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Obstrução ureteral felina : caracterização e avaliação retrospetiva de possíveis fatores prognósticos à admissão hospitalar de 36 casos (2019–2024)
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A obstrução ureteral felina é uma condição emergente e potencialmente fatal, caracterizada por uma apresentação clínica frequentemente inespecífica e sujeita a desafios diagnósticos e terapêuticos significativos. Este estudo teve como objetivo caracterizar a epidemiologia, apresentação clínica, abordagem diagnóstica, tratamento e desfecho daquela condição; e identificar potenciais fatores de prognóstico negativos à admissão hospitalar. No presente estudo foram incluídos 36 felinos com obstrução ureteral admitidos num único centro hospitalar entre janeiro de 2019 e dezembro de 2024, período durante o qual se observou uma tendência geral de aumento no número de casos. A maioria dos animais apresentava sem raça definida (88,9%), com idade média de 8,64 anos e fêmeas esterilizadas (58,3%). A ureterolitíase foi a causa obstrutiva mais comum (86,1%). A doença renal crónica (47,2%) e a cardiomiopatia hipertrófica (11,1%) foram comorbilidades relevantes. Os sinais clínicos mais relatados pelos detentores foram a hiporexia/anorexia, a letargia e o vómito. Em 97,2% dos casos foi identificada azotémia, sendo que níveis séricos elevados de creatinina e fósforo inorgânico à admissão se correlacionaram positiva e significativamente com uma menor sobrevivência. A presença de desidratação (superior a 5%), de anemia e de urocultura positiva também se associaram a um tempo de sobrevivência significativamente menor. A obstrução bilateral demonstrou pior prognóstico comparativamente à unilateral. A dilatação da pelve renal, igual ou superior a 13 mm, associou-se a valores de creatinina mais elevados e de hematócrito mais baixos. Adicionalmente, os animais mais novos apresentaram dilatações da pelve renal significativamente superiores aos dos mais velhos. O maneio médico inicial, incluindo fluidoterapia, a administração de tansulosina e, frequentemente, de corticosteroides em dose anti-inflamatória, foi bem-sucedido em 41,7% dos animais. Metade dos casos (50%) foram sujeitos a intervenção cirúrgica, sendo a colocação de bypass ureteral subcutâneo (SUB) a técnica mais utilizada. A taxa de mortalidade global do estudo foi de 33,3%. Este estudo identifica a desidratação, a anemia, a urocultura positiva, a obstrução bilateral e a gravidade da azotemia e hiperfosfatémia à admissão como possíveis indicadores de prognóstico negativo em felinos com obstrução ureteral, podendo auxiliar na gestão dos casos clínicos e na comunicação com os detentores
Feline ureteral obstruction is an emerging and potentially life-threatening condition, characterized by a frequently nonspecific clinical presentation and significant diagnostic and therapeutic challenges. This study aimed to characterize the epidemiology, clinical presentation, diagnostic approach, treatment, and outcome of this condition, and to identify potential negative prognostic factors at hospital admission. In the present study, 36 cats with ureteral obstruction admitted to a single hospital center between January 2019 and December 2024 were included, during which a general increasing trend in the number of cases was observed. Most animals were mixed-breed (88.9%), with a mean age of 8.64 years, and were spayed females (58.3%). Ureterolithiasis was the most common cause of obstruction (86.1%). Chronic kidney disease (47.2%) and hypertrophic cardiomyopathy (11.1%) were relevant comorbidities. The most frequently reported clinical signs by owners were hyporexia/anorexia, lethargy and vomiting. Azotemia was identified in 97.2% of cases, and higher serum levels of creatinine and inorganic phosphorus at admission were positively and significantly correlated with decreased survival. The presence of dehydration (greater than 5%), anemia and a positive urine culture were also associated with significantly shorter survival times. Bilateral obstruction demonstrated a worse prognosis compared to unilateral obstruction. Renal pelvic dilation equal to or greater than 13 mm was associated with higher creatinine and lower hematocrit values. Additionally, younger animals exhibited significantly greater renal pelvic dilation compared to older ones. Initial medical management including fluid therapy, administration of tamsulosin and frequently corticosteroids at anti-inflammatory doses, was successful in 41.7% of animals. Half of the cases (50%) underwent surgical intervention, with subcutaneous ureteral bypass (SUB) placement being the most commonly performed technique. The overall mortality rate of the study was 33.3%. This study identifies dehydration, anemia, positive urine culture, bilateral obstruction and the severity of azotemia and hyperphosphatemia at admission as possible negative prognostic indicators in cats with ureteral obstruction, which may aid in clinical case management and communication with owners
Feline ureteral obstruction is an emerging and potentially life-threatening condition, characterized by a frequently nonspecific clinical presentation and significant diagnostic and therapeutic challenges. This study aimed to characterize the epidemiology, clinical presentation, diagnostic approach, treatment, and outcome of this condition, and to identify potential negative prognostic factors at hospital admission. In the present study, 36 cats with ureteral obstruction admitted to a single hospital center between January 2019 and December 2024 were included, during which a general increasing trend in the number of cases was observed. Most animals were mixed-breed (88.9%), with a mean age of 8.64 years, and were spayed females (58.3%). Ureterolithiasis was the most common cause of obstruction (86.1%). Chronic kidney disease (47.2%) and hypertrophic cardiomyopathy (11.1%) were relevant comorbidities. The most frequently reported clinical signs by owners were hyporexia/anorexia, lethargy and vomiting. Azotemia was identified in 97.2% of cases, and higher serum levels of creatinine and inorganic phosphorus at admission were positively and significantly correlated with decreased survival. The presence of dehydration (greater than 5%), anemia and a positive urine culture were also associated with significantly shorter survival times. Bilateral obstruction demonstrated a worse prognosis compared to unilateral obstruction. Renal pelvic dilation equal to or greater than 13 mm was associated with higher creatinine and lower hematocrit values. Additionally, younger animals exhibited significantly greater renal pelvic dilation compared to older ones. Initial medical management including fluid therapy, administration of tamsulosin and frequently corticosteroids at anti-inflammatory doses, was successful in 41.7% of animals. Half of the cases (50%) underwent surgical intervention, with subcutaneous ureteral bypass (SUB) placement being the most commonly performed technique. The overall mortality rate of the study was 33.3%. This study identifies dehydration, anemia, positive urine culture, bilateral obstruction and the severity of azotemia and hyperphosphatemia at admission as possible negative prognostic indicators in cats with ureteral obstruction, which may aid in clinical case management and communication with owners
Descrição
Dissertação de Mestrado Integrado em Medicina Veterinária, área científica de Clínica
Palavras-chave
Obstrução ureteral Felinos Prognóstico Ureterolitíase Pielectasia Ureteral obstruction Cats Prognosis Ureterolithiasis Pyelectasis