Incidental Hydronephrosis

Re: Incidental Hydronephrosis

Andrew Kent — Sun, 26 Apr 2015 10:43:36 GMT

Hi Serena,

There are a couple of ways to determine the location of the obstruction depending on what facilities you have available. Ultrasound can be very useful for that and I would try to follow the ureter (which should be distended) from the kidney towards the bladder - you dont always see the actual obstruction but you may be able to see the point where the distension stops.

The second possible method is an antegrade uretero-pyelogram, these are traditionally performed under fluoroscopy and done at the same time as an intervention to resolve the obstruction and so the availability of this is more limited.

Some people would argue that knowing the exact location of the obstruction is not always necessary as in most cases they are managed the same. The exception to this would be with very distal obstructions, where ureteral reimplantation could be an option (albeit with risk of recurrence).

Medical therapy of obstruction is possible but has a low success rate (~10%) and this cat sounds like it has been a more chronic obstruction so would be unlikely to work - it would consist of fluid therapy and ureteral relaxation (analgesia/prazosin/amitriptyline).

You could try an IVU, but with the description of the kidney I would suspect you will get minimal filtration of contrast by that kidney and so minimal ureteral filling.

I'll email you now so that you can send the ultrasound pics - would you mind if I post any good ones on here (with any cropping to remove details)?

Andy

Re: Incidental Hydronephrosis

serena holmes — Sun, 26 Apr 2015 00:15:53 GMT

Hi thanks so much for the advice, I have photos of the ultrasound so can email them-my iPhone won't let me post them on here! My email is holservet@hotmail.com-if you are ok with emailing me your work email address I will email them? Also how would you determine where the obstruction is in the ureter without ivu?

Re: Incidental Hydronephrosis

Andrew Kent — Sat, 25 Apr 2015 17:02:52 GMT

PS an IVU is unlikely to be helpful in this case as the probable obstruction will have massively reduced the GFR.

Re: Incidental Hydronephrosis

Andrew Kent — Sat, 25 Apr 2015 12:01:59 GMT

Hi Serena, Even though the kidney may look terrible many of these cases can show remarkable recovery with intervention. We currently use SUB devices (subcutaneous ureteral bypass) to manage these with excellent results. The aim is to try to save and maximise any residual function. Very happy to comment further if it would be helpful - could you post the ultrasound pics? Andy