10-year-old Male, Schnauzer

History: Lethargy, diarrhea and vomiting for several days.  The dog was thin and dehydrated.  Abnormal laboratory data included leukocytosis (21.1k/ul), anemia (5.0 M/ul), elevated creatinine (4.6 mg/dl), elevated BUN (>130 mg/dl) and hyperphosphatemia (>16.1 mg/dl).

Images:


Findings:

•The prostate gland is enlarged and is causing cranial displacement of the urinary bladder.  There are focal areas of mineralization superimposed on the prostate gland.

•There is faint mineralization superimposed on the urinary bladder.

•Best seen in the ventrodorsal view, there is smooth mineralization of several rugal folds.

•There are multiple sites of chronic degenerative disc disease and spondylosis.

•In the Left lateral view there are several foci of mineralization superimposed on the plane of the kidneys.

•An air pellet and metallic BB are present in the caudal abdominal region.

Conclusions:

•Based on the parenchymal mineralization, the main consideration for the prostate gland enlargement is a prostatic or urothelial tumor.

•The mineralization of the gastric mucosa is typical of uremic gastropathy.

•A cystic calculus may be present.

Recommendations: Unfortunately, the prognosis for this patient is poor due to the possible neoplastic lesion involving the prostate gland and the renal disease.  For definitive diagnosis of the prostatomegaly, a urinary BRAF test (1) or a prostatic aspirate could be considered.  A urinalysis would be justified for further assessment of renal function.

Discussion:

•Radiographic detection of mineralization of the gastric mucosa is an uncommon complication of chronic renal disease in the dog.  However, microscopic lesions of the gastric mucosa are common in these patients (2).  Therefore, there is poor sensitivity of radiographs for detection of gastric wall mineralization.

•Of 28 dogs with renal disease, the following gastric abnormalities were present histologically (2).

•Edema n=17 (61%) •Vasculopathy n=15 (54%) •Atrophy n=14 (50%) •Mineralization n=13 (46%) •Mucosal necrosis and ulceration were uncommon

•Gastric mineralization was directly associated with an elevated Ca X Phos product and the character of the distribution of the mineralization was considered typical of metastatic vs. dystrophic mineralization.  The specific mechanism leading to gastric mineralization with chronic renal disease is not known.

•Other sites of tissue mineralization occurring in dogs with chronic renal disease include kidneys, lungs, heart, larynx, intercostal muscles, aorta, intestines, tongue and foot pads (3,4).  Whether this will be radiographically apparent depends on the degree of mineralization.

References:

1.Mochizuki H, Shapiro SG, Breen M.  Detection of BRAF mutation in urine DNA as a molecular diagnostic for canine urothelial and prostatic carcinoma.  PLoS One 2015; 10(12): e0144170. doi:10.1371/journal.pone.0144170.

2.Peters RM, Goldstein RE, Erb HN, Njaa BL.  Histopathologic features of canine uremic gastropathy:  A retrospective study.  J Vet Intern Med 2005;19:315-320.

3.Cardoso P, Pinto, M, Moroz L, et al.  Dystrophic mineralization in uremic dogs: an update. Pesquisa Veterinária Brasileira. 2019;39:889-899. 10.1590/1678-5150-PVB-6250.

4.Barber D, Rowland G.  Radiographically detectable soft tissue calcification in chronic renal failure.  Vet Radiol 1979;20:117-123.

Photo courtesy of Chris on Unsplash

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