Why is the cat azotemic?

There is hydronephrosis of the right kidney. Tortuous right ureter can be seen extending to the bladder. Can't find the reason for the tortuosity

in the left kidney there is a mild increase of the echogenicity of the renal pelvis fat tissue, also there is a mild increase of the echogenicity of the tissue surrounding the kindney.

in the right kidney there is a moderate dilatation of the renal recesses, there is also a moderate dilatation of the renal pelvis with ecogenic content, i also see a mild dilatation of the right ureter, but there is no presence of ureteral stones, the ureter can be followed to the union with the ureteral papilla.

in the bladder there is a moderate amount of ecogenic content.

the differential diagnosis can be:

left kidney: early pyelonephritis.
right kidney: moderate pyelonephritis with pyelectasis and ureteronefrosis.
bladder: urinary sediment in moderate amount.

i recommend next:
pyelocentesis of the right kidney and culture of the sample.
cistocentesis and culture of the sample.

Happy Spring! The left kidney is normal. The right kidney is enlarged with dilated, fluid-filled renal calyces. There is echogenic debris in the dilated renal pelvis that is not vascular on colour Doppler. The renal cortex is thinned, but has excellent blood flow. The peri-capsular fat is mildly hyperechoic. The right ureter is diffusely dilated and mildly tortuous. It can be followed to the urinary bladder. There is densely shadowing feces in the distal colon. The ureteral papillae are not imaged. The urinary bladder is moderately distended with normal walls. There is a moderate amount of gravity-dependent hyperechoic sediment in the lumen. The visible loops of small intestine are normal. There is a trace effusion between two loops of intestine, cranial to the urinary bladder in the last clip.
DX Right kidney obstructive disease and hydronephrosis leading to acute renal failure. Can not rule-out pre-existing CRD. Potential causes include ueterolithiasis, infection/pyelonephritis, neoplasia, granulomatous dz
Recommendations: survey radiographs screening for ureteroliths preferably after colon evacuation +/- advanced imaging, contrast. UA and urine culture (antibiotics may influence this) Possible pyleocentesis if warranted. IV fluids, pain meds. Intervention may be required including SUB, GFR screening, palliative surgery.

I see an enlarged kidney about 5-5 1/2 cm. The cortex looks a bit thin but appears to be functioning by the Doppler tracing, the medullary papilla are thin and far spaced with an echogenic fluid and a largely dilated renal pelvis. It is about 1 1/2-2 cm, and the fat around the pelvis is hyperechoic. I see no calculus present in the dilated ureter to the bladder. The bladder has a hyperechoic sediment.
I would say kitty has pyelonephritis given sig/hx/US.
Next I would like a C&S.
(but I’m not brave enough to sink a needle through to the renal pelvis yet…😊)

I can see hydronephrosis on the right kidney. In the pelvis is exogenic "material" (no doppler sign, DD: tumor).The right ureter is dilated and I am not sure if there isn't as well some ecogenic material (only very few, and only in some part) in it. There is no evidence for a stone or a tumor along the ureter or bladder causing the dilatation. In the bladder there is some ecogenic material as well. My first thought would be pyelonephritis causing a mild dilatation of the ureter and the debris in the pelvis causing hydronephrosis. (DD tumor or stone which couldn't be found (but the ureter goes directly into the bladder without any obstruction! So it doesn't seem logical to me to be a tumor or a stone causing the dilatation). I am not good or brave enough to go with a needle into the pelvis to get a probe, so I would make a cystocentesis and send it to the laboratory to see if and what bacteria are there. And I would start directly with antibiotics.

Left Kidney measures ~ 4.5 cm long. There is no evidence of pyelectasia. The left ureter is not visible.

The right kidney shows marked pyelectasia. It is enlarged, measuring greater than 5 cm long. There is echogenic material/structure in the renal pelvis near the opening of the ureter. This material does not appear to have any blood flow. The ureter is visualized all the way to the urinary bladder. The ureter is dilated and portions of it have echogenic urine within it. Near the entrance to the urinary bladder the ureter is thickened.

The urinary bladder contains gravity dependent echogenic debris.

My primary differential is a pyelonephritis. The material near the opening of the ureter is most likely cellular debris though a mass/granuloma is possible. Further diagnostics could include aspiration of the urine from the renal pelvis for culture and sensitivity. FNA of the material in the renal pelvis can also be done.

A contrast CT could be considered to try and completely r/o a mass at the opening to the ureter, though not ideal to perform with the azotemia.

Thank you for the post!

Steve

Cavité pyélique dilatée au niveau du rein gauche (zones hypoéchogènes au niveau du système collecteur) uretère tortueux et dilaté! Contenant quelque chose d'échogénécité tissulaire?

Urétérocèle

Rein gauche ok Rein droit le calice est dilaté liquide homogène hypoechogene le flot sanguin au doppler est bon l'uretère droit est dilaté et tortueux dans sa partie proche du rein avec un contenu d'echogenicite variable. le colon est rempli de MF les anses d'intestin grêle devant la vessie sont normales DD maladie obstructtive du rein droit avec hydronephrose et IRA pouvant etre causé par une accumulation dans la partie renale de l'uretère de matériel (cf ureterocele (ou pus hypoechogene homogène ! ou lithiase sans code d'ombre!)

Hello!! Very nice case! How much time it takes to resolve the pielectasia after initiating the right antibiotictjerapy? Thank you in advance!

thank you for sharing

hidronephosis initial
ureteres obstructed