Recurrent hydronephrosis and spontaneous renal rupture caused by lymphoplasmacytic inflammation in a cat

Kim, Junyoung; Oh, Dong-Keun; JunHo, Cho; Kim, Seong-Jun; Yoon, Junghee

doi:10.17221/153/2020-vetmed

Cited by 1 publication

(3 citation statements)

References 12 publications

(17 reference statements)

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“…Hydronephrosis is an illness characterized by dilation of the pelvis and renal calyxes when in the presence of post-renal obstruction being unilateral or bilateral [7]. In cats, it is often associated with obstructive feline lower urinary tract diseases (FLUTD), such as calculi, neoplasms, inflammation and extraluminal masses that lead to compression of the ureter [3].…”

Section: Introductionmentioning

confidence: 99%

“…In cats, it is often associated with obstructive feline lower urinary tract diseases (FLUTD), such as calculi, neoplasms, inflammation and extraluminal masses that lead to compression of the ureter [3]. Less frequent causes include obstructions by blood clots in the renal pelvis or ureter, ectopic ureter, solidified blood calculus and ureter ligation in castration procedures [4,5,7,8,14].…”

Section: Introductionmentioning

confidence: 99%

“…The clinical presentation of the affected patient may occur from months to years after the procedure. Ureteral compression can result in uremic crises, changes in the morphology of the kidney and ureter ipsilateral to the occlusion, and loss of renal function [6] leading to the occurrence of clinical manifestations such as pain on abdominal palpation [13], increased abdominal volume [15], vomiting, anorexia, diarrhea [7], weight loss [8], dehydration [5], polyuria, polydipsia and urinary incontinence [6].…”

Section: Introductionmentioning

confidence: 99%

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Hydronephrosis in a Dog Related to Ovariosalpingohysterectomy

Zaiden

Germano

Neto

et al. 2021

Acta Scientiae. Vet.

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Background: Hydronephrosis is the dilation of the pelvis and renal calyxes due to post-renal obstruction. The obstruction is often associated with extraluminal masses, blood clots and ureter ligation in castration procedures. Ureter ligation is reported as a malpractice. The renal function is reestablished if ligation is rapidly undone, but not for obstructions longer than four weeks. Often, clinical signs are results from months to years after the castration, when nephrectomy is the best therapeutic option. This paper aims to report a case of asymptomatic unilateral hydronephrosis in a 10-year-old dog caused by chronic ureter occlusion with Nylon 3.0 suture during an elective procedure.Case: A 10-year-old female pinscher dog, spayed 3 years ago was admitted at the Surgery Department of the Veterinary Hospital of the Federal University of Jataí (HV-UFJ). The animal was taken for periodontal treatment. In the physical and laboratory examination (complete blood count, hepatic and renal biochemical tests) no significant and noteworthy alterations were found. Ultrasonographic examination showed no changes in the topography and echotexture of the left kidney, however the right kidney was not visualized, with an anechoic structure suggestive of advanced and severe hydronephrosis. Therefore, exploratory laparotomy was proposed to identify the observed structure, with the periodontal treatment considered for a later time. So, a retroumbilical incision was made, followed by linea alba and the removal of simple isolated suture remaining from previous surgical procedure. In the cavity, the viscera were isolated and the left kidney was identified, observing preserved anatomy. On the other hand, the right kidney had altered topography and morphology, being exposed after release of adhesions in adjacent structures. The right renal artery and vein were dissected and a double ligature was made. Then, the right ureter was dissected, observing marked dilatation in the proximal portion and the presence of local ligation with Nylon 3.0. Right ureterectomy and right nephrectomy were performed. After nephrectomy, the capsule was ruptured, observing dark fluid in it and absence of tissue compatible with renal parenchyma. The material was preserved in 10% formaldehyde and sent for histopathological examination. Histopathology revealed risk of rupture of the renal capsule due to the advance of renal degeneration and complete absence of parenchyma. However, contrary to the severity of the histopathological, surgical and ultrasonographic findings, the patient did not present clinical signs at the time of diagnosis.Discussion: In the intraoperative evaluation, the cause of the hydronephrosis was verified to be in fact the ligation of the ureter, which may have been accidental or due to the malpractice of the veterinarian surgeon. Other possible causes such as adhesions and granulomas were ruled out because the Nylon 3.0 suture was found in the proximal portion of the right ureter. It is believed that the patient may have presented clinical signs of hydronephrosis that may have been confused by the tutors as postoperative complications, changes that if identified and performed in time, could have avoided the occurrence or worsening of hydronephrosis and subsequent nephrectomy. Clinically, the bitch did not show clinical signs presented in the literature as consistent with hydronephrosis such as polyuria, polydipsia, abdominalgia, external fistula and anorexia. Therefore, it is believed that this case is one of the first reports of the occurrence of severe hydronephrosis without typical clinical manifestations of hydronephrosis. This fact raises a warning about the thorough monitoring in the postoperative period by owners and veterinarians, in addition to highlighting concerns regarding the occurrence of medical malpractice versus surgical accidents. Keywords: castration, malpractice, nephrectomy, nylon.

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Section: Introductionmentioning

confidence: 99%