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RENAL OSTEODYSTROPHY Accession #101444

RENAL OSTEODYSTROPHY Accession #101444. Christina Copple, DVM Radiology Resident NCSU CVM-VTH. Dobie. Signalment: 5 yr 8 mth MC Miniature Pinscher Current Hx:

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RENAL OSTEODYSTROPHY Accession #101444

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  1. RENAL OSTEODYSTROPHYAccession #101444 Christina Copple, DVM Radiology Resident NCSU CVM-VTH

  2. Dobie • Signalment: • 5 yr 8 mth MC Miniature Pinscher • Current Hx: • Weight loss over last 2 months despite normal appetite, lethargy, deviated mandible, stertorous breathing a couple of days prior to deviation of mandible, NO coughing/vomiting, occasional diarrhea, stable PU/PD, Diet – Hill’s K/D or Pedigree • Past Hx: • Acute renal failure diagnosed at 2 yrs of age (suspect nephrotoxin), Chronic renal failure since with intermittent episodes of vomiting, Previous pancreatitis and suspected hepatitis

  3. Diagnostics • CBC:Neutrophilic leukocytosis, normocytic hypochromic non-regenerative anemia • Chemistry Panel:Azotemia, USG 1.010, hypercalcemic (total serum Ca)/phosphatemic/magnesemic/kalemic, mild hypoalbuminemia, elevated ALT/ALP • Radiographs • Abdominal Ultrasound

  4. Radiographs

  5. Radiographs

  6. Abdominal Ultrasound Left Kidney Left Kidney-Cortical cyst

  7. Abdominal Ultrasound Right Kidney

  8. Diagnosis • Chronic Renal Failure • Suspect Renal Secondary Hyperparathyroidism • Renal Osteodystrophy

  9. Renal Secondary Hyperparathyroidism • Mechanism is multi-factorial • Hyperphosphatemia • Low levels of Calcitriol • Elevated circulating levels of PTH!

  10. Renal Secondary Hyperparathyroidism/Renal Osteodystrophy Osteoclasts

  11. Relevant Research • Two recent papers in Veterinary Radiology & Ultrasound 2008: could not identify the parathyroid gland in dogs without thyroid or parathyroid disease using MRI or CT. • Small parts high-resolution ultrasonography • 1991: NORMAL ULTRASONOGRAPHIC ANATOMY OF THE CANINE NECK, Veterinary Radiology & Ultrasound could not identify the parathyroid glands in healthy dogs. • 1993: ULTRASONOGRAPHIC EVALUATION OF THE PARATHYROID GLANDS IN HYPERCALCEMIC DOGS, Veterinary Radiology & Ultrasound located hyperplastic parathyroid glands in two dogs with hypercalcemia using high-resolution ultrasound. Hypoechoic to thyroid tissue, well-marginated to poorly marginated, ~2mm in size. • 1997: HIGH-RESOLUTION PARATHYROID SONOGRAPHY, Veterinary Radiology & Ultrasound did not identify parathyroid glands or lesions in 2/3 dogs that were hypercalcemic from renal insufficiency but did identify a parathyroid nodule in the remaining dog (measured 6 mm.) Parathyroid gland nodules were identified in other dogs of this study with hypercalcemia due to primary hyperparathyroidism (carcinoma/adenoma/adenomatous hyperplasia) with lesions appearing round to oval and hypoechoic to thyroid tissue. Neoplastic nodules were > 4mm and hyperplastic nodules were <4mm.

  12. References Ettinger, Stephen J. and Edward C. Feldman. Textbook of Veterinary Internal Medicine Diseases of the Dog and Cat. Vol 2. 6th ed. Elsevier: 2000. Kumar, Vinay, MBBS, MD, FRCPath, Abul K. Abbas, MBBS, and Nelson Fausto, MD. Robbins and Cotran Pathologic Basis Of Disease. 7th ed. Elsevier: 1999. Nelson, Richard W., DVM, DACVIM and G. Guillermo Couto, DVM, DACVIM. Small Animal Internal Medicine. 3rd ed. Mosby: 1992. Thrall, Donald E., DVM, PhD, DACVR. Textbook of Veterinary Diagnostic Radiology. 5th ed. Elsevier: 2007. OLIVIER TAEYMANS, RUTH DENNIS, JIMMY H. SAUNDERSMAGNETIC RESONANCE IMAGING OF THE NORMAL CANINE THYROID GLAND. Veterinary Radiology & Ultrasound. Volume 49, Issue 3, Date: May/June 2008, Pages: 238-242. OLIVIER TAEYMANS, TOBIAS SCHWARZ, LUC DUCHATEAU, VIRGINIE BARBERET, INGRID GIELEN, MARK HASKINS, HENRI VAN BREE, JIMMY H. SAUNDERSCOMPUTED TOMOGRAPHIC FEATURES OF THE NORMAL CANINE THYROID GLAND. Veterinary Radiology & Ultrasound. Volume 49, Issue 1, Date: January–February 2008, Pages: 13-19. Erik R. Wisner, John S. Mattoon, Thomas G. Nyland, Thomas W. BakerNORMAL ULTRASONOGRAPHIC ANATOMY OF THE CANINE NECK. Veterinary Radiology & Ultrasound. Volume 32, Issue 4, Date: July 1991, Pages: 185-190. Erik R. Wisner, Thomas G. Nyland, Edward C. Feldman, Richard W. Nelson, Stephen M. GriffeyULTRASONOGRAPHIC EVALUATION OF THE PARATHYROID GLANDS IN HYPERCALCEMIC DOGS. Veterinary Radiology & Ultrasound. Volume 34, Issue 2, Date: March 1993, Pages: 108-111. Erik R. Wisner, Dominique Penninck, David S. Biller, Edward C. Feldman, Christiana Drake, Thomas G. NylandHIGH-RESOLUTION PARATHYROID SONOGRAPHY. Veterinary Radiology & Ultrasound. Volume 38, Issue 6, Date: November 1997, Pages: 462-466.

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