyelo is my first thought and an pyelocentesis and culture would be best. Structure isnt bad otherwise though. Its swollen as well and acute insults like toxic and infectious can look like this as well. FNA of the cortex may help guide the suspicion.
yes i see the clip now and
yes i see the clip now and with that pelvic dilation pyelo is my first thought and an pyelocentesis and culture would be best. Structure isnt bad otherwise though. Its swollen as well and acute insults like toxic and infectious can look like this as well. FNA of the cortex may help guide the suspicion.