Pyelonephritis

Allison Zwingenberger

University of California, Davis


Publication Date: 2012-01-04

History

5 year old female miniature Schnauzer with a 2 day history of lethargy and decreased appetite. The left kidney is palpated as enlarged and painful.

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Question

  1. What are the abnormalities associated with the left kidney?

    Pelvic dilation

    Correct
    Mineralization

    Correct
    Echogenic urine

    Correct
    Hyperechoic retroperitoneal fat

    Correct

Findings

The left kidney is enlarged and the pelvis is markedly dilated with echogenic material. The retroperitoneal tissues surrounding the left kidney are markedly hyperechoic and there is a small volume of perinephric fluid. The left ureter can be followed distally and is moderately dilated and thick walled. It appears to taper distally and cannot be identified inserting into the bladder. There is mild mineralization of the renal parenchyma. The urinary bladder is filled with free floating echogenic material and a layer of hard shadowing mineralized sediment pooling dependently. There is a small volume of free fluid within the abdomen. The ovaries are identified and appear within normal limits.

DDx

The changes to the left kidneys are most consistent with severe pyelonephritis and possible abscessation with marked left ureteritis. Perinephric changes in the left are consistent with severe inflammatory change. Urinary bladder mineralized and cellular debris. Scant ascites. Mildly dilated uterine horns bilaterally which is concerning for the presence of a pyometra. Other differentials which should be considered include hydrometra, mucometra, or phase of estrus cycle.

Diagnosis

The left kidney was removed surgically due to a suspected abscess.

Pathology report: LEFT KIDNEY: SEVERE DIFFUSE NECROSUPPURATIVE PYELONEPHRITIS WITH PAPILLARY AND MEDULLARY NECROSIS, CORTICAL HEMORRHAGE, AND NEUTROPHILIC CAPSULITIS LEFT URETER: MODERATE DIFFUSE NEUTROPHILIC URETERITIS