In the first of new series for DVM Newsmagazine, this case-study approach to radiology is offered to showcase the many possibilities in managing medical cases through imaging.
This case involves multiple uroliths obstructing a cat's ureter and kidney.
Signalment: 10-year-old female spayed domestic shorthaired cat
Presenting complaint: Decreased appetite, vomiting and weight loss for about two weeks and one episode of hematuria
Pertinent history: Mild azotemia with creatinine between 2.5 and 3.1 mg/dl for about two years
Medications: Prescription Diet k/d (Hill's Pet Nutrition), famotidine (2.5 mg every 24 hours)
Physical examination findings: Quiet and alert; body condition score 4/9; renomegaly (right) and a left small kidney (about 2.5 to 3 cm); no pain on abdominal
Figure 1: A lateral radiograph of the patient in this case. Note that the left kidney is larger than the right and that multiple
stones are inside the left ureter and both renal pelves.
Complete blood count: Mild normochromic normocytic nonregenerative anemia (24%)
Serum chemistry profile: Blood urea nitrogen 108 mg/dl; creatinine 5.6 mg/dl; phosphorus 12 mg/dl; potassium 4.7 mEq/L; sodium 147 mEq/L
Urinalysis: Urine specific gravity 1.015; no white blood cells; 10 to 20 red blood cells/hpf; no crystals, no bacteria seen; pH 6.5
Abdominal radiographic examination: See Figure 1
Abdominal ultrasonographic examination: See Figures 2A & 2B
Urine culture: Negative
Blood pressure: 130 mm Hg systolic
Figures 2A & 2B: Abdominal ultrasonograms of the left kidney documenting severe hydronephrosis (12 mm diameter) and hydroureter
with multiple stones in the ureteral lumen that are shadowing.
- Chronic renal- and acute post-renal azotemia
- Multiple ureteroliths and associated ureteral obstruction due to stone disease
Left ureteral obstruction secondary to ureterolithiasis with associated chronic kidney disease (small right kidney and history
of renal azotemia).
- Multiple ureterotomies
- Ureteral reimplantation
- Ureteral stenting