Diagnóstico y manejo del fallo renal en perros
Fecha
2008-06-04
Autores
Ramírez Chinchilla, Laura
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Editor
Universidad Nacional, Costa Rica
Resumen
El fallo renal es una enfermedad compleja, que requiere un tratamiento costoso y
presenta una alta mortalidad. Debido a esto, es importante lograr un diagnóstico
temprano basado en la historia clínica, examen físico, pruebas de laboratorio, exámenes
ecográficos y radiográficos; con el fin de descubrir y tratar la causa del fallo. El
propósito de este trabajo fue establecer el diagnóstico y origen de fallo renal agudo
(FRA) o fallo renal crónico (FRC), así como aplicar los protocolos de manejo en estos
pacientes.
En este estudio se incluyeron solamente los pacientes que presentaron azotemia,
uremia, o donde el estudio histopatológico indicó algún daño a nivel renal.
De los 14 casos con FRA, se brindó un diagnóstico clínico en 12 de ellos. Mediante
necropsia e histopatología se confirmó un caso de nefropatía juvenil; en otros 2
casos los diagnósticos histopatológicos discreparon con el diagnóstico clínico; y en
dos pacientes donde no se había determinado el origen del fallo renal, nos orientó
hacia un posible diagnóstico.
Sólo en 2 de los 9 pacientes observados con FRC, se estableció la ehrlichiosis
como responsable del compromiso renal. Debido a la fisiopatología de esta
enfermedad, es poco probable establecer la causa inicial en un estado crónico.
Se presentó una mortalidad del 71% en los animales con FRA, y el 50% de los
sobrevivientes desarrollaron FRC. La mortalidad en los pacientes con FRC fue del
33%.
Al comparar los protocolos de manejos establecidos en la literatura, con la terapia
que se brinda en nuestro medio, se evidenció que las limitantes económicas y
tecnológicas son las más importantes. Algunos aspectos pueden mejorar, se debe
evitar las complicaciones iatrogénicas durante el tratamiento mediante una
evaluación más rigurosa del paciente e implementar técnicas como la diálisis
peritoneal o el uso de sondas nasogástricas.
Renal failure is a complex disease, with high costs and high mortality. Making an early diagnosis is important, its causes are established from history, physical examination, laboratory assessment; radiography and ultrasonography findings, which should be part of the evaluation of all animals with a clinical suspect of it. The purpose of this study to establish the diagnosis and possible causes of acute renal failure (ARF) or chronic renal failure (CRF), and to apply the management protocols in the patients. In this study were included only animals that developed uremia or azotemia, or with histopathology evidence of renal damage. There were 14 cases of ARF, diagnose as ARF 12 of them. Through necropsy and histopathology we confirmed one case of juvenile nephropathy. In other 2 cases the post-mortem diagnosis further specified the clinical diagnosis, and in other 2 cases histopathology findings gave us a possible diagnosis when we didn’t have it. There were 9 patients with CRF, 2 of them had a diagnosis of ehrlichiosis. If the cause of ARF is not determined before it progresses to CRF, establishing the inciting events becomes nearly impossible, because the lesions of CRF are similar no matter the initial cause. Mortality rate in this study was 71% for those with ARF, 50% of those who survived developed CRF. Animals with CRF had a mortality of 33%. Comparing the management protocols mentioned in the literature with those use in our country, it showed us that there are economical and technological limitations, however, many aspects can be improved, iatrogenic complications can be avoided through more aggressive clinical monitoring and new techniques should be applied when the case requires, for example peritoneal dialysis or nasogastric tubes.
Renal failure is a complex disease, with high costs and high mortality. Making an early diagnosis is important, its causes are established from history, physical examination, laboratory assessment; radiography and ultrasonography findings, which should be part of the evaluation of all animals with a clinical suspect of it. The purpose of this study to establish the diagnosis and possible causes of acute renal failure (ARF) or chronic renal failure (CRF), and to apply the management protocols in the patients. In this study were included only animals that developed uremia or azotemia, or with histopathology evidence of renal damage. There were 14 cases of ARF, diagnose as ARF 12 of them. Through necropsy and histopathology we confirmed one case of juvenile nephropathy. In other 2 cases the post-mortem diagnosis further specified the clinical diagnosis, and in other 2 cases histopathology findings gave us a possible diagnosis when we didn’t have it. There were 9 patients with CRF, 2 of them had a diagnosis of ehrlichiosis. If the cause of ARF is not determined before it progresses to CRF, establishing the inciting events becomes nearly impossible, because the lesions of CRF are similar no matter the initial cause. Mortality rate in this study was 71% for those with ARF, 50% of those who survived developed CRF. Animals with CRF had a mortality of 33%. Comparing the management protocols mentioned in the literature with those use in our country, it showed us that there are economical and technological limitations, however, many aspects can be improved, iatrogenic complications can be avoided through more aggressive clinical monitoring and new techniques should be applied when the case requires, for example peritoneal dialysis or nasogastric tubes.
Descripción
Modalidad: Práctica dirigida
Palabras clave
PERRO, ENFERMEDADES, RIÑONES, DIAGNOSTICO (MEDICINA VETERINARIA)