LESIONS OF THE RENAL PELVIS AND PROXIMAL URETER IN VARIOUS NEPHRO-UROLOGICAL CONDITIONS: AN ULTRASONOGRAPHIC STUDY

The applicability of ultrasonography was studied in the diagnosis of lesions of the renal pelvis and ureter in 10 dogs. Ultrasonographic findings of processes associated with dilatation and concretion formation in the renal pelvis were described and the differential diagnosis of the lesions was discussed. The authors propose a new classification system for judging processes characterized by dilatation of the renal pelvis. Experience suggests that ultrasonography is an effective procedure in the diagnosis of certain diseases of the upper urinary tract in dogs.     

Dilated ureters, renal dysplasia, and chronic renal failure in an African elephant (Loxodonta africana)

An ultrasonographic reproductive health examination of a 26-yr-old female African elephant (Loxodonta africana) revealed bilateral ureteral wall thickening and dilatation. On ultrasonographic examination, the bladder and both ureters were normal near the trigone; however, the cranial-most aspect of each ureter was dilated and thickened for a length of 30-50 cm. The same month, elevated blood creatinine (3.0 mg/dl), and urine protein-creatinine ratio (4.0) were observed. Chronic renal failure was diagnosed based on these abnormalities, and the persistent ureteral dilatation was seen on subsequent ultrasound examinations. Complete blood cell counts, serum chemistries, and urinalyses remained relatively unchanged until 24 mo after diagnosis, at which time azotemia, hypophosphatemia, and hypercalcemia (including elevated ionized calcium) developed. Hydronephrosis of both kidneys and prominent sacculation of the left ureter were noted on ultrasonographic examination. Lethargy, ventral edema, and oral mucosal ulceration acutely developed 30 mo after diagnosis. Although blood urea nitrogen remained elevated, creatinine, total calcium, and ionized calcium returned to within reference ranges at that time. Due to rapid clinical decline and grave prognosis, humane euthanasia was elected. Bilateral ureteral dilatation, dysplasia of the right kidney, and chronic nephritis of the left kidney were identified postmortem.     

Perirenal pyelocaliceal diverticulum in an infant cat

A 3-month-old female tortoise-shell cat showing azotemia died with a marked swollen abdomen. Necropsy revealed a huge perirenal cyst (8.5 x 6.0 x 4.5 cm) on the ventral aspect of the right kidney. The cyst was filled with the pellucid yellow fluid with a smell of urine. The lumen was connected with irregularly dilated renal pelvis by a narrow channel passing through the renal parenchyma. The cyst was lined by epithelial cells and its wall was consisted of collagen fibers and smooth muscle cells as that of the renal pelvis and ureter. Renal parenchyma adjacent to the channel showed interstitial infiltration of the lymphoid cells. The cyst was a diverticulum of the renal pelvis due to an impaired development.     

Clinical and ultrasonographic findings, diagnosis and treatment of pyelonephritis in 17 cows

The goal of the present study was to describe the clinical, haematological and ultrasonographic findings and treatment of 17 cattle with pyelonephritis. Fifteen cattle had an abnormal general condition, which varied in severity; five animals had signs of colic. The urine was brownish-red in 11 animals and cloudy in 13. Clumps of purulent material were seen in the urine of nine animals and clots of blood in two. The specific gravity was lower than normal in 13 animals and ranged from 1.005 to 1.020. A urine test strip revealed protein in 16 animals, blood in 16 and leukocytes in 12. Bacteriological examination of urine yielded Corynebacterium renale in 11 animals, Arcanobacter pyogenes in two and Escherichia coli in one. Rectal examination revealed abnormalities of the urinary tract in 11 animals; there was dilatation of the left ureter and/or enlargement of the left kidney in eight cases, and dilatation of the right ureter and/or enlargement of the right kidney in three others. The most frequent abnormal haematological finding was an increase in the serum concentrations of total protein, fibrinogen, urea and creatinine, a decreased haematocrit and a positive glutaraldehyde test. In 13 animals, ultrasonography via the rectum and right flank using a 5.0MHz transducer revealed dilatation of the right or left ureter, cystic lesions in one or both kidneys and dilatation of the renal sinus. Eight animals were euthanased or slaughtered at the owners' request or because of a poor prognosis. Nine (53%) animals were successfully treated; five received antibiotics and four underwent unilateral nephrectomy and antibiotic therapy. The treated animals were clinically healthy when discharged from the clinic 10-21 days after admission. A follow-up via telephone 8-24 months later revealed that none had experienced complications and all were in full production. In cattle with severe unilateral pyelonephritis, unilateral nephrectomy is the treatment of choice.     

Exophthalmus secondary to a sinonasal cyst in a horse

CASE DESCRIPTION: A 13-year-old female Miniature Horse was evaluated for progressive unilateral exophthalmia of the left globe of 3 weeks' duration. CLINICAL FINDINGS: Results of a physical examination were unremarkable. Ophthalmic examination identified exophthalmus of the left globe with complete resistance to retropulsion and mild blepharoconjunctivitis. Computed tomography revealed a large, space-occupying mass within the left caudal maxillary and left conchofrontal sinuses. The mass extended into the left retrobulbar space and contacted the cribriform plate. Trephination yielded copious amounts of turbid yellow fluid. The diagnosis was a sinonasal cyst. TREATMENT AND OUTCOME: Subtotal surgical excision of the cyst via a frontonasal osteoplastic flap was curative, with complete resolution of the exophthalmus. Histologic examination confirmed diagnosis of a sinonasal cyst. There was no evidence of cyst recurrence by 4 months after surgery. CLINICAL RELEVANCE: Sinonasal cyst should be a differential diagnosis for retrobulbar disease in horses. Exophthalmia may be the only clinical finding in horses with a sinonasal cyst.     

Microscopic and ultrastructural lesions of the ureter and renal pelvis in sows with regard to Actinobaculum suis infection

Tissues from ureter and renal pelvis of 18 sows naturally (n = 15) and experimentally (n = 3) infected with Actinobaculum suis (former Actinomyces, Eubacterium suis) were studied using light and scanning as well as transmission electron microscopy. The results were compared with the findings from 11 clinically healthy sows as controls. The lesions in both the ureter and renal pelvis of naturally and experimentally infected animals were similar. In severe cases there were necrotizing ureteritis and pyelitis with accumulation of bacterial colonies in some cases. Several superficial epithelial cells were found phagocytosing necrotic debris. In mild cases the main lesions included epithelial cell hyperplasia, desquamation of the superficial epithelial cells and goblet cell metaplasia with intraepithelial cyst formation. The goblet cells were found in the superficial as well as in the intermediate cell layers. Generally, it was observed that severe purulent ureteritis and pyelitis/ pyelonephritis in sows were to be expected only in mixed infection of A. suis with other bacteria. The findings were compared and discussed with the changes in the infected urinary bladder of sows and the alterations induced by urinary tract infection in man.     

Dissolution of a struvite nephrolith in a dog.

A large radiodense calculus in the left renal pelvis of a 22-month-old, male Great Dane disappeared one month following surgical removal of two struvite (magnesium ammonium phosphate) calculi from the right renal pelvis. The dog's urine likely became undersaturated with struvite for a sufficient period to permit dissolution of the renal calculus. Several factors may have contributed to the decrease in urine struvite concentration, including eradication of a urease-producing Proteus sp from the urinary tract and induction of polydipsia and compensatory polyuria by oral administration of sodium chloride.     

Results of renal ultrasonography performed before and during administration of saline (0.9% NaCl) solution to induce diuresis in dogs without evidence of renal disease

OBJECTIVE: To evaluate the effect of saline (0.9% NaCl) solution administered IV to induce diuresis on 15 dimensional variables of the kidneys, size of renal pelvis, and diameter of the cranial part of the ureters. ANIMALS: 25 dogs without evidence of renal disease that were undergoing chemotherapy for various neoplasms. PROCEDURE: The kidneys, cranial aspect of the ureters, and trigone area of the urinary bladder of each dog were examined ultrasonographically before and during IV administration of saline solution (2.7 to 18.8 ml/kg of body weight/h). RESULTS: Ultrasonography revealed unilateral and bilateral pyelectasis during diuresis in 16 of 23 (70%) dogs but unilateral pyelectasis in only 1 dog before diuresis. Unilateral pyelectasis during diuresis was observed in 11 of 16 (69%) dogs. Pyelectasis during diuresis was categorized as slight in 15 of 21 (71%) kidneys. Degree of pyelectasis during diuresis was not identical in both kidneys of 13 of 16 (81 %) dogs. Diuresis did not induce ureterectasis, and it did not cause changes in 15 dimensional variables of the kidneys. CONCLUSIONS: In nonsedated, nonazotemic dogs, IV administration of saline solution to induce diuresis may cause slight pyelectasis without evidence of ureterectasis. CLINICAL RELEVANCE: When dilatation of the cranial part of the ureter is > 2 mm at the same time that ipsilateral pyelectasis is detected during ultrasonographic examination of the urinary tract system of a nonsedated, nonazotemic dog receiving IV administration of saline solution to induce diuresis, additional examinations are recommended to determine the possibility of early obstructive nephropathy or pyelonephritis.     

ULTRASONOGRAPHIC FINDINGS IN 14 DOGS WITH ECTOPIC URETER

To evaluate ultrasonography as an alternative to contrast radiography for diagnosis of ectopic ureter in dogs, ultrasonography of the urinary tract was performed prospectively in a series of urinary incontinent dogs anesthetized for contrast radiography. Fourteen dogs had ectopic ureter based on surgical, necropsy or unequivocal contrast radiographic findings. There were eight females and six males of a variety of breeds; five were Labrador retrievers. Mean (range) age at the time of diagnosis was 1.2 (0.2–4) years for females and 3.5 (0.3–5) for males (p < 0.05). Ectopic ureters were unilateral in five dogs (2 left; 3 right) and bilateral in nine dogs. Both ultrasound images and contrast radiographs were positive for 21 (91%) ectopic ureters; the same two ectopic ureters were not detected using either modality. The termination of each of the five normal ureters was visible on ultrasound images; two (40%) were visible on radiographs. Other ultrasonographic findings included dilatation of the ectopic ureter and/or ipsilateral renal pelvis in ten (43%) instances, evidence of pyelonephritis in two dogs (with enlargement of the contralateral kidney in one dog), and urethral diverticuli in one dog. Ultrasonography is a practical diagnostic test for ectopic ureter in dogs. In this series there was close correlation between the ultrasonographic and contrast radiographic findings for each ectopic ureter, but ultrasonography enabled more accurate determination of normal ureteral anatomy.     

Ultrasonography of the equine neonatal kidney

Ultrasonography is important in the clinical examination of the foal. The ultrasonographic appearance and size of the neonatal kidneys were defined and an imaging protocol established in 6 normal Thoroughbred foals (mean age +/- s.d. 5.0 +/- 3.2 days). Characteristically, in both the heart-shaped right kidney and bean-shaped left kidney, the renal cortex was more echogenic than the medulla. The terminal recesses, renal crest and pelvis were identified, as was the ureter, which contained anechoic urine in its lumen. The renal, interlobar and arcuate vessels were seen. For the right kidney, the ultrasonographic probe was placed at the 14-17th intercostal spaces and paralumbar fossa. For the left kidney, the probe was at the 16th or 17th intercostal spaces and paralumbar fossa. Perirenal structures, including the caudate lobe of the liver, the dorsal extremity of the spleen, the adrenals, the aorta and caudal vena cava were also identified. An understanding of the ultrasonographic appearance of the normal neonatal kidney, accompanied by a routine imaging protocol to ensure that all regions of each kidney are examined, permit a more informed interpretation of renal images in the first few days postpartum.     

Renal pelvic rupture,intrapelvic haematoma and retroperitoneal haemorrhage associated with obstructive ureterolithiasis in a cat

A neutered female cat presented with a 9-day history of hyporexia and depression. The referring veterinarian had identified moderate non-regenerative anaemia, haematuria and suspected unilateral obstructive ureterolithiasis. Subsequent ultrasonography revealed moderate distension of the left renal pelvis with echogenic material, ureteral distension and ureterolithiasis. A partial ureteral obstruction was suspected. After 4 days of medical management, there was further distension of the renal pelvis with well-delineated echogenic material and an accumulation of perinephric fluid. A left nephroureterectomy was performed. Renal pelvic rupture with intrapelvic haematoma and retroperitoneal haemorrhage was confirmed by histopathology. Eighteen months following surgery, the cat remained clinically well with normal renal values.     

Histopathological retrospective study of canine renal disease in Korea, 2003~2008

Renal disease includes conditions affecting the glomeruli, tubules, interstitium, pelvis, and vasculature. Diseases of the kidney include glomerular diseases, diseases of the tubules and interstitium, diseases of renal pelvis, and developmental abnormalities. Renal tissue samples (n = 70) submitted to the Department of Veterinary Pathology of Konkuk University from 2003 to 2008 were included in this study. Tissue histopathology was performed using light microscopy with hematoxylin and eosin stains. Masson''s trichrome, Congo Red, and Warthin starry silver staining were applied in several individual cases. Glomerular diseases (22.9%), tubulointerstitial diseases (8.6%), neoplastic diseases (8.6%), conditions secondary to urinary obstruction (24.3%), and other diseases (35.7%) were identified. Glomerulonephritis (GN) cases were classified as acute proliferative GN (5.7%), membranous GN (4.3%), membranoproliferative GN (4.3%), focal segmental GN (2.9%), and other GN (4.2%). The proportion of canine GN cases presently identified was not as high as the proportions identified in human studies. Conversely, urinary obstruction and end-stage renal disease cases were relatively higher in dogs than in human populations.     

Renal extramedullary plasmacytoma in a dog

A 10-year-old, intact male Siberian husky dog was presented for a suspected left renal cyst. Computed tomography (CT) identified a large, left kidney mass with retroperitoneal hemorrhage. A left-sided nephrectomy was performed, and histopathology confirmed a renal plasmacytoma. Perioperative screening for multiple myeloma was negative. The dog was lost to follow-up and was euthanized 11 months after surgery. A necropsy was not performed. To the authors’ knowledge, this is the first case of renal extramedullary plasmacytoma in a dog.Key clinical message:This report describes the clinical presentation, and laboratory, diagnostic imaging, and surgery findings of a case of renal extramedullary plasmacytoma in a dog.     

The use of computed tomography in the diagnosis of an ectopic ureter in a Quarter Horse filly

This report describes a 4‐month‐old Quarter Horse filly with an ectopic ureter. The filly presented with signs of urinary incontinence, which had been present since birth. Computed tomography (CT) examination and cystoscopy confirmed a diagnosis of a unilateral ectopic ureter. A nephrectomy of the left kidney was performed and renal function was closely monitored post operatively. The filly was treated for abdominal chylous effusion as a post operative complication. The filly survived to discharge from the hospital, and maintained normal urinary function at 12 months post operatively.     

Idiopathic renal haematuria in an Egyptian Arabian stallion

A 17-year-old Egyptian Arabian stallion was presented for haematuria and blood clots in the urine of 4 days’ duration. During micturition, haematuria was noted mid-stream with passage of blood clots occurring at the end of urination. Physical examination findings were unremarkable aside from pale mucous membranes. Cystoscopic examination revealed intermittent passage of frank blood (with clots) from the left ureteral orifice compared to grossly normal-appearing urine issuing from the right ureteral orifice. Transcutaneous ultrasonographic evaluation of the right kidney yielded normal findings while the left kidney exhibited pyelectasia, a decreased cortico-medullary ratio, and markedly increased echogenicity of the renal pelvis. Diagnosis of idiopathic renal haematuria was confirmed at necropsy.     

Renal pathology and urinary protein excretion in a 14-month-old Bernese mountain dog with chronic renal failure

The renal pathology and urinary protein pattern of a 14-month-old female Bernese mountain dog with chronic renal failure was investigated. Sodium dodecyl sulphate-polyacrylamid gel electrophoresis and subsequent Western blot analysis of urine showed the presence of heavy and light chains of immunoglobulin, transferrin, albumin, vitamin D-binding protein, transthyretin and retinol-binding protein (RBP), but no excretion of Tamm-Horsfall protein (THP). Histopathological examinations of the kidneys revealed severe membranous glomerulonephritis accompanied by tubular dilatation, tubular atrophy and interstitial fibrosis. The renal expression of megalin, the main endocytic receptor for the re-uptake of proteins in proximal tubules, RBP and THP was reduced or completely absent, indicating severe tubular dysfunction. The identified urinary proteins may be of interest as additional markers for the diagnosis of juvenile nephropathy in Bernese mountain dogs.     

Intrarenal pelvic nephroblastoma in a meerkat (Suricata suricatta).

Nephroblastoma is the most common primary renal tumor in children and has also been reported in domestic and nondomestic animal species. Intrapelvic renal nephroblastoma is a rare variant of this tumor type in human patients. Postmortem examination of a captive meerkat (Suricata suricatta), which was found dead, revealed enlargement of the pelvis of the left kidney by a tumor mass. Gross, histological, and immunohistochemical findings were consistent with a diagnosis of triphasic intrapelvic renal nephroblastoma. This is the first reported spontaneous case of intrapelvic renal nephroblastoma in a nonhuman species.     

Diagnosis,treatment, and long-term follow-up of bilateral,upper urinary tract infection (UTI) in a cat

A case of bilateral, upper urinary tract infection caused by haemolytic E coli in a female Birman cat is presented. Ultrasonographic examination of the kidneys documented changes in size, outline, echogenicity and architecture. Ultrasound guided fine needle aspiration of fluid from the renal pelvis was used to make the diagnosis. Fluid was submitted for culture and sensitivity and based on the results, antimicrobial therapy was initiated. The treatment was monitored over a 406-day follow-up period. Despite extensive treatment with specific antibiotics and supportive therapy, recurrence of urinary tract infection occurred.     

LAPAROSCOPIC SONOGRAPHY IN THE URINARY SYSTEM

This work reports the use of laparoscopic-transducer sonography for the examination of the urinary system in a swine model. Animals underwent a two-phase study. In the first phase, the urinary system was examined using laparoscopic sonography. In the second a partial ureteral obstruction was induced, and sonographic changes were recorded and evaluated. Sonography was used to evaluate kidneys, ureters, and bladder. Anatomic structures were evaluated and the following pathological findings were identified: renal cysts, one polycystic kidney, dilation of the renal pelvis, hydronephrosis, and one perirenal pseudocyst. Where necessary, contrast digital fluoroscopy (excretory urography and retrograde ureteropyelography) was also performed. Laparoscopic sonography mainly is used for evaluation prior to laparoscopic surgery to guide decisions relating to surgery. The quality of the images obtained laparoscopically is superior to that of percutaneous or transabdominal images, because artifacts are reduced and the contact surface of the transducer is placed directly over the study area. Laparoscopic sonography proved highly effective for studying renal and ureteral disorders prior to minimally invasive surgery.     

Hypertensive retinopathy in a cat

A 12-year-old cat presented for sudden blindness was diagnosed with hypertensive retinopathy on the basis of ophthalmologic and ultrasonic examination. Renal failure due to a large intranephric cyst obstructing the right ureter and renal artery was the suggested cause of the systemic hypertension. The cat died 8 hours after unilateral nephrectomy.