What's Your Diagnosis? - Case 2: Anamnesis
Assoc Reptilian Amphibian Vet 9[3]:50-52 Fall'99 Case Report 12 Refs

HISTORY: A five-year-old, 1.5 kg, female iguana, (Iguana iguana), was referred for evaluation of anorexia of several weeks duration. The iguana appeared depressed and inactive. Radiographs from the referring veterinarian demonstrated bilateral, poorly defined soft tissue densities in the caudal coelom. DIAGNOSIS: Ultrasound examination of the coelomic cavity revealed bilateral caudal to mid-coelomic soft tissue masses containing multiple, hypoechoic, cystic structures varying from 0.25 to 2.7 cm in diameter. All other coelomic organs were unremarkable. Exploratory surgery was planned to determine the nature of the coelomic masses and to remove the masses if possible. Immediately upon entering the coelom, large cystic kidneys were identified in the caudal coelom. Small, normal, inactive ovaries were identified, and the oviducts and adrenal glands also appeared normal. Due to severe renal pathology the owner was given the option of euthanasia during surgery, but declined. Sharp dissection was used to perform a partial nephrectomy of the anterior 3 cm of the right kidney, containing several large cysts and multiple smaller cysts. The iguana recovered uneventfully, and was discharged one day after surgery on oral fluid supplementation and liquid enteral nutrition. Histopathologic evaluation of the renal specimen revealed multiple renal cortical cysts. Histopathological diagnoses included end-stage kidney disease; marked tubular cyst formation; marked interstitial fibrosis and granulocytic inflammation; marked, chronic intratubular and interstitial urate granulomas (renal gout); and moderate, multifocal tubular epithelial adenomatous hyperplasia. Based on extensive renal pathology, the prognosis for the patient was poor, and the owner elected euthanasia. Necropsy was not permitted.