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貓之慢性腎衰竭
作者: 許如瑩;賴政宏;鄭豐邦
中文病名: 貓之慢性腎衰竭
英文病名: Chronic Renal Failure in Cats
疾病描述:

血液中之尿素、肌酸酐或非蛋白氮上升時稱為氮血症( Azotemia ),氮血症的嚴重程度導致臨床症狀出現時則稱為尿毒症(Uremia)[17],而當雙側腎臟失去其四分之三的工作能力時便可稱做腎衰竭[22]。腎衰竭可分為急性及慢性兩種病程。急性腎衰竭通常起因於腎臟缺血缺氧或接觸具腎毒性物質,而使腎元中代謝旺盛的近端小管及亨利氏環的上皮細胞受損,造成腎功能突然下降,在移除致病因子後可能恢復正常。而慢性腎衰竭則是指腎臟的損害已持續至少三個月以上,受損的區域遍及整個腎元,且不具恢復性,最後會由纖維結締組織取代形成end - stage kidney[11],代表腎臟已經完全沒有濃縮過濾尿液的功能了。慢性腎衰竭分級,目前根據 international renal interest society分為四級,主要是根據血中的creatinine濃度來區分,這個分級也被認為和存活時間有關[17]。

病因:
造成慢性腎衰竭的原因在先天性方面有,例如阿比西尼亞和東方短毛較常見的類澱粉沉著症,以及在波斯和喜瑪拉雅較常見的多囊腎疾病。後天造成慢性腎衰竭的因子有各種感染,例如細菌性感染、leptospirosis或feline infectious peritonitis等都可能造成腎臟慢性受損。其他像是免疫複合物沉積在絲球體,lymphosarcoma、renal cell carcinoma、nephroblastoma等腫瘤">腫瘤。另外急性腎衰竭的病程減緩後也可能變成慢性腎衰竭。腎結石造成的雙側水腎,副甲狀腺亢進導致高血鈣沉積在腎臟,或是自發性的慢性腎衰竭等等[17]。

臨床症狀:
根據2010年的危險因子調查,在診斷出慢性腎衰竭前的一年常可見多喝多尿多渴的症狀,尿量增加,或是有下泌尿道疾病,頻繁嘔吐,食慾下降,減少乾飼料的攝食量,毛髮狀況變差,黏膜蒼白肌肉無力,疲倦,不明原因的體重下降等。這些也常是慢性腎衰竭病患在就診時表現出的臨床症狀[14]。

預防控制方法:

之慢性腎衰竭多為年老自發性疾病,在預防控制上較為困難,但仍須以長期飲食控制為主,使用低磷低蛋白處方飼料,並每天攝取足夠水分已達控制目的。

相關圖片:
Fig. 1 放射線檢查-雙側腎臟輕微縮小 (許如瑩)
Fig. 2 超音波檢查-左側腎臟偏小(許如瑩)
Fig. 3超音波檢查-右側腎臟偏小(許如瑩)
參考文獻:

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參考連結: