RENAL OSTEODYSTROPHYAccession #101444

Christina Copple, DVM

Radiology Resident

NCSU CVM-VTH

Dobie

• Signalment:– 5 yr 8 mth MC Miniature Pinscher

• Current Hx:– Weight loss over last 2 months despite

normal appetite, lethargy, deviated mandible, stertorous breathing a couple of days prior to deviation of mandible, NO coughing/vomiting, occasional diarrhea, stable PU/PD, Diet – Hill’s K/D or Pedigree

• Past Hx:– Acute renal failure diagnosed at 2 yrs of age

(suspect nephrotoxin), Chronic renal failure since with intermittent episodes of vomiting, Previous pancreatitis and suspected hepatitis

Diagnostics

• CBC: Neutrophilic leukocytosis, normocytic hypochromic non-

regenerative anemia • Chemistry Panel: Azotemia, USG 1.010, hypercalcemic (total

serum Ca)/phosphatemic/magnesemic/kalemic, mild

hypoalbuminemia, elevated ALT/ALP • Radiographs• Abdominal Ultrasound

Radiographs

Radiographs

Abdominal Ultrasound

Left Kidney

Left Kidney-Cortical cyst

Abdominal Ultrasound

Right Kidney

Diagnosis

• Chronic Renal Failure

• Suspect Renal Secondary Hyperparathyroidism

• Renal Osteodystrophy

Renal Secondary Hyperparathyroidism

• Mechanism is multi-factorial– Hyperphosphatemia– Low levels of Calcitriol– Elevated circulating levels of PTH!

Renal Secondary Hyperparathyroidism/Renal

Osteodystrophy

Osteoclasts

Relevant Research Two recent papers in Veterinary Radiology & Ultrasound 2008: could not

identify the parathyroid gland in dogs without thyroid or parathyroid disease using MRI or CT.

Small parts high-resolution ultrasonography 1991: NORMAL ULTRASONOGRAPHIC ANATOMY OF THE CANINE NECK,

Veterinary Radiology & Ultrasound could not identify the parathyroid glands in healthy dogs.

1993: ULTRASONOGRAPHIC EVALUATION OF THE PARATHYROID GLANDS IN HYPERCALCEMIC DOGS, Veterinary Radiology & Ultrasound located hyperplastic parathyroid glands in two dogs with hypercalcemia using high-resolution ultrasound. Hypoechoic to thyroid tissue, well-marginated to poorly marginated, ~2mm in size.

1997: HIGH-RESOLUTION PARATHYROID SONOGRAPHY, Veterinary Radiology & Ultrasound did not identify parathyroid glands or lesions in 2/3 dogs that were hypercalcemic from renal insufficiency but did identify a parathyroid nodule in the remaining dog (measured 6 mm.) Parathyroid gland nodules were identified in other dogs of this study with hypercalcemia due to primary hyperparathyroidism (carcinoma/adenoma/adenomatous hyperplasia) with lesions appearing round to oval and hypoechoic to thyroid tissue. Neoplastic nodules were > 4mm and hyperplastic nodules were <4mm.

ReferencesEttinger, Stephen J. and Edward C. Feldman. Textbook of Veterinary Internal Medicine Diseases of the Dog and Cat. Vol 2. 6th ed. Elsevier: 2000.

Kumar, Vinay, MBBS, MD, FRCPath, Abul K. Abbas, MBBS, and Nelson Fausto, MD. Robbins and Cotran Pathologic Basis Of Disease. 7th ed. Elsevier: 1999.

Nelson, Richard W., DVM, DACVIM and G. Guillermo Couto, DVM, DACVIM. Small Animal Internal Medicine. 3rd ed. Mosby: 1992.

Thrall, Donald E., DVM, PhD, DACVR. Textbook of Veterinary Diagnostic Radiology. 5th ed. Elsevier: 2007.

OLIVIER TAEYMANS, RUTH DENNIS, JIMMY H. SAUNDERS MAGNETIC RESONANCE IMAGING OF THE NORMAL CANINE THYROID GLAND. Veterinary Radiology & Ultrasound. Volume 49, Issue 3, Date: May/June 2008, Pages: 238-242.

OLIVIER TAEYMANS, TOBIAS SCHWARZ, LUC DUCHATEAU, VIRGINIE BARBERET, INGRID GIELEN, MARK HASKINS, HENRI VAN BREE, JIMMY H. SAUNDERS COMPUTED TOMOGRAPHIC FEATURES OF THE NORMAL CANINE THYROID GLAND. Veterinary Radiology & Ultrasound. Volume 49, Issue 1, Date: January–February 2008, Pages: 13-19.

Erik R. Wisner, John S. Mattoon, Thomas G. Nyland, Thomas W. Baker NORMAL ULTRASONOGRAPHIC ANATOMY OF THE CANINE NECK. Veterinary Radiology & Ultrasound. Volume 32, Issue 4, Date: July 1991, Pages: 185-190.

Erik R. Wisner, Thomas G. Nyland, Edward C. Feldman, Richard W. Nelson, Stephen M. Griffey ULTRASONOGRAPHIC EVALUATION OF THE PARATHYROID GLANDS IN HYPERCALCEMIC DOGS. Veterinary Radiology & Ultrasound. Volume 34, Issue 2, Date: March 1993, Pages: 108-111.

Erik R. Wisner, Dominique Penninck, David S. Biller, Edward C. Feldman, Christiana Drake, Thomas G. Nyland HIGH-RESOLUTION PARATHYROID SONOGRAPHY. Veterinary Radiology & Ultrasound. Volume 38, Issue 6, Date: November 1997, Pages: 462-466.