Pyelonephritic end-stage kidney and ureterocutaneous fistula in a Shetland pony - PubMed (original) (raw)
Pyelonephritic end-stage kidney and ureterocutaneous fistula in a Shetland pony
Jan Schinköthe et al. J Vet Diagn Invest. 2023 Sep.
Abstract
A 12-y-old Shetland Pony was presented with a mucus-secreting fistula in the right paralumbar fossa. Surgery was performed to unravel the origin of the fistula. The horse died under anesthesia and was forwarded to autopsy. The right kidney was markedly atrophic and fibrotic, consistent with unilateral end-stage kidney. The right ureter was markedly thickened, but with luminal continuity leading into the urinary bladder where a partial obstruction caused by nodular para-ureteral fat necrosis was evident. The lumen of the cutaneous fistula was continuous with the right ureter; therefore, we diagnosed the lesion as a ureterocutaneous fistula. Anomalies of the ureter are uncommon, and ureterocutaneous fistula formation in equids has not been reported previously to our knowledge.
Keywords: end-stage kidney; fistula; kidney; pony; ureter; ureterocutaneous.
Conflict of interest statement
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Figures
Figure 1.
Thickened right ureter and para-ureteral mass with postmortem radiographic findings in a female Shetland pony. A. Left kidney (arrow), urinary bladder (asterisk), para-ureteral mass (#), and a severely thickened right ureter (arrowhead). B. The right ureter is ligated by 2 sutures (arrows), with 1 suture in the fistula remnant (arrowhead). C. Radiographic image prior to contrast agent application (CAA). The right ureter is markedly thickened (arrow), and the para-ureteral mass near the urinary bladder (asterisk) is partially mineralized (arrowhead). D. Radiographic image after CAA. A continuous lumen of the right ureter starts at the surgically removed edge (arrow), involves the ureteral outlet (arrowhead), and leads to accumulation of CAA in the urinary bladder (asterisk).
Figure 2.
Mucus-filled, thickened right ureter and para-ureteral mass of fat necrosis in a Shetland Pony. A. Markedly dilated and mucus-filled ureter, with adventitial fibrosis. B. The mucosal lamina propria (LP) and tunica adventitia (TA) are markedly expanded by fibrous connective tissue; the muscular tunic (TM) is infiltrated by adipocytes. H&E. C. The ureteral urothelium is hyperplastic (arrowhead), and the mucosal lamina propria is infiltrated by a few lymphocytes, macrophages, and neutrophils. H&E. D. Cut section of the para-ureteral mass, with the compressed right ureter (arrow) embedded in the fibrous connective tissue that surrounds the necrotic and mineralized mass.
Figure 3.
Pyelonephritic end-stage kidney in a Shetland pony. A. Right kidney with a thick fibrous connective tissue capsule and right ureter (arrow). B. Dashed rectangle near the kidney capsule from image A depicts dense fibrous connective tissue at the top followed by moderate, nodular-to-confluent, lymphohistioplasmacytic inflammation (arrow), and intimal and medial fibrosis of blood vessels (arrowhead). Inset shows a few lymphocytes, macrophages, and single plasma cells (arrowhead). H&E. C. Markedly dilated tubules lined by flattened epithelium and lumina partially filled with eosinophilic flocculent material. H&E. D. Polysaccharide-rich intratubular casts (thyroidization). Periodic acid–Schiff.
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