Monitoramento da resposta inflamatória em cães com doença renal crônica IV submetidos à hemodiálise intermitente
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Data
2019-09-12
Autores
Azevedo, Maria Gabriela Picelli de
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Universidade Estadual Paulista (Unesp)
Resumo
A doença renal crônica (DRC) é uma enfermidade comum em cães idosos. No insucesso do tratamento clínico tem-se a opção das terapias de substituição renal, onde se destaca a hemodiálise intermitente (HDI). Tanto a técnica de HDI como o estado clínico dos cães com DRC podem desencadear uma reação inflamatória. A proteína C reativa (CRP) é uma proteína de fase aguda que pode ser utilizada como marcador da resposta inflamatória em cães. O objetivo deste estudo foi de avaliar o uso da proteína C reativa como um biomarcador de lesão inflamatória na monitoração da resposta inflamatória de cães com DRC no estádio IV submetidos a hemodiálise intermitente e comparar dois métodos de dosagem da proteína C reativa em cães com doença renal crônica IV. Foram selecionados 16 cães com doença renal crônica IV, divididos em dois grupos: 8 animais no grupo tratamento clínico, 8 animais no grupo hemodiálise intermitente e 7 animais sadios no grupo controle. Foram coletadas amostras de sangue antes da primeira e da última sessão de tratamento de ambos os grupos, para avaliação de hemograma, bioquímica sérica (ureia, creatinina, albumina, potássio, fósforo). Para determinação das concentrações da proteína C reativa foi utilizado o método de ELISA (Dog CRP ELISA (CRP-4), Life Diagnostics Inc.) método de ELISA sanduíche (Kit CATALYST CRP TEST , IDEXX Catalyst®), ambos conforme as recomendações do fabricante. Foi observado elevada concentração de proteína C reativa no GHDI quando comparado com GC (p= <0,001) nos dois momentos avaliados, e quando comparado o GHDI ao GTC (p= 0,0406) no M0. Não foi observada a diferença estatística dos valores de CRP entre o M0 e MTerminal em nenhum dos grupos. A CRP apresentou correlação positiva moderada com os leucócitos totais (r=0,5479, p=0,0152), correlação negativa moderada com albumina (r=-0,5974, p=0,0069) e hemácia (r=-0,5878, p=0,0131). Notou-se redução nas concentrações séricas de ureia, creatinina e fósforo após as sessões de hemodiálise intermitente com diferença significativa em relação ao grupo controle e grupo tratamento clínico, no MTerminal, e quando comparado os dois 2 momentos observou se redução nas concentrações de ureia (p=0,0116) e creatinina, (p= 0,0250), aumento dos valores de leucócitos totais (p= 0,0391) no GHDI e aumento dos valores de creatinina (p= 0,0372) e fósforo (p= 0,0135) no GTC. A correlação entre as técnicas aplicadas foi positiva forte (r=-0,7039, p=<0,001). Não foi observada diferença na taxa de sobrevivência entre os animais com doença renal crônica IV.
Chronic Kidney Disease (CKD) is a common disease in older dogs. When the clinical treatment is unsuccessful, kidney replacement therapies become an option, the most prevalent of which is Intermittent Hemodialysis (IHD). Both the IDH technique and the clinical condition of the CKD patients may trigger an inflammatory reaction. C-reactive protein (CRP) is an acute phase protein that may be used as a marker for inflammatory response in dogs. This study aims at evaluating the use of C-Reactive Protein as a biomarker for inflammatory injuries in the monitoring process of the inflammatory response in dogs affected by Stage IV Chronic Kidney Disease undergoing intermittent hemodialysis, in addition to comparing the two different tests to measure CRP in these patients. Sixteen dogs with Stage IV chronic kidney disease were selected for the study and divided into two groups: 8 animals in the clinical treatment group; and 8 animals in the intermittent hemodialysis group. In addition, seven healthy animals were included in a third group as a control. Blood samples were collected before the first and the last treatment session for both groups for a full blood count and serum biochemistry assay (urea, creatinine, albumin, potassium and phosphorus). A canine CRP ELISA Kit (Dog CRP ELISA (CRP-4), Life Diagnostics Inc.) and the CATALYST CRP TEST device (IDEXX Catalyst®) were used to determine the concentration of C-Reactive protein according to the manufacturer’s instructions. We observed an increased concentration of C-Reactive Protein in the GHDI in contrast with the CG (p= <0,001) at both moments evaluated, as well as when comparing the GHDI with the GTC (p= 0,0406) at M0. There were no statistically significant differences in the CRP values between M0 and MTerminal within any of the groups. CRP presented a moderate positive correlation with the total leukocyte levels (r=0,5479; p=0,0152) and a moderate negative correlation with the albumin (r=-0,5974; p=0,0069) and red blood cell levels (r= -0,5878; p=0,0131). There was a reduction in the serum concentrations of urea, creatinine and phosphorus after the intermittent hemodialysis sessions, with statistically significant differences in comparison with the control and clinical treatment 4 groups at MTerminal. When comparing both moments, there was a reduction in the concentrations of urea (p=0,0116) and creatinine (p= 0,0250), and an increase in the total levels of leukocytes (p= 0,0391) in the IHDG, as well as an increase in the levels of creatinine (p= 0,0372) and phosphorus (p= 0,0135) in the CTG. There was a strong positive correlation (r= -0,7039; p=<0,001) between the two tests and no differences were observed in the survival rates of animals with Stage IV Chronic Kidney Disease.
Chronic Kidney Disease (CKD) is a common disease in older dogs. When the clinical treatment is unsuccessful, kidney replacement therapies become an option, the most prevalent of which is Intermittent Hemodialysis (IHD). Both the IDH technique and the clinical condition of the CKD patients may trigger an inflammatory reaction. C-reactive protein (CRP) is an acute phase protein that may be used as a marker for inflammatory response in dogs. This study aims at evaluating the use of C-Reactive Protein as a biomarker for inflammatory injuries in the monitoring process of the inflammatory response in dogs affected by Stage IV Chronic Kidney Disease undergoing intermittent hemodialysis, in addition to comparing the two different tests to measure CRP in these patients. Sixteen dogs with Stage IV chronic kidney disease were selected for the study and divided into two groups: 8 animals in the clinical treatment group; and 8 animals in the intermittent hemodialysis group. In addition, seven healthy animals were included in a third group as a control. Blood samples were collected before the first and the last treatment session for both groups for a full blood count and serum biochemistry assay (urea, creatinine, albumin, potassium and phosphorus). A canine CRP ELISA Kit (Dog CRP ELISA (CRP-4), Life Diagnostics Inc.) and the CATALYST CRP TEST device (IDEXX Catalyst®) were used to determine the concentration of C-Reactive protein according to the manufacturer’s instructions. We observed an increased concentration of C-Reactive Protein in the GHDI in contrast with the CG (p= <0,001) at both moments evaluated, as well as when comparing the GHDI with the GTC (p= 0,0406) at M0. There were no statistically significant differences in the CRP values between M0 and MTerminal within any of the groups. CRP presented a moderate positive correlation with the total leukocyte levels (r=0,5479; p=0,0152) and a moderate negative correlation with the albumin (r=-0,5974; p=0,0069) and red blood cell levels (r= -0,5878; p=0,0131). There was a reduction in the serum concentrations of urea, creatinine and phosphorus after the intermittent hemodialysis sessions, with statistically significant differences in comparison with the control and clinical treatment 4 groups at MTerminal. When comparing both moments, there was a reduction in the concentrations of urea (p=0,0116) and creatinine (p= 0,0250), and an increase in the total levels of leukocytes (p= 0,0391) in the IHDG, as well as an increase in the levels of creatinine (p= 0,0372) and phosphorus (p= 0,0135) in the CTG. There was a strong positive correlation (r= -0,7039; p=<0,001) between the two tests and no differences were observed in the survival rates of animals with Stage IV Chronic Kidney Disease.
Descrição
Palavras-chave
Diálise, Rins, Proteína C reativa, Dialysis, Kidneys, C-reactive protrein