ABSTRACT
A insuficiência renal aguda foi avaliada em 351 cadelas com piometra, selecionando-se 132 pelos critérios: creatinina > 2,4 mg/dL e/ou ureia > 80 mg/dL e/ou aumentos relativos de 100% de creatinina e/ou ureia séricas, no diagnóstico, 24 horas após a ovariossalpingohisterectomia e na retirada dos pontos. Foi administrado Ringer lactato de sódio até 90 mL/kg/h, durante quatro horas, ou três dias. Os parâmetros avaliados antes e após cada terapia foram: peso, pressão arterial sistólica (PAS), frequência cardíaca, função renal, hemogasimetria arterial, bioquímica sérica e urinária, unidade de remoção de ureia, fração de excreção de eletrólitos e clearance de creatinina. A análise univariada detectou diferença significante (p < 0,05) para: PAS, pH urinário, peso corpóreo, ureia e creatinina séricas, fração de excreção de eletrólitos e clearance da creatinina. Comparadas as sobreviventes (79,6%) com as não sobreviventes (20,4%), respectivamente, detectou-se creatinina sérica de 2,38 ± 1,33 mg/dL (média ± desvio padrão) e mediana 2,2 mg/dL e de 5,54 ± 3,0 mg/dL (média ± desvio padrão) e mediana 4,4 mg/dl, com diferença significante (p < 0,0001). Quanto ao clearance da creatinina endógena nas sobreviventes, 1,82 ± 1,74 mL/kg/min (média ± desvio padrão) e mediana 1,34 mg/dL e as não sobreviventes 0,36 ± 0,38 mg/dL (média ± desvio padrão) e mediana 0,23 mg/dL, com diferença significativa (p < 0,0001). Conclui-se que o critério de inclusão pode auxiliar na seleção dos animais em estado grave e o clearance da creatinina, considerado relevante quando observados valores > 1 mL/kg/min; negativo com valores < 1 mL/kg/min e indicador de falência renal grave e ou morte para valores < 0,5 ml/kg/min.
Acute renal failure (ARF) was evaluated prospectively in 351 female dogs with piometra, 132 animals were selected for this study, fulfilling the following criteria, measured in three moments (immediately after the diagnosis, 24 hours after the hysterectomy and when the suture was removed): creatinine > 2.4 mg/dL and/or urea > 80 mg/dL and/or relative increases of 100% in comparison with values previously obtained. The animals selected for the prospective study received conservative treatment consisting in lactated Ringer solution, with the maximum dose of 90 mL/kg/hr, during four hours. The factors evaluated before and after the therapy were: weight, systolic arterial pressure, heart rate, renal function, arterial hemogasometry, serum and urinary biochemistry and the endogenous renal creatinine clearance. The evaluated parameters showed significant statistical differences (p < 0.05) when companing: PAS (systolic arterial pressure), urinary pH, wheigt, serum urea and creatinine, excretion electrolyte rate and creatinine clearance. Howerer, the survining animals (79.6%) that received the treatment described above showed decresead levels of serum creatinine- 2,38 ± 1,33mg/dL and median 2.2 mg/dL when compared to the non-survining animals (20.4%) that received the same treatment 5.54 ± 3.0mg/dL and median 4.4mg/dL (p < 0.0001). When comparing the endogenous creatinine clearance, the survining animals had higher values 1.82 ± 1.74mL/kg/min and median 1.34 mL/kg/min than the non-survining animals 0.36 ± 0.38 mL/kg/min and median 0.23 mL/kg/min (p < 0.0001). Concluding: the criteria used to include the animals in this study can help to select the severely affected animals. Values higher than 1mL/kg/min are considered as a good prognosis while values lower than 1mL/kg/min are considered as a restricted prognosis. Values lower than 0.5 mL/kg/min are considered as strong predictors of severe renal failure or death.