Kafr El-Sheikh Vet. Med. J. Vol. 4 No. I (2006) (745-761)
THE ROLE OF ULTRASONOGRAPHY AND OTHER AIDS
IN TILE DIAGNOSIS OF EXPERIMENTAL SURGICAL
UNILATERAL HYDRONEPHROSIS OF DOGS.
Abd-EL-Roof Y.M.
Animal Medicine Depnnment, Faculty of vet. Med. Benha University.
ABSTRACT
This study was carried out on 10 dogs were allotted into two groups, the first
included 5 dogs sathjected to experimentally- induced unilateral hydronephrosis,
while the second represented by 5 (logs (.Sham Operated dogs) as a surgical
control. These dogs were subjected to clinical. haematological and urine
examinations. Also Biochemical analysis of serum collected from these dogs was
carried out. These dogs were examined ultrasonographically. Also. postmortem and
histopathological examinations were carried out on kidneys of necropsied dogs.
Results of this study can be summarized as /hllow. Clinical examinations of dogs
with surgical unilateral hydronephrosis showed intense lumbar pain at one week
then dogs showed no symptoms but the enlarged left kidney could be palpated.
lluematological examinations indicated significant increase o/ PCV%, itiBCs and
newrophil %. while significant decrease of lymphocyte % and monocyte %.
Biochemical analysis of serum of dogs with unilateral hydronephrosis showed
significant decrease of albumin, total proteins and sodium, while significant
increase of urea and creatinine. Urine examination fear dogs with surgical
unilateral hvdronephrosis revealed that urine pll was decreased after 20 clays postoperative. The specific gravity was decreased after Slays post- operation. Protein,
Bilirubin and haentaluria were detected after 5 days post- operative.
Ultrasonographic examinations for dogs with surgical unilateral hydronephrosis
showed that left kidney size was increased and distended with fluid. Parenchyma
became compressed and lost its normal architecture. Post. mortem exam mat on of
kidneys revealed dilatation of ureter and enlargement of left kidney that filled with
urine. Microscopically revealed cystic dilatation of renal tubules and flattening of
their lining epithelium. Also, degeneration of the lining epithelium of some renal
tubules with pres-ence of hyaline casts was recorded
INTRODUCTION
Renal disorders are amongst common diseases of the dog but as with
other organs, not all diseases or lesions of the kidney resulting in clinical
signs (Chandler et rd., 1995). Clinical signs and accumulated laboratory data may
not always point towards existing renal disease. Abdominal radiography can
also uncover suspected or unsuspected renal abnormalities, which can be
characterized further with ultrasonography. Ultrasonography appears to be
more sensitive than radiography in differentiating the internal
characteristics of renal lesions (Konde et a!., 1986). Most cases of
hydronephrosis occurs unilaterally and is only found at necropsy. During
chronic obstruction of ureteral flow caused by cicatrisation.stones and
tumor growth, the increased intrapelvic hydrostatic pressure induces pelvic
Kafr El-Sheikh Vet. Med. J. Vol. 4 No. I (2006) (745-761)
dilatation and medullar atrophy. In more advanced cases, cortical atrophy
also developed, giving rise to a watery fluid filled sac. In more acute
obstruction, the rapid increase in the pelvic hydrostatic pressure leads to
ischemia,nccrosis and cessation of urine fonnation(Grnys,1983). in dogs
with unilateral hydronephrosis, there are episodes of abdominal and lumbar
pain. Urine analysis showed proteinuria and there was pronounced absolute
neutrophilia and azotemia. (Knollenbell et at, 1988). During uretric
obstruction. the renal blood flow and glomerular filtration rate failed
significantly with rapidly formed azotemia. hyperkalemia, disturbance of
acid base balance with impairment of urine concentration ability with a
consequent large — scale loss of sodium and water (Ganon and Ansori,
1990). Early diagnostic changes of hydronephrosis are restricted to
scattering of normal pelvic echoes and form an cchogenic ring or horse
shoe with an anechoic center with a distended fluid- filled ureter. In mild or
moderate hydronephrosis, normal renal parenchyma can be recognized
surrounding the distended pelvis. In more severe cases of hydronephrosis,
the distended fluid filled pelvis become more obvious and the normal
strong echoes of the peripelvic fat and filled tissue may be lost completely.
The surrounding parenchyma become compressed and losses its normal
architecture. Eventually the kidney may become a fluid - filled sac with only
a thin outer rind. In most severe cases, the distended fluid filled ureter can
be detected although it often follows a very tortuous
course (Burr, 1992).
Unilateral ureteral obstruction histologically showed that glomcruli are preserved more
readily than tubular elements, leading to preponderance of glomeruli in residual cortical
tissue. Fibrosis and cellular infiltration occur. Unilateral ureteral obstruction may lead to
irreversible uretral dilatation proximal to the obstruction. (Osborne and Finco, 1995).
This work is aimed to detect the efficiency of ultrasonography in relation to other aids
in the diagnosis of experimental unilateral ureteral obstruction induced surgically.
MATERIAL AND METHODS
This study was carried out on 10 dogs aged from one to 3 years and weighted 10 to 15
Kg. These animals were kept under observation for 2 weeks before experimental work. These
animals were divided into two groups.The first group consisted of 5 dogs that were subjected
to surgical induction of unilateral hydronephrosis according toDongivoo and Chang
(2001). The second group (Sham-operated dogs) included live dogs that was subjected to
celiotomy technique and only gentle manipulation of the left kidney and ureter without
ligation of the ureter, according to AhdEL- Alaksoud, (1990). All dogs were subjected to
careful clinical examination according to Kelly, (1984). Blood samples from cephalic vein
were collected according to Kirk and Bistner, (1985). The blood samples were divided into
two portions, the first one was with anticoagulant for estimation of' blood picture, while the
other was without anticoagulant to obtain clear non- hemolysed serum for biochemical
Kafr El-Sheikh Vet. Med. J. Vol. 4 No. I (2006) (745-761)
analysis 'the estimation of blood picture included total erythrocytic count (Bernard e1 al.,
2000), total leukocytic count (('oles, 1986), haemoglobin content (.Schalm, 1975),
packed cell volume (Frankel et al., 1970) and differential leucocytic count (Jain, 1986).
Biochemical analysis of serum included estimation of sodium and potassium (Henry et at,
1974). calcium (Teitz, 1970), phosphorus (Anderson and Cockayn, /993), chloride,
(Skeggs and Hoschstrasser, 1964), total proteins (Henry, 1964), albumin (Drupt,
1974), urea (Patton
and Crouch, 1977), uric acid (Wilding and Heath, 1975) and
creatininc (Young, 1990).
Also urine samples were collected by using urethral
catheterization and urine parameters were estimated by using combi-9
strips (Pasteur lab.). Ultrasonographic examination of the kidneys was
performed according to the method described by Barr, (1992). Real
time ultrasonographic images were obtained using 5 and 7.5 MHz
sector transducer. At the end of the experiment, kidneys of nccropsied
dogs were examined macroscopically and histopathological specimens
of about 0.5 cm thickness were collected from each lesion of kidneys of
necropsied dogs for histopathological examination, Harris, (1990).
Obtained data were statistically analyzed according to Norman and
Baily (1997).
RESULTS AND DISCUSSION
(A) Clinical features:
Clinical examination of dogs with surgically- induced unilateral
hydronephrosis showed inappetcnce and intense lumbar pain one week
post-operative. Then lately these dogs showed no symptoms except an
enlargement of the left kidney that could be palpated by abdominal
palpation. However, after 6 weeks post- operative, the dogs become
dehydrated and emaciated. These dogs did not show any symptoms of
renal disease because the contra lateral kidney was functioning
normally. The intense lumbar pain may be due to acute ureteral
obstruction. These signs were similar to those observed by Grups
(1992), Knolfenbelt et aL. (1988), Ettinger, (1989), Stone,
(1990), Osborne et at, (1995), Nelson and Couto, (1992) and
Alklrodrp, (2000).
(H) Haematological examination (Tables 1, 2):
The mean value of PCV% was significantly increased in the 25`r
day post-operative in dogs with unilateral hydronephrosis then highly
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significantly increased in the 3001 day post- operative, then reached its
maximal value in the 42"" day. The increase in PCV% may be attributed to deh ydration,
Kelly, (1984). The mean values of RBCS count and Hb were riot significantly changed. The
mean value of WRCS count was significantly increased in the 5'h day post operative in control
sham operated dogs and dogs with unilateral hydronephrosis then decreased gradually to
reach its minimal value in the 42?' day post-operative in sham operated dogs while in dogs
with unilateral hydroncphrosis the values of WBCs increased continuously to reach its
maximal value in the 421hJ day. The mean values of neuu•ophil % was significantly increased
in the 5`t' day post-operative in dogs with unilateral hydroncphrosis then increased gradually
to reach its maximal value in the 42"° post-operative. The mean values of lymphocytes %
was significantly decreased in the 30th day post-operative in dogs with unilateral
hydronephrosis then decreased gradually to reach its minimal value in the 42nd post-operative.
The mean value of monocyte % for dogs with unilateral hydronephrosis was significantly
decreased in the 25"' day post- operative to reach its minimal value in the 30" post-operative.
These results were coincided with those of Knuttenhell el al., (1988) and Kelly (1984).
(C) Biochemical analysis ot'serum (Table, 3):
Serum analysis for dogs with surgically-induced unilateral hydronephrosis indicated
significant decrease of albumin and total proteins in the 5th day post- operative, reaching
minimal value in the 20°' clay for total proteins and 15" for albumin and then increased
gradually. The mean values of scrum urea and creatinine were significantly increased in the
5"' day post-operative, then decreased gradually. These results were similar to those recorded
by Nelson and Cottfo(1992)and Dan woo and Chang (2001).
The mean value of serum sodium was significantly decreased in the 5th day postoperative, then increased gradually. Mean values, of scrum uric acid, potassium, calcium,
phosphorus and chloride were not significK2fr EI-Shcikh Vet. Med. J. Vol. 4 No. 1 (2006)
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increased in size. At 25 days post-ligation of the left ureter (photo 5), the kidney length was
significantly increased than control. At 30 days post-ligation (photo 6), the kidney increased in
size and became a fluid filled Sac. At 42 days post-ligation (photo 7), the kidney size
decreased gradually. The contralateral kidney and kidneys of control dogs did not show any
remarkable ultrasanographic changes in the shape and size (photo 1). These results were
coincided with those of Gillenwater, (1992) and Semi/ca and Abd- El- Ghaffar,
(1997).
(F) Macroscopic examination of kidneys of necropsied dogs:
The post-morlem examination of kidneys of dogs after 42 days post- ligation with
surgically induced unilateral hydronephrosis revealed dilatation of ureter and renal pelvis of
the left kidncy(photo 8).In addition the affected left kidney was enlarged in size and filled
Kafr El-Sheikh Vet. Med. J. Vol. 4 No. I (2006) (745-761)
with urine.Morcover. the cut surface of the left kidney showed dilation of renal pelvis and
calyces with severe atrophy of renal medulla. This appearance was coincided with
ultrasonographic results and was similar to that observed by Nall (1983) and Semieka and
Abd El-Gbaffar (1997).
(G) Histopathological examination:
The microscopic examination of the affected kidneys after 42 days post-ligation (photo
9, 10) revealed that the pathological changes were mostly in the renal tubules, while the
glomeruli appeared fairly normal. These changes were represented by cystic dilatation of the
renal tubules and flattening of their lining epithelium. Focal inflammatory cellular infiltrations
of the interstitial tissue mostly lymphocytes were observed. Also, degeneration of the lining
epithelium of some renal tubules with presence of hyaline casts was recorded. Moreover,
Fibrous connective tissue proliferations with lymphocytic cellular aggregation in the
interstitial tissue were detected. This appearance was coincided with the macroscopic and
ultrasonographic results and was similar to that observed by Osborne et aL, (1995) and
Setrtieka and Abd- El- Ghaff ir, (1997).
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Acknowledgement
I would like to express my deepest thanks to staff members of' Veterinary Surgery
Department - Faculty of Veterinary Medicine - Benha University, for their
valuable help and support during conducting the experimental surgery. Also, my
grateful thanks are extended to staff members of veterinary pathology- Faculty of
Veterinary Medicine - Benha University for their valuable help in the pathological
aspect of this study.