How Do Kidneys Change After Chemotherapy? Ultrasound Insights into Feline Renal Lymphoma

Ultrasonographic Characteristics of Renal Lymphoma in Cats Receiving Chemotherapy

Alessia Cordella; Chantelle Franklin; Helen Dirrig; Stefano De Arcangeli; Jennifer Lenz

Introduction

Renal lymphoma is the most common renal neoplasm in cats and is frequently associated with nephromegaly, subcapsular hypoechoic rims, and renal nodules on ultrasonography. While ultrasonography is routinely used for diagnosis and monitoring, detailed descriptions of post-chemotherapy ultrasonographic changes in feline renal lymphoma are limited. This study aimed to characterize renal ultrasonographic features at diagnosis and after chemotherapy and to correlate imaging findings with clinical status and renal function markers.

Methods

This multicenter retrospective study included cats with cytological or histological confirmation of renal lymphoma that received multiagent chemotherapy and had renal ultrasonographic examinations available both at diagnosis (T0) and after treatment initiation (T1). All cats were treated with COP-based chemotherapy protocols, with cytarabine added in most cases. Renal ultrasound images were reviewed by a board-certified radiologist blinded to clinical data, assessing renal size, subcapsular rim, nodules/masses, pelvic distension, and perinephric changes. Clinical response, serum creatinine, and blood urea nitrogen (BUN) concentrations were recorded and compared between time points.

Results

Twenty-four cats were included, most of which had bilateral renal involvement and nephromegaly at diagnosis. At first follow-up (median 33 days), 83% of cats showed ultrasonographic improvement, characterized by reduced or resolved nephromegaly, decreased or resolved hypoechoic subcapsular rim, and reduction or disappearance of renal nodules or masses. Nephromegaly and subcapsular rim frequency were significantly reduced after chemotherapy, and renal length and nodule size decreased significantly. Most cats demonstrated parallel clinical improvement and resolution or reduction of azotemia, with significant decreases in serum creatinine and BUN concentrations.

Limitations

The retrospective design, small sample size, and variability in timing of follow-up ultrasonography limit standardization and generalizability. Only cats with confirmed renal lymphoma and available imaging follow-up were included, potentially introducing selection bias toward cats with better early outcomes.

Conclusions

Following chemotherapy, feline renal lymphoma commonly demonstrates marked improvement on ultrasonography, including normalization of renal size and resolution or reduction of subcapsular rims and renal nodules. Ultrasonographic changes frequently correlated with clinical response and improvements in renal function, supporting renal ultrasound as a valuable, non-invasive tool for monitoring treatment response in cats with renal lymphoma.

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