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Renal Medullary Cysts The case of Tobey Montaldo 134495

Renal Medullary Cysts

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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. - PowerPoint PPT Presentation

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Page 1: Renal Medullary Cysts

Renal Medullary Cysts

The case of Tobey Montaldo134495

Page 2: Renal Medullary Cysts

Signalment and History

7 year old MC Golden Retriever Suspect pyelonephritis Microscopic hematuria Isosthenuria Polyuria/Polydipsia Intermittent urinary incontinence

Page 3: Renal Medullary Cysts

Treatment prior to referral

For treatment of recurrent E. coli UTI

Clavamox for 10 days Amoxicillin for 6 weeks Cephalexin, undetermined duration

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Imaging

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

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Imaging

CT scan on 8/29/07: renal corticomedullary or medullary cavitary lesions, bilateral, solitary hepatic cyst

Renal infarcts seen, some associated with cysts

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Recheck Ultrasound

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

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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

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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

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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

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Treatment of Humans with MSK

If hypercalciuric, thiazide diuretics Manage any renal calculi Treat UTIs with antibiotics Decreased Na/Increased K intake

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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.