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Renal Medullary Cysts. The case of Tobey Montaldo 134495. Signalment and History. 7 year old MC Golden Retriever Suspect pyelonephritis Microscopic hematuria Isosthenuria Polyuria/Polydipsia Intermittent urinary incontinence. Treatment prior to referral.

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renal medullary cysts

Renal Medullary Cysts

The case of Tobey Montaldo

134495

signalment and history
Signalment and History
  • 7 year old MC Golden Retriever
  • Suspect pyelonephritis
  • Microscopic hematuria
  • Isosthenuria
  • Polyuria/Polydipsia
  • Intermittent urinary incontinence
treatment prior to referral
Treatment prior to referral

For treatment of recurrent E. coli UTI

  • Clavamox for 10 days
  • Amoxicillin for 6 weeks
  • Cephalexin, undetermined duration
imaging
Imaging
  • Ultrasound performed on 7/17/07: possible pyelonephritis; right renal medullary cavitations or cysts—rule out abscess or neoplasia
imaging1
Imaging
  • CT scan on 8/29/07: renal corticomedullary or medullary cavitary lesions, bilateral, solitary hepatic cyst
  • Renal infarcts seen, some associated with cysts
recheck ultrasound
Recheck Ultrasound
  • Recheck on 1/16/08: slight changes in sizes of cysts, persistent left pyelectasia
differential diagnoses for medullary or corticomedullary cysts
Differential Diagnoses for Medullary or Corticomedullary Cysts
  • Polycystic Kidney Disease
  • Simple renal cortical cysts—degenerative
  • Neoplasia—carcinoma, sarcoma
  • Abscessation
  • Medullary Sponge Kidney?? No reports in dogs, but recognized syndrome in humans
medullary sponge kidney
Medullary Sponge Kidney
  • Usually non-progressive, asymptomatic
  • Often found incidentally during renal imaging
  • Clinical signs, if present, include hematuria, UTI, or renal calculi
  • May have mild concentration defect or mild proteinuria
  • High risk of struvite or oxalate calculi
  • May be associated with congenital hemihypertrophy and Wilms’ tumor, but not always
medullary sponge kidney1
Medullary Sponge Kidney
  • Laboratory tests: urinalysis, calcium excretion (tend to be hypercalciuric), urine culture (may have UTI—urine stasis)
  • Imaging: excretory urography (radial, linear striations in papillae, or cystic, ectatic collecting ducts)
  • Ultrasound or CT useful, but probably unnecessary, as this is not a progressive dz
treatment of humans with msk
Treatment of Humans with MSK
  • If hypercalciuric, thiazide diuretics
  • Manage any renal calculi
  • Treat UTIs with antibiotics
  • Decreased Na/Increased K intake
references
References

Ginalski J, Portmann L, Jaeger P. Does medullary sponge kidney cause nephrolithiasis? American Journal of Roentgenology 1990; 155:299-302.

Rommel D, Pirson Y. Medullary sponge kidney—part of a congenital syndrome. Nephrology Dialysis Transplantation 2001; 16:634-636.

Trachtman H. Medullary sponge kidney. www.emedicine.com/ped/topic1394.htm 2007.