Unexplained polyuria and non-obstructive hydronephrosis in a urological department

Korzets, Asher; Sachs, David; Gremitsky, Andrey; Gershkovitz, Regina; Farrage, Gabriel; Chlibowsky, Abraham; Erlich, Nahum

doi:10.1093/ndt/gfh229

Cited by 12 publications

(6 citation statements)

References 12 publications

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“…RP dilation may be enhanced with administration of high rates of fluids or diuretics. 16,18,19,29 It is now well known that cats with CKD have a certain degree of interstitial inflammation and fibrosis and tubular atrophy that are more severe with advanced disease and positively correlated with the severity of azotemia. 30,31 Renal parenchymal and/or capsular fibrosis associated with CKD could limit RP dilation and/or renomegaly in an obstructed kidney owing to decreased compliance of fibrotic tissue despite increased pressure within the renal urine collection system.…”

Section: Discussionmentioning

confidence: 99%

Minimal renal pelvis dilation in cats diagnosed with benign ureteral obstruction by antegrade pyelography: a retrospective study of 82 cases (2012–2018)

Lemieux

Vachon

Beauchamp

et al. 2021

Journal of Feline Medicine and Surgery

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Objectives The aim of the study was to describe renal pelvis (RP) and ureteral ultrasonographic measurements in a population of cats with confirmed benign ureteral obstruction (UO) by antegrade pyelography. The secondary objective was to further describe clinical findings associated with minimally dilated obstructed kidneys in an attempt to better understand its occurrence. Methods Retrospective case series of cats diagnosed with benign UO were confirmed by antegrade pyelography. Medical records were reviewed and signalment, diagnostic imaging results, serum creatinine (SCr) concentration and urine culture results were recorded. Each obstructed kidney was categorized into two groups: group 1 included all RP measurements ⩽4 mm and group 2 included all RP measurements >4 mm. Results A total of 82 cats with 114 obstructed ureters met the inclusion criteria. Fifty (61%) cats had a unilateral UO and 32 (39%) had a bilateral UO. Thirty (26%) kidneys were included in group 1 while 84 (74%) were included in group 2. Nine (8%) kidneys had an RP dilation ⩽2 mm. Median RP and ureteral diameters were 6.6 mm (range 1.1–37.0 mm) and 3.2 mm (range 0.0–11.0 mm), respectively. RP size correlated positively with ureteral diameter in the study population ( P <0.0001), but not in group 1 when analyzed separately ( P = 0.47). UO was secondary to stones in 80 (70%) ureters. Seventeen (21%) cats had a positive urine culture. At admission, 79 (96%) cats were azotemic with a median preoperative SCr concentration of 444 µmol/l (range 108–1326 μmol/l). The mean (95% confidence interval [CI]) preoperative SCr concentration was significantly higher in group 1 (762 µmol/l [498–1165 μmol/l]) than in group 2 (409 µmol/l [333–502 μmol/l]). RP size in the two groups correlated negatively with preoperative SCr concentration ( P = 0.0002). Conclusions and relevance Feline UO may be associated with minimal RP dilation and the severity of RP and ureteral dilation can be highly variable. Absence of significant RP dilation does not rule out UO in cats.

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Section: Discussionmentioning

confidence: 99%

Minimal renal pelvis dilation in cats diagnosed with benign ureteral obstruction by antegrade pyelography: a retrospective study of 82 cases (2012–2018)

Lemieux

Vachon

Beauchamp

et al. 2021

Journal of Feline Medicine and Surgery

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“…Compared with patients who received placebo, the rate of increase in kidney volume was low in both study groups (2.8% per year in toluaptan and 5.5% per year in placebo) contrasting to 10% per year in other studies [14][15][16]. If abnormal bladder function combines with acute hydronephrosis progressive renal failure may occur.…”

Section: Discussionmentioning

confidence: 68%

Bilateral (Acute) Hydronephrosis Mimicking Polycystic Renal Pathology

Moyosore¹

2017

MOJAP

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Complete or partial urethral obstruction results in progressive nephropathy in the subsequent calyxal and renal parenchymal damage. We report a case controlled giant hydronephrosis mimicking multiple polycystic kidney disease (PCKD). The fluid content in the collecting duct is about 1.4 liters.A 40 years old man with renal dimensions measuring RK: 118 x 62 mm; LK: 120 x 65 mm respectively reported for ultrasound examination. There was no evidence of malignancy after 8-month follow-up ultrasonography with drug treatment in the Internal Medical Unit; plus urologic evaluation and documentation. Expelled urinary volume via catheter was consistently measured.Although clinical symptoms and alternate list of diagnosis were suspected, it turned out to be a case of large hydronephrosis. Accurate diagnosis became challenging due to distortion of renal parenchyma and calyxal atrophy.Examining clinical presentations, real-time sonogram evaluation and treatment medication, it is concluded that ureteric calculus may be a main cause of bilateral hydronephrosis.

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“…The mechanism of the hydronephrosis in ROMK KO mice is not clear, even though higher urine volume can be one of the causes of hydronephrosis, e.g., bilateral nonobstructive urinary dilatation in nephrogenic diabetes insipidus (DI) (17). As reported, AQP2 KO mice suffer from severe hydronephrosis, presumably as a consequence of an inability to cope with the extreme polyuria (21,27).…”

Section: Discussionmentioning

confidence: 97%

Urinary bladder hypertrophy characteristic of male ROMK Bartter’s mice does not occur in female mice

Kim

Guo

et al. 2018

American Journal of Physiology-Regulatory, Integrative and Comp

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The renal outer medullary potassium channel (ROMK; K1.1) plays an important role in Na and K homeostasis. ROMK knockout (KO) mice show a similar phenotype to Bartter's syndrome of salt wasting and dehydration due to reduced Na-2Cl-K-cotransporter activity but not in ROMK1 KO mice. ROMK KO mice also show hydronephrosis; however, the mechanism of this phenotype has not been understood. We have previously demonstrated a gender-sex difference in hydronephrosis and PGE production in ROMK KO mice. In this study we compared the gender-sex difference in bladder hypertrophy and hydronephrosis in ROMK KO mice. The bladder weight, bladder capacity, and the thickness of urothelium in male ROMK KO showed average increased two to approximately fourfold greater than wild-type (WT) mice, but there was no difference in either female or ROMK1 KO mice. The thickness of the urothelium was 648.8 ± 33.2 µm vs. 302.7 ± 16.5 µm ( P < 0.001) and the detrusor muscle 1,940.7 ± 98.9 µm vs. 1,308.2 ± 102.1 µm ( P = 0.013), respectively, in 12-mo male ROMK KO mice compared with the same age WT mice. Western blotting detected ROMK expression at 45~48 kDa, and both ROMK1 and ROMK2 mRNA were detected by quantitative PCR in the bladder. Immunofluorescence staining showed ROMK stained in the bladder, ureter, and urethra in WT but not in KO. In addition, there was a correlation between the severity of hydronephrosis and the bladder weight in male but not in female ROMK KO mice. In conclusion, ROMK expressed in the urinary tract at both protein and mRNA levels; significant enlargement and hypertrophy of the bladder may contribute to hydronephrosis in male ROMK KO mice.

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Unexplained polyuria and non-obstructive hydronephrosis in a urological department

Cited by 12 publications

References 12 publications

Minimal renal pelvis dilation in cats diagnosed with benign ureteral obstruction by antegrade pyelography: a retrospective study of 82 cases (2012–2018)

Minimal renal pelvis dilation in cats diagnosed with benign ureteral obstruction by antegrade pyelography: a retrospective study of 82 cases (2012–2018)

Bilateral (Acute) Hydronephrosis Mimicking Polycystic Renal Pathology

Urinary bladder hypertrophy characteristic of male ROMK Bartter’s mice does not occur in female mice

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