Small kidneys with significantly thickened cortices

14 yr MN DSH with seizure and nystagmus episode 3 weeks ago.  Echo revealed some pericardial effusion and unclassified cardiomyopathy (reviewed by Dr. Lamy).  Responded to a furosemide trial – no further pericardial effusion and LA size WNL on recheck echo.  Current thoughts for addressing his heart included continuing with furosemide at a low dose and adding in pimobendan.  Unfortunately, Shadow has been losing weight and not eating well.  Abdominal ultrasound stable from 3 weeks ago.  Major findings – significant renal cortices thickening, most distal end of left pancreas very hypoechoic and rest of left pancreas mildly thickening with mild inc. in echogenicity to surrounding mesentery, plump mesenteric lymph nodes maintaining normal shape, significant gas in lumen of small bowel and stomach with normal wall layering.  Blood work 3 weeks ago started with high normal renal values and HCT 27% with an increase in MCV on the automated count.  Yesterday, renal values have increased BUN 40, creat 2.3, SDMA 23, K 3.3 and HCT down to 22%, still with an increased MCV.  Dr. Lamy is still suspicious of non-cardiac causes for the pericardial effusion, so we are weighing our next steps and would love input

2 responses to “Small kidneys with significantly thickened cortices”

  1. subjectively near end stage

    subjectively near end stage interstitial nephrosis pattern and likely some level of pancreatitis causing prerenal effect as well to azotemia. Nothing looks neoplastic though. If you can tap the pleural effusion cytospsin it down with immediate slide prep to asse exfoliating neoplasia could have lung carcinomatosis or similar causing the effusion if the la size is not > 1.5 and concurrent pleural effusion its not likely cardiogenic.

    • Thank you Eric. The

      Thank you Eric. The furosemide mopped all the pericardial effusuion up and didn’t see any pleura eff. with the renal and pancreas issues that you mentioned and the underlying cardiac disease, seems like he has enough going on to continue making him feel poor. Every time I see kidneys like that I still panic

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