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Abnormal renal palpation

image of Abnormal renal palpation
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Abstract

When renal disease is suspected, abdominal palpation is critical to the initial physical examination. Abdominal palpation will reveal changes in renal morphology that accompany various pathophysiological processes. This chapter covers diagnostic approaches to abnormal findings such as increased/decreased size, and altered shape/consistency. Domestic shorthaired Cat with ethylene glycol toxicosis; Weimaraner with pyelonephritis.

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Figures

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4.8 Polycystic kidney disease in a Persian cat. (a) The renal cortex is distorted with multiple fluid-filled cysts. (b) These cysts can readily be detected by ultrasonographic examination. (Courtesy of the Feline Advisory Bureau)
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4.11 Ultrasonography demonstrating hydronephrosis. Ultrasonograms of a 3-year-old female (recently neutered) Chihuahua, presenting shortly after routine ovariohysterectomy. (a) Longitudinal image of the left kidney shows the hyperechoic fat of the renal pelvis markedly separated by anechoic fluid, consistent with severe hydronephrosis. The outline of the kidney is expanded, the normal architecture of the renal medulla is compressed, but the cortex is relatively normal. (b) Longitudinal view of the right kidney in the same dog showing normal renal architecture. (Courtesy of Anna Newitt, University of Liverpool)
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4.12 Ultrasonography demonstrating nephrolithiasis. Ultrasongram of the left kidney of a 7-year-old male Dalmatian, presenting with apparent sublumbar pain. Hyperechoic shadowing regions are present in the renal pelvis (arrowed), consistent with nephrolithiasis (probably urate given the breed). (Courtesy of Anna Newitt and Alistair Freeman, University of Liverpool)
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4.13 Excretory urography demonstrating nephrolithiasis in a 7-year-old Dalmatian presenting with apparent sublumbar pain (same dog as in Figure 4.12 ). (a) Nephroliths (probably urate) are evident on plain lateral abdominal radiography (arrowed). (b) Filling defects can be seen during subsequent urography (arrowed). (Courtesy of Anna Newitt and Alistair Freeman, University of Liverpool)
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4.14 Excretory urography demonstrating hydronephrosis. Excretory hydronephrosis in a 3-year-old female (recently neutered) Chihuahua, presenting shortly after routine ovariohysterectomy (same dog as in Figure 4.11 ). There is evidence of (a) left-sided renomegaly, (b) dilatation of the left renal pelvis and (c) left ureter dilatation. The findings are suggestive of hydronephrosis secondary to iatrogenic ligation. (Courtesy of Anna Newitt, University of Liverpool)
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4.15 Histopathological images of renal parenchyma from an 11-month-old Cocker Spaniel bitch with familial nephropathy. The Bowman’s spaces are dilated and empty; some contain components of vascular glomerular tufts and proteinaceous material. There is multifocal calcification of the Bowman’s capsules, tubular basement membranes and glomerular basement membranes. (a) H&E stain; original magnification X100. (b) H&E stain; original magnification X400.
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4.16 Transmission electron micrographs of glomeruli from (a) an 11-month-old Cocker Spaniel bitch with familial nephropathy and (b) a normal dog. In the affected dog, there is evidence of basement membrane thickening (red arrows) and splitting (green arrows). (Original magnification X5400).
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4.17 Pyelonephritis in a 9-year-old neutered Weimaraner bitch. (a) Ultrasonogram of the left kidney, demonstrating dilatation of the renal pelvis (arrowed) and poor corticomedullary definition. (b) Specimen of urine demonstrating gross turbidity. (a, Courtesy of Annette Kerins, University of Liverpool)
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4.18 Right lateral abdominal radiograph of an anaplastic sarcoma causing dramatic unilateral renomegaly, altered shape and altered position in a 7-year-old Bassett Hound bitch. (Courtesy of Anna Newitt and Laura Blackwood, University of Liverpool)
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4.19 Renal lymphoma. (a) Right lateral abdominal radiograph of a Domestic Shorthaired Cat with bilateral renomegaly caused by lymphoma. Small intestinal impaction (from ingestion of cat litter) was the result of concurrent pica. (b) Right lateral and (c) ventrodorsal abdominal radiographs of a 14-year-old Domestic Shorthaired Cat with unilateral renomegaly caused by lymphoma. (d) Ultrasonogram of the left kidney of an 11-year-old neutered male Persian cat with bilateral renal lymphoma. There is renomegaly (left kidney = 5.6 cm) and poor corticomedullary definition. Two cysts are also present within the renal cortex, probably secondary to concurrent polycystic kidney disease. (a, Courtesy of Dr Penney Barber; b–c, Courtesy of Anna Newitt and Rachel Steen, University of Liverpool; d, Courtesy of Anna Newitt and Dan Batchelor, University of Liverpool)
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4.20 (a) Right lateral abdominal radiograph demonstrating bilateral renomegaly. (b) Ultrasonogram of the left kidney, demonstrating renomegaly with some loss of corticomedullary definition. (c) Photomicrograph demonstrating mild vacuolation of renal tubular epithelial cells, and elongated pale yellow crystals within the tubular lumen (arrowed). (H&E stain; original magnification X400) (a–b, Courtesy of Anna Newitt, University of Liverpool; c, Courtesy of Gail Leeming, University of Liverpool)

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