Computed tomography and nephrotomy in a Warmblood stallion with bilateral nephrolithiasis.
Authors: Schlote M T, Drozdzewska K, Ehrle A, Lischer C, Gehlen H
Journal: Journal of equine veterinary science
Summary
# Editorial Summary Bilateral kidney stones are a rare but serious condition in horses, typically presenting with non-specific signs such as chronic weight loss and elevated kidney markers—as demonstrated in this case of an adult Warmblood stallion with hypercalcaemia and azotaemia. Ultrasonography and transrectal palpation provided initial diagnostic clues, but computed tomography of the caudal abdomen proved invaluable for precise characterisation of the mineralised deposits, allowing clinicians to identify which kidney stone was most amenable to surgical removal (nephrotomy) based on size, location and three-dimensional anatomy. Although the right-sided nephrolith was ultimately selected for surgery due to superior imaging demarcation, the horse subsequently developed a surgical site infection that proved fatal within three weeks. This case illustrates both the diagnostic power of CT imaging for renal pathology in adult horses and the considerable perioperative challenges associated with nephrotomy, suggesting that whilst CT can now guide surgical decision-making with greater precision, the procedure carries substantial risk and should be reserved for carefully selected cases where medical management has failed and prognosis is guarded.
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Practical Takeaways
- •When bilateral renal calculi are suspected, CT imaging should be considered as it provides superior anatomical detail compared to ultrasound and transrectal palpation for surgical planning decisions.
- •CT-guided selection of the most accessible or demarcated calculus may improve surgical outcomes in horses with multiple nephroliths.
- •Post-operative infection remains a significant complication risk in equine nephrotomy; strict surgical site management protocols are essential.
Key Findings
- •CT imaging provided superior three-dimensional visualization of bilateral renal calculi compared to ultrasonography and transrectal examination, enabling precise determination of size, position and extent of mineralization.
- •The right kidney nephrolith was better demarcated on CT than the left, influencing the surgical decision to perform nephrotomy on the right side.
- •CT of the caudal abdomen is technically feasible in adult horses and provides valuable information for surgical planning in nephrolithiasis cases.
- •Surgical site infection developed post-nephrotomy, resulting in euthanasia three weeks after surgery.