Dog with unilateral hydronephrosis

RE: Dog with unilateral hydronephrosis

gerard mclauchlan — Thu, 14 Jun 2018 16:49:49 GMT

Sounds good let us know what you find.

RE: Dog with unilateral hydronephrosis

nej41 — Thu, 14 Jun 2018 16:46:17 GMT

Thanks everyone for your help! After discussing with the owners we are going to refer for further imaging etc

RE: Dog with unilateral hydronephrosis

gerard mclauchlan — Sat, 09 Jun 2018 17:46:30 GMT

Ureterotomy. Wouldn’t recommend nephrectomy as we don’t know the function of the obstructed or indeed the other kidney so patient may become azotaemic post removal - essentially the obstructed kidney may still have some function and enough to stop the patient developing clinical signs of renal failure

RE: Dog with unilateral hydronephrosis

Beats — Sat, 09 Jun 2018 17:32:03 GMT

[quote user="gerard mclauchlan"]gain SUB complication rate low (5% mortality vs 20% traditional surgery)[/quote]

Hi Gerard,

Thanks for posting with info on cutting-edge treatments. Very interesting what you say about not being able to predict what kidneys will return to functioning when ureter is stented/bypassed.

Regarding the mortality rate with SUB, what is the "traditional surgery" that is being compared? I would have thought that the mortality rate for removing a hydronephrotic kidney (or leaving it alone) would be much lower than 20%?

Cheers,

Dave

RE: Dog with unilateral hydronephrosis

gerard mclauchlan — Sat, 09 Jun 2018 17:18:04 GMT

For ureters obstructed with stones (90% will be oxalate) the chance of unobstructing is usually quoted at <10% (fluids, prazosin , mannitol etc). If you check out any of the SUB papers from Allyson Berent or her textbook (veterinary image guided interventions) it will have references. Kyles et al (2005) reported medical management successful in 8-17% of ureteral stone cases

RE: Dog with unilateral hydronephrosis

Anthony Todd — Sat, 09 Jun 2018 16:44:54 GMT

[quote user="gerard mclauchlan"] obstruction in cats most commonly due to urethral plugs[/quote]

Ohhh errrr, we could get into a discussion here.

Not doubting you, but have you got a reference for "8%", still interested after 50 odd years...... and the epidemic with Go Cat [you're too young!!]

RE: Dog with unilateral hydronephrosis

gerard mclauchlan — Sat, 09 Jun 2018 16:17:04 GMT

We try relaxants for ureteral oxalate stones but only successful in 8% cases. Urethral obstruction in cats most commonly due to urethral plugs

RE: Dog with unilateral hydronephrosis

Anthony Todd — Sat, 09 Jun 2018 15:58:13 GMT

[quote user="Glen McIntosh"]ureteric stone[/quote]

I have had a number of these [oxalate??] although nobody wanted to find out....., one removed via an intraurethrally placed stent, then mechanical removal under GA. [Lovely post op feeling!!]

I then got one in the UK but was laughed at when I mentioned removal and GA etc. and put on tamsulosin which has worked every time since and also cut out my very high oxalate diet....!! bran okra, spinach and grains [ring any feline bells??].

I wonder why urethral relaxants aren't used in the cat, even locally, into the urethra in an urethral obstruction??

RE: Dog with unilateral hydronephrosis

gerard mclauchlan — Sat, 09 Jun 2018 15:26:39 GMT

Hey

again SUB complication rate low (5% mortality vs 20% traditional surgery) if you’ve trained in how to place subs correctly. Complications like kinking often minimised by correct placement also. SUB great best option for obstructed cats if put in correctly .

RE: Dog with unilateral hydronephrosis

Marie Kubiak — Sat, 09 Jun 2018 15:16:47 GMT

[quote user="gerard mclauchlan"]

Hi marie, with appropriate training ureteral stenting in dogs has a very low complication rate (dramatically better than traditional surgery). I don’t recommend stents in cats due to the high level of dysuria seen - the recommendation is SUB placement in cats.

[/quote]

ah, sorry it was the SUB I was thinking of.

Marie

RE: Dog with unilateral hydronephrosis

gerard mclauchlan — Sat, 09 Jun 2018 14:24:05 GMT

RE: Dog with unilateral hydronephrosis

Marie Kubiak — Sat, 09 Jun 2018 13:24:26 GMT

[quote user="gerard mclauchlan"]

for me this dog needs a ureteral stent.

[/quote]

Is there not a high complication rate for these? I was dissuaded from pursuing this option for my cat (not an option I wanted anyway) due to the associated severe complications/mortality and this was the opinion of a specialist doing them very regularly.

Marie

RE: Dog with unilateral hydronephrosis

Glen McIntosh — Fri, 08 Jun 2018 19:44:47 GMT

[quote user="bob lehner"]

How weird - I was diagnosed with a hydronephrotic left kidney when I was a student Drinking beer

[/quote]

Me three.

Diagnosed with left hydronephrosis at age 13. Hadn’t started drinking beer yet. Also congenital. Had a partial nephrectomy and right as rain since (until this year when I developed a left ureteric stone, but all good again now following laser lithotripsy).

Both were painful in the extremis.

RE: Dog with unilateral hydronephrosis

bob lehner — Fri, 08 Jun 2018 19:03:45 GMT

[quote user="Martin Atkinson"] I was diagnosed with a hydronephrotic left kidney about 15 years ago [/quote]

How weird - I was diagnosed with a hydronephrotic left kidney when I was a student Drinking beer (to which I was not accustomed) brought on episodes of excruciating renal colic (said to be much worse than child birth!). In those days it was investigated via i.v.u (pre-ultrasound) and I had a nephroplasty op - where they trimmed away a lot of excess renal capsule.

They said mine was congenital - the ureter had kinked round an aberrant renal vein, causing obstruction and back pressure.

Touching wood, it has been OK since - apart from one episode of ureteral calculus many years after the op.

p.s. I don't drink beer now .....

RE: Dog with unilateral hydronephrosis

Martin Atkinson — Fri, 08 Jun 2018 18:18:56 GMT

I can only vouch for my personal experience. I was diagnosed with a hydronephrotic left kidney about 15 years ago during an investigation for an abdominal mass the doctor feared may be a pancreatic tumour due to my symptoms - similar to your patient. I'm the only person who ever came out of hospital smiling after being told they only have one functional kidney as the alternative was far worse!

My right kidney is 50% larger than normal presumably to compensate and it is almost certainly congenital/hereditary because they found my mother had one when she was post-mortemed after dying of a heart attack.

I was told there was a risk it could rupture if I had a serious accident (and I've a few of those)! I'm more worried I don't have a spare if the right one is injured, but on balance we let sleeping dogs lie and left it there. Its only on occasions such as this that I think about it.

Maybe a bit irrelevant but hope that helps.

RE: Dog with unilateral hydronephrosis

gerard mclauchlan — Fri, 08 Jun 2018 17:37:30 GMT

Maybe - could be a congenital ectopic ureter with ureteral stenosis although this tends to be more common in males. A schnauzer is predisposed to oxalate stones so could be a stricture from previous stone also

RE: Dog with unilateral hydronephrosis

nej41 — Fri, 08 Jun 2018 17:32:38 GMT

Thanks for your input, that's interesting. The kidney does look like a bladder! Is there any chance it could be a congentital problem?

RE: Dog with unilateral hydronephrosis

gerard mclauchlan — Fri, 08 Jun 2018 17:25:08 GMT

Hey , yes it’s been shown in obstructed cats that imaging doesn’t predict return to function. I’ve seen many cats where kidney essentially looks like big bladder with no obvious parenchyma - 4 weeks post unobstuction normal parenchyma seen

RE: Dog with unilateral hydronephrosis

Anthony Dennison — Fri, 08 Jun 2018 17:17:00 GMT

[quote user="gerard mclauchlan"]for me this dog needs a ureteral stent. Can be placed cystoscopically.[/quote]

But the OP did an IVU and there was no uptake into the affected kidney at all? If the affected kidney is just fluid with no obvious kidney tissue remaining, is there any point doing a ureteral stent?

RE: Dog with unilateral hydronephrosis

gerard mclauchlan — Fri, 08 Jun 2018 17:12:51 GMT

Hi,

for me this dog needs a ureteral stent. Can be placed cystoscopically. Could be stricture or spay associated obstruction. With the back pressure you may not see contrast in ureter. We know from cats that length of obstruction and appearance on imaging not predictive of response to unobstruction. Happy to chat further if you want

RE: Dog with unilateral hydronephrosis

nej41 — Fri, 08 Jun 2018 17:08:26 GMT

Thanks for your reply. Yes I wondered about it being congenital since there has been no known clinical signs from it.

I am a bit worried about causing a uroabdomen from trying to drain it! Maybe that's unlikely..

RE: Dog with unilateral hydronephrosis

Anthony Dennison — Fri, 08 Jun 2018 17:00:33 GMT

Welcome to the forum!

Interesting that there no uptake whatsoever. Suggests it may even be a congenital issue? I personally would remove it, lowers the risk of a uroabdomen. Could you try and drain some of the fluid percutaneously by ultrasound guidance and see what kind of fluid it is?