{"id":6368,"date":"2023-07-06T14:12:15","date_gmt":"2023-07-06T17:12:15","guid":{"rendered":"https:\/\/www.ufrgs.br\/lacvet\/?p=6368"},"modified":"2025-08-05T08:46:29","modified_gmt":"2025-08-05T11:46:29","slug":"caso-clinico-178es","status":"publish","type":"post","link":"https:\/\/www.ufrgs.br\/lacvet\/cc_interativos\/caso-clinico-178es\/","title":{"rendered":"Caso Cl\u00ednico 178ES"},"content":{"rendered":"
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Identifica\u00e7\u00e3o<\/strong><\/p>\n\t\t\t

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Esp\u00e9cie: Canina
Ra\u00e7a: SRD
Idade: 7 anos
Sexo: f\u00eamea
Peso: 16,4 kg<\/p>\n\n<\/div>\n\t\t<\/div>\n\n

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Anamnese<\/strong><\/p>\n\t\t\t

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Tutor relatou que o animal manifestava epis\u00f3dios de poli\u00faria e polidipsia. Apresentava hiporexia e sua urina encontrava-se com colora\u00e7\u00e3o marrom. N\u00e3o apresentava nenhum outro sinal cl\u00ednico.<\/p>\n\n<\/div>\n\t\t<\/div>\n\n

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Exame f\u00edsico<\/strong><\/p>\n\t\t\t

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  • Escore corporal: 5\u2191<\/mark> (escala de 1-9, ideal 5).<\/li>\n\n\n\n
  • Estado mental alerta.<\/li>\n\n\n\n
  • Normo-hidratado.<\/li>\n\n\n\n
  • Mucosas normocoradas.<\/li>\n\n\n\n
  • Temperatura retal: 38,9 \u00b0C (ref.: 37,5\u2013 39,2).<\/li>\n\n\n\n
  • Tempo de preenchimento capilar: <2 s (ref.: 1-2).<\/li>\n\n\n\n
  • Frequ\u00eancia card\u00edaca: 188 bpm\u2191<\/mark> (ref.: 60\u2013160).<\/li>\n\n\n\n
  • Aumento bilateral dos linfonodos submandibulares.<\/li>\n\n\n\n
  • Sopro grau 1 ou 2 no lado esquerdo do cora\u00e7\u00e3o.<\/li>\n<\/ul>\n\n<\/div>\n\t\t<\/div>\n\n
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    Exames complementares<\/strong><\/p>\n\t\t\t

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    Dia 12<\/strong>–Ultrassonografia abdominal total<\/strong><\/p>\n\n\n\n

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    • Rins com contornos irregulares e visualiza\u00e7\u00e3o de \u00e1rea fina hiperecog\u00eanica em formato de cunha, compat\u00edvel com pequena \u00e1rea de infarto. Rela\u00e7\u00e3o cortical\/medular aumentada, jun\u00e7\u00e3o corticomedular pouco definida e irregular. Par\u00eanquima cortical hipoecog\u00eanico, compat\u00edvel com aumento de diurese ou aumento de press\u00e3o sangu\u00ednea. Exame compat\u00edvel com nefropatia ou sobrecarga renal cr\u00f4nica.<\/li>\n\n\n\n
    • Est\u00f4mago em reple\u00e7\u00e3o m\u00ednima, paredes hipoecog\u00eanicas espessadas, com estratifica\u00e7\u00e3o mural pouco definida. Peristaltismo presente, normal. Imagem compat\u00edvel com gastrite edematosa, gastrite ur\u00eamica ou inflama\u00e7\u00e3o aguda.<\/li>\n<\/ul>\n\n<\/div>\n\t\t<\/div>\n\n
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      Tratamento e evolu\u00e7\u00e3o<\/strong><\/p>\n\t\t\t

      <\/span><\/div>\n\t\t<\/div>\n\t\t\t
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      Dia 15:\u00a0 paciente retornou ao hospital com bom estado geral n\u00e3o apresentando mais incontin\u00eancia urin\u00e1ria, contudo passou a apresentar v\u00f4mito aguado. Foi prescrito benazepril (anti-hipertensivo e vasodilatador), \u00f4mega 3 (antioxidante) e ranitidina (protetor g\u00e1strico).<\/p>\n\n\n\n

      Dia 25: paciente emagreceu e apresentou menos apetite. Recebeu fluidoterapia (reposi\u00e7\u00e3o eletrol\u00edtica e hidrata\u00e7\u00e3o) e citrato de maropitant (antiem\u00e9tico) subcut\u00e2neos. Manteve medica\u00e7\u00f5es anteriores e adicionou metoclopramida (antiem\u00e9tico).<\/p>\n\n\n\n

      Dia 53: foi recomendado manter fluidoterapia em casa duas vezes por semana e seguir com as medica\u00e7\u00f5es anteriores.<\/p>\n\n\n\n

      Dia 244: tutor relatou que o animal estava vomitando uma vez por semana. Mantida a fluidoterapia subcut\u00e2nea e medica\u00e7\u00f5es anteriores, tendo sido acrescido suplemento alimentar.<\/p>\n\n\n\n

      Dia 320:\u00a0 retornou para avalia\u00e7\u00e3o, apresentando bom estado geral, comendo bem e com ganho de peso. V\u00f4mitos espor\u00e1dicos. Mantida a fluidoterapia e medica\u00e7\u00f5es anteriores, com o acr\u00e9scimo de hidr\u00f3xido de alum\u00ednio (quelante de f\u00f3sforo). Prescri\u00e7\u00e3o de ra\u00e7\u00e3o terap\u00eautica renal.<\/p>\n\n<\/div>\n\t\t<\/div>\n\n

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      Hemograma<\/strong><\/p>\n\t\t\t

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      Eritrograma<\/strong><\/td>Dia 0<\/strong><\/td>Dia 43<\/strong><\/td>Dia 244<\/strong><\/td>Dia 320<\/strong><\/td>Dia 404<\/strong><\/td><\/tr>
      Eritr\u00f3citos (5,5-8,5 milh\u00f5es\/\u00b5L)<\/td>5,65\u00a0<\/td>5,47\u2193<\/mark><\/td>4,99\u2193<\/mark><\/td>4,66\u2193<\/mark><\/td>5,33\u2193<\/mark><\/td><\/tr>
      Hemat\u00f3crito (37-55%)<\/td>42\u00a0<\/td>39\u00a0<\/td>39\u00a0<\/td>36\u2193<\/mark><\/td>39\u00a0<\/td><\/tr>
      Hemoglobina (12-18 g\/dL)<\/td>14,2\u00a0<\/td>14,1\u00a0<\/td>13,0<\/td>12,4\u00a0<\/td>13,8\u00a0<\/td><\/tr>
      VCM (60-77 fL)<\/td>74\u00a0<\/td>71\u00a0<\/td>78\u2191<\/mark><\/td>77<\/td>73<\/td><\/tr>
      CHCM (32-36%)<\/td>34<\/td>36<\/td>33<\/td>34<\/td>35<\/td><\/tr>
      Plaquetas<\/strong><\/td>\u00a0<\/td>\u00a0<\/td>\u00a0<\/td>\u00a0<\/td>\u00a0<\/td><\/tr>
      Quantidade (200-500 \u00d7103<\/sup>\/\u00b5L)<\/td>264<\/td>n.d.\u00a0<\/td>350<\/td>480<\/td>392<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

      n.d.: n\u00e3o determinado.<\/p>\n\n\n\n

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      Leucograma<\/strong><\/td>Dia 0<\/strong><\/td>Dia 43<\/strong><\/td>Dia 244<\/strong><\/td>Dia 320<\/strong><\/td>Dia 404<\/strong><\/td><\/tr>
      Leuc\u00f3citos totais (6.000-17.000\/\u00b5L)<\/td>10.550\u00a0<\/td>7.200\u00a0<\/td>7.900\u00a0<\/td>7.000\u00a0<\/td>5.300\u2193<\/mark><\/td><\/tr>
      Miel\u00f3citos (0\/\u00b5L)<\/td>0\u00a0<\/td>0\u00a0<\/td>0\u00a0<\/td>0\u00a0<\/td>0\u00a0<\/td><\/tr>
      Metamiel\u00f3citos (0\/\u00b5L)<\/td>0\u00a0<\/td>0\u00a0<\/td>0\u00a0<\/td>0\u00a0<\/td>0\u00a0<\/td><\/tr>
      Neutr. bast. (<300\/\u00b5L)<\/td>0\u00a0<\/td>0\u00a0<\/td>0\u00a0<\/td>0\u00a0<\/td>0\u00a0<\/td><\/tr>
      Neutr. seg. (3.000-11.500\/\u00b5L)<\/td>7.702\u00a0<\/td>5.040\u00a0<\/td>5.688\u00a0<\/td>4.060\u00a0<\/td>3.445\u00a0<\/td><\/tr>
      Bas\u00f3filos (<200\/\u00b5L)<\/td>0\u00a0<\/td>0\u00a0<\/td>0\u00a0<\/td>0\u00a0<\/td>0\u00a0<\/td><\/tr>
      Eosin\u00f3filos (100-1.250\/\u00b5L)<\/td>633\u00a0<\/td>360\u00a0<\/td>237\u00a0<\/td>840\u00a0<\/td>212\u00a0<\/td><\/tr>
      Mon\u00f3citos (150-1.350\/\u00b5L)<\/td>633\u00a0<\/td>144\u2193<\/td>474<\/td>420\u00a0<\/td>265\u00a0<\/td><\/tr>
      Linf\u00f3citos (1.000-4.800\/\u00b5L)<\/td>1.583\u00a0<\/td>1.656\u00a0<\/td>1.501<\/td>1.680\u00a0<\/td>1.378\u00a0<\/td><\/tr><\/tbody><\/table><\/figure>\n\n<\/div>\n\t\t<\/div>\n\n
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      Bioqu\u00edmica sangu\u00ednea<\/strong><\/p>\n\t\t\t

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      <\/td>Dia 0<\/strong><\/td>Dia 43<\/strong><\/td>Dia 244<\/strong><\/td>Dia 320<\/strong><\/td>Dia 404<\/strong><\/td><\/tr>
      Amostra<\/td>soro<\/td>soro<\/td>soro<\/td>soro<\/td>soro<\/td><\/tr>
      Hem\u00f3lise<\/td>ausente<\/td>ausente<\/td>ausente<\/td>ausente<\/td>ausente<\/td><\/tr>
      AnticoagulanteA<\/sup><\/td>nenhum<\/td>nenhum<\/td>nenhum<\/td>nenhum<\/td>nenhum<\/td><\/tr>
      Prote\u00ednas totaisB<\/sup> (60-80 g\/L)<\/td>70\u00a0<\/td>68\u00a0<\/td>68\u00a0<\/td>66\u00a0<\/td>66\u00a0<\/td><\/tr>
      Prote\u00ednas totaisC<\/sup> (54-71 g\/L)<\/td>n.d.\u00a0<\/td>n.d.\u00a0<\/td>n.d.\u00a0<\/td>n.d.\u00a0<\/td>n.d.\u00a0<\/td><\/tr>
      Albumina (26-33 g\/L)<\/td>34\u2191<\/mark><\/td>n.d.\u00a0<\/td>30\u00a0<\/td>31\u00a0<\/td>34\u2191<\/mark><\/td><\/tr>
      Ureia (21-60 mg\/dL)<\/td>177\u2191<\/mark><\/td>201\u2191<\/mark><\/td>335\u2191<\/mark><\/td>277\u2191<\/mark><\/td>269\u2191<\/mark><\/td><\/tr>
      Creatinina (<1,4 mg\/dL)<\/td>3,4\u2191<\/mark><\/td>4,2\u2191<\/mark><\/td>7,7\u2191<\/mark><\/td>5,6\u2191<\/mark><\/td>6,9\u2191<\/mark><\/td><\/tr>
      C\u00e1lcio (9,0-11,3 mg\/dL)<\/td>n.d.\u00a0<\/td>n.d.\u00a0<\/td>13,7\u2191<\/mark><\/td>n.d.\u00a0<\/td>n.d.\u00a0<\/td><\/tr>
      F\u00f3sforo (2,6-6,2 mg\/dL)<\/td>n.d.\u00a0<\/td>n.d.\u00a0<\/td>4,8\u00a0<\/td>5,6\u00a0<\/td>4,1\u00a0<\/td><\/tr>
      FA (<156 U\/L)<\/td>35\u00a0<\/td>n.d.\u00a0<\/td>n.d.\u00a0<\/td>42\u00a0<\/td>n.d.\u00a0<\/td><\/tr>
      ALT (<102 U\/L)<\/td>39\u00a0<\/td>n.d.\u00a0<\/td>n.d.\u00a0<\/td>52\u00a0<\/td>n.d.\u00a0<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

      B<\/sup>Estimadas por refratometria; C<\/sup>Determinadas por espectrofotometria. n.d.: n\u00e3o determinado.<\/p>\n\n<\/div>\n\t\t<\/div>\n\n

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      Urin\u00e1lise<\/strong><\/p>\n\t\t\t

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      <\/td>Dia 15<\/strong><\/td>Dia 244<\/strong><\/td>Dia 404<\/strong><\/td><\/tr>
      M\u00e9todo de coletaA<\/sup><\/td>cist<\/td>mic<\/td>mic<\/td><\/tr>
      Sedimento urin\u00e1rioB<\/sup><\/strong><\/td>\u00a0<\/td>\u00a0<\/td>\u00a0<\/td><\/tr>
      C\u00e9lulas epiteliais<\/td>escamosas (3);\u00a0<\/td>escamosas (1)<\/td>escamosas (3)<\/td><\/tr>
      Cilindros<\/td>ausentes<\/td>ausentes<\/td>ausentes<\/td><\/tr>
      Hem\u00e1cias<\/td>0<\/td>0<\/td><5<\/td><\/tr>
      Leuc\u00f3citos<\/td><5<\/td>0<\/td><5<\/td><\/tr>
      Bacteri\u00faria<\/td>n.d.<\/td>n.d.<\/td>n.d.<\/td><\/tr>
      Exame qu\u00edmico<\/strong><\/td>\u00a0<\/td>\u00a0<\/td>\u00a0<\/td><\/tr>
      pH (5,5-7,0)<\/td>6,0\u00a0<\/td>5,0\u2193<\/mark><\/td>6,0\u00a0<\/td><\/tr>
      Corpos cet\u00f4nicosC<\/sup><\/td>ausente\u00a0<\/td>ausente\u00a0<\/td>ausente\u00a0<\/td><\/tr>
      GlicoseD<\/sup><\/td>ausente\u00a0<\/td>ausente\u00a0<\/td>ausente\u00a0<\/td><\/tr>
      BilirrubinaE<\/sup><\/td>ausente\u00a0<\/td>ausente\u00a0<\/td>ausente\u00a0<\/td><\/tr>
      Urobilinog\u00eanio (<1 mg\/dL)<\/td>\u22480,2\u00a0<\/td>\u22480,2\u00a0<\/td>\u22480,2\u00a0<\/td><\/tr>
      Prote\u00ednaF<\/sup><\/td>+\u2191<\/mark><\/td>ausente\u00a0<\/td>ausente\u00a0<\/td><\/tr>
      SangueG<\/sup><\/td>ausente\u00a0<\/td>ausente\u00a0<\/td>ausente\u00a0<\/td><\/tr>
      RPCUH<\/sup><\/td>0,83\u2191<\/mark><\/td>0,17<\/td>n.d.<\/td><\/tr>
      Exame f\u00edsico<\/strong><\/td>\u00a0<\/td>\u00a0<\/td>\u00a0<\/td><\/tr>
      Dens. espec. (1,015-1,045)<\/td>1,012\u2193<\/mark><\/td>1,012\u2193<\/mark><\/td>1,012\u2193<\/mark><\/td><\/tr>
      Cor<\/td>amarelo<\/td>amarelo claro<\/td>amarelo claro<\/td><\/tr>
      Consist\u00eancia<\/td>fluida<\/td>fluida<\/td>fluida<\/td><\/tr>
      Aspecto<\/td>l\u00edmpido<\/td>l\u00edmpido<\/td>l\u00edmpido<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

      A<\/sup>mic, mic\u00e7\u00e3o natural \u25cf cat, cateteriza\u00e7\u00e3o \u25cf cist, cistocentese \u25cf out, outros (especificar em \u201cObserva\u00e7\u00f5es\u201d)
      B<\/sup>N\u00famero m\u00e9dio de elementos por campo de 400 x
      C<\/sup>tra\u00e7os, \u22485 mg\/dL \u25cf +, \u224815 mg\/dL \u25cf ++, \u224840 mg\/dL \u25cf +++, \u224880 md\/dL \u25cf ++++, \u2265160 mg\/dL
      D<\/sup>tra\u00e7os, \u2248100 mg\/dL \u25cf +, \u2248250 mg\/dL \u25cf ++, \u2248500 mg\/dL \u25cf +++, \u22481000 mg\/dL \u25cf ++++, \u22652000 mg\/dL
      E<\/sup>+, leve \u25cf ++, moderada \u25cf +++, alta
      F<\/sup>+, \u224830 mg\/dL \u25cf ++, \u2248100 mg\/dL \u25cf +++, \u2248300 mg\/dL \u25cf ++++, \u22652000 mg\/dL
      G<\/sup>nh, n\u00e3o hemolisado \u25cf h, hemolisado \u25cf +, leve \u25cf ++, moderada \u25cf +++, alto
      H<\/sup>RPCU, rela\u00e7\u00e3o prote\u00edna\/creatinina urin\u00e1ria (na aus\u00eancia de sedimento ativo)
      – Caninos: <0,2, n\u00e3o protein\u00farico \u25cf 0,2 a 0,5, protein\u00faria lim\u00edtrofe \u25cf >0,5, protein\u00farico
      – Felinos: <0,2, n\u00e3o protein\u00farico \u25cf 0,2 a 0,4, protein\u00faria lim\u00edtrofe \u25cf >0,4, protein\u00farico
      – Equinos: <0,93, n\u00e3o protein\u00farico
      n.d.: n\u00e3o determinado<\/p>\n\n<\/div>\n\t\t<\/div>\n\n

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      Discuss\u00e3o e refer\u00eancias bibliogr\u00e1ficas<\/strong><\/p>\n\t\t\t

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      Devem ser discutidos os achados laboratoriais alterados (referentes a urin\u00e1lise, bioqu\u00edmica sangu\u00ednea e hemograma), estabelecendo as correla\u00e7\u00f5es relevantes com o quadro cl\u00ednico do paciente. N\u00e3o deve ser discutido o tratamento realizado. As altera\u00e7\u00f5es nos achados laboratoriais devem ser justificadas com base nas informa\u00e7\u00f5es contidas na literatura especializada. \u00c9 sugerido organizar a discuss\u00e3o nos seguintes grandes t\u00f3picos:<\/p>\n\n\n\n