Avaliação ecográfica quantitativa da doença renal crónica e lesão renal aguda em felinos através da medição do córtex renal e do diâmetro da aorta abdominal e a sua relação com os biomarcadores renais
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2025
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A doença renal, seja na sua forma aguda (IRA) ou crónica (DRC), é uma patologia que afeta uma elevada percentagem da população felina adulta. Para o seu diagnóstico e estadiamento de acordo com o sistema de classificação IRIS, são utilizados métodos complementares de diagnóstico como a medição sérica dos biomarcadores renais e a realização de ecografias abdominais do trato urinário com regularidade para acompanhamento da evolução do quadro clínico. Tendo em consideração a praticabilidade e a aplicação frequente da ecografia abdominal na patologia em ambiente clínico, assim como estudos anteriores que demonstraram uma associação entre a espessura do córtex renal e a função renal, pretendeu-se, com o presente estudo, determinar se o rácio entre as medições ecográficas da espessura do córtex renal e do diâmetro da aorta abdominal em sístole em felinos poderia constituir um novo marcador ecográfico para diferenciar entre felinos saudáveis e felinos com doença renal, assim como estudar a sua relação com os biomarcadores séricos renais. Para tal, os felinos que integraram o estudo (n=105) foram divididos em felinos considerados saudáveis (n=50), com DRC (n=44) e com IRA (n=11). Para cada grupo, foram obtidas imagens ecográficas em corte sagital de ambos os rins com visualização clara das pirâmides renais e do córtex renal e a medição da espessura do córtex renal foi realizada em três pontos diversos em cada rim, partindo do centro de cada pirâmide renal perpendicularmente ao ponto mais curto da borda posterior da cápsula renal, assim como do diâmetro da aorta abdominal em sístole em corte sagital, imediatamente caudal à bifurcação da artéria renal esquerda. Mais ainda, foi realizada a medição sérica dos biomarcadores renais BUN, fósforo, creatinina e/ou SDMA dos diversos grupos. O valor quantitativo obtido para o rácio em felinos saudáveis foi de 1.04±0.32cm (média±desvio padrão), em felinos com DRC 1.90±0.77cm e, em felinos com IRA, 1.97±0.85cm. Foi possível determinar o ponto de corte do rácio ?1.4cm para distinguir felinos saudáveis de felinos com doença renal, com sensibilidade e especificidade de 81.8% e 86%. A relação do rácio com os biomarcadores renais demonstrou que a creatinina apresentou uma correlação positiva com a espessura do córtex renal, assim como o fósforo apresentou uma correlação negativa com o rácio nos estadios IRIS iniciais da DRC. Em conclusão, os resultados do estudo suportam a utilização do rácio como um marcador quantitativo e não invasivo para diferenciar felinos adultos saudáveis de felinos adultos com doença renal.
Kidney disease, whether in its acute (AKI) or chronic (CKD) form, is a pathology that affects a high percentage of the adult feline population. For its diagnosis and staging according to the IRIS classification system, complementary diagnostic methods are used, such as serum measurement of renal biomarkers and regular abdominal ultrasounds of the urinary tract to monitor the evolution of the clinical condition. Taking into account the practicality and frequent application of abdominal ultrasound in a clinical environment, as well as previous studies that demonstrated an association between renal cortical thickness and renal function, the aim of this study was to determine whether the ratio between ultrasound measurements of cortical renal thickness and abdominal aortic diameter in systole in felines could constitute a new ultrasound marker to differentiate between healthy felines and felines with kidney disease, as well as studying their relationship with renal serum biomarkers. To this end, all felines that took part in the study (n=105) were divided into healthy felines (n=50), CKD felines (n=44) and AKI felines (n=11). For each group, ultrasound images were obtained in a sagittal section of both kidneys with clear visualization of the renal pyramids and the renal cortex and the measurement of the cortical thickness was performed at three different points in each kidney, starting from the center of each renal pyramid perpendicularly to the shortest point of the posterior edge of the renal capsule, as well as abdominal aortic diameter in systole in a sagittal section, immediately caudal to the left renal artery bifurcation. Furthermore, serum measurement of BUN, phosphorus, creatinine and/or SDMA of the different groups was performed. The quantitative value obtained for the ratio in healthy felines was 1.04±0.32cm (mean±standard deviation), in felines with CKD 1.90±0.77cm and, in felines with AKI, 1.97±0.85cm. It was possible to determine the ratio cutoff point ≥1.4cm to distinguish healthy felines from felines with kidney disease, with sensitivity and specificity of 81.8% and 86%. The relationship between ratio and renal biomarkers demonstrated that creatinine had a positive correlation with renal cortical thickness, just as phosphorus had a negative correlation with early CKD IRIS stages. In conclusion, the results support the use of the ratio as a quantitative, non-invasive marker to differentiate healthy adult felines from adult felines with kidney disease.
Kidney disease, whether in its acute (AKI) or chronic (CKD) form, is a pathology that affects a high percentage of the adult feline population. For its diagnosis and staging according to the IRIS classification system, complementary diagnostic methods are used, such as serum measurement of renal biomarkers and regular abdominal ultrasounds of the urinary tract to monitor the evolution of the clinical condition. Taking into account the practicality and frequent application of abdominal ultrasound in a clinical environment, as well as previous studies that demonstrated an association between renal cortical thickness and renal function, the aim of this study was to determine whether the ratio between ultrasound measurements of cortical renal thickness and abdominal aortic diameter in systole in felines could constitute a new ultrasound marker to differentiate between healthy felines and felines with kidney disease, as well as studying their relationship with renal serum biomarkers. To this end, all felines that took part in the study (n=105) were divided into healthy felines (n=50), CKD felines (n=44) and AKI felines (n=11). For each group, ultrasound images were obtained in a sagittal section of both kidneys with clear visualization of the renal pyramids and the renal cortex and the measurement of the cortical thickness was performed at three different points in each kidney, starting from the center of each renal pyramid perpendicularly to the shortest point of the posterior edge of the renal capsule, as well as abdominal aortic diameter in systole in a sagittal section, immediately caudal to the left renal artery bifurcation. Furthermore, serum measurement of BUN, phosphorus, creatinine and/or SDMA of the different groups was performed. The quantitative value obtained for the ratio in healthy felines was 1.04±0.32cm (mean±standard deviation), in felines with CKD 1.90±0.77cm and, in felines with AKI, 1.97±0.85cm. It was possible to determine the ratio cutoff point ≥1.4cm to distinguish healthy felines from felines with kidney disease, with sensitivity and specificity of 81.8% and 86%. The relationship between ratio and renal biomarkers demonstrated that creatinine had a positive correlation with renal cortical thickness, just as phosphorus had a negative correlation with early CKD IRIS stages. In conclusion, the results support the use of the ratio as a quantitative, non-invasive marker to differentiate healthy adult felines from adult felines with kidney disease.
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MESTRADO INTEGRADO EM MEDICINA VETERINÁRIA, VETERINÁRIA, MEDICINA VETERINÁRIA, FELÍDEOS, GATOS, DOENÇAS, DOENÇAS RENAIS, FUNÇÃO RENAL, MEIOS DE DIAGNÓSTICO, ECOGRAFIA, BIOMARCADORES, VETERINARY MEDICINE, FELIDS, CATS, DISEASES, KIDNEY DISEASES, KIDNEY FUNCTION, DIAGNOSTIC PROCEDURES, ULTRASOUND SCAN, BIOMARKERS