SONOGRAPHIC AND SCINTIGRAPHIC EVALUATION OF ACUTE RENAL ALLOGRAFT REJECTION IN CATS

The sonographic features of acute renal allograft rejection in humans and dogs are manifested by increase in renal cross-sectional area and reduction in renal cortical blood flow. These changes have not been investigated in cats. The objectives of this study were to evaluate sonographic and scintigraphic changes during acute renal allograft rejection in cats. Eight SPF, intact, adult, male cats received heterotopic renal allotransplantations. Immunosuppressive doses of cyclosporine and prednisolone were administered for 14 days and then discontinued to allow acute allograft rejection to occur. Serial measurements of renal cross-sectional area, resistive index (RI), echogenicity, and glomerular filtration rate (GFR) were performed to evaluate changes during acute rejection. Upon sonographic confirmation of absent diastolic blood flow or a 20% increase in cross-sectional area of the allograft, a nephrectomy and histopathologic evaluation were performed. Acute allograft rejection was confirmed histologically in all cats. Significant increases in renal cross-sectional area (P < 0.001) occurred postoperatively and during rejection. There were no significant changes in RI (P = 0.43) at any time. A subjective increase in medullary echogenicity and a decrease in corticomedullary demarcation were observed in the rejection period. While GFR decreased significantly in the immediate postoperative period (P < 0.001), no further change occurred during rejection (P = 0.42). Changes in RI and GFR do not appear to be sensitive indicators of acute renal allograft rejection in cats. Serial measurements of renal cross-sectional area appear to be a sensitive method for the early diagnosis of allograft rejection in feline renal transplant recipients.     

Study of association between histologic features and echogenicity of architecturally normal cat kidneys

Thirty-eight grossly and histologically normal cat kidneys were examined ultrasonographically. The echogenicity of the renal cortex was subjectively evaluated by scoring it as largely or not largely different from the echogenicity of the renal medulla and as similar or not similar to the echogenicity of the renal sinus. The presence or absence of a medullary hyperechoic band was determined. The length, width, and height of each kidney was measured. Hematoxylin and eosin-stained sections of each kidney were examined microscopically. The amount of fat vacuoles in the tubular epithelium of the renal cortex was scored as plentiful or not plentiful. The presence or absence of a medullary band of mineral deposits within the lumina of renal tubules was determined. A plentiful amount of fat vacuoles in renal cortex was associated positively with a large difference in echogenicity between cortex and medulla (P less than 0.01) and with similar echogenicity of cortex and sinus (P less than 0.01). The presence of a medullary hyperechoic band was associated positively with a band of mineral deposits within medullary tubular lumen (P 0.01). Kidneys with a large difference in echogenicity between cortex and medulla and kidneys with a plentiful amount of fat vacuoles were not significantly different in size (P = 0.56). These groups were larger (P less than 0.01) in length, width, and height than were kidneys without a large difference in echogenicity between cortex and medulla and kidneys that did not have plentiful cortical fat vacuoles.     

Ultrasonographic Features of the Chinchilla (Chinchilla lanigera) Kidney

Nine healthy chinchillas (Chinchilla lanigera) were used to characterize the ultrasonographic size and anatomical structure of the kidneys. Sonographic evaluations were performed with the aid of a 12-MHz linear probe. Kidney measurements included total width and length, total organ area, cortex and medullary thickness, and width and length of the renal pelvis. Based on the results of this study, normal chinchilla kidneys are located retroperitoneally, with the right kidney in a more cranial location than the left. Statistical analysis showed that measurements were similar between contralateral kidneys and between sexes. Chinchilla kidneys have a single papilla and a wider renal pelvis compared with the renal pelvis of dogs and cats. Moreover, chinchilla kidneys have a longer medullary area. The data herein may aid diagnosis of renal disease in chinchillas, avoiding misinterpretations of ultrasonic findings involving the kidneys of this species.     

ULTRASONOGRAPHIC EVALUATION OF RENAL AUTOGRAFTS IN NORMAL CATS

The purpose of this study was to determine changes in resistive index (RI) and renal size that occur in normal feline kidney autografts in the immediate post-transplant period. Qualitative changes in renal parenchymal echogenicity and pelvic dilation were also noted, although this was not a major focus of the study. Fourteen domestic short-haired cats underwent bilateral nephrectomies followed by an autograft of the right kidney to either the aorta or external iliac artery. Due to post-operative complications, only nine of these cats completed the study. Ultrasonographic determination of the RI and renal size was made before transplantation and on days 1, 4, 7, 10, and 13 following transplantation. No significant changes in renal RI were identified during the study. Renal size increased significantly, peaking at 63% above baseline on day 7, and stayed elevated at 50% above baseline on day 13. There was no evidence of rejection or other abnormalities found on histologic evaluation of the transplanted kidneys. It was concluded that the RI of normal feline renal autografts does not significantly change in the immediate post-operative period. However, significant renal enlargement, likely due to a combination of post-operative edema and hypertrophy, does occur. This study provides baseline information for comparison with feline allografts in the immediate post-transplant period.     

Ultrasonographic determination of resistive index and graft size for evaluating clinical feline renal allografts.

Ultrasonographic examination is a commonly employed technique for postoperative renal allograft evaluation after transplantation. Allograft size and resistive index (RI) are two objective ultrasonographic measures that may help establish a diagnosis and direct postoperative management for grafts with suboptimal function but their diagnostic efficacy has not been evaluated in clinical veterinary patients. Results of 69 feline renal transplant ultrasonographic examinations and RI determinations were studied. Based on clinical parameters at the time of the ultrasonographic examination, patients were grouped into six clinical/functional categories including evaluations of clinically normal grafts, delayed graft function, ureteral obstruction, uroabdomen, graft thrombosis, and rejection. RI, graft size (length, cross-sectional area, and volume), cyclosporine A whole blood trough concentration, Doppler blood pressure, creatinine concentration, and days from transplantation were compared between these categories and associations with each other were examined. RI was of little value in differentiating among the clinical categories with the exception of graft thrombosis. Graft volume and time from transplantation were significantly greater in grafts with signs of rejection and ureteral obstruction compared to clinically normal ultrasound examinations. Graft volume, cross-sectional area and length were generally associated. Cyclosporine A blood concentrations was associated with RI in both the pooled data and in the delayed graft function category. These results indicate RI should be used only as part of a larger clinical picture and in light of other factors including cyclosporine A concentration and the timing of the study relative to the implantation surgery for the diagnosis of postoperative transplantation complications. Graft volume may provide a more sensitive, albeit, nonspecific, indicator of allograft dysfunction.     

B-mode and Doppler ultrasound of chronic kidney disease in dogs and cats

Ultrasound is the imaging test of choice for renal evaluation, because it provides information about the position, size, shape, internal architecture and hemodynamics of the kidneys without harming the patient. In chronic kidney disease, the main findings observed in B-mode ultrasound images are increased cortical echogenicity, loss of corticomedullary differentiation, reduced renal volume and irregular renal contour, and when these changes are associated, they are indicative of end-stage renal disease. However, the cause of kidney disease cannot be determined by ultrasonography, but must be confirmed by means of biopsy, although the presence of ultrasonographic changes indicative of the end-stage of the disease may contraindicate this procedure. The Doppler ultrasound test complements the ultrasonic B-mode examination and enables the assessment of renal perfusion based on a calculation of the hemodynamic indices, which are increased in cases of chronic kidney lesions, with higher values ??in the most severe cases. Thus, ultrasound examinations are not only useful in diagnostics but also play an important role in defining the prognosis of patients with chronic kidney disease.     

RENAL SONOGRAPHIC MEASUREMENTS IN THE DOG PRECEDING AND FOLLOWING UNILATERAL NEPHRECTOMY

The purpose of this study was to establish sonographic baseline values for normal kidneys initu and to document sonographic changes following unilateral nephrectomy. Normal canine renal measurements were determined sonographically prior to and following unilateral nephrectomy. These included: cortical thickness (cranial, caudal, dorsal, ventral, lateral and medial), medullary measurements (cranial and caudal) and measurements of the renal silhouette (length, height and width). The latter group of measurements was obtained to determine renal volume. Normal parameters were obtained from sixteen healthy dogs prior to nephrectomy; the unilateral nephrectomy group was comprised of eight of these animals, the remaining eight dogs were part of an allo-transplant study.¹ The mean sonographic value for the length of the kidney was 60.3 mm ± 6.4 (n = 26) while the widths and heights were 34.7 ± 3.8 (n = 27) and 27.8 mm ± 3.3 (n = 26) respectively. Renal cortical measurements were found to be smallest dorsally and ventrally on sagittal and transverse sonograms. The largest volumes were the cranial pole on sagittal scans and the lateral pole on the transverse scans. Pearson correlation coefficient for volume resulted in r values of 0.88, 0.78 and 0.72 for length, height and width (n = 25, dif = 24) respectively.     

SONOGRAPHIC RENAL FINDINGS IN 20 DOGS WITH LEPTOSPIROSIS

Abdominal ultrasound examinations of 20 dogs with confirmed leptospirosis were reviewed retrospectively for renal abnormalities. Three dogs had a normal ultrasound examination. The remaining 17 dogs had sonographic abnormalities of the kidneys. These abnormalities, seen either alone or in combination, included renalmegaly (n=10), pyelectasia (n=9), increased cortical echogenicity (n=15), perinephric effusion (n=5), and a medullary band of increased echogenicity (n=6). At our institution, the medullary band of increased echogencity has only been seen in dogs with leptospirosis and may therefore be a specific sonographic sign for this disease.     

EFFECT OF ANISOTROPY AND SPATIAL COMPOUND IMAGING ON RENAL CORTICAL ECHOGENICITY IN DOGS

The echogenicity of the renal cortex is an important parameter to consider in dogs that are suspected to have renal dysfunction. Focal increases in echogenicity have been attributed to neoplasia, infection, calcification, fibrosis, gas, and infarction. Anisotropic backscatter has been described as a source of focally increased renal cortical echogenicity in several species. The source of anisotropy appears to be the medullary rays, which are oriented perpendicular to the renal capsule. Spatial compound imaging (SCI) is an ultrasound setting that uses beam steering to acquire and average several overlapping scans of an object from different view angles, creating a compound image that is updated in real time. The impact of insonation angle and SCI on renal cortical echogenicity was evaluated ex vivo in eight kidneys from four dogs. Significant angle‐dependent differences in cortical echogenicity were detected with both microconvex and linear transducers (P < 0.0001). Furthermore, the angle‐dependent echogenicity differences persisted when SCI mode was used. Our finding that echogenicity was increased using a perpendicular insonation angle (90°) relative to the tubules, compared to a parallel insonation angle (0°) should assist in the interpretation of ultrasonographic images of the dog kidney.     

ULTRASONOGRAPHIC FINDINGS IN ETHYLENE GLYCOL (ANTIFREEZE) POISONING IN A PREGNANT QUEEN AND 4 FETAL KITTENS

A one year old female Siamese-Persian mixed breed cat in late third trimester of pregnancy was presented for anorexia and lethargy. Abdominal radiographs were normal. Abdominal ultrasound revealed markedly increased cortical and moderately increased medullary echogenicity of the maternal kidneys. Cortical echogenicity of all fetal kidneys were similarly increased in echogenicity. Premortem clinicopathologic and postmortem histopathologic findings were indicative of ethylene glycol nephrosis presumably secondary to antifreeze ingestion.     

CONTRAST HARMONIC ULTRASOUND APPEARANCE OF CONSECUTIVE PERCUTANEOUS RENAL BIOPSIES IN DOGS

Ultrasound‐guided percutaneous renal biopsy may be associated with complications, especially when using larger needles. Contrast harmonic ultrasound increases blood pool echo intensity, enhancing parenchymal lesions. Therefore, contrast harmonic ultrasound is a potential alternative screening method for postbiopsy renal lesions. Renal biopsies were performed using 14 G needles in 11 healthy Beagles, at three occasions: 0 (“Baseline Biopsy”; BB), 4 (“Biopsy 2”; B2), and 6 months (“Biopsy 3”; B3). Ultrasound and contrast harmonic ultrasound of biopsied kidneys were performed approximately 30 min after biopsy (week 0) at BB and B2, and repeated once every week (weeks 1–3) until normal appearance. At B3, only contrast harmonic ultrasound was performed, both immediately and 30‐min postbiopsy. Contrast harmonic ultrasound images were reviewed using subjective and semiquantitative methods to describe lesions including number, shape, size, sharpness, echogenicity, and evolution. More renal lesions were detected with contrast harmonic ultrasound (22/22) compared with conventional ultrasound (14/22). The majority appeared at week 0 as hypoechoic tract(s) (27/33), the other (6/33) as ill‐defined areas or area/tract combination, all having variable size, shape, and echogenicity. Seven tracts had a small subcapsular hematoma. In most kidneys, similar or gradual decrease of size and sharpness, and increased echogenicity was observed until normal appearance occurred at week 1 (1/22), week 2 (18/22), or week 3 (22/22). Two Beagles developed complications. At B3, immediately postbiopsy, tracts were hyperechoic in 9/11 kidneys, becoming hypoechoic again 30 min later. Contrast harmonic ultrasound is a valuable method to evaluate postbiopsy renal lesions in dogs.     

AGE AND DIET EFFECTS ON RELATIVE RENAL ECHOGENICITY IN GERIATRIC BITCHES

Under controlled, but varied dietary conditions 35 geriatric, uninephrectomized, spayed Beagle bitches (dogs) observed for 4 years, renal cortical and renal medullary echogenicity was measured relative to hepatic and splenic echogenicity. Regardless of the diet fed, 60-75% of these aged dogs had renal cortical echogenicity less than that of either the liver or spleen across time; 25-35% of these dogs had renal cortical echogenicity equal to that of the liver, but less than that of the spleen across time. Less than 3% of these dogs had renal cortical echogenicity greater than that of the liver, but less than that of the spleen. Only 1 (one) of these dogs had renal cortical echogenicity equal to that of the spleen and that occurred at only one of the 14 chronologic assessments. Therefore, in either mature or aged dogs imaged with 4.0 to 5.0 MHz equipment, the renal cortical echogenicity should be considered normal if it is less than or equal to that of the liver and less than that of the spleen. In 29 dogs imaged with the 4.0/5.0 MHz equipment and 6 dogs imaged with 7.5 MHz equipment, there was no significant diet or individual dog effect. The 7.5 MHz (6 dog) group had significantly higher average cortical echogenicity scores than the 4.0/5.0 MHz (29 dog) group. However, the occurrence of renal cortical echogenicity greater than liver echogenicity was seen in only 5 of 83 samples (approximately 6.0%) made on 6 dogs imaged with 7.5 MHz equipment and only 1 of 375 samples (approximately 0.27%) made on 29 dogs with 4.0/5.0 MHz equipment. With the exception of one occurrence, all dogs had renal medullary echogenicity less than that of the liver or spleen regardless of imaging equipment frequency. The renal medulla was always hypoechoic compared to the cortex.     

Early renal ultrasonographic findings in dogs with experimentally induced ethylene glycol nephrosis

Renal ultrasonographic changes were evaluated in 5 dogs administered 10 ml of commercial antifreeze (95% ethylene glycol)/kg of body weight, PO, and in 2 dogs given placebos. Studies were made prior to and after ingestion on an hourly basis over a period of 8 to 10 hours. All dogs were anesthetized immediately after toxin or placebo ingestion for the duration of the study. Renal cortical echogenicity was evaluated in comparison with that of the adjacent liver and spleen. Echogenicity of the renal medulla and definition of the corticomedullary junction were assessed. Within 4 hours after ethylene glycol administration, renal cortical echogenicity of all intoxicated dogs increased from normal to surpass that of liver and approach or equal that of the spleen. Medullary echogenicity in all intoxicated dogs progressively increased over the course of the study, with changes recognized within 5 hours after ethylene glycol administration. An ultrasonographic pattern consisting of nearly equal, marked increase in cortical and medullary echogenicity and relatively hypoechoic corticomedullary junction and central medullary regions was recognized concurrent with the development of anuria in 3 of the 5 intoxicated dogs. Mild, transient increases in cortical and medullary echogenicity were observed in anesthetized control dogs. However, no statistical difference (P less than 0.05) was detected between baseline, peak, and terminal echogenicity values in these dogs. Blood and urine samples were collected hourly from intoxicated dogs to coincide with ultrasonographic studies. Most clinicopathologic values derived from these samples were not statistically different (P less than 0.05) from those reported in a study that used a similar intoxication protocol in nonanesthetized dogs.     

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.     

Evaluation of oxidative stress markers for the early diagnosis of allograft rejection in feline renal allotransplant recipients with normal renal function

The purpose of this study was to identify oxidative damage to renal allografts during graft rejection by evaluating changes in oxidative markers and plasma lactate levels in feline renal allotransplant recipients. Heterotopic renal allotransplantations were performed between 8 adult feline cross-matched donors. Following 14 d of immunosuppression, the drugs were discontinued to allow allograft rejection. Baseline and serial postoperative evaluations of serum creatinine, plasma lactate, plasma thiobarbituate reactive substances (TBARS), plasma creatol, urine creatol, and renal sonographic cross-sectional area were performed. When sonographic evaluation revealed the absence of blood flow to the allograft, the rejected kidney was nephrectomized and evaluated histopathologically. Allograft rejection occurred in all cats by day 26. A significant elevation in body temperature occurred during the rejection period. No significant change was observed between any of the time periods for plasma TBARS, creatol, or urine creatol. There was a significant decrease in plasma lactate levels throughout the study. Markers of oxidative stress from venous blood did not reflect renal allograft rejection in cats with a normally functioning native kidney. Renal allograft rejection may be associated with significant increases in body temperature and warrants further investigation.     

MOST DOGS WITH MEDULLARY RIM SIGN ON ULTRASONOGRAPHY HAVE NO DEMONSTRABLE RENAL DYSFUNCTION

The medullary rim sign is a distinct hyperechoic line in the renal medulla parallel to the corticomedullary junction that has been reported in dogs with a variety of renal diseases. To examine the association between medullary rim sign and renal disease, the medical records of thirty-two dogs that had medullary rim sign were reviewed retrospectively. Eighteen dogs (56%) had no evidence of renal dysfunction; 14 (44%) had clinicopathological evidence of renal disease, including 6 (19%) that had hypercalcemic nephropathy. Most dogs (72%) in which medullary rim sign was the only ultrasonographic finding affecting the kidneys had no evidence of renal dysfunction. In contrast, 78% dogs that had medullary rim sign and other renal signs (reduced size, increased medullary echogenicity, and pyelectasia) had renal disease. On the basis of this study, the medullary rim sign appears to be a non-specific ultrasonographic sign; however, the possibility cannot be excluded that is a sentinel sign of subclinical renal disease.     

Evaluation of the Clinical and Histologic Features of Renal Allograft Rejection in Cats

OBJECTIVES: To describe the clinical signs and histopathologic features of renal allograft rejection in cats, and to provide a historical, untreated control group for use in future studies of feline renal allograft rejection. ANIMALS: Fourteen adult research cats. METHODS: Renal transplantation and bilateral nephrectomy were performed in pairs of immunogenically mismatched cats. A physical examination was performed, and packed cell volume, total protein, and plasma creatinine concentrations were measured each day after surgery. The cats were euthanatized when plasma creatinine concentration exceeded 7 mg/dL or when weight loss exceeded 20%. Renal histopathology was scored according to the Banff 97 criteria by 3 pathologists. RESULTS: Nine cats completed the study. Plasma creatinine exceeded 7 mg/dL in 5 cats, weight loss exceeded 20% in 3 cats, and 1 cat was found dead. Clinical signs in cats with rejection were nonspecific or absent. Rectal temperature decreased by 0.8 +/- 0.5 degrees C in the 24 hours before euthanasia. The pathologists agreed on the allograft histopathologic category in 6 of 9 cats. The histologic consensus was acute/active rejection in 8 cats and normal in 1 cat. Median survival time of the 8 cats with histologically confirmed allograft rejection was 23 days (range, 8-34 days). CONCLUSIONS AND CLINICAL RELEVANCE: Renal allograft rejection is associated with minimal clinical signs. Therefore, plasma creatinine concentration should be measured routinely in patients with a functioning allograft. An increase in plasma creatinine concentration is highly suspicious for allograft rejection, although a biopsy of the renal allograft is needed for definitive diagnosis.     

Ultrasonographic findings in dogs and cats with oxalate nephrosis attributed to ethylene glycol intoxication: 15 cases (1984-1988)

Renal ultrasonographic findings in 12 dogs and 3 cats determined to have oxalate nephrosis presumed to be secondary to ethylene glycol intoxication were examined. Ultrasonographic changes varied from mild to marked increases in renal cortical echogenicity. A pattern of greater than normal cortical and medullary echogenicity with persistence of areas of lesser echo intensity at the corticomedullary junction and central medullary regions was observed. This pattern, termed the halo sign, was recognized in 7 dogs and 1 cat concurrent with the development of clinical anuria. Ultrasonographic patterns in these clinical cases were similar to those observed in a previous study of dogs with experimentally induced ethylene glycol nephrosis. Ultrasonographic findings were not considered pathognomonic of ethylene glycol nephrosis. Due to the high death rate reported in the cases surveyed, detection of ultrasonographic changes was considered to warrant a guarded to poor prognosis. Because of the association of the halo sign with anuria, its detection was considered to warrant a grave prognosis.     

RENAL AND HEPATIC ULTRASONOGRAPHY IN THE NEONATAL DOG

The ultrasonographic appearance and size of the liver and kidneys of a litter of five pups was examined from birth until six months of age, and compared with a group of five adults of the same breed. Increased renal cortical echogenicity was evident for the first two weeks of life. Up to 12 weeks of age renal size was relatively large in comparison with body size parameters. After 12 weeks measures of renal size were proportionate with body size and were not significantly different from adult dogs. The neonatal liver had a similar ultrasonographic appearance to the adult, although in the first eight weeks parenchymal echogenic stippling was less coarse and portal veins were less well delineated. Measures of hepatic length were inaccurate during the first four weeks after birth due to changes in body conformation. From eight weeks to six months of age these measures were proportionate with body size, although the ratios differed from adult dogs.     

Preliminary Results of Clinical Renal Allograft Transplantation in the Dog and Cat

Renal allograft transplantation was performed as treatment for terminal renal failure in six veterinary patients. Three patients failed to survive the postsurgical period, one patient died due to acute allograft rejection, one patient died subsequent to complications of previous parenteral hyperalimentation and infection, and one patient was euthanatized due to the inability of the clients to maintain the effort necessary to manage a transplant recipient. Further clinical studies are necessary to determine if renal transplantation with cyclosporine (cyclosporin A)/prednisolone immunosuppression has the potential to provide practical treatment of terminal renal disease in clinical veterinary medicine. Pharmacologic and immunologic monitoring of transplant recipients with individualized immunosuppression is imperative. Careful surveillance is necessary to identify and eliminate nosocomial sources of infection. Candidates for transplantation cannot be critically ill or malnourished prior to surgery, and pet owners must be prepared for the financial and time commitments associated with caring for a renal allograft recipient.