Azotemia em felinos: prevalência, graduação e correlação clínica em 1188 casos (2009 - 2017)

Abstract

Azotemia is the blood elevation of nitrogen compounds as a result of pre-renal, renal or post-renal changes. The biochemical parameter most commonly used to measure azotemia is serum creatinine concentration, whose elevation above reference values indicates impairment of renal excretory function. Reduced renal blood flow, changes in the renal parenchyma, or urine excretion result in azotemia, which, according to time and grade, will trigger several systemic changes called uremic syndrome. Changes in the urinary tract of felines are frequent and present high mortality. The objective of the present study was to verify the prevalence of azotemia in animals treated at the from 2009 to 2017, to quantify and correlate with the probable causes. The study was retrospective and information contained in clinical records and laboratory tests was used. The degree of azotemia was classified according to the International Renal Intervention Society (IRIS), from 1.6 mg / dl to 2.8 mg / dl, as light, from 2.9 mg / dl to 5 mg / dl, moderate to above 5 mg / dl, intense. Statistical analysis was performed to correlate the variables, using the Fisher and Chi-square test with the BioStat and free software programs. A total of 5923 cards were evaluated, of which 1188 (20%) presented azotemia. Of these, 669 were males (58%), 447 females (38%), 14% were aged from 0 to 11 months, 47% from 1 to 5 years, 23% from 6 to 10 years and 16% from 10 to. The most frequent diagnoses were feline lower urinary tract disease, chronic renal disease (CKD), neoplasias, traumas and fractures, rhinotracheitis, hepatic lipidosis, gastritis, intoxication, pancreatitis, cholangiohepatitis, hyperthyroidism, cholangitis, hypertrophic cardiomyopathy, pneumonia, sinusitis, dystocia, fecaloma, otitis and diabetes mellitus. Considering the four main clinical conditions associated with azotemia, the first was feline lower urinary tract disease, with 268 animals (22.55%) and of these, 60.4% (162) had a creatinine concentration above 5 mg / dl. The second was chronic kidney disease (CKD), with 127 cases (10.69%), with degrees of azotemia varying from mild to severe. Neoplasms represented the third diagnosis associated with azotemia, with 53 cases (4.46%). Trauma was the fourth most common cause, with 4.3% (51) and of these, 42 (82.35%) had mild azotemia (creatinine 1.6 to 2.8 mg / dl). A significant association (p <0.0001) between the diagnoses and the degree of azotemia was observed. With regard to age and diagnosis, there was a significant association (p <0.0001) with the DTUIF occurring more frequently in the range of animals up to 5 years, CKD in animals over 10 years, trauma, over 10 years and neoplasia, from 0 to 5 years. In the association between sex and diagnosis, a significant association (p <0.0001) between males and DTUIF and CKD and trauma in females was observed. Considering the degree of azotemia, the results corroborate those described in the literature, which refer to more intense post-renal azotemia, as well as the pre-renal causes for mild azotemia. Also regarding the age and sex, the DTUIF was diagnosed in the age and sex described as the most predisposed in our work. The fact that animals from 0 to 5 years old are those diagnosed with neoplasias associated with azotemia may be due to the fact that they are mostly hematopoietic neoplasms. It is interesting to observe the association of females with trauma, since the literature cites that they are whole males more prone. Likewise, the cause for the number of females with CKD (82) to be nearly double the number of males (42) should be investigated. Azotemia is a frequent alteration in felines, being associated with clinical and individual conditions. Thus, it is important to identify them to direct the therapeutic behavior and improve the prognosis of the patients.