Avaliação da hemodiafiltração no período peri-operatório da ovário-salpingo-histerectomia, em cadelas com piometra e refratárias ao tratamento conservador da insuficiência renal aguda / Avaliation of perioperative hemodiafiltration in pyometra ovarohystectomy bitches and non-recovery of conservative treatment in acute renal failure
AUTOR(ES)
Paulo Cesar de Carvalho Ferreira
DATA DE PUBLICAÇÃO
2006
RESUMO
Acute renal failure (ARF) was evaluated retrospectively in 147 and prospectively in 351 female dogs with piometra. 27 and 132 animals were respectively selected for this study, fulfilling the following criteria, measured in three moments (immediately after the diagnosis, 24 hours after the hysterectomy and when the suture was removed): creatinine ≥ 2,4mg/dl and/or urea ≥ 80mg/dl and/or relative increases of 100% in comparison with values previously obtained. The animals of the retrospective study were used as control. The animals selected for the prospective study received conservative treatment consisting in Lactated Ringer Solution, with the maximum dose of 90ml/kg/h, during 4 hours. The factors evaluated before and after the therapy were weight, systolic arterial pressure, heart rate, renal function, arterial hemogasometry, serum and urinary biochemistry and the endogenous renal creatinine clearance. Five animals that did not respond adequately to the conservative treatment and showed uremic syndrome were randomly chosen and submitted to hemodiafiltration (HDF), given in 3 sessions of 2 hours each, during 3 days, with appropriate solutions for HDF and polissulfona membrane. During the HDF two animals died after the last session of HDF, one animal remained alive for 18 days, another animal for 12 days and one animal survived. The rate of death for the animals in the retrospective study was 40.7% and 20.4% for the prospective group. The animals of the prospective study that died were compared with the alive animals that were selected from the total population for that group, using univariada analysis of the values of serum urea and creatinine, electrolyte rate of excretion, arterial bicarbonate and creatinine clearance and it was observed that there was significative difference (p<0.05), however when this data was submitted to a multivariated analysis and the ROC curve were plotted it was detected that the area under it was of 0,867 (p<0.0001), IC:0,769-0,966. Therefore it was possible to conclude that a creatinine value higher than 2,6mg/dl predicted the death of the animals with piometra and ARF, with 93% of sensibility and 77% of specificity. Regarding the animals that were submitted to HDF and died, it was observed that they presented a -7days prolonged life in relation with the animals that received only the conservative treatment, suggesting that the HDF is a method to increase lifetime, offering extra time for the animal to recover.
ASSUNTO(S)
rim acid-base status sepse cães hemodiálise sepsis equilibrio ácido-base dogs hemodialysis kidney
