Small Animal Internal Medicine, Cummings School of Veterinary Medicine at Tufts University, Grafton, MA, USA.
Small Animal Internal Medicine, Friendship Hospital for Animals, Washington, DC, USA.
J Feline Med Surg. 2021 Aug;23(8):700-707. doi: 10.1177/1098612X20972039. Epub 2020 Nov 20.
Hyperammonemia occurs in cats with hepatobiliary and nutritional (cobalamin and arginine deficiency) disorders, and has also been documented in four cats with renal azotemia. We hypothesized that in cats with renal azotemia, fasting hyperammonemia would correlate with indices of worsening kidney function, and would be independent of cobalamin, potassium, systemic inflammation or urinary tract infection (UTI) with urease-producing bacteria.
A fasted blood sample was prospectively collected for ammonia and cobalamin analysis from 18 client-owned cats with renal azotemia (creatinine [Cr] ⩾1.6 mg/dl, urine specific gravity <1.030 or documentation of historical chronic kidney disease [CKD]). Correlations between blood ammonia and selected biochemical parameters were analyzed using Pearson's correlation coefficient.
Seven castrated males and 11 spayed females with a median age of 12 years (range 4-19 years) were enrolled. Ten of 18 (56%) cats presented for acute kidney injury (AKI) or acute on chronic kidney disease (AoCKD), and 8/18 (44%) presented for progressive CKD. The median Cr was 5.9 mg/dl (range 1.9-24.7 mg/dl). Hyperammonemia was documented in 4/18 (22%) cats, with a median of 95 µmol/dl (range 85-98 µmol/dl), and all four of these cats were classified as AKI/AoCKD. Blood ammonia concentrations had a significant moderate positive correlation between blood urea nitrogen (BUN) ( = 0.645, = 0.003), Cr ( = 0.578, = 0.012) and serum phosphorus ( = 0.714, = 0.0009) but not with cobalamin, potassium or white blood cell count. No cats had UTIs with urease-producing bacteria.
A correlation exists between blood ammonia and BUN, Cr and phosphorus in cats with renal azotemia. Future studies are warranted in a larger population of cats to determine the true prevalence, etiology and potential therapeutic effect of medical management of hyperammonemia on long-term prognosis in cats with kidney disease.
高血氨症发生于患有肝胆和营养（钴胺素和精氨酸缺乏）疾病的猫，也有文献报道在 4 例患有肾性氮血症的猫中出现过。我们假设在患有肾性氮血症的猫中，空腹高血氨与肾功能恶化的指标相关，并且与钴胺素、钾、全身炎症或产脲酶细菌引起的尿路感染（UTI）无关。
前瞻性地从 18 例患有肾性氮血症的患宠猫（肌酐 [Cr] ⩾1.6mg/dl，尿比重 <1.030 或有慢性肾病 [CKD]病史）中采集空腹血样进行氨和钴胺素分析。使用 Pearson 相关系数分析血氨与所选生化参数之间的相关性。
纳入了 7 只去势雄性猫和 11 只去势雌性猫，中位年龄为 12 岁（范围 4-19 岁）。18 例猫中有 10 例（56%）为急性肾损伤（AKI）或慢性肾病急性加重（AoCKD），8 例（44%）为进展性 CKD。Cr 的中位数为 5.9mg/dl（范围 1.9-24.7mg/dl）。18 例猫中有 4 例（22%）出现高血氨症，中位数为 95μmol/dl（范围 85-98μmol/dl），这 4 例均被归类为 AKI/AoCKD。血氨浓度与血尿素氮（BUN）（ = 0.645， = 0.003）、Cr（ = 0.578， = 0.012）和血清磷（ = 0.714， = 0.0009）呈显著中度正相关，但与钴胺素、钾或白细胞计数无相关性。无猫存在产脲酶细菌引起的 UTI。
肾性氮血症猫的血氨与 BUN、Cr 和磷之间存在相关性。需要在更大的猫群中进行进一步研究，以确定高血氨症的真实患病率、病因学和对患有肾脏疾病的猫的长期预后进行医学治疗的潜在治疗效果。
