Avaliação da proteinúria como marcador de lesão/doença renal subclínica em cães
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2014-05-29
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A proteinúria renal é considerada o marcador clinicopatológico de doença renal crónica em cães e gatos, previamente à manifestação de azotemia. Além disso, a sua presença pode contribuir para a progressão da doença renal crónica. Assim, o principal objetivo deste trabalho foi detetar a presença de lesão ou doença renal subclínica, através da avaliação de proteinúria renal, em animais aparentemente saudáveis.
Integram este estudo 82 cães com idade igual ou superior a sete anos e sem presença de sinais clínicos compatíveis com lesão ou doença renal. A todos os animais for recolhida urina por cistocentese ecoguiada e realizada uma análise de urina tipo II. Os animais com presença de sedimento urinário ativo foram excluídos deste estudo. Nos animais com proteinúria, sem sedimento urinário ativo, foram realizadas mais uma ou duas reavaliações, com a tira reativa de urina e com intervalos de 7 a 10 dias, para confirmar a proteinúria. Nos animais com proteinúria persistente na tira reativa de urina, foi determinado o rácio proteína/creatinina urinário, tendo sido avaliada ainda a dimensão renal por ecografia e, também, as pressões arteriais. Para esses animais foram também avaliadas as concentrações séricas de: ureia, creatinina, albumina, sódio, potássio, cloro, cálcio e fósforo.
Detetou-se a presença de proteinúria renal, através da avaliação com a tira reativa de urina, em 24 animais. De seguida, tendo em conta o valor do rácio proteína/creatinina urinário e o sistema de subestadiamento da proteinúria da International Renal Interest Society, estes animais foram divididos em três grupos: proteinúricos (n=5), proteinúricos borderline (n=10) e não proteinúricos (n=9). Os animais proteinúricos borderline e os proteinúricos apresentaram um menor rácio rim/aorta e valores de pressão arterial sistólica mais elevados. Não se verificou muita descrepância nos valores obtidos relativos à bioquímica sérica, entre os diferentes grupos. Observou-se uma forte correlação positiva entre a magnitude da proteinúria obtida através da média das tiras reativas de urina com a magnitude da proteinúria obtida através do rácio proteína/creatinina urinário; e que o risco de lesão nos órgãos-alvo com base na pressão arterial sistólica, está significativamente associado com o subestadiamento da proteinúria.
Renal proteinuria is considered the clinicopathologic marker of chronic kidney disease in dogs and cats, even before the onset of azotemia. It may also contribute to the progressive nature of chronic renal disease. Thus, the main objective of this study was to detect the presence of early renal injury or disease, through the detection of renal proteinuria in apparently healthy animals. In this study were evaluated 82 dogs, aged seven years or more, without clinical signs consistent with renal injury or illness. All urine samples were collected by cystocentesis and submitted to urinalysis type II. Animals with presence of active urinary sediment were excluded from this study. In animals with proteinuria, without active urinary sediment, one or two revaluations were performed to confirm the proteinuria, using the reactive urine strip with intervals of 7-10 days. In animals with persistent proteinuria in the reactive strip, the protein/creatinine ratio was determined, as well as renal dimension evaluated by ultrasound and the arterial pressures measured. Serum concentrations of urea, creatinine, albumin, sodium, potassium, chlorine, calcium and phosphorus were also evaluated in these animals. Renal proteinuria was detected in 24 animals, by the assessment of the urine reactive strip. Next, considering the underlying values of urinary protein/creatinine ratio and the International Renal Interest Society system of proteinuria understaging, the animals were divided into three groups: proteinuric (n=5), borderline proteinuric (n=10) and non-proteinuric (n=9). Lower mean and median values for the kidney/aorta ratio and higher mean and median values for the systolic blood pressure were found in the borderline proteinuric and proteinuric animals. The values of serum biochemistry didn’t vary greatly between different groups. A strong positive correlation between the magnitude of proteinuria, obtained by the mean of urine test strips, and the magnitude of proteinuria by urinary protein/creatinine ratio was found; in addition, it was observed that the risk of injury in target organs based on systolic blood pressure is significantly associated with understaging of proteinuria.
Renal proteinuria is considered the clinicopathologic marker of chronic kidney disease in dogs and cats, even before the onset of azotemia. It may also contribute to the progressive nature of chronic renal disease. Thus, the main objective of this study was to detect the presence of early renal injury or disease, through the detection of renal proteinuria in apparently healthy animals. In this study were evaluated 82 dogs, aged seven years or more, without clinical signs consistent with renal injury or illness. All urine samples were collected by cystocentesis and submitted to urinalysis type II. Animals with presence of active urinary sediment were excluded from this study. In animals with proteinuria, without active urinary sediment, one or two revaluations were performed to confirm the proteinuria, using the reactive urine strip with intervals of 7-10 days. In animals with persistent proteinuria in the reactive strip, the protein/creatinine ratio was determined, as well as renal dimension evaluated by ultrasound and the arterial pressures measured. Serum concentrations of urea, creatinine, albumin, sodium, potassium, chlorine, calcium and phosphorus were also evaluated in these animals. Renal proteinuria was detected in 24 animals, by the assessment of the urine reactive strip. Next, considering the underlying values of urinary protein/creatinine ratio and the International Renal Interest Society system of proteinuria understaging, the animals were divided into three groups: proteinuric (n=5), borderline proteinuric (n=10) and non-proteinuric (n=9). Lower mean and median values for the kidney/aorta ratio and higher mean and median values for the systolic blood pressure were found in the borderline proteinuric and proteinuric animals. The values of serum biochemistry didn’t vary greatly between different groups. A strong positive correlation between the magnitude of proteinuria, obtained by the mean of urine test strips, and the magnitude of proteinuria by urinary protein/creatinine ratio was found; in addition, it was observed that the risk of injury in target organs based on systolic blood pressure is significantly associated with understaging of proteinuria.
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Dissertação de Mestrado Integrado em Medicina Veterinária, Ciências Veterinárias
Palavras-chave
Proteinúria , Insuficiência renal crónica , Cães , Diagnóstico subclínico