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- Which portosystemic shunt causes renomegaly?
Masahiro Murakami, Reo Nishi, Kindele N. Lenoir
Background:
Congenital portosystemic shunts (PSS) are abnormal vascular connections that bypass the liver, leading to systemic circulation of unfiltered blood. This condition is associated with morphological changes such as renomegaly (enlarged kidneys). However, the relationship between PSS type and kidney size has not been extensively studied using advanced imaging like computed tomography (CT). This study aimed to assess renal enlargement across different PSS types and explore its correlation with clinical variables and biochemical markers.
Methods:
This retrospective cross-sectional study analyzed CT-derived renal size measurements (renal length-to-L2 vertebral body ratio, RL/L2) in 53 dogs with congenital PSS. The dogs were classified into four PSS types: intrahepatic (IH), extrahepatic portocaval (EHPC), extrahepatic portoazygos (EHPA), and extrahepatic portophrenic (EHPP). Data collected included clinical information, biochemical results, and kidney dimensions from CT scans. Statistical analyses assessed differences in kidney size among PSS types and correlations with clinical parameters.
Results:
-Renal Size: RL/L2 ratios were significantly larger in IH (3.55 ± 0.38) and EHPC (3.55 ± 0.38) compared to EHPA (2.78 ± 0.18) and EHPP (3.10 ± 0.23).
-Prevalence of Renomegaly: Renomegaly was most common in EHPC (100%) and IH (94.7%), less common in EHPP (85.7%), and rare in EHPA (24.5%).
-Age and Body Weight: Dogs with EHPA and EHPP were older at presentation and had less severe renomegaly, suggesting a slower disease progression. In contrast, IH and EHPC cases presented at younger ages with more severe renal enlargement.
-Biochemical Correlations: Positive correlations were found between RL/L2 ratio and alkaline phosphatase (ALP) and ammonia levels (NH3), while negative correlations were noted with creatinine (Cre), albumin (Alb), and total protein (TP). These patterns reflect greater hepatic dysfunction in cases with pronounced renomegaly.
Limitations:
Retrospective design and limited sample size for certain PSS types reduced generalizability.
Lack of a standardized reference range for kidney size in juvenile dogs may have influenced results.
Variability in surgical and medical management across cases.
Conclusions:
Renomegaly is a common finding in dogs with PSS, particularly in IH and EHPC types. The severity of renomegaly correlates with hepatic dysfunction and earlier clinical presentation. CT is a valuable tool for diagnosing renal enlargement and understanding its clinical implications in PSS. Future studies should focus on standardizing reference ranges and exploring the impact of shunt fraction on renomegaly.
Box-and-whisker plots of RL/L2 ratios at presentation in dogs with a portosystemic shunt in different shunt-type groups. Each box represents the range between the 25th and 75th percentile. The horizontal line within each box represents the median, and the x represents the mean. Whiskers represent minimum and maximum values. Individual values are indicated by the circle. Single asterisk shows a significant difference between the two groups (P < .05) and double asterisks (P < .01). IH, intrahepatic; EHPC, extrahepatic portocaval; EHPA, extrahepatic portoazygos; EHPP, extrahepatic portophrenic shunt groups.
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