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Doença renal crónica em gatos : estudo retrospetivo de 50 casos
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A Doença Renal Crónica (DRC) em gatos é uma doença irreversível e progressiva, geralmente de origem idiopática, que afeta a qualidade de vida dos gatos e dos seus tutores. Este estudo visou caracterizar a DRC idiopática em 50 gatos, com foco no diagnóstico, gestão clínica e identificação de indicadores de prognóstico por estadio. Registos clínicos (2018–2023) do Hospital Veterinário da Universidade de Lisboa foram analisados retrospectivamente. A seleção baseou-se nos doseamentos de creatinina e de DMAS séricas elevadas (estadios II IV, da IRIS). Gatos com doenças extra-renais foram excluídos. Um grupo de conveniência do estadio I foi incluído. A classificação seguiu as diretrizes IRIS 2023. Foram determinados o tempo mediano até progressão de estadio (mPE) e o tempo de sobrevivência (mTS), com significância estatística a p < 0,05. No estadio I (n=6), sem sinais clínicos, observou-se apenas alterações ecográficas (100%) e D.U.<1035 (50%). O mPE foi 943 dias (IQT 488-1434) e o mTS 1678 dias (IQT 1129-2349). No estadio II (n=28), todos apresentaram azotémia, D.U<1035, seguido de alterações ecográficas (96,4%), PU/PD (57,4%), desidratação (50%), proteinúria (46,4%), hiporexia (42,9%), letargia (36%), perda de peso (32,1%), vómito (19%), anorexia (10%), hiperfosfatémia (10,7%) e sinais neurológicos (3,6%). Hospitalizações: 1 a 2 vezes e com duração mediana 3 dias por internamento; mPE e mTS: 848 dias (IQT 488-1464) e 885 dias (IQT 488-1159) respetivamente. No estadio III (n=10), todos os animais tinham azotémia, D.U.<1035, desidratação, proteinúria, alterações ecográficas, além de perda de peso (80%), letargia (70%), hiperfosfatémia (70%), vómito (50%), PU/PD (57,1%), anorexia (50%), hiporexia (20%), sinais neurológicos (20%) e hipocalcémia (10%). Hospitalizações: 1 a 2 vezes com duração mediana 4 dias por internamento e mPE: 336 dias (IQT 182-366), mTS: 345 dias (IQT 214-519) respetivamente. No estadio IV (n=6), observou-se anorexia, azotémia, desidratação, perda de peso, D.U.<1035, alterações ecográficas e hiperfosfatémia, seguidas de hipocalcémia (83,3%), letargia (83,3%), vómito (50%), proteinúria (46,4%), sinais neurológicos (33,3%) e PU/PD (16,7%). Hospitalizações: 3 a 5 vezes, com uma duração mediana 5 dias por internamento e com mPE e mTS: 114 dias (IQT 110-150). Fatores associados aos estadios III e IV incluíram anemia, anorexia, sinais neurológicos, perda de peso, hiperfosfatémia e hipocalcémia. Estes dados reforçam a importância do diagnóstico precoce, dado o agravamento dos sinais, hospitalizações mais frequentes e redução da sobrevivência com a progressão da doença. São necessários mais estudos que comprovem a eficácia das terapêuticas e apoiem igualmente o desenvolvimento de estratégias preventivas adequadas
Chronic Kidney Disease (CKD) in cats is a progressive and irreversible condition mostly of idiopathic origin that negatively impacts the quality of life of both cats and their owners. This study aimed to characterize idiopathic CKD in 50 cats focusing on diagnostic and clinical management and to identify prognostic indicators across CKD stages. Clinical records (2018 2023) from the HEV Lisbon University Hospital were retrospectively reviewed. Cats were screened based on elevated blood creatinine and SDMA levels (IRIS stages II–IV). CKD was staged according to the 2023 IRIS guidelines. A convenience group of stage I cats was also included. Cats with extra-renal diseases were excluded. The median time for CKD progression to the next stage (mDP) and the median survival time (mST) were determined. Statistical analysis was performed with significance set at p < 0.05. 50 cats were included. In stage I (n=6), in the absence of clinical signs, only ultrasonographic changes (100%) and decreased urine specific gravity (USG) (50%) were present. The mDP was 943 (IQR 488-1434) and mST was 1678 (IQR 1129-2349) days. All stage II cats (100%, n=28) showed azotemia, decreased USG followed by ultrasonographic changes (96.4%), polyuria/polydipsia (PU/PD) (57.4%), dehydration (50%), proteinuria (46.4%), hyporexia (42.9%), lethargy (36%), weight loss (WL) (32.1%), vomiting (19%), anorexia (10%), hyperphosphatemia (10.7%), and neurological signs (NS) (3.6%). Cats were hospitalized 1 to 2 times, with a median duration of 3 days (IQR 0.5 4). The mDP was 848 (IQR 488-1464) and mST was 885 (IQR 488-1159) days. All stage III cats (100%, n=10) presented azotemia, decreased USG, dehydration, proteinuria, ultrasonographic changes, followed by WL (80%), lethargy (70%), hyperphosphatemia (70%), vomiting (50%), PU/PD (57.14%), anorexia (50%), hyporexia (20%), NS (20%), and hypocalcaemia (10%). Cats were hospitalized 1 to 2 times, with a median duration of 4 days (IQR 3-4). The mDP was 336 (IQR 182-366) and mST was 345 (IQR 214-519) days. All stage IV cats (100%, n=6) exhibited anorexia, azotemia, dehydration, WL, decreased USG., ultrasonographic changes, and hyperphosphataemia, followed by hypocalcaemia (83.3%) lethargy (83.3%) vomiting (50%), proteinuria (46.4%), NS (33.3%) and PU/PD (16.7%). Cats were hospitalized 3 to 5 times, with a median duration of 5 days (IQR 5-6). Both mDP and mST were 114 (IQR 110-150) days. Factors significantly associated with stage III and IV included anaemia, anorexia, NS, WL hyperphosphataemia and hypocalcaemia. These findings underscore the importance of early CKD diagnosis in cats, as the disease advances through the IRIS stages, it is associated with worsening clinical signs, more frequent and prolonged hospitalizations and a decrease in median survival time. Further studies on CKD etiology are urgently needed to foster targeted therapeutics and preventive strategies
Chronic Kidney Disease (CKD) in cats is a progressive and irreversible condition mostly of idiopathic origin that negatively impacts the quality of life of both cats and their owners. This study aimed to characterize idiopathic CKD in 50 cats focusing on diagnostic and clinical management and to identify prognostic indicators across CKD stages. Clinical records (2018 2023) from the HEV Lisbon University Hospital were retrospectively reviewed. Cats were screened based on elevated blood creatinine and SDMA levels (IRIS stages II–IV). CKD was staged according to the 2023 IRIS guidelines. A convenience group of stage I cats was also included. Cats with extra-renal diseases were excluded. The median time for CKD progression to the next stage (mDP) and the median survival time (mST) were determined. Statistical analysis was performed with significance set at p < 0.05. 50 cats were included. In stage I (n=6), in the absence of clinical signs, only ultrasonographic changes (100%) and decreased urine specific gravity (USG) (50%) were present. The mDP was 943 (IQR 488-1434) and mST was 1678 (IQR 1129-2349) days. All stage II cats (100%, n=28) showed azotemia, decreased USG followed by ultrasonographic changes (96.4%), polyuria/polydipsia (PU/PD) (57.4%), dehydration (50%), proteinuria (46.4%), hyporexia (42.9%), lethargy (36%), weight loss (WL) (32.1%), vomiting (19%), anorexia (10%), hyperphosphatemia (10.7%), and neurological signs (NS) (3.6%). Cats were hospitalized 1 to 2 times, with a median duration of 3 days (IQR 0.5 4). The mDP was 848 (IQR 488-1464) and mST was 885 (IQR 488-1159) days. All stage III cats (100%, n=10) presented azotemia, decreased USG, dehydration, proteinuria, ultrasonographic changes, followed by WL (80%), lethargy (70%), hyperphosphatemia (70%), vomiting (50%), PU/PD (57.14%), anorexia (50%), hyporexia (20%), NS (20%), and hypocalcaemia (10%). Cats were hospitalized 1 to 2 times, with a median duration of 4 days (IQR 3-4). The mDP was 336 (IQR 182-366) and mST was 345 (IQR 214-519) days. All stage IV cats (100%, n=6) exhibited anorexia, azotemia, dehydration, WL, decreased USG., ultrasonographic changes, and hyperphosphataemia, followed by hypocalcaemia (83.3%) lethargy (83.3%) vomiting (50%), proteinuria (46.4%), NS (33.3%) and PU/PD (16.7%). Cats were hospitalized 3 to 5 times, with a median duration of 5 days (IQR 5-6). Both mDP and mST were 114 (IQR 110-150) days. Factors significantly associated with stage III and IV included anaemia, anorexia, NS, WL hyperphosphataemia and hypocalcaemia. These findings underscore the importance of early CKD diagnosis in cats, as the disease advances through the IRIS stages, it is associated with worsening clinical signs, more frequent and prolonged hospitalizations and a decrease in median survival time. Further studies on CKD etiology are urgently needed to foster targeted therapeutics and preventive strategies
Descrição
Dissertação de Mestrado Integrado em Medicina Veterinária, área científica de Clínica
Palavras-chave
Doença renal crónica Gatos Diagnóstico Estadiamento Prognóstico Chronic Kidney Disease Cats Diagnosis Staging Prognosis