Presentation
Presented with PU/PD, wobbling, lethargy, and vomiting.
Patient Data
The liver is mildly rounded at the caudal border and is displacing the gastric axis caudally. The spleen is mildly enlarged. The kidneys are easily visualized on all projections and are increased in opacity, but normal in size and shape. The peritoneal and retroperitoneal detail is normal. The small intestine is normal in size and contains fluid. The colon and cecum contain gas and fecal material. There is mild spondylosis deformans in the lumbar spine. There are metallic spay sutures in the ventral abdominal wall from previous surgery. Sandbags are acting as positional aids on the v/d projection.
Impression: Renal opacification, likely due to toxicity.
Case Discussion
Acute kidney injury secondary to ethylene glycol toxicosis. The diffuse opacification of the kidneys is characteristic of a global toxicity and crystal accumulation. Degenerative causes of renal parenchymal opacity are due to mineralization and tend to be regional or multifocal.
When ethylene glycol is broken down in the body, it eventually produces oxalic acid, which combines with calcium in the blood to form calcium oxalate. This calcium oxalate is filtered by the kidneys into the renal tubules, where water is reabsorbed and the pH becomes more acidic. Under these concentrated, acidic conditions, the calcium oxalate precipitates out of solution and forms crystals that deposit in the tubules, damaging kidney tissue. This substance is radiopaque, causing increased absorption of x-rays in the kidneys which are normally a soft tissue opacity.
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