Intermittent Hemodialysis, an Alternative Treatment for Ovine With Acute-on-Chronic Kidney Disease.

Abstract

Chronic Kidney Disease (CKD) is a syndrome composed of numerous comorbidities such as the failure of excretion of toxins and nitrogenous compounds from metabolism, as well as the failure to maintain endocrine, water, electrolyte and acid-base homeostasis in all mammals. As it is a non-regenerative and progressive disease, any endogenous or exogenous insults in the organ in question will lead to the intensification of all these mentioned disorders associated with decreased urinary output. Several studies in humans and animals recommend the use of renal replacement therapy, especially in those who already have CKD, and who are in uremic syndrome. This report aims to demonstrate that the use of intermittent hemodialysis (HI) in sheep is a therapeutic alternative in those in renal failure. A six-year-old Bergamasca sheep was presented with lateral decubitus, dyspnea, dark liquid diarrhea, apathy, anorexia and pulmonary crepitation on auscultation. Laboratory tests showed azotemia and electrolyte changes such as hypocalcemia, hypokalemia, hypochloremia, isosthenuria (1,012), pyuria, glycosuria, and a protein: creatinine ratio of 0.88. In ultrasonography, the real resistivity index was above 0.54, being suggestive of loss of renal perfusion. The treatment chosen consisted of electrolytic and fluid replacement, associated with HI. After HI, the sheep showed great clinical and laboratory improvement as expected, however, despite not having survived, the histopathological findings of the necropsy pointed out segments of glomerulosclerosis, thus reinforcing the hypothesis that the animal already had a CKD which was aggravated due to the association of hypovolemia, hypotension by anesthetic drugs and the indiscriminate use of NSAIDs. Despite the death of the sheep, HI again proved to be a therapy of rapid clinical and laboratory improvement of the patient compared to conventional clinical treatment, thus being an important treatment alternative for sheep with a high impact on reproduction, production, and research.