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Unilateral pyelonephritis?

Sonopath Forum

Sonopath Forum

Unilateral pyelonephritis?

-4 year old MN Aussie/Catahoula mix

-presents for evaluation of recent onset of icterus

-mild elevations of ALT, SAP

-Hct 28 yesterday (not repeated today)

-not azotemic

-aside from the kidneys below, all other major organs appeared normal; there is a small hyperechoic “nodule” associated with the jejunal mesentery that I believe is unrelated but I will put an image below in case someone disagrees.

-The left kidney looks terrible and is much bigger than the right (~8.5 vs. ~7.4 in length).

 

-4 year old MN Aussie/Catahoula mix

-presents for evaluation of recent onset of icterus

-mild elevations of ALT, SAP

-Hct 28 yesterday (not repeated today)

-not azotemic

-aside from the kidneys below, all other major organs appeared normal; there is a small hyperechoic “nodule” associated with the jejunal mesentery that I believe is unrelated but I will put an image below in case someone disagrees.

-The left kidney looks terrible and is much bigger than the right (~8.5 vs. ~7.4 in length).

 

-I am assuming the primary ddx is lepto but I haven’t seen such unilateral renal changes.  Other things I should consider?

 

Thanks! 

Comments

Pankatz
November 11, 2015 at 9:09 pm -

The right kidney doesn’t look

The right kidney doesn’t look entirely normal to me either. I would put possible pre-existing renal dysplasia and neoplasia with pyelonephritis on your differential list. You should be able to FNA that left kidney (but I would check clotting factors on this one first) Could this patient have IMHA with anemia? If icteric, bilirubin should be up as well.

smbrowndvm
November 11, 2015 at 10:43 pm -

I recommended they recheck a

I recommended they recheck a PCV, check a blood smear, and look for auto-agglutination also but I don’t know the results on that.  I’m sure the bilirubin was probably up but I just got a verbal report on which values were affected.

If you FNA a kidney with pyelonephritis, do you get inflammatory cells if you just sample the cortex?  The other vet was worried about hemangiosarcoma; I am assuming a hemangiosarcoma-affected kidney would yield only blood?  

I’m not sure the owner will allow them to go much further but I was curious what the possibilities were.

 

Thanks for the comments.  

 

Pankatz
November 12, 2015 at 3:45 am -

  My thinking would be to FNA

  My thinking would be to FNA the meaty-bumpy part of the cortex mainly to look for neoplastic cells (like lymphoma, carcinoma). I don’t think FNA otherwise is  great for diagnosing inflammatory processes where core biopsy would be preferred. Making the call for renal dysplasia is a histopathological diagnosis. Pyelocentesis would be the preferred method to confirm pyelonephritis, but you could also culture the urine from a cystocentesis sample as second best option, but you could miss the diagnosis. My experience with hemangiosarcoma and FNA’s is that they almost always come back as non-specific blood, but you might get lucky on this one.

 

EL
November 12, 2015 at 7:43 pm -

The kidneys may actually be a

The kidneys may actually be a red herring in this case the liver/icterus is primary but on these kidneys they look classic pyeleo wiht pyelectasia and fuzzy pelvic fat. Nice eye on th erk nodule…. I dont think its anything but a 25 g fna should clear that up. 6 weeks abs on C/S results and recheck the sonogram is way I would go here. Lepto when hits kidneys will often give a pericapsular fluid pattern see here:

http://sonopath.com/members/case-studies/cases/leptospirosis-suspected-3-year-old-fs-french-bulldog

 may be interstitial in chronic form or nsf but azotemia is present. No rules.

http://sonopath.com/members/case-studies/cases/renal-failure-leptospirosis-9-year-old-mn-english-bulldog

 

 

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