Nefrite Intersticial Crónica Felina: revisão da literatura e apresentação de casos clínicos
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Data
2022
Autores
Rousseau, Ana Teresa Castilho
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Resumo
A doença renal crónica (DRC) felina é uma doença de carácter tipicamente progressivo e irreversível com elevada prevalência, que afeta gatos de qualquer idade, mas é mais prevalente em animais séniores (11-14 anos) e geriátricos (> 15 anos), ou com idade superior a 7 anos.
A nefrite intersticial crónica (NIC), é uma alteração morfológica frequentemente relacionada com a DRC felina, sendo o achado histopatológico mais comummente encontrado naquela. Histologicamente, lesões renais de NIC são multifocais e segmentadas, com infiltrados linfoplasmócitários e gordura, degeneração e atrofia tubular, fibrose intersticial, mineralização e glomeruloesclerose.
Com este trabalho pretendeu-se avaliar a prevalência de NIC em gatos, as possíveis etiologias e a sua relação com outras alterações linfoplasmocitárias. Para isso recolheu-se relatórios histopatológicos dum laboratório de referência, onde encontrámos um número extremamente baixo de casos enviados para diagnóstico histopatológico. Apenas 33 análises histopatológicas de rim de gato doméstico foram submetidas ao laboratório num total de 2 anos de trabalho do mesmo. Estes corresponderam a uma percentagem de apenas 2,13% dos 1546 casos de peças provenientes de gatos que foram analisadas.
Esta percentagem de análises histopatológicas foi muito reduzida tendo em conta a elevada prevalência de casos de DRC em gatos, não correspondendo à magnitude de diagnósticos feitos anualmente. Apesar do baixo número de casos, a representatividade do diagnóstico de Nefrite Intersticial Crónica foi contundente, tendo sido diagnosticada NIC em 73,3% dos casos renais estudados.
Neste trabalho descreveu-se ainda dois casos clínicos de DRC felina por NIC que apresentavam outras comorbilidades linfoplasmocitárias, incluindo Cistite idiopática Felina (CIF), Doença Inflamatória Intestinal Crónica (DIIC) e Gengivoestomatite Crónica Felina, sugerindo uma predisposição para uma resposta linfoplasmocitária exacerbada, possivelmente devido a um mau funcionamento do eixo Hipotálamo-hipófise-adrenal.
É notória a escassez de estudos de investigação em Medicina Interna de Animais de Companhia que se dediquem aos possíveis fatores de risco e etiologias de DRC, sendo necessários muitos mais estudos para uma melhor compreensão e abordagem da patologia na prática clínica.
Palavras-chave: DRC felina, alterações linfoplasmocitárias, histopatologia, fatores de risco
Feline chronic kidney disease (CKD) is a typically progressive and irreversible disease with a high prevalence, which affects cats of any age, but is more prevalent in senior (11-14 years) and geriatric (> 15 years) animals, or aged over 7 years. Chronic interstitial nephritis (CIN) is a morphological alteration frequently related to feline CKD, being the histopathological finding most commonly found in that one. Histologically, renal lesions of CIN are multifocal and segmented, with lymphoplasmacytic infiltrates and fat, tubular degeneration and atrophy, interstitial fibrosis, mineralization and glomerulosclerosis. The aim of this study was to evaluate the prevalence of CIN in cats, the possible etiologies and its relationship with other lymphoplasmacytic alterations. For this, histopathological reports were collected from a reference laboratory, where we found an extremely low number of cases sent for histopathological diagnosis. Only 33 histopathological analyzes of domestic cat kidneys were submitted to the laboratory in a total of 2 years of work. These corresponded to a percentage of only 2.13% of the 1546 cases analyzed. This percentage of histopathological analyzes was very low considering the high prevalence of CKD cases in cats, not corresponding to the magnitude of diagnoses made annually. Despite the low number of cases, the representativeness of the diagnosis of Chronic Interstitial Nephritis was overwhelming, with CIN being diagnosed in 73.3% of the renal cases studied. This study also described two clinical cases of feline CKD due to CIN that had other lymphoplasmacytic comorbidities, including Feline Idiopathic Cystitis (FIC), Chronic Inflammatory Bowel Disease (IBD) and Feline Chronic Gingivostomatitis, suggesting a predisposition to an exacerbated lymphoplasmacytic response, possibly due to a malfunction of the hypothalamic-pituitary-adrenal axis. The scarcity of research studies in Companion Animal Internal Medicine dedicated to possible risk factors and etiologies of CKD is notorious, and many more studies are needed for a better understanding and approach of the pathology in clinical practice. Keywords: feline CKD, lymphoplasmacytic alterations, histopathology, risk factors
Feline chronic kidney disease (CKD) is a typically progressive and irreversible disease with a high prevalence, which affects cats of any age, but is more prevalent in senior (11-14 years) and geriatric (> 15 years) animals, or aged over 7 years. Chronic interstitial nephritis (CIN) is a morphological alteration frequently related to feline CKD, being the histopathological finding most commonly found in that one. Histologically, renal lesions of CIN are multifocal and segmented, with lymphoplasmacytic infiltrates and fat, tubular degeneration and atrophy, interstitial fibrosis, mineralization and glomerulosclerosis. The aim of this study was to evaluate the prevalence of CIN in cats, the possible etiologies and its relationship with other lymphoplasmacytic alterations. For this, histopathological reports were collected from a reference laboratory, where we found an extremely low number of cases sent for histopathological diagnosis. Only 33 histopathological analyzes of domestic cat kidneys were submitted to the laboratory in a total of 2 years of work. These corresponded to a percentage of only 2.13% of the 1546 cases analyzed. This percentage of histopathological analyzes was very low considering the high prevalence of CKD cases in cats, not corresponding to the magnitude of diagnoses made annually. Despite the low number of cases, the representativeness of the diagnosis of Chronic Interstitial Nephritis was overwhelming, with CIN being diagnosed in 73.3% of the renal cases studied. This study also described two clinical cases of feline CKD due to CIN that had other lymphoplasmacytic comorbidities, including Feline Idiopathic Cystitis (FIC), Chronic Inflammatory Bowel Disease (IBD) and Feline Chronic Gingivostomatitis, suggesting a predisposition to an exacerbated lymphoplasmacytic response, possibly due to a malfunction of the hypothalamic-pituitary-adrenal axis. The scarcity of research studies in Companion Animal Internal Medicine dedicated to possible risk factors and etiologies of CKD is notorious, and many more studies are needed for a better understanding and approach of the pathology in clinical practice. Keywords: feline CKD, lymphoplasmacytic alterations, histopathology, risk factors
Descrição
Orientação: Joana Tavares de Oliveira
Palavras-chave
MESTRADO INTEGRADO EM MEDICINA VETERINÁRIA, MEDICINA VETERINÁRIA, VETERINÁRIA, VETERINARY MEDICINE, KIDNEY DISEASES, CHRONIC DISEASES, CATS, HISTOPATHOLOGY, RISK FACTORS, DOENÇAS RENAIS, DOENÇAS CRÓNICAS, GATOS, HISTOPATOLOGIA, FATORES DE RISCO