13 year old FS Shih Tzu presented for lethargy, disorientation and concern of poor quality of life
– several year history of pu/pd (owners have been very tolerable!)
– bloodwork in the past has been supportive of persistent hypercalcemia and primary hyperparathyroidism (malignancy of hypercalcemia panel was run)
– long history of elevated ALP
– ACTH stim test run in the past has also been supportive of Cushing’s
– past abdominal ultrasound (2009) showed normal renal size and architexture and normal adrenals
13 year old FS Shih Tzu presented for lethargy, disorientation and concern of poor quality of life
– several year history of pu/pd (owners have been very tolerable!)
– bloodwork in the past has been supportive of persistent hypercalcemia and primary hyperparathyroidism (malignancy of hypercalcemia panel was run)
– long history of elevated ALP
– ACTH stim test run in the past has also been supportive of Cushing’s
– past abdominal ultrasound (2009) showed normal renal size and architexture and normal adrenals
– owners always have been agreeable with testing but declined pursuing treatments
– on presentation, markedly elevated ALP, azotemia, hypercalcemia, hyperphosphatemia and urine SG 1.025
– u/s normal exceptp for kidneys:
– left kidney has no identifiable normal tissue and mutiple cysts of varying size – some with septatation
– right kidney also cystic but affected to a lessor degree with some normal renal architexture seen
– aspirate of large kidney cyst: brown tinged clear fluid SG 1.022 TS 4.6
– core biospsy and FNA (performed at post-mortem): cytological unremarkable renal epithelium (pathologist commented that samples were of excellent quality and cells well-preserved) – she suggested possibility of renal hyperplasia due to renal failure?
Could this be a form of acquired polycystic renal disease in a dog? neoplasia?
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26 responses to “Dog renal cysts”
Jacquie I am thinking the
Jacquie I am thinking the stones are the culprit. The pelvis has stones in it and they migrate and since the kidneys were normal on the prior sonogram primary pkd is unlikely as that is a gradual progressive disease and doesn’t start overnight. Stones move from the cm junction into the pelvis and block tubules as they move so it would make sense that scarring of the collecting ducts would cause dilation of the ducts and cystic formation but this is only a theory even though I see it all the time and usually associate with infarcts especially in the cat. PKD is also a possibility but seems strange it would show up all in one year. My theory is supported also by the “normal” histopath as this is a structural (plumbing) change and not necessarily a cellular change that would be reflected by histopath such as interstial nephrosis or glomerulonephrosis/itis.
I am concerned about the “pu/pd” here with usg of 1025 as that is not usually noticeable as true pupd which is usually defined as usg< 1.020. Given the stones I am thinking that periodic dysuria/pollakiuria from stone passage is more likely and am concerned with the acth stim positive in light of usg being > 1.020. Stress + maybe or atypical Cushing’s??? Maybe Remo can help here further.
Jacquie I am thinking the
Jacquie I am thinking the stones are the culprit. The pelvis has stones in it and they migrate and since the kidneys were normal on the prior sonogram primary pkd is unlikely as that is a gradual progressive disease and doesn’t start overnight. Stones move from the cm junction into the pelvis and block tubules as they move so it would make sense that scarring of the collecting ducts would cause dilation of the ducts and cystic formation but this is only a theory even though I see it all the time and usually associate with infarcts especially in the cat. PKD is also a possibility but seems strange it would show up all in one year. My theory is supported also by the “normal” histopath as this is a structural (plumbing) change and not necessarily a cellular change that would be reflected by histopath such as interstial nephrosis or glomerulonephrosis/itis.
I am concerned about the “pu/pd” here with usg of 1025 as that is not usually noticeable as true pupd which is usually defined as usg< 1.020. Given the stones I am thinking that periodic dysuria/pollakiuria from stone passage is more likely and am concerned with the acth stim positive in light of usg being > 1.020. Stress + maybe or atypical Cushing’s??? Maybe Remo can help here further.
Main reason for acquired
Main reason for acquired cysts in chronic kidney disease is tubular obstruction – either by interstitial fibrosis or reno-or uretral liths. Although hyperplasia of the surviving renal tubules occurs this should not result in obstruction. The urine SG would be classified as inappropriate and would result in a degree of PuPd. The hypercalcemia and Cushing’s disease would have contributed to the PuPd.
Main reason for acquired
Main reason for acquired cysts in chronic kidney disease is tubular obstruction – either by interstitial fibrosis or reno-or uretral liths. Although hyperplasia of the surviving renal tubules occurs this should not result in obstruction. The urine SG would be classified as inappropriate and would result in a degree of PuPd. The hypercalcemia and Cushing’s disease would have contributed to the PuPd.
When in doubt blame it on the
When in doubt blame it on the stones:)
When in doubt blame it on the
When in doubt blame it on the stones:)
That’s great – I just learned
That’s great – I just learned something new.
Thanks
Jacquie
That’s great – I just learned
That’s great – I just learned something new.
Thanks
Jacquie
Yeh that’s the cool part of
Yeh that’s the cool part of what we do here:)
Yeh that’s the cool part of
Yeh that’s the cool part of what we do here:)
An interesting update on this
An interesting update on this case. I must have mis-read the first report from the pathologist as she was only reading the cytology from the FNA’s of the kidney.
I just got the report back from the core-biopsies that are now telling a different story. There was cellular atypia present that is suggestive of renal carcinoma. The samples were small so a larger one is needed to make a definitive call. I have read that renal carcinoma can be cystic but also read about cystadenomas and cystadenocarcinomas of the kidney, the later however seems to be present most often in German Shephards who also have concurrent skin lesions.
What is the difference between renal carcinoma and renal cystadenocarcinoma (the presence of cysts vs no cysts?) Are they different diseases?
I guess this case also illustrates how there can be a difference what you get from FNA vs core biopsy.
Jacquie
An interesting update on this
An interesting update on this case. I must have mis-read the first report from the pathologist as she was only reading the cytology from the FNA’s of the kidney.
I just got the report back from the core-biopsies that are now telling a different story. There was cellular atypia present that is suggestive of renal carcinoma. The samples were small so a larger one is needed to make a definitive call. I have read that renal carcinoma can be cystic but also read about cystadenomas and cystadenocarcinomas of the kidney, the later however seems to be present most often in German Shephards who also have concurrent skin lesions.
What is the difference between renal carcinoma and renal cystadenocarcinoma (the presence of cysts vs no cysts?) Are they different diseases?
I guess this case also illustrates how there can be a difference what you get from FNA vs core biopsy.
Jacquie
So this Shihtzu wanted to be
So this Shihtzu wanted to be a german shepherd!!
looking back at that image again and again technically the loss of cm definition would suggest neoplasia but this happens all the time with stone dystrophy and shihtzus are the stone poster children. Thanks for the histopath and follow up and interesting outcome!! Yes any time there are cysts the fna can never be trusted as the junction from pathological tissue to cyst is the dx area… similar to biliary or bronchogenic carciomas
From a google search:
renal cystadenoma
inherited as an autosomal dominant trait in middle-aged German shepherd bitches with generalized nodular dermatofibrosis.
Main article: Kidney cancer
Renal cell carcinoma
Classification and external resources
Micrograph of the most common type of renal cell carcinoma (clear cell) – on right of the image; non-tumour kidney is on the left of the image. Nephrectomy specimen. H&E stain.
ICD-10 C64
ICD-9 189.0
ICD-O: M8312/3
OMIM 144700 605074
DiseasesDB 11245
MedlinePlus 000516
eMedicine med/2002
Renal cell carcinoma
(RCC, also known as hypernephroma) is a kidney cancer that originates in the lining of the proximal convoluted tubule, the very small tubes in the kidney that filter the blood and remove waste products.
Renal Cystadenocarcinoma
General Considerations
•renal cystadenocarcinoma is an autosomal dominant condition in GSD with a genetic linkage to chromosome 5
•renal cystadenocarcinoma represent 6% of all renal tumors in GSD
•renal cystadenocarcinoma has also been described in a GSD-cross dog and Golden Retriever
•renal cystadenocarcinoma is a bilateral disease with slowly progressive deterioration of renal function
•ultrasonography results in earlier diagnosis and more successful treatment of renal neoplasia in humans
•renal tumors, except for LSA, produce a mixed echogenicity with disruption of the normal renal architecture
•renal LSA is usually hypoechoic
•ultrasonography is also useful in detecting neoplastic involvement of regional lymph nodes and adjacent structures such as the adrenal glands ± caudal vena cava
So this Shihtzu wanted to be
So this Shihtzu wanted to be a german shepherd!!
looking back at that image again and again technically the loss of cm definition would suggest neoplasia but this happens all the time with stone dystrophy and shihtzus are the stone poster children. Thanks for the histopath and follow up and interesting outcome!! Yes any time there are cysts the fna can never be trusted as the junction from pathological tissue to cyst is the dx area… similar to biliary or bronchogenic carciomas
From a google search:
renal cystadenoma
inherited as an autosomal dominant trait in middle-aged German shepherd bitches with generalized nodular dermatofibrosis.
Main article: Kidney cancer
Renal cell carcinoma
Classification and external resources
Micrograph of the most common type of renal cell carcinoma (clear cell) – on right of the image; non-tumour kidney is on the left of the image. Nephrectomy specimen. H&E stain.
ICD-10 C64
ICD-9 189.0
ICD-O: M8312/3
OMIM 144700 605074
DiseasesDB 11245
MedlinePlus 000516
eMedicine med/2002
Renal cell carcinoma
(RCC, also known as hypernephroma) is a kidney cancer that originates in the lining of the proximal convoluted tubule, the very small tubes in the kidney that filter the blood and remove waste products.
Renal Cystadenocarcinoma
General Considerations
•renal cystadenocarcinoma is an autosomal dominant condition in GSD with a genetic linkage to chromosome 5
•renal cystadenocarcinoma represent 6% of all renal tumors in GSD
•renal cystadenocarcinoma has also been described in a GSD-cross dog and Golden Retriever
•renal cystadenocarcinoma is a bilateral disease with slowly progressive deterioration of renal function
•ultrasonography results in earlier diagnosis and more successful treatment of renal neoplasia in humans
•renal tumors, except for LSA, produce a mixed echogenicity with disruption of the normal renal architecture
•renal LSA is usually hypoechoic
•ultrasonography is also useful in detecting neoplastic involvement of regional lymph nodes and adjacent structures such as the adrenal glands ± caudal vena cava
This is a primary renal cyst
This is a primary renal cyst from the path 400 cd. You can see the well defined, though degenerative, structural pattern adjacent to the cyst. I drained and cultures pseudomonas from that cyst as well. Geriatric standard poodle.
Perirenal pseudocyst which is
Perirenal pseudocyst which is not actually a cyst but a fluid accumulation that separates the cortex from the capsule.
Perirenal pseudocyst which is
Perirenal pseudocyst which is not actually a cyst but a fluid accumulation that separates the cortex from the capsule.
Polycystic kidney disease
Polycystic kidney disease with pelvic stones in a renal failure cat
Polycystic kidney disease
Polycystic kidney disease with pelvic stones in a renal failure cat
Renal lymphoma with a
Renal lymphoma with a cortical cyst and pyelectasia. Was surprised on this one as i was expecting mixed inflammation on fna thinking pyelo and primary cyst but got lsa instead.
Renal lymphoma with a
Renal lymphoma with a cortical cyst and pyelectasia. Was surprised on this one as i was expecting mixed inflammation on fna thinking pyelo and primary cyst but got lsa instead.
Renal Carcinoma with focal
Renal Carcinoma with focal mineralization.
Renal Carcinoma with focal
Renal Carcinoma with focal mineralization.
Thanks Eric!
Thanks Eric!
Thanks Eric!
Thanks Eric!
You can see the well defined, though degenerative, structural pattern adjacent to the cyst. I drained and cultures pseudomonas from that cyst as well. Geriatric standard poodle.