Putative uraemic colitis in the dog
The patient here is a 3 y.o. FN mini Schnauzer with bilateral ureteral calculi and plasma urea >40 mmol/L, creatinine 500umol/L.
Left ureter with calculus
…and the right ureter similarly affected
This patient very likely had pyelonephritis (UTI is present in something like 80% of dogs with ureteral calculi…much more so than in cats) although she lacked signs of sepsis.
The interesting thing is the degree of diffuse swelling of the colon wall:
Descending colon viewed in longitudinal plane. The wall is diffusely thickened (oedematous) and the lumen contains scanty liquid faeces with numerous gas bubbles.
Obviously, as with many of the cases I post on here, it’s not necessarily the case that we can assume association = causation based on one or two cases. However, I’m just interested in the possibility. I’ve seen unexplained apparent colitis in uraemic patients before, often those with uraemic gastropathy, and in human medicine uraemic colitis is certainly documented:
Cureus. 2019 Jan; 11(1): e3826.
Uremic Pancolitis in an Adult Patient with Newly Diagnosed, Rapidly Progressive Crescentic Immunoglobulin A Nephropathy
Monitoring Editor: Alexander Muacevic and John R Adler
Hector H Gonzalez, Meaghan McMahon,2 Angel E Sanchez,1 Jennifer G Foster,1 and Ira Lazar
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6402858/
‘Uremic pancolitis is a rare manifestation of an impairment in the intestinal barrier due to underlying risk factors and intestinal insults. Local pro-inflammatory cytokines (interleukin 1 (IL-1), Tumor necrosis factor-a (TNF-a), IL-6, IL-13) lead to the propensity for barrier degeneration [1]. The insult in renal disease, particularly end-stage renal disease, results in uremic toxins, which transverse the intestinal barriers into circulation and have the potential to affect many organ systems. The subsequent disease process that ensues as a cause of uremia includes pericarditis, colitis, and encephalopathy.’
