Prevalência de infecção urinária em cães diagnosticados com Diabetes mellitus

Abstract

Diabetes mellitus is an endocrine disease related to an alteration in the feedback system that regulates serum glucose concentrations, triggering hyperglycemia, polyuria (PU), compensatory polydipsia, polyphagia, weight loss, among other signs. The presence of glucose in the urine serves as a substrate for bacterial fermentation, and in addition, the decreased leukocyte response and tissue perfusion, also caused by endocrinopathy, contribute to the development of urinary tract infections, such as sporadic bacterial cystitis, recurrent bacterial cystitis, emphysematous cystitis and subclinical bacteriuria in animals affected by diabetes mellitus. Thus, this project has as its primary objective to verify the prevalence of urinary infection in dogs with diabetes mellitus, belonging to the series of the Endocrinology Service of the UFU Veterinary Hospital between 2017 and 2020, testing the hypothesis that PU and urinary dilution could mask clinical signs and laboratory alterations, limiting the use of the current urinary tract infection (UTI) classification proposed by the International Society for Companion Animal Infectious Diseases (ISCAID, 2019). Thirty-three diabetic dogs had their medical records analyzed basically according to the ISCAID norms (ISCAID scenario 4) and also considering polyuria as a potentially difficult manifestation of the observation of clinical signs consistent with cystitis by ISCAID, associated with leukocyturia/hematuria as alterations potentially indicative of UTI (DM 1 scenario). Considering that the sedimentoscopic visualization of bacteria could also be impaired by urinary dilution in DM, another 4 scenarios were also proposed, considering and disregarding the finding of isolated leukocyturia/hematuria (without bacteriuria) being considered as potential indicators of UTI. Data were obtained from a total of 39 urinalysis performed in the period of tree years. It was observed that in the ISCAID 4 scenario, 5% of diabetics would be investigated for cystitis and 67% of them would have subclinical bacteriuria. The DM 1 scenario, on the other hand, indicates that up to 54% of diabetic patients could have cystitis and that 38% would still have subclinical bacteriuria. Interestingly, when PU is no longer included (DM 2 scenario), the number of diabetic dogs with subclinical UTI potential becomes 82%, leaving only 10% suspected of having cystitis. When isolated leukocyturia/hematuria (without bacteriuria) were considered as potential indicators of UTI (scenarios 5 and 6), up to 8% more diabetic canines would be candidates for cystitis, and another 15% would belong to the subclinical UTI group. Thus, our results show that the ISCAID classification may be considerably underestimating the number of diabetic dogs with UTI, deserving future investigations about its applicability for this group of patients.