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Renal Medullary Cysts

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

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  1. Renal Medullary Cysts The case of Tobey Montaldo 134495

  2. Signalment and History • 7 year old MC Golden Retriever • Suspect pyelonephritis • Microscopic hematuria • Isosthenuria • Polyuria/Polydipsia • Intermittent urinary incontinence

  3. Treatment prior to referral For treatment of recurrent E. coli UTI • Clavamox for 10 days • Amoxicillin for 6 weeks • Cephalexin, undetermined duration

  4. Imaging • Ultrasound performed on 7/17/07: possible pyelonephritis; right renal medullary cavitations or cysts—rule out abscess or neoplasia

  5. Imaging • CT scan on 8/29/07: renal corticomedullary or medullary cavitary lesions, bilateral, solitary hepatic cyst • Renal infarcts seen, some associated with cysts

  6. Recheck Ultrasound • Recheck on 1/16/08: slight changes in sizes of cysts, persistent left pyelectasia

  7. 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

  8. 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

  9. 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

  10. Treatment of Humans with MSK • If hypercalciuric, thiazide diuretics • Manage any renal calculi • Treat UTIs with antibiotics • Decreased Na/Increased K intake

  11. 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.

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