April's Case of the Month
Probable Polycystic Kidney Disease in a 10 year old Yorkshire Terrier
Tyler Anderson DVM
Patient Information:
Age: 10 years
Gender: Male Neutered
Species: Canine
History:
An abdominal ultrasound and echocardiogram study were recommended due to recent elevation of ALT on senior blood work and a Grade III/VI systolic murmur. The patient was otherwise asymptomatic having no evidence of PU/PD or azotemia.
Image Interpretation:
Abdominal sonographic findings:
The liver was mildly enlarged having an anechoic cyst visualized in the dorsal right liver, measuring ~ 0.7 x 0.9cm.
The kidneys were severely enlarged bilaterally (Length L/R ~ 7.9/10.9cm) having multifocal anechoic cysts throughout the cortical and medullary spaces. Almost no “normal” renal parenchyma could be visualized due to severe compression by the space-occupying cystic lesions.
A single small urinary calculus was noted in the bladder, measuring ~ 1.0mm.
The echocardiogram study revealed myxomatous mitral (mild) and tricuspid (moderate) valve disease and pulmonary hypertension (moderate).
Diagnosis and Sonographic Analysis:
Differentials for bilaterally enlarged kidneys having multifocal cavitary-cystic lesions include Polycystic Kidney Disease vs. Neoplasia vs. Renal abscess (unlikely due to the number of cysts). Aspiration or biopsy of the kidneys would be required for a definitive diagnosis. Biopsies were not performed in this patient. A prescription renal diet and serial blood work/urine sampling were recommended to monitor renal function.
Right liver cyst in the dorsal aspect of the liver. Hepatic cystic lesions are a common occurrence in patients with PKD.
The left kidney in sagittal plane: Due to severe enlargement of the left kidney, the entire length of the kidney did not fit within the imaging window. Calipers were approximated along the caudal pole based on live visualization of the organ and the approximated renal contour along the caudal pole.
The right kidney in sagittal plane. Due to the bilateral nature of the cystic lesions, and the presence of a hepatic cyst, PKD is highly suspected.
Special thanks to Banfield Rockville for the interesting case.