Hi guys,
Just wanted a second opinion on this kidney. 10 year old male neutered domestic shorthair came in for dental prophylaxis. Incidental finding of haematuria on urinalysis, no clinical signs. Haematuria persisted after 2 weeks.
Urinalysis showed USG: 1.049, PH: 6 Protein 2+, Blood 4+ and no growth after 48 hours. Blood work was unremarkable.
The right kidney was subnormal in size with complete loss of corticomedullary definition.
Hi guys,
Just wanted a second opinion on this kidney. 10 year old male neutered domestic shorthair came in for dental prophylaxis. Incidental finding of haematuria on urinalysis, no clinical signs. Haematuria persisted after 2 weeks.
Urinalysis showed USG: 1.049, PH: 6 Protein 2+, Blood 4+ and no growth after 48 hours. Blood work was unremarkable.
The right kidney was subnormal in size with complete loss of corticomedullary definition.
The left kidney showed hyperechoic triangular striations towards the medulla in the caudal pole with focal cortical depression, potentially secondary to chronic renal infarct.
Bladder had mild thickeneding on the cranio-ventral aspect.
Questions:
What are the differentials for the right kidney in a 10 year old cat? Can this be congenital renal dysplasia?
Can the changes of the kidneys caused the haematuria?
Would you do a FNB on the right kidney?
Comments
Big kidney little kidney
Big kidney little kidney syndrome. The right kidney is progressively infarcting down to a raisin owing to usually interstitial nephrosis, stone moving or pyelonephritis. Systemic thromboembolic events can do this as well but when throwing clots to kidneys they usually dont live long enough to scar up pretty infarcts like these. The opposite kidney usually swells a bit with compensatory hypertrophy but may also undergo the same process (like these with the smaller infarcts) with the same result til renal failure occurs when 65-70% of functional parenchyma is compromised. Nice image set.
Big kidney little kidney
Big kidney little kidney syndrome. The right kidney is progressively infarcting down to a raisin owing to usually interstitial nephrosis, stone moving or pyelonephritis. Systemic thromboembolic events can do this as well but when throwing clots to kidneys they usually dont live long enough to scar up pretty infarcts like these. The opposite kidney usually swells a bit with compensatory hypertrophy but may also undergo the same process (like these with the smaller infarcts) with the same result til renal failure occurs when 65-70% of functional parenchyma is compromised. Nice image set.
Possibly can be a cause for
Possibly can be a cause for the hematuria but kidney looks fairly inactive – consider interstitial cystitis. Dysplasia not likely as only one kidney affected.
Possibly can be a cause for
Possibly can be a cause for the hematuria but kidney looks fairly inactive – consider interstitial cystitis. Dysplasia not likely as only one kidney affected.
Make sure you check the
Make sure you check the trigone and as much of the urethra as you can see
Make sure you check the
Make sure you check the trigone and as much of the urethra as you can see
Thank you everyone for the
Thank you everyone for the feedback!
So just to clarify: the right kidney is most likely caused by chronic renal disease. The bloods are normal and patient have no clinical signs due to compensating left kidney?
Does the right kidney warrant a biopsy to get a diagnosis given there’s no evidence of inflammation or just monitor it via ultrasound. If the latter: what are monitoring for? More infarcts? Size?
@randyhermandvm: Are we mainly looking for uroliths or calculi in the trigone and urethra? I couldn’t see any abnormalities.
Thank you everyone for the
Thank you everyone for the feedback!
So just to clarify: the right kidney is most likely caused by chronic renal disease. The bloods are normal and patient have no clinical signs due to compensating left kidney?
Does the right kidney warrant a biopsy to get a diagnosis given there’s no evidence of inflammation or just monitor it via ultrasound. If the latter: what are monitoring for? More infarcts? Size?
@randyhermandvm: Are we mainly looking for uroliths or calculi in the trigone and urethra? I couldn’t see any abnormalities.
Looking for any pathology
Looking for any pathology including stones, masses, strictures etc
I figured you probably looked- but I just wanted to make sure.
Looking for any pathology
Looking for any pathology including stones, masses, strictures etc
I figured you probably looked- but I just wanted to make sure.
Until 65-75% of the
Until 65-75% of the functional parenchyma is damaged you won’t have renal failure and if the active process has stopped then clinical signs at the time of exam won’t be present either but this cat has had some period of malaise when undergoing than acute-on-chronic crisis to get to this point. You could bx the RK but I dont know how much it will help the overall management. If there were a concurrent inflammatory pattern with the rk (not present in these images) then I would remove it at this point and bx the LK to assess the active process. You can check infectious tites and see if there is a systemic bug that may be linked to this…
Aweseome! Thanks EL!
Aweseome! Thanks EL!
Until 65-75% of the
Until 65-75% of the functional parenchyma is damaged you won’t have renal failure and if the active process has stopped then clinical signs at the time of exam won’t be present either but this cat has had some period of malaise when undergoing than acute-on-chronic crisis to get to this point. You could bx the RK but I dont know how much it will help the overall management. If there were a concurrent inflammatory pattern with the rk (not present in these images) then I would remove it at this point and bx the LK to assess the active process. You can check infectious tites and see if there is a systemic bug that may be linked to this…
Aweseome! Thanks EL!
Aweseome! Thanks EL!
U bet! If you happen to get
U bet! If you happen to get histopath please add it to the thread.
U bet! If you happen to get
U bet! If you happen to get histopath please add it to the thread.