RESUMO
OBJECTIVE: Compare erythropoiesis-related factors between different stages of canine chronic kidney disease (CKD). ANIMALS: 8 healthy adult dogs (controls), and 24 dogs with CKD, equally divided into 3 groups based on International Renal Interest Society-CKD Guidelines (stage 2, 3, and 4) were recruited between December 2012 and December 2014. METHODS: The following were assessed in all dogs and then compared between groups: bone marrow cytology, CBC, reticulocyte count, urinalysis, serum biochemistry, blood pressure, occult gastrointestinal bleeding, and serum concentrations of parathyroid hormone (PTH), erythropoietin, interleukin-1ß, interleukin-3, tumor necrosis factor-α (TNFα), and interferon-γ. RESULTS: Erythropoiesis inducing and suppressing factors and the results of the bone marrow cytology of dogs in stage 2 CKD did not differ from the control group. The presence of reticulocytosis in CKD stage 2 suggests that blood loss or erythrocyte destruction might be contributing to developing anemia. Anemia in dogs with progressive CKD was associated with increasing PTH and TNFα and with elevation of the ratio of myeloid to erythroid precursor cells caused by hypoplasia of the erythroid series. The latter was represented mainly by a decrease in the population of polychromatophilic rubricytes and metarubricytes. CLINICAL RELEVANCE: Increased PTH and TNFα seem to contribute to the reduced percentage of polychromatophilic rubricytes and erythroid population, thereby aggravating the anemia of dogs with advanced CKD. Gastrointestinal blood loss contributes to anemia in all canine CKD stages.
Assuntos
Anemia , Doenças do Cão , Insuficiência Renal Crônica , Cães , Animais , Células Precursoras Eritroides , Fator de Necrose Tumoral alfa , Anemia/etiologia , Anemia/veterinária , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/veterinária , Inflamação/complicações , Inflamação/veterinária , Hemorragia Gastrointestinal/complicações , Hemorragia Gastrointestinal/veterináriaRESUMO
Background and study aims: Small-bowel capsule endoscopy (SBCE) is a safe and efficient method for diagnosis of small-bowel diseases. Since its development, different models have appeared. The aim of this study was to analyze which of the different models of SBCE has the best diagnostic yield. Patients and methods: Extensive medical literature research was reviewed, using MESH terms, searching studies comparing different SBCE types. We analyzed the diagnostic yield of all the comparisons and when there were 2 or more studies that compared the same model of SBCEs, a meta-analysis was performed. Results: Ten eligible studies including 1065 SBCEs procedures were identified. The main indication was occult gastrointestinal bleeding in 9/10 studies. Two of them included anemia, chronic diarrhea and/or chronic abdominal pain. The indication in one article was celiac disease. In 9 studies, different types of SBCEs (MiroCam, Endocapsule, OMOM and CapsoCam) were compared with PillCam (SB, SB2 and SB3). Three studies compared MiroCam vs PillCam and CapsoCam vs PillCam, while two studies contrast Endocapsule vs PillCam. None of the SBCEs show superiority over PillCam [OR 0.78 (95%CI;0.60-1.01)]. One study compared SBCEs other than Pillcam (MiroCam vs Endocapsule). Nine studies did not find statistical differences between SBCEs, one showed better diagnostic yield of Mirocam compared with PillCam SB3 (p=0.02). The difference between these SBCE was not replayed in the metaanalysis [OR 0.77 (95%CI;0.49-1.21)]. Conclusions: Despite the appearance of new SBCE models, there are no differences in diagnostic yield; therefore, SBCE endoscopist's performance should be based on experience and availability.
Assuntos
Endoscopia por Cápsula , Doença Celíaca , Enteropatias , Endoscopia por Cápsula/métodos , Doença Celíaca/diagnóstico , Hemorragia Gastrointestinal/diagnóstico , Humanos , Enteropatias/diagnóstico , Intestino DelgadoRESUMO
Obscure gastrointestinal (GI) bleeding is a diagnostic challenge, because interaction between endoscopic and radiological methods are required. After ruling out gastro-colonic causes, we should search for small bowel vascular lesions, inflammatory disorders and malignant lesions that may cause two types of obscure GI bleeding: obscure-occult and obscure-overt bleeding. The prupose of the present review is to analyze the results of these techniques and to make recommendations regarding management and treatment of this disease.
La hemorragia digestiva de origen oscuro representa un desafío diagnóstico, donde es importante el complemento entre métodos endoscópicos y radiológicos. Luego de descartar causas gastro-colónicas, el estudio se centra en la búsqueda de lesiones vasculares, inflamatorias, tumorales, que provocan el sangrado de origen oscuro, ya sea oculto o evidente. En esta revisión se analizan los resultados de estas técnicas y se proponen algunas conductas en el enfrentamiento de esta patología.