猫下尿道病课件

猫下泌尿道疾病的食物疗法 Dr med vet LaurieBucherWALTHAMCentreforPetNutrition 猫下泌尿道疾病的发病率有多少 LUTDs 猫发病率及死亡率LUTDs DatafromWalkeretal 1977 Lawleretal 1985 LulichandOsborne 1996 猫LUTDs的症状 排尿异常停用猫沙盆血尿尿闭尿频 尿道阻塞无特异性症状 引起症状的原因 53只猫尿道阻塞病因 DatafromOsborneetal 1989 非阻塞性病因LUTD 109只猫 DatafromBuffingtonetal 1997 10岁以上猫LUTD的病因 DatafromBartges 1997 猫LUTDs的重要病因分析 非特异性病因60 尿道结石草酸钙及鸟粪石尿道阻塞鸟粪石为主其他病因anatomicabnormalities behaviourproblems DiagnosisofLUTDsincats SignsofLUTD Urinalysis Urinalysis Crystalluria Urinalysis CrystalluriaHaematuria Urinalysis CrystalluriaHaematuriaPyuria DiagnosisofLUTDsincats SignsofLUTD Urinalysis Urineculture DiagnosisofLUTDsincats SignsofLUTD Urinalysis Urineculture RadiographyUltrasonographyCystoscopy IsdietarymodificationrelevantinthemanagementofLUTDsincats IsdietarymodificationrelevantinthemanagementofLUTDsincats DietaryingredientsandfeedingpatternscaninfluenceurinepHurinevolumeurinarysoluteconcentration Dietarymodificationcanbeusedto DissolveandpreventrecurrenceofstruviteurolithsPreventreformationofthemineral struvite componentofurethralplugsmayreducerecurrenceofobstructionReducetheriskofrecurrenceofcalciumoxalateurolithsReducetherecurrenceofsignsincatswithidiopathiccystitis Assessingtheeffectofdietontheriskofcrystalformationinurine Whatissaturation Thedegreeofsaturationoftheurineprovidesthe drivingforce forcrystalformationSupersaturatedurinehasthepotentialtocausecrystalprecipitationInhighlysupersaturatedurineprecipitationwilloccurmorereadilypre formedcrystalswillgrowfaster Zonesofsupersaturationandcrystallisationbehaviours Formationproduct Solubilityproduct StruviteoxalateRSS 1 2 5 Labilesupersaturation oversaturation spontaneouscrystallisation rapidcrystalgrowth Metastablesupersaturation nodissolution nohomogeneouscrystallisation Undersaturation nocrystallisation dissolution Managementofsterilestruviteuroliths Nutritionalgoal undersaturationofurinestruviteRSS 1 0 Howisthisachieved Managementofsterilestruviteuroliths AcidificationofurinetopH6 0 6 5Enhancementofurinevolume decreaseofspecificgravityto 1 035Restrictionofdietarymineralcontentmagnesium0 03 0 08g 400kcalphosphorus0 5 1 0g 400kcal Managementofsterilestruviteuroliths FelineS OControlpHormula canned struviteRSS0 58 0 18 Managementofcalciumoxalateuroliths Whataretheriskfactorsforcalciumoxalateurolithiasisincats Possibleriskfactorsforcalciumoxalateurolithiasis LowurinevolumeHyperoxaluriaHypercalciuriaImbalanceofinhibitorsandpromotorsofcrystallisationandcrystalaggregationLowurinepH increasedintestinalabsorption Hypercalciuria Hyperoxaluria Increasedsaturation Crystallisation Crystalaggregation Crystalgrowth Calciumoxalateurolith increasedendogenousproduction IslowurinepHariskfactorforcalciumoxalateformation 0 2 4 6 8 Relativesupersaturation 5 5 5 6 6 5 7 UrinepH StruviteRSS CaOxRSS UrinepH NH4Cl Control NaHCO3 Diet Catsfedadrydietwithaurinaryacidifier alkaliniser Stevensonetal 2000 Managementofcalciumoxalateuroliths Nutritionalgoal undersaturationofurinecalciumoxalateRSS 1 0 Managementofcalciumoxalateuroliths FelineS OControlpHormula canned CaOxRSS0 45 0 16 Zonesofsupersaturationandcrystallisationbehaviours Formationproduct Solubilityproduct CalciumoxalateRSS 1 14 Labilesupersaturation oversaturation spontaneouscrystallisation rapidcrystalgrowth Metastablesupersaturation nodissolution nohomogeneouscrystallisation Undersaturation nocrystallisation dissolution Managementofidiopathiccystitis Causesofnon obstructiveLUTDin109cats DatafromBuffingtonetal 1997 Negativeculture Radiography ultrasonographycystoscopy Noabnormality Idiopathic cystitis Idiopathiccystitisincats IsnotadiagnosisRepresentsfailuretoidentifyacauseforsignsofLUTDCatsmayhavedifferentcausesfortheirsigns Biologicalbehaviourofidiopathiccystitisincats EpisodicclinicalsignsSignsresolvespontaneouslywithinafewdaysirrespectiveoftreatment Recurrenceafterafewweeks months Therapeuticchallengesinidiopathiccystitis Shortendurationof flare PreventrecurrenceofsignsCorrectunderlyingpathology Therapeuticrecommendationsinclude antibioticsantispasmodicscorticosteroids diureticsacidifersamitriptyline Whichhavebeenproventobeeffective Aimofstudy TocomparerecurrenceofsignsincatswithidiopathiccystitisfedcannedordryFelinepHControlDiet Diagnosisofidiopathiccystitis HistoryofabnormalmicturitionResultsofurinalysisRadiographicfindingsCystoscopicfindings Diagnosisofidiopathiccystitis Absenceofalternativediagnosisurolithiasisbacterialinfectionanatomicdefectneoplasiabehaviouralproblem Studydesign CatsassignedtodryorcanneddietgroupEndpoints12monthsrecurrenceofsignsofLUTD Studydesign PE CBC bloodgas serumbiochemistry UATelephonequestionnaireTelephonequestionnairePE bloodgas UAPE CBC bloodgas serumbiochemistry UATelephonequestionnaireTelephonequestionnairePE CBC bloodgas serumbiochemistry UATelephonequestionnairePE CBC bloodgas serumbiochemistry UATelephonequestionnaire monthly PE CBC bloodgas serumbiochemistry UA Time03days7days2weeks4weeks2months3months4months5months6months7to11months12months Results signalment DSH domesticshorthair DLH domesticlonghairHim Himalayan PxS PersianxSiameseME maleentire MN maleneuterFE femaleentire FN femaleneuter Results recurrenceofsignsofLUTD Norecurrencein 89 ofcatsfedthecanneddiet61 ofcatsfedthedrydietSignificantdifferencebetweengroups C2 P 0 05 Results recurrenceofsignsofLUTD Comparisonoftreatmentsforidiopathiccystitis DatafromBarsantietal 1982 Chewetal 1998 Markwelletal 1999 Conclusions SignificantlyfewercatsfedcannedpHControlDietshowedrecurrenceofsignsRecurrenceincatsfeddrypHControlDietwassimilartothatseeninpreviousstudiesindependentoftreatmentamitriptyline Conclusions CannedpHControlDietcanreducetheproportionofcatswithidiopathiccystitisthatshowrecurrenceofsignsFirsttreatmentshowntobeeffectiveinacontrolledclinicalstudy Indicationsfordietarymanagement IdiopathiccystitisreducerecurrenceofsignsStruvitecontainingurethralplugspreventreformationofmineralcomponentreducedrecurrenceofobstruction Struviteurolithsdissolve preventrecurrenceCalciumoxalateurolithsreduceriskofrecurrence Maintainingahealthylowerurinarytractonadaytodaybasis MeasurementsmadebyWalthamtoassesslowerurinarytracthealth UrinepHUrinevolumeandspecificgravity concentration RelativesupersaturationMicroscopicassessment Struvitecrystals Calciumoxalatecrystals Urinevolume specificgravity Glassware U tube Combinetemperature pHprobe Walthamurinemonitoringsystem WalthamurinepHmo