I’m still getting updates on this case, As I don’t have his file with me, so I don’t have all clinical analysis and the medication, so I’ll give you what I remember…sorry
- Kenji, male cat 2 y, DSH, comes for a 2nd opinion. He’s already on fluids, Antibiotics and AINES.
- Disuryc and stranguryc, hematuria
- Elevated BUN (74) and Creatine (2,4)
- leucocytosis (around 40!!)? with neutrophilia
ULTRASOUND
? 
- Enlarged kidneys with moderate pelvis distention, hyperechoic heterogeneous cortex with partial loss or cortico-medular differentiation. Small non obstrutive calculi on both pelvis.
- Bladder collapsed but then distended with serum, as the cat had a catheter? to control urine production. Bladder wall thicked all over, irregular hyperechoic mucosa that s to be disconnecting itself from the wall. Abundant sediment and debris in urine.
- Both proximal ureters were not particularly distended, but found them distended and tortuous slightly forward, followed bot until the bladder. The left had? small calculi just near the entrance to the bladder, but there was urethral distension, before and after the calculi until the urethral entrance on bladder. Right ureter? was distended until entering the bladder.
Sedated the cat and collected urine from both pelvis (it was clear, but no further test were done with it:-( . The urine in bladder was bloody.
DD:
Severe cystitis with mucosal detachment, cannot exclude diffuse transmural neoplasia, but unlikely since the marked leucocytosis.? I suspected pyelonephrites, but the urine on he pelvis was pretty clear, so the changes in the bun and Creat could be only from the obstruction and nephritis?
COMMENTS:
I don’t think obstruction is related to the presence of calculus in the ureter, as the left ureter is dilated after that. I’ m thinking the the wall inflammation is so severe that is causing urethral obstruction?
The cat was on put on large spectrum antibiotics, on fluids, 2 days later the creat was elevated to 4. The bladder catheter was kept, (still I think it was kept there too long…., I would have prefer a relaxation protocol of they were worried with obstrution then leaving a catheter on a probable severe inflammation, but not my call).
I’ve reccheked a weel later. The bladder still looks bad now as it is small it looks more a a chronic bladder inflammation, with a small rigid bladder. The calculus seem to have come down to the bladder. I still see both ureters slightly distended, but the hidronefrosis seem to be smaller, but the peri-pielic fat is more reactive, so????? now the kidneys look to have a pyelonefrites/nephritis with the left with a subcasular inflamation/hematoma. I don’t know yet the new blood results as I left before they process them.
Do you see urethral obstruction from severe cystitis? I think this was my first… in case it confirms. I’ve found an article on pelvis stenosis of the ureter, but that was a congenital malformation.
Thank you for your feedback
Happy New Year to All
Comments
This patient is in different phases of passing stones and along the way inflammation and scarring and clots/pus can cause the hydro as well. Bottom line it needs ureteral +/- urethral (see image of urethral stent) stents asap and likely dialysis to buy some time. AMC in NYC Allyson Berent and Chick Weiss would be that regional referral but other facility that does IR would be the way to go. The second to last image shows the subcapsular fluid accumulation that can be from insult but LSA can also do this so a 25g fna of that renal cortex would be in order too to be sure you don;t have 2 things going on. You can also do a temporary decompression with US-guided pyelocentesis to buy a little time and of course culture the pelvic fluid.
You can also put power Doppler on the renal cortices to assess blood flow and ensure there is perfusion.
Great case but please try to stick to the short bullet format so we can skim faster through the facts.Please let us know what happens… Remo or Peter any further recs here?
My 2 cents worth: this cat needs urgent intervention to try and save the kidneys.
Here is an image of a ureteral stent of a similar kidney that was decompressed and now stable with a stent/IR. The stent looks like a heartworm in the renal pelvis (double echogenic line). But yes as Remo says needs surgery either traditional or IR if available in your region. The stent is placed transcutaneously guided by fluoroscopy into the dilated renal pelvis (usually needs about 1/2 cm dilation as a target, and then passed through the ureter and pig tailed into the urinary bladder so it doesn’t move. Of there are obstructive stones in the pelvis they can be removed at that time as well.
Hi
First – Happy New Year!!!
Sorry for the long post, try to be shorter in the future, promise 🙂
Thank you for your replies.
I don’t have IR available in my country, I’ve read thoroughly about it, still considering if we can do it US guided, I think so, wouldn’t that be cool ! But fluoroscopy is not an option so far.
Got back the lab from the last day I’ve scanned the cat, creat is lowered to 1.7, leucocitosis remains around on40, cat was eating and doing well and went home.
I’ll recheck the cat hopefully next week.
I imagine the LK e doing ok as the RK looks worse for wear on the last scan.
Eric, the Imagine didn’t show up, can you repost it? Thank you.
Thank you again
Carolina
Carolina I would leave it open for us guided decompression with a 22 or 25 gauge us guided pyelocentesis. We were transfering servers so may have been lost in the switch but here is the urethral stent
and the renal/ureteral stent