Acute-on-Chronic Kidney Disease in a Cat

Harley, a 15-year-old domestic short-haired cat was hospitalized for acute-on-chronic kidney disease. On admission, he was receiving oral prednisone at 5 mg q24h for feline asthma, fluoxetine at 5 mg q24h for inappropriate urination, and amlodipine at 2.5 mg q24h for hypertension secondary to chronic kidney disease. Mild mature neutrophilia and moderate azotemia were evident on CBC and serum chemistry results, respectively. Remaining parameters were within normal limits. Urinalysis results showed isosthenuria, pyuria, and mixed bacteriuria; urine culture results were pending. Abdominal ultrasonography showed moderate bilateral renal pelvic dilation and subtle hyperechoic areas within the renal cortices. In addition, Harley was persistently hypertensive at 220 mm Hg systolic pressure as measured by Doppler ultrasound. Pyelonephritis was suspected.