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放射性碘治疗后甲亢猫肾功能的肾小球和肾小管标志物的短期和长期随访

Short- and long-term follow-up of glomerular and tubular renal markers of kidney function in hyperthyroid cats after treatment with radioiodine.

作者信息

van Hoek I, Lefebvre H P, Peremans K, Meyer E, Croubels S, Vandermeulen E, Kooistra H, Saunders J H, Binst D, Daminet S

机构信息

Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium.

出版信息

Domest Anim Endocrinol. 2009 Jan;36(1):45-56. doi: 10.1016/j.domaniend.2008.10.001. Epub 2008 Nov 7.

Abstract

Hyperthyroidism can mask co-existing chronic kidney disease (CKD). Previous studies showed that post-treatment renal azotemia can be predicted by pre-treatment assessment of glomerular filtration rate (GFR). We hypothesized that treatment of hyperthyroidism may have different effects on glomerular and tubular function and these changes might be predicted by additional pre-treatment variables than GFR. Serum total T4 (TT4), creatinine and blood urea nitrogen (BUN), blood pressure (BP), body weight (BW), GFR, urine specific gravity (USG), urinary protein/creatinine ratio (UPC) and retinol binding protein/creatinine ratio (uRBP/c) were evaluated before and 1, 4, 12 and 24 weeks post-treatment with radioiodine ((131)I) in 21 non-azotemic hyperthyroid cats. Cats were divided 24 weeks post-treatment into group A (normal kidney function, n=16) and group B (impaired kidney function, n=5). Serum TT4, GFR, UPC and uRBP/c decreased significantly after treatment for the complete group and group A (P<0.05), although GFR and uRBP/c did not change in group B. Serum creatinine and BW increased significantly from 1 week after treatment (P<0.05). There was no change in BUN, USG or BP. Pre-treatment serum TT4, GFR and USG differed significantly between group A and B (P<0.05). GFR at 4 weeks after treatment and maximum decrease in GFR could be partially predicted by a formula using pre-treatment GFR, serum TT4, serum creatinine, BUN and/or USG. Significant changes in kidney function occur within 4 weeks post-treatment and none thereafter. Pre-treatment measurement of GFR, USG and serum TT4 can have possible predictive value regarding the development of post-treatment renal azotemia.

摘要

甲状腺功能亢进可能掩盖并存的慢性肾脏病(CKD)。既往研究表明,治疗后肾性氮质血症可通过治疗前肾小球滤过率(GFR)评估进行预测。我们推测,甲状腺功能亢进的治疗可能对肾小球和肾小管功能有不同影响,且这些变化可能通过除GFR之外的其他治疗前变量进行预测。对21只非氮质血症的甲状腺功能亢进猫在放射性碘(¹³¹I)治疗前以及治疗后1、4、12和24周评估血清总T4(TT4)、肌酐、血尿素氮(BUN)、血压(BP)、体重(BW)、GFR、尿比重(USG)、尿蛋白/肌酐比值(UPC)和视黄醇结合蛋白/肌酐比值(uRBP/c)。治疗24周后,猫被分为A组(肾功能正常,n = 16)和B组(肾功能受损,n = 5)。治疗后,全组和A组的血清TT4、GFR、UPC和uRBP/c显著降低(P < 0.05),尽管B组的GFR和uRBP/c没有变化。血清肌酐和BW从治疗后1周起显著升高(P < 0.05)。BUN、USG或BP没有变化。A组和B组治疗前的血清TT4、GFR和USG有显著差异(P < 0.05)。治疗后4周时的GFR以及GFR的最大降幅可通过使用治疗前GFR、血清TT4、血清肌酐、BUN和/或USG的公式进行部分预测。治疗后4周内肾功能发生显著变化,此后无变化。治疗前GFR、USG和血清TT4的测量对于治疗后肾性氮质血症的发生可能具有预测价值。

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