Трансплантация почки коту с двусторонним поликистозом

Трансплантация почки коту с двусторонним поликистозом
Great writing has the power to transport us to new worlds, introduce us to fascinating ideas, and change how we see our own lives. This specially selected compilation brings together articles that exemplify this transformative potential. We've prioritized depth, originality, and readability in choosing these pieces across various genres and topics. Discover your next favorite read among the following standout articles we're excited to share.
  1. https://www.internetwill.co.uk/the-intriguing-world-of-china-replica-rolex-swiss-watches/
  2. https://www.caspar-mode.de/de-beste-screenprotectors-voor-de-huawei-mate-10-lite/
  3. https://www.newcq.org/2025/03/25/the-allure-of-omega-orange-replica-watches-in-luxurious-leather-straps/
  4. https://www.marketing2win.co.uk/the-allure-and-risks-of-omega-seamaster-watch-replicas/
  5. https://www.info-tschernobyl06.de/de-beste-coque-voor-de-iphone-13-pro-bescherming-en-stijl/
  6. https://www.vuurklip.net/testing-procedures-for-elf-bars-in-the-e-cigarette-industry/
  7. https://www.theworkspg.com/warum-macht-das-dampfen-mich-schwindelig/
  8. https://www.twpofwashington.org/de-beste-bescherming-voor-je-lenovo-tab-m10-plus-een-gids-voor-de-perfecte-case/
  9. https://www.transitioningtohealth.net/die-faszination-der-stundenglass-gravity-bong-und-3d-druck/
  10. https://www.colbooks.org/understanding-the-perfect-clone-watch-scam-a-guide-for-watch-enthusiasts/
  11. https://www.linkinglearningtolife.org/de-beste-telefoonhoesjes-voor-de-xiaomi-mi-10-pro/
  12. https://www.compactpower.co.uk/the-allure-of-cartier-tank-louis-watch-replicas/
  13. https://www.pwccwr.org/the-bong-hits-4-jesus-case-a-deep-dive-into-free-speech-and-cannabis-culture/
  14. https://www.uksurvivalschool.co.uk/understanding-the-iso-6149-2-standard-a-comprehensive-overview/
  15. https://pastatehogrally.com/cartier-diamond-replica-watches-the-perfect-blend-of-style-and-affordability/
  16. https://www.meringueboutique.com/het-perfecte-horlogebandje-stijl-en-functionaliteit/
  17. https://www.erythrozyten-info.de/understanding-standards-australia-and-sai-global-a-comprehensive-overview/
  18. https://www.mrsdirect.co.uk/the-allure-of-replica-vintage-omega-speedmaster-watches/
  19. https://www.magnusthemasseur.co.uk/exploring-delmars-standard-textbook-of-electricity/
  20. https://www.mucke-gegen-rechts.de/the-allure-of-the-omega-apollo-replica-a-timepiece-beyond-compare/
  21. https://www.bangkokapartment.org/the-art-of-animal-bongs-a-unique-twist-on-water-pipes/
  22. https://www.millelacsgolf.com/why-does-hookah-make-you-dizzy/
  23. https://www.bomacsolutions.co.uk/de-perfecte-coque-voor-je-iphone-5c-bescherming-en-stijl/
  24. https://www.griffair.co.uk/understanding-the-ansi-z10-standard-a-comprehensive-overview/
  25. https://www.gruene-radler-berlin.de/de-beste-telefoonhoesjes-voor-de-oppo-reno-serie/
  26. https://www.adlershof-convent.de/die-welt-der-e-zigaretten-ein-blick-auf-den-vape-shop-in-saltcoats/
  27. https://www.davidurquharttravel.co.uk/the-allure-of-hublot-replica-watches-a-guide-to-prices-in-dubai/
  28. https://www.psrn.org/the-truth-about-fake-omega-speedmaster-watches/
  29. https://www.aicvb.org/de-beste-telefoonhoesjes-voor-de-oppo-reno2-z/
  30. https://ponyexpressministorage.com/3503
  31. https://www.skitigneslesbrevieres.co.uk/the-importance-of-the-brc-global-standards-directory-in-modern-supply-chain-management/
  32. https://www.northernairelodge.com/wat-is-het-magsafe-hoesje/
  33. https://www.goldenaquarium.net/the-importance-of-pdf-a-1a-standard-in-document-preservation/
  34. https://www.surreyaccidentrepaircentre.co.uk/understanding-finance-and-farm-management-insights-from-standard-bank/
  35. https://www.mindsetappraisals.com/de-beste-samsung-galaxy-s23-hoesjes-bescherming-en-stijl/
  36. https://www.manorfarmgame.co.uk/the-world-of-11-rolex-replica-clone-3135-watches/
  37. https://www.pricechemical.com/the-synchronized-dance-of-time-exploring-the-intricacies-of-dna-replication-through-the-lens-of-a-watch/
  38. https://www.filmcels.co.uk/hublot-diamond-watch-replica-a-closer-look-at-the-world-of-high-quality-replicas/
  39. https://www.silvasurfercomputers.co.uk/the-rise-of-fake-zenith-watches-in-the-usa/
  40. https://www.daltonssteakhouse.com/allergien-gegen-das-dampfen-ein-blick-auf-die-risiken-von-e-zigaretten/
  41. https://www.rudolf-craemer.de/the-adoption-of-common-core-national-educational-standards-implications-and-challenges/
  42. https://www.feinkost-leuchten.de/the-art-of-enjoying-bong-candles-a-unique-fusion-of-aromatics-and-water-pipes/
  43. https://www.tesanj.org/the-allure-of-panerai-luminor-regatta-replica-watches/
  44. https://www.telsis.co.uk/the-impact-of-fake-omega-seamaster-planet-ocean-in-the-uk/
  45. https://www.mnaventures.org/die-welt-der-wasserpfeifen-ein-blick-auf-glas-bongs/
  46. https://www.formazione-spirituale.org/the-allure-of-replica-watches-exploring-the-cheapest-fake-rolex-on-aliexpress/
  47. https://www.saabsavior.com/the-allure-of-the-omega-spectre-a-detailed-look-at-the-lug-to-lug-replica/
  48. https://www.religionandspiritualityforum.com/the-impact-of-boys-vaping-understanding-the-risks-of-e-cigarettes/
  49. https://www.austinareaechosociety.org/the-ultimate-guide-to-finding-the-best-watch-replica-site/
  50. https://www.cpem-marseille.com/the-controversy-surrounding-lucozade-vape-an-analysis-of-the-risks-and-benefits/
  51. https://www.pagedive.com/the-truth-about-fake-tag-heuer-4000-watches/
  52. https://www.kompetenzzentrum-hannover.de/wie-man-eine-wasserpfeife-zeichnet-eine-schritt-fuer-schritt-anleitung/
  53. https://www.erythrozyten-info.de/the-importance-of-milady-standard-cosmetology-in-modern-beauty-education/
  54. https://www.flamingofanny.com/die-welt-der-e-zigaretten-packwoods-1000mg-vape-im-fokus/
  55. https://www.nopornpledge.com/the-importance-of-o-ring-standard-sizes-in-metric-systems/
  56. https://www.fistralbackpackers.co.uk/the-art-of-smoking-exploring-the-world-of-pill-bongs-and-water-pipes/
  57. https://www.cko-mannheim.de/de-beste-screen-protectors-voor-de-vivo-y76-5g/
  58. https://www.container-finden.de/replica-reloj-hublot-geneve-the-risks-and-consequences-of-counterfeit-watches/
  59. https://www.custommarketingco.com/are-elf-bars-banned-exploring-the-controversy-surrounding-e-cigarettes/
  60. https://www.meringueboutique.com/de-perfecte-horlogebandje-van-aerowatch-stijl-en-functionaliteit/
  61. https://www.telecentros.org/die-faszination-der-wasserpfeife-eine-reise-durch-geschichte-und-kultur/
  62. https://www.adoptabritt.org/exploring-the-legal-age-for-vaping-what-age-can-you-vape/
  63. https://www.morrowind-mod.com/the-art-of-enjoying-cookies-and-bongs-a-unique-smoking-experience/
  64. https://www.jarnacny.com/the-controversy-surrounding-diamon-vapes-in-the-e-cigarette-industry/
  65. https://www.writersconferencenyc.org/how-to-spot-fake-audemars-piguet-watches/
  66. https://www.corvettecafe.org/the-controversy-surrounding-best-replica-rolex-black-gmt-watches/
  67. https://www.koleksi.org/who-makes-the-best-replica-rolex-watches/
  68. https://www.phlylabs.de/the-allure-of-omega-watches-a-closer-look-at-replications/
  69. https://www.medanrentalmobil.com/the-allure-of-rolex-submariner-replica-watches-a-deep-dive-into-affordable-luxury/
  70. https://www.audubonmiamivalley.org/die-faszination-von-wasserpfeifen-amsterdam-vodka-bong-und-ihre-bedeutung-in-der-modernen-kultur/
  71. https://www.asklilach.co.uk/de-beste-telefoonhoesjes-voor-de-samsung-s9/
  72. https://www.fraservineyard.com/de-beste-telefoonhoesjes-voor-de-iphone-6s/
  73. https://www.industrial-ventilation.net/the-importance-of-percussion-in-music-education-a-deep-dive-into-standard-of-excellence-book-2/
  74. https://www.mustanghobbies.com/exploring-the-world-of-hookah-tops-a-comprehensive-guide/
  75. https://www.cafelatino-jazz.com/the-rise-of-hookah-pens-a-trend-in-2014-and-beyond/
  76. https://www.daltonssteakhouse.com/dabwood-thc-vape-eine-neue-ara-des-dampfens/
  77. https://ellis-construction.com/3456
  78. https://www.frenchriverconnection.org/the-allure-of-imitation-luxury-watches/
  79. https://www.themediacube.co.uk/understanding-national-metal-roofing-standards-importance-and-implementation/
  80. https://www.fosterfacts.net/la-montre-raplique-un-equilibre-entre-luxe-et-accessibilite/
  81. https://etownpanel.com/3481
  82. https://www.manthorpeforge.co.uk/the-importance-of-iso-business-continuity-standard-22301/
  83. https://marspc.com/how-to-know-when-your-elf-bar-is-done-a-guide-to-electronic-cigarettes/
  84. https://www.bullsheadwilpshire.co.uk/de-beste-screenprotectors-voor-de-oneplus-nord-n10/
  85. https://www.cassandra2.com/vape-liquid-wholesale-the-ins-and-outs-of-e-cigarette-liquid-distribution/
  86. https://www.o2-usa.org/die-kunst-des-handgemachten-handmade-bongs-und-ihre-bedeutung-in-der-wasserpfeifen-kultur/
  87. https://www.midkentvehicleservices.co.uk/the-importance-of-standard-bank-proof-of-payment-pdf-in-financial-transactions/
  88. https://www.auvets.com/the-giraffe-bong-a-unique-addition-to-the-world-of-water-pipes/
  89. https://www.bunburycompany.org/the-allure-of-omega-replicas-a-deep-dive-into-timepieces/
  90. https://www.cewdc.org/where-can-i-buy-a-high-line-replica-rolex-watch-and-not-get-ripped-off/
  91. https://www.trffoodshelf.org/2025/03/26/the-aqua-terra-omega-replica-a-timeless-classic/
  92. https://www.lola-national.org/2025/03/27/de-voordelen-van-een-magnetisch-iphone-7-telefoonhoesje/
  93. https://www.heelspurs.co.uk/les-montres-rolex-lart-de-la-raplique-aaa-suisse/
  94. https://www.beautyskinuk.co.uk/die-faszination-der-wasserpfeifen-eine-reise-in-die-welt-des-bambus-bongs/
  95. https://www.fairleelibrary.org/das-vapen-auf-teneriffa-was-sie-wissen-sollten/
  96. https://www.cubelite.co.uk/the-pros-and-cons-of-purchasing-5-elf-bars-for-20/
  97. https://www.dr-g-dumais.com/3504
  98. https://www.kabelanschluss-anmelden.de/the-art-of-enjoying-heir-bongs-a-deep-dive-into-the-world-of-water-pipes/
  99. https://www.med-bettge.de/the-importance-of-icse-board-1st-standard-books-for-early-education/
  100. https://www.desertpridecenter.org/die-kultur-des-wasserpfeifenrauchens-ein-blick-auf-rakhoi-bong-da/
  101. https://www.businesspursuits.co.uk/the-danger-of-elfbar-queimado-a-cautionary-tale-of-vaping/
  102. https://ellis-construction.com/3451
  103. https://www.cathedraleventcenter.com/de-perfecte-oplossing-voor-stijl-oozoo-horlogeband-in-rozegoud/
  104. https://www.foirephoto-bievres.com/de-beste-screenprotectors-voor-de-ipad-6/
  105. https://www.lesleyharrison.net/the-allure-of-cartier-ecrou-replica-watches/
  106. https://songwritingtipsonline.com/de-beste-coque-voor-ipad-6-bescherming-en-stijl/
  107. https://www.foleygroupinfo.com/3498
  108. https://www.rapidproxy.org/the-allure-of-the-panerai-replica-pam000297-a-blend-of-heritage-and-modern-craftsmanship/
  109. https://www.sopressata.org/the-rise-of-rectangle-vapes-a-look-into-the-future-of-e-cigarettes/
  110. https://etownpanel.com/3482
  111. https://www.kayceecleaningservices.co.uk/de-beste-iphone-covers-bescherming-en-stijl-in-een/
  112. https://www.safety4toddlers.com/the-allure-of-hookah-lounges-in-las-vegas/
  113. https://www.externe-festplatte24.de/the-rise-of-bongs-exploring-the-world-of-water-pipes/
  114. https://www.aids2014community.org/the-truth-behind-breitling-b13356-chronographe-certifie-chronometre-unveiling-the-fake-market/
  115. https://www.sarcoidosisresearch.org/the-importance-of-standard-algorithm-multiplication-in-mathematics-education/
  116. https://www.premierfisheries.co.uk/the-top-ten-rolex-replicas-for-sale/
  117. https://www.griffair.co.uk/understanding-vibration-test-standards-a-comprehensive-guide/
  118. https://www.laptopinfo.co.uk/die-welt-der-e-zigaretten-ein-blick-auf-die-cali-company-und-thc-vapes/
  119. https://www.rc-durch.de/de-perfecte-leer-case-voor-je-iphone-x/
  120. https://www.ccufc.co.uk/the-importance-of-standard-lesson-commentary-in-modern-education/
  121. https://www.bomacsolutions.co.uk/de-voordelen-van-een-privacy-screen-protector-voor-de-oneplus-6/
  122. https://19thave76.com/the-rising-trend-of-vape-hookahs-understanding-prices-and-options/
  123. https://www.bullsheadwilpshire.co.uk/de-geschiedenis-van-airpods-wanneer-kwam-de-eerste-versie-uit/
  124. https://www.omlandmarkinternationalschool.org/2025/03/13/the-allure-of-omega-watch-replicas-in-007-bond-movies/
  125. https://www.clickingagent.com/essential-glass-bong-accessories-for-an-enhanced-smoking-experience/
  126. https://www.peacehousefoundation.org/de-perfecte-bescherming-voor-je-honor-10-telefoonhoesjes/
  127. https://www.marlowvw.co.uk/de-beste-screenprotectors-voor-de-lg-k22/
  128. https://www.orlandovineyard.org/die-vielfalt-der-elf-bar-pi9000-geschmacker-ein-leitfaden-zur-elektronischen-zigarette/
  129. https://www.theulsterscots.com/de-rolex-batman-een-iconische-horlogeband-en-zijn-betekenis/
  130. https://www.cookcountyforeclosurehelp.org/the-legalities-of-vaping-exploring-the-controversy-surrounding-marys-lost-vapes/
  131. https://www.bluemoonbottleneck.co.uk/are-disposable-vapes-being-banned-in-the-uk/
  132. https://www.launchhelmetcams.com/exploring-the-world-of-replica-watches-the-case-of-the-1200-swiss-grade-fake-rolex/
  133. https://www.abbyloopers.org/the-art-of-hookah-exploring-tabaco-para-hookah-and-its-cultural-significance/
  134. https://www.kennelcustoms.co.uk/the-importance-of-national-employment-standards-and-minimum-wage-in-todays-economy/
  135. https://www.gslps.org/die-welt-der-e-zigaretten-der-geek-vape-100w-im-fokus/
  136. https://aea-usa.com/de-perfecte-bescherming-voor-je-oppo-find-x3-neo-telefoonhoesjes/
  137. https://www.hotel-colonia.de/the-art-of-enjoying-swiss-cheese-bongs-a-unique-twist-on-water-pipes/
  138. https://www.inmamarti.com/the-importance-of-national-social-studies-standards-2018/
  139. https://www.sao-paulo-brasilien.de/the-allure-of-breitling-imitations-a-closer-look-at-replica-watches/
  140. https://www.bmw-parts-wholesale.com/the-dangers-of-fake-omega-cards-in-the-watch-industry/
  141. https://www.mikvehyisrael.org/understanding-national-probate-court-standards-ensuring-fairness-and-efficiency-in-probate-proceedings/
  142. https://www.kinsella-consulting-engineers.co.uk/the-impact-of-vaping-on-digestive-health-can-vaping-make-you-feel-bloated/
  143. https://www.churchillcuprugby.com/the-importance-of-understanding-modern-standard-arabic-grammar/
  144. https://www.love-poems-quotes.com/de-beste-samsung-galaxy-j3-hoesjes-bescherming-en-stijl/
  145. https://www.nurseatstarbucks.com/clones-chinos-de-rolex-en-mexico-the-rise-of-replica-watches/
  146. https://www.dasd-dms.org/the-impact-and-importance-of-national-common-core-state-standards/
  147. https://www.usdlc.org/replica-tag-heuer-calibre-36-versus-original-a-comprehensive-comparison/
  148. https://www.kennelcustoms.co.uk/understanding-the-sae-j1402-standard-a-comprehensive-overview/
  149. https://www.goldenaquarium.net/understanding-national-standards-in-music-education/
  150. https://www.vtmorganheritagedays.org/de-beste-screenprotectors-voor-de-galaxy-m33-5g/
  151. https://www.desertstar.co.uk/the-allure-of-cartier-replica-watches-in-the-netherlands/
  152. https://www.coserrc.org/de-beste-hoesjes-voor-de-motorola-edge-2022/
  153. https://www.gruene-radler-berlin.de/de-beste-xiaomi-12-accessoires-voor-jouw-smartphone/
  154. https://www.viande-attitude.com/the-ultimate-guide-to-choosing-the-best-vape-starter-kit/
  155. https://www.cyclingteam.org/exploring-the-world-of-wholesale-swiss-replica-watches/
  156. https://www.jimhjelmcouture.com/de-beste-qvc-laptop-deals-van-het-jaar/
  157. https://www.footprintsusa.net/the-controversy-surrounding-elfbar-bg-and-the-future-of-vaping/
  158. https://www.greenwichwoodworks.co.uk/the-comprehensive-guide-to-glass-bong-prices-understanding-the-market/
  159. https://www.jumpforfunparty.com/de-beste-hoesjes-voor-de-google-pixel-8/
  160. https://www.kamala-yoga.de/the-allure-of-perfect-super-knockoff-watches-a-deep-dive-into-the-world-of-replica-timepieces/
  161. https://www.gerhardtzahntechnik.de/the-impact-of-ace-pens-on-the-vape-industry/
  162. https://www.magnusthemasseur.co.uk/understanding-the-iso-450012018-standard-for-occupational-health-and-safety/
  163. https://www.be-granite-marble.co.uk/de-beste-waterdichte-hoesjes-voor-de-iphone-12-mini/
  164. https://www.peachcobblersale.org/understanding-the-bs4504-standard-a-comprehensive-guide/
  165. https://www.life-in-motion.org/the-allure-of-breitling-replica-leather-strap-watches/
  166. https://www.homeschoolingnb.com/the-world-of-movado-knockoffs/
  167. https://www.bjacool.co.uk/the-allure-of-luxury-exploring-the-world-of-replica-rolex-watches-on-amazon/
  168. https://www.grandnewporthotel.com/the-art-of-rewriting-ap-copy-for-watch-brands/
  169. https://www.ighthamcarpets.co.uk/the-cartier-pasha-watch-replica-automatic-a-timeless-classic/
  170. https://www.alonelysky.com/de-tijdloze-schoonheid-van-het-jacob-jensen-horlogebandje-722/
  171. https://www.joeyo.org/the-impact-of-nikotin-i-elfbar-on-the-electronic-cigarette-industry/
  172. https://www.casayoses.com/exploring-the-ethics-of-purchasing-replica-watches/
  173. https://wolfs111.com/die-welt-der-premium-e-zigaretten-qualitat-und-genuss-im-fokus/
  174. https://www.lionvilleymca.org/the-allure-of-luxury-exploring-the-best-rolex-replicas/
  175. https://www.tierrasdelsol.com/the-art-and-science-of-the-sandglas-gravity-bong/
  176. https://www.composttea.org/the-allure-of-replica-breitling-watches-a-comprehensive-guide/
  177. https://www.workshopforwomen.com/3496
  178. https://www.rudolf-craemer.de/the-role-of-the-national-bureau-of-standards-and-technology-in-modern-society/
  179. https://www.wwoofgreece.org/exploring-the-accusoft-pdf-viewer-standard-trial-a-comprehensive-overview/
  180. https://www.musicserve.net/exploring-the-best-hookah-flavors-a-guide-for-enthusiasts/
  181. https://www.funeral-poems.com/die-welt-der-wasserpfeifen-lustige-bongs-und-ihre-vielfalt/
  182. https://www.insurersoffers.com/the-allure-of-ebays-best-rolex-replicas-a-comprehensive-guide/
  183. https://www.bouchercon2011.com/de-beste-hoesjes-voor-xiaomi-buds-3-bescherming-en-stijl/
  184. https://www.jardinesdegerena.com/die-faszination-des-wasserpfeifenrauchens-ein-blick-auf-die-welt-der-shishas/
  185. https://www.ms-traveling.de/de-beste-telefoonhoesjes-voor-de-samsung-a53-5g/
  186. https://www.alonelysky.com/de-beste-horlogebandjes-voor-de-fitbit-charge-2/
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Анамнез

22 февраля 2021, в Нефроцентр «Ответ» филиал г. Санкт-Петербург поступил кот Фунтик, метис, 7 лет.

В январе 2021 обратились в стороннюю клинику с жалобами на снижение аппетита, увеличение живота в размерах в последние несколько месяцев, был поставлен диагноз: двусторонний поликистоз, на в/в инфузиях в сочетании с терапией отмечен рост почечных показателей.

Стоит уточнить, что владельцы намеренно обратились в «Ответ», с целью определения возможности трансплантации почки, поэтому на момент поступления на руках у них уже были результаты лабораторных исследований из списка необходимых инфекций перед трансплантацией, данный факт значительно ускорил процесс предоперационной подготовки реципиента.

На момент поступления

22.02.21

Креатинин 640 мкмоль/л, Мочевина 54,3 ммоль/л, ОС стабильно тяжелое, гипорексия, тургор снижен, дегидратация 6-7 %, кахексия средней степени.

ОАМ: микрофлора все поле зрения, плотность 1,010, лейкоциты 20-25, слизь+.

УЗИ брюшной полости: интраренальные структуры почек замещены конгломератом анэхогенных, частично гетерогенных включений (за счет крупнодисперсного аморфного компонента), размером до 3,5 см в диаметре. Нефромегалия.

Учитывая гетерогенность содержимого кист, было принято решение о проведении ТИАБ под контролем УЗИ, с целью исключения возможности неоплазии и целесообразности трансплантации, признаки подострого панкреатита, энтерита, гастрита, умеренного холецистита (сладж – около 30% ж.п.)

ЭХО сердца: утолщение стенки МЖП в базальном сегменте, неоднородность миокарда, гемодинамически стабильно.

Проведен забор крови на Тропонин I

Начата иммуносупрессивная терапия и процесс подбора донора на гистосовместимость (процесс подбора донора и определения степени гистосовместимости пары донор-реципиент рассмотрен в статье «Трансплантация почек у животных»).

25.02.21

День пересадки

О.С. стабильно тяжелое, Т, А/Д в норме. Креатинин 642 Мочевина 57

Тропонин I -0,1

Получены результаты ТИАБ содержимого кист почки

Ввиду специфики метода трансплантации, при котором почка донора «подсаживается» реципиенту в область гипогастрия, мы столкнулись с дилеммой следующего характера: уже имеющаяся билатеральная нефромегалия увеличивает внутрибрюшинное давление, создавая существенную компрессию на органы брюшной полости. При помещении в область гипогастрия еще одной почки (трансплантата) и без того большое внутрибрюшинное давление возрастет, что может быть опасным для всех органов в брюшной полости. В первую очередь может пострадать трансплантат, который нуждается в адекватной перфузии и отсутствии любых компрессионных нагрузок, по крайней мере в фазу «запуска», которая длится от 6 часов до 2 суток, тогда когда трансплантат наиболее уязвим вследствие интраоперационной ишемии. Для снижения внутрибрюшинного давления было принято решение о совмещении трансплантации с нефроэктомией, но выполнить это не удалось ввиду тяжелого состояния реципиента и анестезиологических рисков, связанных с увеличением продолжительности трансплантации. Во время операции было решено провести нефроэктомию через некоторое время, в случае удачного разрешения трансплантации.

26.02.21

Фаза «запуска» трансплантата, характеризующаяся полиурией до 4 мл/мин/кг, в нашем случае продлилась 6 часов. На следующий день трансплантат проявил свою состоятельность в части фильтрационной способности: за ночь креатинин упал на 217 ед.

О.С стабильное Т, А/Д в норме. Кот начал есть самостоятельно, докармливание через стому.

Креатинин 415 Мочевина 58 WBC 16 HTC 37

А Fast – свободная жидкость в следовом кол-ве в проекции мочевого пузыря.

T fast – свободной жидкости в грудной полости/полости перикарда не визуализируется, гемодинамика сердца не нарушена.

27.02.21

Креатинин 264 мкмоль/л, Мочевина 59 ммоль/л

Улучшение общего состояния, аппетит усилился, докармливание через стому. УЗИ брюшной полости: увеличение трансплантата в размере (в сравнении с данными почки донора) без допплерографических / допплерометрических изменений данных артериального кровотока, пиелоэктазия, значительное утолщение стенки мочевого пузыря в проекции неоуретероцистоанастомоза.

28.02.21

О.С стабильное, ест самостоятельно, Т, А/Д в норме.

Креатинин 228 мкмоль/л, Мочевина 37ммоль/л УЗИ – значительное утолщение стенок мочеточника на всём протяжении вплоть до неоуретероцистоанастомоза, при этом размер лоханки без отрицательной динамики; ОАМ – плотность 1,021, белок 0,3, лейкоциты 0-3, м/фл +.

Проведено снятие уретрального катетера.

01.03.21

О.С стабильное, ест сам, Т, А/Д в норме.

Креатинин 211 мкмоль/л, Мочевина 34 ммоль/л

05.03.21

О.С стабильное, Т, А/Д в норме, аппетит в норме.

Креатинин 170 мкмоль/л, Мочевина 25 ммоль/л

Ввиду отличного состояния пациента, хорошего аппетита и стабилизации почечных показателей в пределах допустимых норм, нами было принято решении выписке животного на амбулаторное лечение. При стабильном состоянии выписка и снятие стомы запланировано на 06.03.21 – 07.03.21

07.03.21

О.С стабильное, вялый, аппетит снижен с вечера 06.03.21, докармливание через стому.

Повышение температуры до 40,5.

Креатинин 140 Мочевина 13 WBC 13 HTC 23

Нами было принято во внимание возможность наличия у животного вирусной инфекции.

Проведено забор необходимых анализов на инфекции.

09.03.21

О.С стабильно, Т, А/Д в норме, аппетит отсутствует, кормление через стому, чихает.

Креатинин 115 Мочевина 8 WBC 16 HCT 17

ОАМ: белок 0,3, плотность 1,020, лейкоциты 0-2.

Проведено трансфузия 30 мл отмытой эритроцитарной массы и 32 мл плазмы

Вечер – с аппетитом съел пауч.

11.03.21

О.С стабильное, активный, аппетит сохранен, снижен, Т, А/Д в норме, стул оформленный.

Чихает, появились серозные выделения из глаза и носа.

Проведена корректировка назначений.

Креатинин 116 Мочевина 10 НСТ 23 WBC 23

12.03.21

О.С, удовлетворительное, Т, А/Д в норме, обильные истечения из носа и глаз, гипорексия, докармливание через стому.

Креатинин 103 Мочевина 9 НСТ 19 WBC 22

Получены результаты лабораторных исследований.

17.03.21

ОС удовлетворительное, м/и, стул в норме, Т, А/Д в норме, гнойные истечения из глаз и носа, гипорексия, докармливание через стому.

Креатинин 143 Мочевина 12 НСТ 27 WBC 17

19.03.21

ОС стабильное, Т, А/Д в норме, аппетит в норме, истечения из глаз и носа скудные

Креатинин 133 Мочевина 11 НСТ 21 WBC 20

Выписка

22.03.21

ОС стабильное, Т, А/Д в норме, аппетит отличный, истечения из глаз и носа скудные

Проведено: снятие стомы, отмена ИПС.

Креатинин 118 Мочевина 11,8 НСТ 26 WBC 17

ОАМ: плотность 1,027, белок 0,3, лейкоциты 0-2, эритроциты 0-2, м/фл +

09.04.21

Фунтик и Гангста (донор) дома

Материал предоставлен владельцем

17.04.21

На момент написания данного клинического случая, мы решили связаться с владельцами с целью получения информации о самочувствии Фунтика.

Из разговора выяснили, что в последние 3 дня отмечена вялость и однократная рвота.

Стоить уточнить, что из разговора с владельцем стало известно о том, что в последнюю неделю ими самостоятельно были отменены некоторые препараты. К вечеру Фунтик был в Московском Филиале «Ответа».

О.С. стабильное, Т 39,5, А/Д: 140/80

Креатинин 246 мкмоль/л, Мочевина 59 ммоль/л, ОКА WBC 12 HTC 35 ОАМ: плотность 1,010, лейкоциты единичные, м/ф +

Забор крови на определение уровня циклоспорина

УЗИ: значительное увеличение размеров трансплантата, высокоскоростной высокорезистивный поток артериального кровотока.

На основании анамнеза, результатов полученных лабораторных исследований, а также данных УЗИ мы полагаем, что имели дело с отторжением трансплантата в ранний посттрансплантационный период на фоне снижения иммуносупрессивной терапии.

18.04.21

О.С стабильное, Т, А/Д, норма, Креатинин 316 Мкмоль/л Мочевина более 59 ммоль/л Аппетит сохранен, снижен

УЗИ: увеличение трансплантата в размере

19.04.21

О.С. стабильное, Т, А/ Д, норма, аппетит снижен

Креатинин 362 мкмоль/л, Мочевина более 59 ммоль/л

20.04.21

О.С стабильное

Креатинин 343 мкмоль/л, мочевина более 59 ммоль/л

ОАМ-плотность 1,020, белок 0,4, лейкоциты 0-5, м/фл +++

Аппетит снижен

21.04.21

О.С

Креатинин 222 мкмоль/л, мочевина 53 ммоль/л

УЗИ

Аппетит отличный, самочувствие хорошее, Т, А/Д норма. Так как в московском филиале «Ответа» совсем недавно произошли кадровые решения и 21 апреля мы не имели возможность провести доплерографическое исследование, было принято решение отправить Фунтика на УЗИ в стороннюю клинику.

22.04.21

Фунтик отправился домой.

26.04.21

Со слов владельца самочувствие отличное, аппетит в норме.

Креатинин 140, мочевина 8

УЗИ не проводилось.

Вывод

Каждый клинический случай трансплантации почки у животного уникален и исходя из вышенаписанного, становится ясно, что не всё зависит от действий врача и клиники вцелом.

В случае с Фунтиком нашим недочетом, по всей видимости, явился недостаток общения с владельцами до трансплантации. Вероятней всего, мы в недостаточной степени смогли донести до владельцев информацию о важности тщательного наблюдения за состоянием животного в ранний посттрансплантационный период, а также о важности ежедневной без уменьшения кратности дачи необходимых препаратов.

В любом случае, для нас этот случай послужил ценным опытом и примером того, как владельцы могут по своему интерпретировать наши слова. Признаем своим ошибки, будем стараться их исправить.

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Нефрология
Нефрология
Гемодиализ
Гемодиализ
Трансплантация почек
Трансплантация почек
Рентген, УЗИ - визуальная диагностика
Рентген, УЗИ - визуальная диагностика
Лаборатория
Лаборатория

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Алипов Александр Андреевич Познакомиться x

Окончил Санкт-Петербургскую Академию Ветеринарной Медицины.

По окончании был приглашен в аспирантуру на кафедру фармакологии.

Тема кандидатской диссертации – «Особенности васкуляризации сосудов головы и шеи млекопитающих».

Алипов Александр Андреевич
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Суворов Олег Николаевич Познакомиться x

Опыт работы с 2005

Специализация нефрология

Образование Санкт-Петербургская Государственная Академия ветеринарной мtдицины, 2005

Дополнительное образование, оконченные курсы, стажировки:

2006-2009 год Аспиратнт кафедры общей и частной хирургии СПБГАВМ.

Суворов Олег Николаевич
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Кондрашов Иван Сергеевич Познакомиться x

Окончил УГАВМ. С апреля 2018 г. и по настоящее время работаю в центре ОТВЕТ в должности ветеринарного врача.

Визуальная диагностика, хирургический (ортопедический) прием, провожу операции разного уровня сложности.

Участвую в разработке и проведении хирургической составляющей в комплексе мероприятий по трансплантации почек.

Кондрашов Иван Сергеевич
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