renal fna

Re: renal fna

HMC — Mon, 06 Dec 2010 13:04:57 GMT

Thanks for the tips. Both cats will, at the end of today, be no more.

I tried fna of one cat- the one who was hospitalised on a drip, blind without ultrasound guidance and without applying suction. I just got back fluid so stopped. She went for ultrasound the next day (friday) and the dx was PKD (she was a DSH) and so she was euthanased (very very severe azotaemia and dehydration).

The other cat had his scan today; dx = lymphoma. He is now clinically dehydrated so will be euth'ed (within the next hour).

Such a coincidence not only to have 2 cats with renomegaly, but also cats that I actually really liked!!

Re: renal fna

Richard Fox — Fri, 03 Dec 2010 09:22:22 GMT

Obviously these kidneys appear enlarged but as Mark says there is enlarged and large kidneys. Is there proteinurira as this might point to glomeular disease/amyloid. Very big kidneys would prob indicate lymphoma and thus aspiration would be useful. Urinalysis would hopefully exclude a UTI?

Re: renal fna

Mark Holmes — Thu, 02 Dec 2010 22:21:34 GMT

There are large kidneys and LARGE kidneys. The first would suggest ARF/ pyelonephritis/renal abscess, particularly if associated with pain. The second = lymphoma, kidneys really huge but non painful, smooth and symetrical this can be diagnosed in 2mins with 25g needle and diff quick within a 10 min consult.

Re: renal fna

Laurence Webb — Thu, 02 Dec 2010 21:34:59 GMT

[quote user="Hannah Chilton"]

ps I don't have the results of the scans yet- one is due to be done tomorrow and the other on monday.

[/quote]

I'd probably ask the ultrasonographer to take FNAs. The ultrasonographer should be able to aim for any areas of interest and try to avoid big blood vessels.

In the absence of ultrasound I'd just stick a needle in as the risks aren't too high

Re: renal fna

emerald — Thu, 02 Dec 2010 21:24:39 GMT

Toxicity?

Re: renal fna

Jillian Hall — Thu, 02 Dec 2010 18:27:27 GMT

I've not got a problem sticking a needle in almost anything but it'd be nervous doing it without ultrasound guidance. I like to know I'm aiming for a nice representative area of cortex that's not too close to major vessels or other important structures.

You could send them back to the ultrasonographer. If they're taking referrals cases I assume they will be happy with FNAing any organ you ask.

Re: renal fna

Rob Loxley — Thu, 02 Dec 2010 17:49:57 GMT

are they PKD breeds?

Re: renal fna

Richard Fox — Thu, 02 Dec 2010 16:37:04 GMT

Bilateral renomegally - Lymphoma vs ARF for me in an adult cat - is there any evidence of azotaemia, ureamia or proteinuria before you asipirate. The only fairly conclusive result is inflamm (not aetiologically specific) or neoplasia from my point of view or remotely amyloidosis.We dont often get many useful aspirates except lymphoma TBH

For indications of sampling have a read of this cytology book online:

http://books.google.com/books?id=Kd6Ikp8lry8C&lpg=PP1&dq=canine%20and%20feline%20cytology&pg=PA253#v=onepage&q=renal%20aspiration&f=false

Take aspirates from central and peripheral areas, imbolilise the kidney with one hand or use an assistant. US guided can be used but cat should pref. be in dorsal recumbency. Caudal pole aspiration of LHS kidney minimises asp of pancreas or intestines. Medial to lat , Introduce at caudal pole ventral kidney and move to dorsal minimises puncture of renal vessels (if that makes sense). 25-27 guage 1.5" is best. If there is a lack of material then try a bit bigger needle.

Re: renal fna

Mark Holmes — Thu, 02 Dec 2010 16:17:59 GMT

Renal FNA easy, clip area and prep. (Although I know plenty who don't bother) take needle and poke into kidney. Remove needle and gently blow contents onto slide with syringe. Bob's your uncle!

Don't aspirate kidney as you might with MCT

In general is taking fna of any tissue such at lymph node, renal lymphoma etc you are better not aspirating but relying on capillary action to draw cells in. Gently blow cells onto slide results in better cell preservation.

Re: renal fna

HMC — Thu, 02 Dec 2010 15:20:22 GMT

ps I don't have the results of the scans yet- one is due to be done tomorrow and the other on monday. the biochem/haem showed azotaemia- ridiculously high for one cat (who also has sky-high hyperphosphataemia) and moderate for the other, both have moderate/severe anaemia too.