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伴有和不伴有血液透析的急性肾损伤犬的高脂血症。

Hyperlipasemia in dogs with acute kidney injury treated with and without hemodialysis.

机构信息

Small Animal Clinic, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland.

Clinical Diagnostic Laboratory, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland.

出版信息

J Vet Intern Med. 2023 May-Jun;37(3):1067-1076. doi: 10.1111/jvim.16693. Epub 2023 Apr 4.

Abstract

BACKGROUND

Hyperlipasemia has been reported in dogs with acute kidney injury (AKI) but associations with AKI severity, hemodialysis (HD) treatment, and outcome have not been extensively evaluated.

OBJECTIVES

Investigate the prevalence and clinical relevance of hyperlipasemia in dogs with AKI, treated with and without HD.

ANIMALS

Client-owned dogs (n = 125) with AKI.

METHODS

Retrospective data extraction from medical records, including signalment, cause of AKI, duration of hospitalization, survival, plasma creatinine concentration, and 1,2-o-dilauryl-rac-glycero-3-glutaric acid-(6'-methyresorufin) ester (DGGR) lipase activity at admission and throughout hospitalization.

RESULTS

A DGGR-lipase activity >3× the upper reference limit (URL) was found in 28.8% and 55.4% of dogs at admission and during hospitalization, respectively, but only 8.8% and 14.9% of dogs, respectively, were diagnosed with acute pancreatitis. Hyperlipasemia >10 × URL was observed in 32.7% of dogs during hospitalization. The DGGR-lipase activity was higher in dogs with International Renal Interest Society (IRIS) Grades 4-5 than Grades 1-3, but correlation between DGGR-lipase activity and creatinine concentration was poor (r  = .22; 95% confidence intervals [CI], 0.04-0.38). Treatment with HD was not associated with DGGR-lipase activity independent of IRIS grade. Survival to discharge and 30 days after admission was 65.6% and 59.6%, respectively. High IRIS grades (P = .03) and high DGGR-lipase activity at admission (P = .02) and during hospitalization (P = .003) were associated with nonsurvival.

CONCLUSIONS AND CLINICAL IMPORTANCE

Hyperlipasemia is frequent and often marked in dogs with AKI despite only a minority being diagnosed with pancreatitis. Hyperlipasemia is associated with AKI severity but not independently with HD treatment. High IRIS grade and hyperlipasemia were associated with nonsurvival.

摘要

背景

已有研究报道急性肾损伤(AKI)犬会出现高胰酶血症,但高胰酶血症与 AKI 严重程度、血液透析(HD)治疗及预后的关系尚未得到广泛评估。

目的

研究 AKI 犬出现高胰酶血症的流行情况及临床意义,并分析有无 HD 治疗的影响。

动物

125 例 AKI 患犬,均为就诊患宠。

方法

从病历中提取相关信息,包括一般信息、AKI 病因、住院时间、存活情况、入院时和住院期间的血肌酐浓度、1,2-二油酰基-sn-甘油-3-谷氨酸-(6'-甲氧基荧烷)酯(DGGR)脂肪酶活性。

结果

入院时和住院期间,分别有 28.8%和 55.4%的犬出现 DGGR 脂肪酶活性>3×参考上限(URL),但仅有 8.8%和 14.9%的犬被诊断为急性胰腺炎。住院期间,有 32.7%的犬出现 DGGR 脂肪酶活性>10×URL。IRIS 分级 4-5 级犬的 DGGR 脂肪酶活性高于分级 1-3 级犬,但 DGGR 脂肪酶活性与肌酐浓度的相关性较差(r=0.22;95%置信区间,0.04-0.38)。HD 治疗与 IRIS 分级无关,不会改变 DGGR 脂肪酶活性。出院时和入院后 30 天的存活率分别为 65.6%和 59.6%。IRIS 分级高(P=0.03)、入院时(P=0.02)和住院期间(P=0.003)DGGR 脂肪酶活性高与预后不良相关。

结论

尽管只有少数犬被诊断为胰腺炎,但 AKI 犬的高胰酶血症较为常见,且通常较为严重。高胰酶血症与 AKI 严重程度相关,但与 HD 治疗无关。高 IRIS 分级和高胰酶血症与预后不良相关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d502/10229356/acf5b6956858/JVIM-37-1067-g002.jpg

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