Ultrasound Guided Ethanol Sclerotherapy for Polycystic Kidney Disease in a Cat: Case Report
R. Gonzalez; M. Lee; J. Amicio; T. Rosalen; H.S. Zundano; A. Provasi; D. Damasio; M.M. Jericó
Polycystic kidney disease is a disorder in which large portions of normally differentiated renal parenchyma are displaced by multiple cysts. Renal cysts develop in preexisting nephrons and collecting ducts. Both kidneys are invariably involved because of the inherited nature of the disease. This heritable form of polycystic kidney disease (PKD) has been reported to affect up to 45% of Persian and Persian related cats. In humans, autosomal dominant polycystic disease (ADPKD) has a prevalence of approximately 1:1000 and the disease accounts for approximately 10% of end-stage renal failure. In cats, cysts often remain undetected until they have become of sufficient size and number to contribute to renal failure or abdominal enlargement. For these reasons, patients typically are clinically normal during initial stages of cyst formation and growth. Elimination of renal cysts and associated renal parenchymal lesions is not yet feasible. Therefore, treatment is often limited to minimizing the pathophysiologic consequences of renal cyst formation and growth. A 6-year-old, neutered female, Persian cat was referred with a 1-month history of polyuria and polydipsia. On physical examination, the cat was hydrated and with no signs of systemic disease. Blood was submitted for a complete blood count and serum biochemistry analysis. Abnormalities included mild azotemia (creatinine 2.1mg/dL; urea 71mg/dL). There was no other alterations in biochemical profile. The abdominal ultrasound revealed multiple cysts in both kidneys varying of 2.69cm to 0.62cm. One session of ultrasound-guided ethanol (95%) sclerotherapy was performed under general anesthesia. After 7- days of the procedure, the cat was reexamined and performed an abdominal ultrasound. Complete blood count and biochemical profile were within the reference ranges, including creatinine and urea. The cysts remain diminished, between 0.4-0.8 cm and repeated exams revealed no alterations in size and number for 6-months. The ultrasound-guided ethanol sclerotherapy is used to manage single cysts (kidney or liver) in veterinary medicine. This report suggests that multiple renal cysts may be successfully managed in some instances by a single ethanol injection.