

肾脏和泌尿系统疾病
犬慢性肾病 (CKD)
慢性肾病在犬只中的发病率约为 0.5% 至 1.5%。虽然 CKD 通常是老年犬的常见疾病,但这种疾病也可以遗传,例如凯恩梗这一犬种中的 多囊肾病,还有可能因感染和药物不良反应而致病。1
一旦确诊慢性肾病,就可以根据国际肾脏病学会 (IRIS) 制定的指南对患犬进行“分期”和治疗或监测。分期的初始依据是临床稳定患宠的空腹血肌酐或 对称性二甲基精氨酸 (SDMA) 结果的重复值。但是,业界目前也在研究 成纤维细胞生长因子23 (FGF23) 和 胱抑素 C (CysC) 等生物标志物,以改善早期诊断。2-4 提早确诊有助于更早地采取干预措施。
虽然 CKD 具有渐进性,但营养调整可对该疾病患犬的健康和寿命产生积极影响。饮食管理的目标是:维持充足的营养;减轻 CKD 的临床后果,包括 尿毒症体征;解决因肾功能障碍导致的 体内稳态 变化;减缓疾病进展;以及改善生活质量。1


重要信息
- 营养状况的连续评估以及为患宠定制的营养计划至关重要。5
- 评估肌肉质量尤为重要,因为肌酐在肌肉质量下降的患宠中可能会产生误导性偏低的结果。6
- 瘦体重的流失与 CKD 所致的死亡率增加有关。7-9
- 确保摄入足够的热量。如果能量需求得不到满足,身体组织就会发生分解代谢,导致瘦体重流失,并增加 CKD 患犬的发病和死亡风险。5
- 在饮食改变时要倍加谨慎,以降低因厌食症而导致拒绝特定饮食的风险。需要改变饮食时,请在犬感觉良好的情况下逐步进行。
- 对于 CKD 患犬,治疗性肾脏饮食比成犬维护期饮食更有利于临床结果。8,10,11
- CKD 患犬治疗饮食中的关键营养调整包括减少磷摄入量、采用蛋白质改良饮食方案,以及添加钾、Omega-3 脂肪酸及碱化缓冲液。
- 在 CKD 和高磷血症患犬中,磷的调节作用被破坏,并伴随甲状旁腺激素 (PTH) 或 FGF23 升高,进一步加剧了现有肾脏疾病带来的持续损伤。根据 IRIS 分期,通过限制饮食中的磷摄入量和使用磷酸盐结合剂来管理血清磷酸盐水平。1
- 犬肾小球疾病中的膳食蛋白质改良可能会降低肾小球内压、减少蛋白尿并降低尿毒症毒素生成速度。12 然而,大多数研究不支持蛋白质限制对于 CKD 进展的作用。13,14
- 维持充足的钾对正常肾功能至关重要,低钾会导致 CKD 或使 CKD 恶化。5
- 通常建议为 CKD 患犬补充鱼油中的 Omega-3 脂肪酸。15
- CKD 与代谢性酸中毒有关,该疾病具有多种不良反应,包括蛋白质代谢的改变。肾脏配方饮食方案中包括碱化剂,以帮助解决这一问题。
- CKD 患犬治疗饮食中的关键营养调整包括减少磷摄入量、采用蛋白质改良饮食方案,以及添加钾、Omega-3 脂肪酸及碱化缓冲液。


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参考文献
- International Renal Interest Society (IRIS). (2019). IRIS staging of CKD (modified 2019). http://www.iris-kidney.com/pdf/IRIS_Staging_of_CKD_modified_2019.pdf
- Kim, J., Lee, C. M., & Kim, H. J. (2020). Biomarkers for chronic kidney disease in dogs: A comparison study. Journal of Veterinary Medical Science, 82(8), 1130–1137. doi: 10.1292/jvms.20-0125
- Miyagawa, Y., Akabane, R., Ogawa, M., Nagakawa, M., Miyakawa, H., & Takemura, N. (2021). Serum cystatin C concentration can be used to evaluate glomerular filtration rate in small dogs. Journal of Veterinary Medical Science, 82(12), 1828–1834. doi: 10.1292/jvms.20-0201
- Nabity, M. B., Lees, G. E., Boggess, M. M., Yerramilli, M., Obare, E., Yerramilli, M., Rakitin, A., Aguiar, J., & Relford, R. (2015). Symmetric dimethylarginine assay validation, stability, and evaluation as a marker for the early detection of chronic kidney disease in dogs. Journal of Veterinary Internal Medicine, 29(4), 1036–1044. doi: 10.1111/jvim.12835
- Parker, V. J. (2021). Nutritional management for dogs and cats with chronic kidney disease. Veterinary Clinics of North America: Small Animal Practice, 51(3), 685–710. doi: 10.1016/j.cvsm.2021.01.007
- Hall, J. A., Yerramilli, M., Obare, E., Yerramilli, M., Melendez, L. D., & Jewell, D. E. (2015). Relationship between lean body mass and serum renal biomarkers in healthy dogs. Journal of Veterinary Internal Medicine, 29(3), 808–814. doi: 10.1111/jvim.12607
- Parker, V. J., & Freeman, L. M. (2011). Association between body condition and survival in dogs with acquired chronic kidney disease. Journal of Veterinary Internal Medicine, 25(6), 1306–1311. doi: 10.1111/j.1939-1676.2011.00805.x
- Pedrinelli, V., Lima, D. M., Duarte, C. N., Teixeira, F. A., Porsani, M., Zarif, C., Amaral, A. R., Vendramini, T., Kogika, M. M., & Brunetto, M. A. (2020). Nutritional and laboratory parameters affect the survival of dogs with chronic kidney disease. PLoS ONE, 15(6), e0234712. doi: 10.1371/journal.pone.0234712
- Rudinsky, A. J., Harjes, L. M., Byron, J., Chew, D. J., Toribio, R. E., Langston, C., & Parker, V. J. (2018). Factors associated with survival in dogs with chronic kidney disease. Journal of Veterinary Internal Medicine, 32(6), 1977–1982. doi: 10.1111/jvim.15322
- Hall, J. A., MacLeay, J., Yerramilli, M., Obare, E., Yerramilli, M., Schiefelbein, H., Paetau-Robinson, I., & Jewell, D. E. (2016). Positive impact of nutritional interventions on serum symmetric dimethylarginine and creatinine concentrations in client-owned geriatric dogs. PLoS ONE, 11(4), e0153653. doi: 10.1371/journal.pone.0153653
- Jacob, F., Polzin, D. J., Osborne, C. A., Allen, T. A., Kirk, C. A., Neaton, J. D., Lekcharoensuk, C., & Swanson, L. L. (2002). Clinical evaluation of dietary modification for treatment of spontaneous chronic renal failure in dogs. Journal of the American Veterinary Medical Association, 220(8), 1163–1170. doi: 10.2460/javma.2002.220.1163
- IRIS Canine GN Study Group Standard Therapy Subgroup, Brown, S., Elliott, J., Francey, T., Polzin, D., & Vaden, S. (2013). Consensus recommendations for standard therapy of glomerular disease in dogs. Journal of Veterinary Internal Medicine, 27(Suppl 1), S27–S43. doi: 10.1111/jvim.12230
- Finco, D. R., Brown, S. A., Crowell, W. A., Groves, C. A., Duncan, J. R., & Barsanti, J. A. (1992). Effects of phosphorus/calcium-restricted and phosphorus/calcium-replete 32% protein diets in dogs with chronic renal failure. American Journal of Veterinary Research, 53(1), 157–163.
- Finco, D. R., Brown, S. A., Crowell, W. A., Duncan, R. J., Barsanti, J. A., & Bennett, S. E. (1992). Effects of dietary phosphorus and protein in dogs with chronic renal failure. American Journal of Veterinary Research, 53(12), 2264–2271.
- Brown, S. A., Brown, C. A., Crowell, W. A., Barsanti, J. A., Allen, T., Cowell, C., & Finco, D. R. (1998). Beneficial effects of chronic administration of dietary omega-3 polyunsaturated fatty acids in dogs with renal insufficiency. The Journal of Laboratory and Clinical Medicine, 131(5), 447–455. doi: 10.1016/s0022-2143(98)90146-9
- Pelander, L., Häggström, J., Larsson, A., Syme, H., Elliott, J., Heiene, R., & Ljungvall, I. (2019). Comparison of the diagnostic value of symmetric dimethylarginine, cystatin C, and creatinine for detection of decreased glomerular filtration rate in dogs. Journal of Veterinary Internal Medicine, 33(2), 630–639. doi: 10.1111/jvim.15445