加载中…
个人资料
瑞鹏刘小红
瑞鹏刘小红 新浪个人认证
  • 博客等级:
  • 博客积分:0
  • 博客访问:6,545
  • 关注人气:61
  • 获赠金笔:0支
  • 赠出金笔:0支
  • 荣誉徽章:
相关博文
推荐博文
谁看过这篇博文
加载中…
正文 字体大小:

Feline Systemic Hypertension

(2012-02-09 14:03:55)
标签:

娱乐

分类: 内科专题

Feline Systemic Hypertension

Feline Hypertension

•            why measure blood pressure

•             为什么测量高血压?

Because the consequence of hypertension is devastated
因为高血压的后果是毁灭性的
target organ damage
会损坏器官

•     cause of hypertension

•     高血压的原因

•     pathophysiology

•     病理生理学

•     target organ damage

•     以损坏器官为目标

•     screening

•     筛选

•     diagnosis and treatment

•     诊断和治疗

Cause of hypertension
高血压的原因

•Primary renal disease  原发性肾脏疾病

•  -chronic kid disease(CKD) -慢性肾脏病

•  -polycystic kid disease(PKD) -多囊肾

•Glomerulonephropathies   肾小球肾病

•Hyperthyroidism  甲亢

•Adrenal disease  肾上腺疾病

•Acromegaly  肢端肥大症

•Polycathaemia 红细胞增多症

•Increased intracranial pressure 颅内压升高

 

 

Determinants of ABP

动态血压的决定因素

     MAP=CO×TPR

    

    

    CO=HR×CV

   

    CO∝total body water

 

Neurohormonal control of BP
血压的神经激素控制

 

•                           baroreceptors 压力感受器

•Neurological       chemoreceptors化学感受器

•神经学上的         CNS ischaemic response

•                           中枢神经系统缺血反应

•Hormonal            catecholamines儿茶酚胺

•激素的                 ADH 抗利尿激素

•                            ANF心钠素

•                            RAAS

•                            肾素-血管紧张素-醛固酮系统

 

   BP血压

  

    arteriole spasm          protect capillary bed

    微动脉痉挛                保护毛细血管床

   

 

 

   arteriole sclerosis     capillary bed hypoxia

   微动脉硬化               毛细血管床缺氧

      arteriole spasm

      微动脉痉挛    

                       target organ damage  损害器官

                  

Target organ damage

 

 

 

 

 

 

•                  cause and effect

CKD cause systemic hypertension

•Activation of RAAS、

•肾素-血管紧张素-醛固酮系统的激活

•Hyperaldosteronism

•高醛甾酮症

•Sodium retension

•钠潴留

•Increased sympathetic activity

•交感神经活动增加

 

 

 

 

 

 

 

 

 

•       renin  肾素

 

• 

•angiotensinⅡ血管紧缩Ⅱ

 

 

•Aldosterone         TPR

•醛固酮

 

•Sodium retension

•钠潴留

 

•Systemic hypertension

•全身性高血压

 

 

•Target organ-kidneys

 

•     CKD cause systemic hypertension

 

•     systemic Hypertension cause CKD

•     

Renal autoregulation

•BP

 

•Arteriole spasm           protect capillary bed

•微动脉痉挛                   保护毛细血管床

•CKD-afferent glomerular artreiole dilation maintains GFR 慢性肾脏病-入球小动脉扩张来维持肾小球滤过率 。

•Renal autoregulation sacrificed to maintain GFR

•肾脏自动调整来维持肾小球滤过率

•Elevated systolic blood pressure transmitted to glomerular capillary

•升高的收缩压传到肾小球毛细血管

 

Progression of chronic kidney disease

                                

Glomerular

Capillary

Pressure

肾小球毛细血管压

(mmHg)

Target organ-kidneys 目标器官:肾脏

•                                    chronic kidney disease

•                                                   慢性肾脏疾病

 

•                                                preglomerular vasodilation

•Systemic hypertension            肾小球前血管扩张

 

•全身性高血压                          glomerular hypertension

•                                                肾小球高压

 

•                                                progressive renal injury

•                                                  越来越来严重的肾脏损伤

Systolic blood pressure >160 mmHg
收缩压>160 mmHg

   Prevarence of hypertension in CKD

     慢性肾脏疾病中高血压的普遍性

•20% of cats with CKD are hypertensive(19%-65%)

•20%患有慢性肾脏疾病的猫是高血压的(19%-65%)

•66% of cats with CKD that are hypertensive are azotaemic

•66%患的肾脏疾病的猫的高血压是氮血症的

•azotaemia usually not severe

•氮血症 通常不严重。

 

 

Target organ-heart  目标器官- 心脏

•Systolic murmur and gallop rhythm common

•收缩杂音伴随奔马律

•Left ventricular hypertrophy-may regress with treatment

•左心室肥大——治疗后可恢复

•Human-diastolic CHF common

 

•CHF rare in cats with hypertension

•高血压的猫罕有充血性心力衰竭

•Caution with IV fulid administration

•静脉输液治疗要慎重

Target organ damage- vascular
损害器官-血管

Target organ damage
损伤器官

•The eyes 眼睛

 

•Target organ-eyes

•目标器官-眼睛

•Most commonly identified target organ damage

•最能够检查出来的器官损伤

•Complete retinal detachment\hyphaema

•视网膜完全脱离

Be familiar with normal fundus appearance
对眼底部的样子很熟悉

•Target organ-eyes

•Always perform fundoscopy

•通常使用眼底检查

Hypertensive choroidopathy
高血压性脉络膜病

choriocapillaries:

脉络膜血管

    no autoregulatory vasoconstriction

    不是自动调整的血管收缩

    exudation of plasma into subretinal space

    血浆渗出进入视网膜下腔

             bullous detachment大泡状脱离

                  focal or complete  病灶的或全身的

                  retinal oedema  视网膜水肿

                  retinal folds  网膜皱襞

Target organ-eyes

•大泡状脱离

•视网膜出血

Target organ-eyes

Target organ damage

•The CNS

•中枢神经系统

Cerebral blood flow autoregulation:
大脑血流量自动调整:

•Maintain constant cerebral blood flow

•维持恒定的大脑血流量

•Severe hypertension-transmission of systemic pressure

•严重的高血压-全身血压的传递

•  CNS heamorrage\infraction\ischemia

•   中枢神经系统出血/中断/局部缺血

•   SPB>180mmHg

•   收缩压 >180mmHg

•   brain or spinal cord affected

•   脑髓和脊髓受影响

•   Eg seizures,vestibular signs

•   例如痉挛、前庭症状

•Acute onset clinical signs

•急性临床症状发作

•Good prognosis for recovery if hypertension controlled

•假如高血压得到控制,恢复时预后良好

Target organ-brain
目标器官-脑髓

Diagnosis of hypertension
高血压的诊断

•Indirect methods 间接方法

•  1 oscillometric  动脉搏动描记器

•   accurate BP reading in anaesthetised cats

•   在猫麻醉时能准确测出血压

 

•   2 doppler

•多普乐

 

•   accurate BP reading in aneasthetised and conscious cats

•   在猫处于麻醉和清醒状态中都能准备测出血压

•                                                    -easy to use 使用简单

•Doppler vs oscillometric              -repeatability of results 结果可重复                                                                                                                             

•多普乐与动脉搏动描记器比较     -faster results   更快出结果

 

Doppler methods-the “white coat effect”
多普乐方法-

•Sympathetic stimulation increases HR and blood pressure

•交感神经刺激 增加呼吸频率和血压

 

 

 

 

 

 

•“White coat” effect:-27mmHg to 75 mmHg

•白大衣效应 :-27mmHg to 75 mmHg

•Habituation dose not occur after multiply visits

•多次刺激没有发生成瘾

•Minimised after 10-15 min acclimatisation

•在10-15分钟的适应后减小到最少

 

 

Systolic BP measurement
收缩压测量

Which patient?
患病的范畴是什么?

•All cats>10 y    所有小于10岁的猫

•All cats with CKD   所有慢性肾脏疾病的猫

•All cats with systolic heart murmur 所有收缩杂音的猫

•All cats with CNS signs  所有有中枢神经系统症状的猫

•All cats with cs of ocular end-organ damage

•所有患有视觉器官末稍中枢系统损伤的猫

•all cats with diseases cause hypertension

•所有的患有能引起高血压的疾病的猫

         primary renal disease  原发肾脏疾病

          hyperthyroidism 甲亢

          adrenal disease 肾上腺疾病

          acromegaly   肢端肥大症

          polycythaemia   红细胞增多症

Systolic BP measurement
收缩压测量

•10 mins ,quiet room, owner present

•10分钟,在安静的房间,宠主出现

•Forelimb,hindlimb, or tail

•前肢 ,后肢或尾部

Systolic BP measurement
收缩压测量

 

 

 

 

 

•Cuff width =40% circumference of limb

•橡皮囊细带宽度= 腿周长的40%

•Undesized cuffs overestimate SBP

•较小的橡皮囊细带测出来的估计比正常收缩压高

•Oversized cuffs underestimate SBP

•较大的橡皮囊细带测出来的估计比正常收缩压低

Systolic BP measurement
收缩压测量

•Cuff mid-way between carpus and elbow

•橡皮囊细带在腕部和肘部之间的中点

Systolic BP measurement
收缩压测量

•Cat seating,sternal recumbency

•猫坐着或胸部朝下卧着

•Cuff level with heart

•橡皮囊细带和心脏在同一水平线上

•30-60s between reading

•读数在30-60s之间

•5readings,discard 1st< 20%variation in at least 3 consecutive readings

•5次计数,除去第一次读数,连续三资测量的读数变化率必须小于20%

 

Systolic BP measurement
收缩压测量
look carefully at end-organ damage
仔细看器官末稍损伤

•Fundic examination(topical mydriatics)基底检查()

局部瞳孔放大剂)

•Renal palpation

•肾脏触诊

 

•Cardiac gallops,murmurs,arrhythmias  奔马律,心杂音,心律不齐

When is elevated
什么时候血压升高?

What other date to collect?
要收集其它什么数据呢

•Rule out scendary cause of hypertension

•排除高血压的继发性原因

•    haematology  血液病学

•     biochemistry ,include electrolytes 生物化学,包括电解质

•     total T4  总T4

•     urine specific gravity 尿比重

•     urinalysis尿分析

•     urine protein:creatinine 尿蛋白:肌酸酐

•Consider abdorminal ultrasonography-renal\adrenal diseases  考虑腹部超声波检查法 –肾脏或肾上腺疾病

Chronic kidney disease
慢性肾脏疾病
the most common cause of hypertension in cats
在猫中最常见的引起高血压的原因
CKD can be staged using IRIS staging system
CKD能够用IRIS分级系统进行分级

•Staging system for CKD     CKD分级系统

•  Step1:staging is initially based on testing plasma creatinine assessed on at least two occasions on the stable patient  首先根据检查血浆肌酐来进行评估级数,在稳定的病人身上至少进行两次。

• Step2:cases are then sub-stage based on proteinuria and blood pressure

                 根据蛋白尿和血压进行次分级。

 

Plasma creatinine concentration

血浆肌酐浓度

 

•Substaging CKD:urine protein to creatinine ratio(up\c)

•CKD次分级:尿蛋白肌酸比

 

 

 

 

•Substaging CKD:the risk of end-organ damage of hypertension

•CKD次分级:高血压的器官末稍损伤的风险。

Proteinuria-dipsticks and UPCS
蛋白尿——测验片 和UPCS

•Urine dipsticks 尿液测验片

-only reliable to detect proteinuria in glomeruloneuphropathies 只有在肾小球病时检测蛋白尿是可靠的

-most common finding trace or1+protein uninterpretable:negative ,borderline ,or postiveUPC

Urine protein:creatinine  尿蛋白:肌酐

-most reliable methods for detection of proteinuria

-检测蛋白尿最可靠的方法。

-must be accompanied by full UA and TPP

-必须伴随着全尿酸(或尿(嘧啶核)苷酸 ,尿的醛固酮
尿刊酸,咪唑丙烯酸)和焦磷酸硫胺素。

Refractometer –urine spicific gravity尿比重折射计

 

What are the benefit stagingof CKD?
给CKD分级有什么好处呢?

•Prognostic information 诊断信息

•   CKD stage at time of diagnosis strongly correlated with survival  CKD在诊断时间上的分级和成活有着强烈的关系

 

 

 

 

•Proteinuria in cats with CKD is predictive of survival

•患有CKD的猫能检测出蛋白尿可预测它能成活

•Proteinuria in cats with hypertension is predictive of survival  患有高血压的猫能检测出蛋白尿可预测它也能成活

 

Proteinuria and CKD 蛋白尿和慢性肾病

Treatment of hypertension
高血压的治疗

•1 BP>=160   血压>=160

•   CNS or ocular signs  中枢神经系统或视觉症状

•   start treatment 开始治疗

•2 BP 160-179(moderate risk) 血压在160-179(中度危险)

•   No CNS or ocular signs 没有中枢神经系统或视觉症状

•   Recheck 1-2× over 1-2 months 超过1-2个月重新检查1-2次

•   BP160-179   血压:160-179

•   Start treatment开始治疗

•3 BP>=180(high risk)   血压>180

•   No CNS or ocular signs   没有中枢神经系统或视觉症状

•   Recheck 1-2× over 1-2 weeks    超过1-2个月重新检查1-2次

•   BP>=180

•   Start treatment开始治疗

Treatment of hypertension
高血压的治疗

 

 

 

•Recheck BP 7-10 d after starting amlodipine

•在服用氨氯地平 后7-10后再没一次血压

•If BP>=160mmHg,increase amlodipine dose or add an ACE-inhibitor 假如BP>=160mmHg,增加氨氯地平剂量或添加血管紧张素转换酶抑制剂

•If BP<=160mmHg,recheck every 1to 4 months

•假如BP<=160mmHg,每1到4个月重新检测血压

•  

Use of ACE-I
血管紧张素转换酶抑制剂的使用

•ACE-I cause a increase in GFR

•血管紧张素转换酶抑制剂引起肾小球滤过率增加

•0-20% elevation in  serum creatinine

•血清肌酐升高0-20%

•  Do not use ACE-I in decompensated CKD

•  代谢失调性CKD时不要使用血管紧张素转换酶抑制剂

•2 date sets serum biochemistry ideal

•2 个数据使血清生化理想

•0nly in cats that are eating and drinking

•只有猫才服用那个

•Check creatinine 7 d after start ACE-I

•开始服用ACE-I7天后检查肌酸酐

Hypertension and dietary Na restriction
高血压和饮食中Na离子的限制

•May not lower in systemic blood pressure

•可能不低于全身血压

•May have adverse effects via activation of RAAS

•通过肾素-血管紧张素-醛固酮系统激活可能会有副作用。

Case study:baby
病例研究

•19yr old FN DSH  19岁, 猫    ,短毛家猫

•Normal the night before 晚上之前正常

•Sudden onset falling over ,could not stand

•突然发作,摔倒了,之后不能站立

•PE 体格检查

•HR190,gallop 心率190  ,奔马律

Neurological examination:
神经系统检查:

•R head tilt  头呈R状倾斜

•Vertical nystagmus

•垂直性眼球震颤

•R postural reaction+proprioceptive deficits

•R状姿势反应+本体感觉障碍

•Spinal reflexes normal

•脊反射 正常

•Right central vestibular lesion

•左中前庭损伤

investigation:
调查

•Systolic blood  pressure 220mmHg

•收缩压220mmHg

•    Hypertension-cause or effect of CNS signs

•    由高血压引起或影响的中枢神经系统症状

•Fundic examination 

•基底检查

•   bullous retinal detachment 

•大疱视网膜脱离

•   retinal folds网膜皱襞

investigation:
haematology :normal
血流学:正常

 

 

 

 

 

 

 

Assessment:

评估:

•-stage Ⅱ CKD  慢性肾病 2期

•-high risk (Ⅳ) hypertension 高血压高危四级

•-borderline proteinuria 不明确的蛋白尿

Treatment
治疗

•Amlodipine 1.25mg q 24h PO

•氨氯地平1.25mg q 24h PO

•7 days later systolic BP 170mmHg

•7天后SBP170mmHg

•Benazepril 2.5mg q 24h PO  

•贝那普利 2.5mg q 24h PO

•10 days later SBP 145mmHg

•10天后SBP 145mmHg

•14 mo later-normal ,no residual neurological dificits

•14 mo 后-正常,神经障碍痊愈

•-no residual neurological dificits    神经障碍痊愈

•-SBP=170mmHg 

•-increase amlodipine to 1.25mg AM,0.625mg PM

•增加氨氯地平到1.25mg AM,0.625mg PM

renomegaly肾肿大

•Perirenal pseudocysts肾周假囊肿               FIP

•Renal lymphoma肾淋巴瘤                           ARF急性肾功能衰竭

•Polycystic kidney disease(PKD)多囊肾病   enal abscess肾脓肿

•Hydronephrosis肾盂积水                             renal haematoma 肾血肿

•Compensatory hypertrophy 代偿性肥大      renal carcinoma肾癌

•Pyelonephritis肾盂肾炎                               metastatic neoplasia 转移瘤

•glomerulonephritis肾小球性肾炎

Diagnostic approach诊断方法

•Abdominal palpation-renal palpation

•腹部触诊——肾触诊

•Firm, smooth margins

•结实,边缘光滑

•Firm irregular margins

•结实,边缘不规则

•Fluctuant , smooth margins

•能移动的,边缘光滑

•Fluctuant, irragular

    margins

   能移动的,边缘不规则

 

 

•            Firm, irregular margins 结实,边缘不规则

 

•                           renal neoplasia 肾瘤

•                           inflammatory 发炎

•                           retroperitoneal mass 腹膜后有肿块

Abdominal palpation
腹部触诊

 

 

 

 

 

 

•     Fluctuant , smooth margins能移动的,边缘不规则

•             retroperitoneal fluid  腹膜后积水

•             subcapsular fluid  被膜下积水

•             intraparenchvmal fluid

 

 

 

Abdominal palpation

 

 

•    fluctuant,irregular margins能移动的,边缘不规则

•                Cysts(PKD)多囊肾病

•                haematoma 血肿

•                abscess 脓肿

Diagnostic approach诊断方法

•Abdominal palpation

•腹部触诊

•SBP 收缩压

•Minimum data base

•最小数据库

•Renal imaging肾显像

•FNA or renal biopsy

•细针抽吸或肾活检

Minimum data base最小数据库

•Full blood count 全血计数

•Serum biochemistry 血清生化

•Urinalysis and USG 尿分析和超声波检查

•Urine protein: creatinine尿蛋白:蛋白尿

•Urine culture尿液培养

Renal imaging
肾显像

•                 radiography

 

 

 

 

•                                          

•                                          Ultrasonography

•                                           超声波

•                                           Ureters(dilated)

•                                            输尿管 (扩张)

•                                            renal blood flow

                                            肾血流

 

Renal imagine肾显像

•Excretory urography(EU)下行性尿路造影术

•Digital fluoroscopicEU , CT EU  数字透视 EU , CT EU

•Renal function 肾功

•Visualise non-dialated ureters   可看到没有扩张的输尿管

•Urinary tract integrity    尿道完好

Renal imaging-computed lomography
肾显像-计算机断层扫描

 

•Renal biopsy-complications:

•肾活检-并发症

 

•                        haemorrhage 出血

•                        infraction 断裂

•                        hydronephrosis肾盂积水

•                        infection ,urinoma AV fistula

•                       感染,尿性囊肿AV瘘

•                                   

meggsy

•13y MN DSH

•13岁,母猫,短毛家猫

•Vomiting,inappetence

•呕吐,食欲不振

•Distended abdomen

•腹部扩张

•Massive kedneys

•肾脏肿大

Abdominal palpation腹部触诊

•  Fluctuant , smooth margins 可移动,边缘光滑

•      retroperitoneal fluid 腹膜后积水

•      subcapsular fluid 被膜下积水

•      intraparenchvmal fluid

 

 

•SBP 200mmHg

•Hypertensive choroidopathy

•高血压性脉络膜病

Abdominal ultrasound腹部超声波

Biochemistry and urinalysis
生化和尿检

Assessment 评估

•IRIS CKD stage Ⅱ(hypertensive)(proteinuria)

•IRIS ckd 二期(高血压的)(蛋白尿)

•Ultrasound drainage

•超声波引流

•Amlodipine 1.25mg q 24h PO

•氨氯地平 1.25mg q 24h PO

•Recurrence 3 weeks later

•3周后复发

 

Perirenal pseudocysts肾周假囊肿

•Bilater open capsulectomy

•双侧开放囊切除术

Meggsy post-operative recneck
术后再检查
SBP115mmHg

 

 

 

 

 

 

 

•Persistent proteinuria  持续蛋白尿

•2.5mg benazaepril q 24h PO  贝那普利 2.5mg  q 24h PO

Perirenal pseudocysts肾周假囊肿

•Subcapsular or extracapsular transudate,forms in cat with CKD Idiopathic

•在患有先天性CKD的猫的被膜下或囊外有渗出物形成

•-role of interstitial fibrosis间貭纤维化

•-role of hypertension 高血压

•Conservative therapy V surgery 保守治疗 V 手术

• -treat CKD and hypertension 治疗CKD和高血压

• -laparoscopic capsulotomy or capsulectomy

•  腹腔镜囊切开术 或囊切除术

 

 

Tempie

•11y MN 11岁 公猫

•Anorexia ,vomiting 14d

•厌食,呕吐14天

 

 

 

•Left kidney enlarged, firm smooth margins

•左肾变大,结实,边缘光滑

•Right kidney enarged ,firm irregular margins

•右肾变大,结实,边缘不规则

 

Left kidney

 

 


Tempie

•FIV\FeLV  negative     FIV\FeLV 阴性

•Anaemia:mycoplasma PCR negative,coomb‘s positive

•贫血:支原体PCR阴性,库姆斯血清阳性

•immune-mediated haemolytic anaemia 免

•疫介导溶血性贫血

•IVF,nutritional support,multiagent chemotherapy

•静脉内液,营养支持 ,多种药化学治疗

 

 

 

•Azotemia not correlated with prognosis

•氮血症 和预后没联系

•Remission 14 monthes 14个月后逐渐消失

 

Renal lymophoma –USG
肾淋巴瘤——超声波检查

•Focal hypoechoic masses 局部低回声肿块

•Diffuse increase in echogenicity

•在回声反射中分散增加

•Subcapsular thickening

•被膜下(囊下的 )的厚度

•   -rim or cresent shaped

•   -边缘或新月体有特定形状

•   -no acoustic enhancement  声响没有提高

•   -neoplastic lymphocytes\necrotic debris

•   -淋巴球瘤\坏死碎片

 

 

 

 

 

 

 

 

 

 

 

•Diffuse increase in echogenicity

•回声反射分散增加

•Subcapsular thickening 被膜下厚度

sassy

•13y MN burmilla

•13y 公猫

•Polyuria,polydipsia

•多尿症,烦渴

•Weight loss

•体重减轻

•Inappropriate urination不适当性排尿

Abdominal palpation腹部触诊

•Both kidney enlarged 两肾变大

•Fluctuant ,irregular cortical margin

•能移动的,皮质边缘不规则

•SBP 215mmHg

•Fundoscopy-abnormal

•眼底检查 –不正常

 

 

 

 

 

 

•CKD IRIS stage Ⅱ(hypertensive)

•CKD IRIS 二期(高血压)

•Bacterial cystitis 细菌性膀胱炎

•Borderline proteinuria- posternal or renal?

•不正常的蛋白尿-肾后性的还是肾性的呢?

•Cause of enlarged kidneys?

•肾脏变大的原因是什么呢?

 

 

Assessment评估

•Polycystic kidney disease(PKD)

•多囊肾病

•CKD IRIS stage Ⅲ(H)

•CKD IRIS 三期(高血压)

•Bacterial cystitis

•细菌性膀胱炎

•Borderline proteinuria

•       posternal?

•       renal?

•不正常的蛋白尿,是肾后性的还是肾性的呢?

Plan治疗方案

•Amlodipine 1.25mg q 24h PO

•氨氯地平 1.25mg q 24h PO

•Amoxycillin-clavulanate 3 weeks

•阿莫西林-克拉维酸 3周

•Protein-phosphate restricted diet

•饮食中限制磷酸蛋白

•1month recheck 1个月后复查

•   sBP<160mmHg

•   repeat UA,UPC and urine culture  再做尿分析 、尿比重、尿液培养

•   repeat serum biochem-phosphate potassium  再做生化-磷酸钾

 

Polycystic kidney disease
多囊肾病

 

 

•Worldwide prevalence in Persians 37%

•波斯猫的患病率是37%,全世界流行

•Single autosomal dorminant trait

•一个常染色体的主要性状

•PKD1 gene –exon 29 chromosome E3

•PKD1基因-外显子染色体E3

•Heterozygotes affected,homozygotes lethal

•杂合子显性,纯合子致死

•High genetic penetrance-cyst enlarge with age

•高基因外显率 –随着年龄囊肿增大

 

 

Breeds at risk  
有患病风险的猫品种

Inheritance of PKD
 PKD的遗传

 

 

 

•Heterozygous affected×unaffected

•杂合子显性×隐性

•      Pp×pp

• Pp Pp pp pp

•50% offspring affected   50% 胎生是显性的

Inheritance of PKD
PKD的遗传

 

 

 

•Heterozygous affected×affected

•杂合子显性×杂合子显性

•      Pp×Pp

• PP Pp Pp pp

•60% if homozygous lethal

•假如纯合子致死,就是60%

Clinical signs 临床症状

•Renal failure (CKD stageⅡ﹠ higher)develop late in life 肾衰竭(CKD 二期和更高的)在年老的时候发生

•Renomegaly may be present-palpable renal cysts可能会出现肾肿大——可触摸到肾囊肿

•Systemic hypertension﹠proteinuria common

•常见全身高血压和蛋白尿

Diagnosis test-client owned cats
诊断测验 –客户的猫

•Asymptomatic kitten of  persian\related breeds –PCR  无症状的小波斯猫或相关品种-PCR

•Adulat cat with renomegaly or CKD  -abdominal ultrasound 患有肾肿大 或CKD的成年猫-腹部超声波

 

 

 

Diagnosis:

 

 

•One cyst in both kidnenys or multiply cysts in one kidney

•两个肾都有一个囊 或者一个肾里有多个囊肿

Diagnosis test-ultrasonography
诊断测验 –超声波检测

•Cysts:囊肿 :

•Aenchoic lumen

•内腔无回声

•Sharp posterior margin

•后部边缘尖锐

•Posterior acoustic enhancement

•后部声波提高

 

Genetic test –PKD
遗传测定 –PKD

•Australia  澳洲

•UK  英国

•USA  美国

•Europe 欧洲

Management of PKD positive cats
PKD阳性猫的处理

•Annual examination to screen for CKD:

•采用年检去监控CKD

•1 SBP measurement  测量收缩压

•2 serum biochem    血清生化

•3 urinalysis  尿分析

•4 urine protein :creatinine ratio

•尿蛋白:肌酸酐比率

• When CKD detected 3 to 6-monthly  rechecks:step1 to 4 

• CKD每月检测3到6次,得重新检测步骤1到4

•5 urine culture  尿液培养

 

0

阅读 评论 收藏 转载 喜欢 打印举报/Report
  • 评论加载中,请稍候...
发评论

    发评论

    以上网友发言只代表其个人观点,不代表新浪网的观点或立场。

      

    新浪BLOG意见反馈留言板 电话:4000520066 提示音后按1键(按当地市话标准计费) 欢迎批评指正

    新浪简介 | About Sina | 广告服务 | 联系我们 | 招聘信息 | 网站律师 | SINA English | 会员注册 | 产品答疑

    新浪公司 版权所有