Protein losing nephropathy, glomerulonephritis, and uremic gastritis in a 3-year-old Intact male Labrador Retriever: Our Case Of The Month December 2014

Acute renal failure & protein losing nephropathy; what does it look like on ultrasound? I get this question a lot and essentially the kidneys look like they did before the insult (Lyme likely if in the northeast) came to town but throw a “Christmas tree” of power Doppler on it and you will have the right image in mind. This case of the month is a perfect example if aggressive PLN and thick hyperperistaltic “sea urchin” stomach that makes the sonographer reach for the pepcid just looking at it. Poor dog, bad disease, and just waiting to throw a clot when losing all that AT3.

History

A 3-year-old male Labrador Retriever dog was presented for anorexia and weight loss. CBC was within normal limits, however blood chemistry showed hyperproteinemia, hypoalbuminemia, low albumin/globulin ratio, marked azotemia, hyperphosphatemia, mild hypocalcemia, hyperkalemia, and hyperamylasemia. T4 was within normal range. The urine had a cloudy appearance; 3+ proteinuria and 3+ hematuria were present on urinalysis.

Clinical Differential Diagnosis

Renal disease – acute, chronic, congenital, pyelonephritis, neoplasia. Nephrotic syndrome. Primary glomerulonephritis with secondary renal failure.

DX

Protein-losing nephropathy, glomerulonephritis, uremic gastritis.

Sonographic Differential Diagnosis

Glomerulonephritis – protein losing nephropathy. Suspect Lyme nephritis, or similar immune complex disease. Uremic gastritis.

Image Interpretation

The kidneys present thickened and uniformly echogenic cortices that are hypervascular on power Doppler evaluation. Slight pyelectasia is present due either to fluid therapy (< 0.3 cm) or due to infection (pyelonephritis). The gastric wall is edematous and uniformly thickened consistent with gastritis.