Wendy Blount DVM Sahara 6 yr CM Golden Retriever CC presented to regular vet for dental prophy Bloodwork showed BUN 108 creat 46 phos 88 Referred for possible treatment UA SG 1010 ID: 775542
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Slide1
Urinary Ultrasound Cases
Wendy Blount, DVM
Slide2Sahara
6 yr CM Golden RetrieverCC: presented to regular vet for dental prophyBloodwork showed BUN 108, creat 4.6, phos 8.8Referred for possible treatmentUA – SG 1.010Sediment: WBC 10-20/HPFNo bacteria seen
Slide3Sahara
Abdominal Ultrasound
Slide4Sahara
Abdominal Ultrasound
Slide5Sahara
Abdominal UltrasoundLittle/no distinction in echogenicity between cortex and medulla, isoechoic with fatDDx – nephritis, nephrosisSubjectively small kidneys, irregular bordersPylectasiaUrine culture/sensitivity and Lepto titers submitted
Slide6Sahara
Treatment – pending test resultsAmoxicillin 750 mg PO BID x 3 weeksEnrofloxacin 138 mg PO BID x 2 weeksAlOH powder ¼ tsp on food BIDUrine culture & sensitivity – no growth
Slide7Sahara
L. Pomona 1:100L.icterohaemorrhagiae 1:100L.canicola NEGATIVE L.grippotyphossa 1:3200 L.hardjo NEGATIVE L.bratislava NEGATIVE L.autumnalis 1:1600
Slide8Sahara
TreatmentAfter amoxicillin complete, doxycycline 300 mg PO BID x 3 weeks (with food), to eliminate carrier stateWeaned off AlOH as phosphorus returned to normalOutcome: azotemia resolved over 30 days, and renal values remained normal for 3 yearsTeeth were cleaned 90 days later than plannedChronic renal failure began at 9 years of age
Slide9Lessons from Sahara
Uremic halitosis and/or gingival ulceration due to uremia can prompt owners to request dental cleaning
Pre-anesthetic bloodwork can become tiresome, but occasionally can be lifesaving
It’s not possible to diagnose renal failure without a urinalysis
Benign urine sediment, or even negative urine culture does not rule out pyelonephritis
Doxycycline is required to eliminate Lepto carrier
DON’T FORGET THE LEPTO TITERS FOR RF!!
Slide10DDx Hyperechoic Renal Cortex
Relative to fat, liver and/or spleen
Acute toxicity
– ethylene glycol, raisins, NSAID overdose, Lily, hypercalcemia, etc.
Glomerular disease
– glomerulonephritis, amyloidosis
Chronic Interstitial nephritis
Pyelonephritis or pyogranulomatous nephritis
End stage kidney disease
Non-pathologic fat deposition in the cat
Slide11DDx Medullary Rim Sign
Prominent hyperechoic line at the corticomedullary junction
Slide12DDx Medullary Rim Sign
Prominent
hyperechoic line at the corticomedullary junction
Mineral deposition at CM junction
DDx:
Ethylene glycol toxicity
Hypercalcemic nephropathy
Pyogranulomatous nephritis (FIP, fungal, etc.)
Leptospirosis
Chronic interstitial nephritis
Slide13DDx Pyelectasia
Dilation of the renal pelvis>3 mm in the cat>4 mm in the dog
Slide14DDx Pyelectasia
Pyelonephritis
Urinary obstruction (
early hydronephrosis
) or distended urinary bladder
IV fluid therapy
PU-PD
Diuretic therapy
Congenital defect
Absence of pyelectasia does not rule out pyelonephritis
Slide15Pyelonephritis + CRF/ARF
Left Kidney
Slide16Pyelonephritis + CRF/ARF
Right Kidney
Slide17Pyelonephritis + CRF/ARF
Right Kidney
Slide18DDx Perirenal Fluid
Nephritis – infectious, inflammatory
FIP, pyelonephritis, leptospirosis
Acute nephrosis – renal toxicity
Renal lymphoma
Perirenal pseudocyst
Ruptured upper urinary tract
Hemorrhage - trauma or coagulopathy
Aspiration of the fluid for cytology can be helpful in diagnosis and treatment
If abscessed, peritonitis is a risk
Slide19Urohydropropulsion Guidelines
Sex & SpeciesWeightMax Stone DiameterCatheter SizeFemale dogs>2 kg<3-4mm9FrMale dogs5-10 kg<2-3mm9FrMale dogs>10 kg<3mm9FrFemale Cats>2 kg<3mm9FrMale catsUrohydropropulsion not recommended
If you can pass a 9Fr catheter, you can safely void stones up to 3mm in diameter
http
://
www.cliniciansbrief.com/article/canine-urohydropropulsion
Slide20Sasha
5 yr SF DSHCC: repeated episodes of sterile cystitis as a young catThorough work-up included exam, bloodwork, UA, Urine culture, abdominal rads and abdominal USStruvite stone removed from the bladder 2 years ago – not culturedIn remission since thenRecurrence of stranguria, hematuria, periuria in the past weekFeeds c/d multicare, but mixes in Meow Mix to make it that high dollar food go farther
Slide21Sasha
6 yr SF DSHCC: repeated episodes of sterile cystitis as a young catThorough work-up included exam, bloodwork, UA, Urine culture, abdominal rads and abdominal USStruvite stone removed from the bladder in 2013 – not culturedIn remission for 2 yearsRecurrence of stranguria, hematuria, periuria in the past weekFeeds c/d multicare, but mixes in Meow Mix to make it that high dollar food go farther
Slide22Sasha
UA - hematuria, SG 1.022, no bacteriuria, no crystals, WBC TNTCAbdominal radiographs
Slide23Sasha
UA - hematuria, SG 1.022, no bacteriuria, no crystals, WBC TNTCAbdominal radiographs
Slide24Sasha
UA - hematuria, SG 1.022, no bacteriuria, no crystals, WBC TNTCAbdominal radiographs
Slide25Sasha
UA - hematuria, SG 1.022, no bacteriuria, no crystals, WBC TNTCAbdominal radiographs – right kidney smaller (29mm) and with mildly irregular margins than the left (43mm)Abdominal ultrasound
Left Kidney
Slide26Sasha
UA - hematuria, SG 1.022, no bacteriuria, no crystals, WBC TNTCAbdominal radiographs – right kidney smaller (29mm) and with mildly irregular margins than the left (43mm)Abdominal ultrasound
Slide27Sasha
UA - hematuria, SG 1.022, no bacteriuria, no crystals, WBC TNTCAbdominal radiographs – right kidney smaller (29mm) and with mildly irregular margins than the left (43mm)Abdominal ultrasound
Slide28Sasha
UA - hematuria, SG 1.022, no bacteriuria, no crystals, WBC TNTCAbdominal radiographs – right kidney smaller (29mm) and with mildly irregular margins than the left (43mm)Abdominal ultrasound – right hydronephrotic kidneyFilled with flocculent fluidRight ureter 2.5mmRight nephrectomy
Slide29Sasha
UA - hematuria, SG 1.022, no bacteriuria, no crystals, WBC TNTCAbdominal radiographs – right kidney smaller (29mm) and with mildly irregular margins than the left (43mm)Abdominal ultrasound – right hydronephrotic kidneyFilled with flocculent fluidRight ureter 2.5mmRight nephrectomy – filled with purulent fluidStricture in the right ureter
Slide30Sasha
recovery – severe stranguria for 2 days post-opBUN 80, creat 2.6 the day after surgerySince then, BUN has ranged from normal to the 40’sCreat and phos normal One episode of cystitis 60 days after surgeryDid well for 2 years after surgery, euthanized for renal failure 4 years after surgery
Slide31Lessons from Sasha
Repeating work-up of documented problems can reveal new problems, even when symptoms have not changedUpper urinary tract inflammatory disease can result in lower urinary tract symptomsNothing good comes of leaving a hydronephrotic kidney in placeHydronephrotic kidneys can be, but are not always enlargedEven when end stage
Slide32Lessons from Sasha
The most common cause of hydronephrosis in the cat is a stone lodged in the ipsilateral ureterDDx – stricture, tumor in ureters or bladder trigoneHydroureter can be congenital, associated with ectopic ureterHydronephrosis is often subclinical until another problem surfaces, causing clinical signsThe other ureter is blocked by a stoneDownstream inflammation causes lower urinary tract symptoms, or cat becomes septic
Slide33Summary
PowerPoints
–
Kidney Ultrasound Cases
.pdf of PowerPoint –
Kidney Ultrasound Cases
(1 and
6 slides
per page
)
Client Handouts –
Calcium Oxalate Diet
Videos –
Case Examples,
Urohydropropulsion
Slide34Acknowledgements
Stephanie Lisciandro, ACVIM (Int Med)
Chapter 5: Focused or COAST
3
– Kidneys
Focused Ultrasound Techniques for the Small Animal Practitioner
Editor Greg
Lisciandro
– 2014
Eastex Vet Clinic
Drs. Weatherly, Richards & Acuna
“Sahara,” “
Molly,”and
many case example images & videos
Slide35Acknowledgements
Animal Medical Center of Jacksonville
Dr. Ira Lee Stephens - “Sahara”
North Street Veterinary Clinic
Dr. Cheryl Russell - “Molly”
Ward Animal Hospital
“Molly”
Southwood Drive Animal Clinic
Drs. Shawn Penn & Doug Ashburn
“Sasha” & Many case example images
Slide36