5 yr indoor only MN DSH with renal azotemia, normal HCT and low normal K. The right kidney looks like infarctions (BP on very spicy cat under sedation was 170 systolic initially, so started amlodipine) and the left appears hydronephrosis. Could trace the ureter until just cranial to bladder. No visible stone other than the one shown on peri-diverticular border/non-obstructive. Have him on IVF, amitriptyline, amlodipine, buprenorphine and marbofloxacin (inactive sediment, no culture performed). Azotemia has not improved (moderate elevations). Thoughts/should I be referring for a SUB
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Stone mover… the infarcts are likely from old insults (Comet tail infarcts) like this but this one is obstructed. Needs a SUB. usually medical alone doesnt help when its this obstructed. SUBs are placed if at least 5 mm of peyelectasia with obstruction.
Recent publication has shown that medical management can be of benefit:
Isabelle Merindol, Catherine Vachon, Tristan Juette, and Marilyn Dunn. Benign ureteral obstruction in cats: Outcome with medical management. J Vet Intern Med. 2023 May-Jun; 37(3): 1047–1058.
Published online 2023 Apr 19. doi: 10.1111/jvim.16709
Abstract
Background: Limited information is available regarding the outcome of medical man- agement (MM) of benign ureteral obstruction in cats (BUO).
Hypothesis: Describe clinical characteristics and outcome of MM of BUO.
Animals: Seventy-two client-owned cats with 103 obstructed kidneys.
Methods: Medical records of cats diagnosed with BUO between 2010 and 2021 that received >72 hours of MM were retrospectively reviewed. Clinical data, treatment, and outcome were reviewed. Outcome was classified as success, partial success, or failure based on ultrasound findings. Factors associated with outcome were assessed. Results: Seventy-two cats with 103 obstructed kidneys were enrolled. The causes of obstruction were uroliths in 73% (75/103), strictures in 13.5% (14/103), and pyone- phrosis in 13.5% (14/103) of affected kidneys. Median serum creatinine concentra- tion at presentation was 4.01 mg/dL (range, 1.30-21.3 mg/dL). Outcome after MM was considered a success in 30% (31/103), partial success in 13% (13/103), and fail- ure in 57% (59/103) of kidneys. Success was reported in 23% (17/75) of kidneys with uroliths, 50% (7/14) with pyonephrosis, and 50% (7/14) with strictures. Median time to a successful outcome was 16 days (range, 3-115 days). Distal and smaller uroliths (median length, 1.85 mm) were significantly associated with success (P = .05 and P = .01, respectively). Median survival times were 1188 days (range, 60-1700 days), 518 days (range, 7-1812 days), and 234 days (range, 4-3494 days) for success, partial success, and failure, respectively.
Conclusions and Clinical Importance: We found a higher success rate for MM of BUO than previously reported. Smaller distal uroliths (<1-2 mm) were more likely to pass.
Thank you both. We rechecked the cat today 5 days in to medical management – pelvic dilation continues to improve and creatinine is also coming down to 3.2. The urine in the bladder was anechoic initially and now looks more like a snow globe so appears to be breaking down some renoliths.