Renal cytology

Ultrasonographic Features of Presumed Renal Telangiectasia in Three Pembroke Welsh Corgis

Renal telangiectasia has been reported in Pembroke Welsh corgis with chronic hematuria; however, the sonographic features of these lesions have never been described. Two dogs with confirmed renal telangiectasia and one dog with presumptive renal telangiectasia were identified in a medical record search. All dogs had one or more variably sized renal nodules identified on abdominal ultrasound. The nodules in two of the three dogs were similar, appearing hyperechoic with numerous punctate hypoechoic to anechoic foci throughout. None of the nodules showed evidence of hemodynamic flow on Doppler ultrasound. Renal telangiectasia should be considered as a benign differential diagnosis, particularly in Pembroke Welsh corgis.

Renal scintigraphy as an early and efficient method for detecting loss of renal function in a cat

Case summary

A 6-year-old mixed-breed male cat was evaluated for a routine annual health assessment. No alterations on physical examination were observed other than mild pain on palpation of the right kidney. Complete blood count, serum biochemistry (including symmetric dimethylarginine), urinalysis and urine protein:creatinine ratio were within the reference intervals for the species. Abdominal ultrasonography showed the presence of asymmetric kidneys, decreased corticomedullary definition, presence of a cyst on the left kidney and moderate renal pelvis dilatation on the right kidney. Dynamic renal scintigraphy (technetium [^99mTc]-diethylenetriamine pentaacetic acid) revealed a single functioning kidney on the left. Static renal scintigraphy (^99mTc-dimercaptosuccinic acid) exhibited renal activity practically restricted to the left kidney (relative uptake was 99% for the left kidney and 1% for the right kidney). Results of renal scintigraphy showed that the left kidney was compensating for the lack of function of the right one. GFR was 2.17 ml/min/kg, which is considered subclinical renal insufficiency and is in accordance with the case, as the cat was asymptomatic and did not present alterations in laboratory parameters.

Relevance and novel information

Renal scintigraphy was an important tool to determine the loss of renal function in one of the kidneys and mild reduction of global GFR. In this case report, renal scintigraphy proved to be more sensitive in the assessment of renal function than other tests routinely performed.

Contrast-enhanced computed tomography findings of canine primary renal tumors including renal cell carcinoma, lymphoma, and hemangiosarcoma

In veterinary medicine, abdominal ultrasonography is used to rank the differential diagnosis of renal lesions. However, a conventional sonographic examination may show nonspecific findings. The purpose of this study was to assess the computed tomography (CT) findings of canine renal tumors, including renal cell carcinoma (RCC), lymphoma, and hemangiosarcoma (HSA). In this retrospective study, the following CT parameters were recorded for each dog: 1) extent of renal involvement of tumors, 2) enhancement pattern, 3) number of renal tumors, 4) renal tumor vessel enhancement in the corticomedullary phase, 5) presence of lymphadenopathy and lung metastasis, and 6) attenuation values of the renal tumors on the pre- and post-contrast corticomedullary, nephrographic, and excretory phase images. Fifteen dogs met the inclusion criteria, of which nine had RCCs, four had lymphomas, and two had HSAs. RCCs tended to show heterogeneous enhancement and unilateral renal involvement, and vessel enhancement was detected in the corticomedullary phase in dogs with RCC. Conversely, renal lymphomas showed homogeneous enhancement, bilateral renal involvement, and multiple masses; in these dogs, no vessel enhancement was detected in the corticomedullary phase, and the incidence of lymphadenopathy was low. However, in dogs with lymphadenopathy, the renal lymphoma was associated with regionally severe lymphadenopathy. Finally, renal HSAs tended to show heterogeneous enhancement with a non-enhanced area and unilateral renal involvement; in these dogs, vessel enhancement was detected in the nephrographic phase, with the enhancement expanding around the vessel. These findings had no significant differences. Further studies with a larger sample size are required to examine the association between CT and histopathological findings.

Diagnostic utility of renal fine-needle aspirate cytology and ultrasound in the cat

Objectives The primary objective of this study was to retrospectively assess the diagnostic utility of feline renal fine-needle aspiration cytology by assessing diagnostic yield, cytologic characteristics and diagnostic accuracy. The secondary objective was to characterize ultrasonographic features of sampled kidneys to determine if they influenced diagnostic yield. Methods Slides, images and patient data were collected from the University of Minnesota Veterinary Medical Center database. Slides were designated as diagnostic or non-diagnostic. Non-diagnostic slides were used in calculating diagnostic yield and excluded from other analysis. Slides were evaluated for cytologic characteristics and assigned a single primary diagnosis. Ultrasound still images were evaluated for descriptive characteristics and characteristics of specific lesions were described. Cases with confirmatory testing were used to determine diagnostic sensitivity, specificity and positive and negative predictive values for detecting neoplasia. Results Of 96 cytologic submissions available for review, diagnostic yield was 68%; 48% of samples were at least moderately cellular. Of 87 cases with ultrasound data, kidneys showing subcapsular renal infiltrate, diffuse renal enlargement without pelvic dilation and infiltrative/nodular change were more likely to yield diagnostic samples. Of 12 confirmed cases, cytology was 100% sensitive and specific for the detection of neoplasia (four round-cell tumors and two carcinomas). Three cases with non-neoplastic histologic diagnoses were considered cytologically normal, two incorrectly diagnosed the pathology present, and one correctly diagnosed the pathology. While some imaging characteristics were more commonly seen in neoplastic vs non-neoplastic lesions, the sample size was insufficient for definitive correlation. Conclusions and relevance This is the first major analysis of feline ultrasound-guided renal fine-needle aspiration cytology. This technique generates adequate samples for interpretation at rates comparable to other soft tissues and is most useful in the diagnosis of neoplasia. Some imaging characteristics are indicative of the likelihood of obtaining an adequate sample for cytologic interpretation.

Evaluation of the diagnostic utility of cytologic examination of renal fine-needle aspirates from dogs and the use of ultrasonographic features to inform cytologic diagnosis

OBJECTIVE To describe cytologic characteristics of renal fine-needle aspirate (FNA) samples from dogs, evaluate proportions of cytologic specimens deemed adequate for interpretation (diagnostic yield), assess diagnostic utility of cytologic examination for neoplastic and nonneoplastic diseases, and characterize ultrasonographic features of evaluated kidneys to determine whether the imaging characteristics could be used to inform cytologic interpretations. DESIGN Retrospective, observational study. SAMPLE 102 cytologic specimens and 97 ultrasonographic studies from 100 dogs. PROCEDURES Medical records were reviewed to identify dogs that underwent ultrasound-guided renal FNA. Slides were categorized as adequate or inadequate for interpretation; adequate slides were used for retrospective cytologic diagnosis. Sensitivity, specificity, and predictive values of cytologic examination for detection of neoplastic and nonneoplastic conditions were calculated by comparison with histologic or lymphoid cell clonality assay results. Ultrasonographic characteristics of neoplastic and nonneoplastic renal lesions were described. RESULTS 74 of 102 (72%) specimens had slides adequate for interpretation; 26 were included in the diagnostic accuracy analysis. Sensitivity of cytologic examination was 78% and 50% for detection of neoplastic and nonneoplastic conditions, respectively, with specificities of 50% and 77%, respectively; sensitivity for detection of lymphoma was 100%. Ultrasonographic appearance of kidneys with confirmed neoplasia varied; masses were most commonly found in kidneys with carcinoma (5/5), lymphoma (5/7), or other neoplasia (3/4) and absent in kidneys with nonneoplastic conditions (n = 5). CONCLUSIONS AND CLINICAL RELEVANCE Renal FNA specimens were adequate for interpretation at rates comparable with those reported for other organs and were considered clinically useful for diagnosis of neoplasia. Imaging characteristics may potentially aid differentiation between neoplastic and nonneoplastic lesions; however, further investigation is needed.

All lesions great and small, part 2. Diagnostic cytology in veterinary medicine

This is the second in a two‐part review of diagnostic cytopathology in veterinary medicine. As in human medicine, cytopathology is a minimally invasive, rapid, and cost‐effective diagnostic modality with broad utilization. In this second part, the diagnostic applications of cytology in respiratory, gastrointestinal, genitourinary, endocrine, ocular, and central nervous system tissues are discussed with a section describing fluid analysis in veterinary medicine. As noted in the previous manuscript, which characterized the cytology of the skin/subcutis, musculoskeletal, and lymphoid tissues, the interpretation of veterinary cytology samples must be undertaken with extensive knowledge of the breadth of animal species, including familiarity with the frequency and clinical progression of diseases, both of which can be influenced by species, breed, and husbandry conditions. Similar to part one, this review focuses on the most common domestic companion animal species (dog, cat, and horse) and highlights lesions that are either unique to veterinary species or have relevant correlates in people. The cytologic features and biological behavior of similar lesions are compared, and selected mechanisms of disease and ancillary diagnostics are reviewed when appropriate. Supporting figures illustrate a subset of lesions. While not an exhaustive archive of veterinary cytology, the goal is to give cytopathologists working in human medicine a general impression of correlates and unique entities in veterinary practice. Diagn. Cytopathol. 2014;42:544–552. © 2014 Wiley Periodicals, Inc.

Long-term survival after combination chemotherapy for bilateral renal malignant lymphoma in a dog

CASE HISTORY

A 6-year-old, entire male Flat-coated Retriever was presented with a history of lethargy, polydipsia and seizures. Clinical chemistry had shown marked azotaemia.

CLINICAL FINDINGS AND DIAGNOSIS

Radiography and ultrasonography revealed bilateral renomegaly, and cytology of fine needle aspirates from the kidneys was diagnostic of malignant lymphoma. The dog was treated with a modified high-dose cyclophosphamide-, vincristine-, and prednisolone-based chemotherapy protocol, achieved remission, and returned to normal quality of life. Survival time was 346 days from the time of diagnosis.

CLINICAL RELEVANCE

Malignant lymphoma in the kidneys of dogs has been considered to carry a uniformly poor prognosis. Long-term remission after medical treatment has not previously been reported. The favourable outcome in this case illustrates the limitations of clinical staging in determining the outcome for individual patients.

Diagnostic approach to hematuria in dogs and cats

Hematuria indicates the presence of urogenital disease in dogs and cats. Persistent hematuria (macroscopic or microscopic) should be evaluated to determine the source of bleeding and the underlying cause so that appropriate treatment can be recommended. Results of the history and physical examination often help to localize disease to the urinary tract (either upper or lower) or genital tract. Additional diagnostic evaluation, including laboratory testing(eg, urinalysis, urine culture), diagnostic imaging (eg, abdominal radiographs, ultrasound), and collection of tissues for cytologic or histopathologic evaluation, may be needed to identify the underlying cause. If a thorough evaluation fails to reveal the source or cause of hematuria, exploratory celiotomy should be considered,especially if idiopathic renal hematuria is possible.