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
- 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.
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?
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