SDMA e GGT urinária na lesão renal aguda em cães sépticos e sua correlação com achados histopatológicos renais
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Data
2021-02-22
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Universidade Estadual Paulista (Unesp)
Resumo
A lesão renal aguda (LRA) é definida como síndrome resultante da diminuição abrupta e persistente da taxa de filtração glomerular que culmina em altos índices de mortalidade e morbidade. Embora a fisiopatologia não esteja completamente esclarecida, a LRA é uma das principais complicações que ocorrem em quadros de sepse. Por esse motivo, considera-se relevante o estudo de biomarcadores não invasivos que permitam identificar de forma prematura e eficiente a LRA em pacientes com sepse. Uma condição potencial de sepse na medicina veterinária é a piometra, sendo os animais acometidos considerados bons modelos experimentais. Neste estudo prospectivo e cego utilizaram-se de 20 cadelas com piometra, consideradas sépticas, de acordo com a classificação SIRS (Síndrome da Resposta Inflamatória Sistêmica), atendidas junto ao hospital veterinário da UNESP- Jaboticabal e Universidade de Franca. Com base no grau histopatológico de lesão renal, as pacientes foram distribuídas em três grupos: discreto, moderado e severo. Os biomarcadores testados para avaliar a eficiência da predição de LRA foram creatinina sérica (p= 0,079), dimetilarginina simétrica sérica (SDMAs) (p=0,650), gama glutamil transferase urinária (GGTu) (p=0,093) e relação GGTu/creatinina urinária (uGGTC) (p=0,707). Não houve diferença estatística para nenhum dos biomarcadores avaliados em relação aos grupos e, portanto, verificou-se que tais marcadores não foram clinicamente úteis na identificação do grau de severidade de lesão renal aguda ao diagnóstico em cadelas acometidas por sepse. Sugere-se a validação de outros biomarcadores renais em pacientes sépticos comparando a LRA com a histopatologia renal.
Acute kidney injury (AKI) is defined as a syndrome resulting from the abrupt and persistent decrease in the glomerular filtration rate that culminates in high rates of mortality and morbidity. Although the pathophysiology is not completely understood, AKI is one of the main complications that occur in sepsis. For this reason, the study of non-invasive biomarkers is considered relevant to the early and efficient identification of AKI in patients with sepsis. A potential condition of sepsis in veterinary medicine is pyometra. The animals affected are considered good experimental models. In this prospective blind study, 20 female dogs with pyometra considered septic, according to the classification SIRS (Systemic Inflammatory Response Syndrome), were used. The bitches were attended at the veterinary hospital of UNESP- Jaboticabal and Universidade de Franca. The patients were divided into three groups based on the histopathological degree of kidney injury, divided into mild, moderate and severe. The tested biomarkers to assess the efficiency of AKI prediction were creatinine (p = 0.079), serum symmetric dimethylarginine (SDMA) (p =0,650), the urinary glutamyl transferase range (GGTu) (p = 0.093) and the ratio GGTu / urinary creatinine (GGtc) (p = 0.707). There was no statistical difference for any of the biomarkers evaluated in relation to the groups, therefore, they were not clinically useful in identifying the degree of severity of acute kidney injury, at the time of diagnosis in bitches affected by sepsis. The validation of other renal biomarkers in septic patients is suggested by comparing AKI with renal histopathology.
Acute kidney injury (AKI) is defined as a syndrome resulting from the abrupt and persistent decrease in the glomerular filtration rate that culminates in high rates of mortality and morbidity. Although the pathophysiology is not completely understood, AKI is one of the main complications that occur in sepsis. For this reason, the study of non-invasive biomarkers is considered relevant to the early and efficient identification of AKI in patients with sepsis. A potential condition of sepsis in veterinary medicine is pyometra. The animals affected are considered good experimental models. In this prospective blind study, 20 female dogs with pyometra considered septic, according to the classification SIRS (Systemic Inflammatory Response Syndrome), were used. The bitches were attended at the veterinary hospital of UNESP- Jaboticabal and Universidade de Franca. The patients were divided into three groups based on the histopathological degree of kidney injury, divided into mild, moderate and severe. The tested biomarkers to assess the efficiency of AKI prediction were creatinine (p = 0.079), serum symmetric dimethylarginine (SDMA) (p =0,650), the urinary glutamyl transferase range (GGTu) (p = 0.093) and the ratio GGTu / urinary creatinine (GGtc) (p = 0.707). There was no statistical difference for any of the biomarkers evaluated in relation to the groups, therefore, they were not clinically useful in identifying the degree of severity of acute kidney injury, at the time of diagnosis in bitches affected by sepsis. The validation of other renal biomarkers in septic patients is suggested by comparing AKI with renal histopathology.
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Nefrologia veterinária, Sepse, Biopsia renal, Prognóstico, Acute kidney injury, Sepsis, Kidney biopsy, Prognosis