Clinical Sciences and Services, Royal Veterinary College, Hawkshead Lane, Hertfordshire, AL9 7TA, UK.
J Small Anim Pract. 2023 Dec;64(12):781-787. doi: 10.1111/jsap.13661. Epub 2023 Aug 10.
Ureteral obstruction is a common post-renal cause of azotaemia in cats. The objective of this study was to describe clinicopathological and point-of-care ultrasound findings in azotaemic cats that may increase the index of suspicion of ureteral obstruction.
A retrospective case-control study was conducted of azotaemic cats presenting to the emergency room of a referral teaching hospital. Cats were included if they were azotaemic and had point-of-care ultrasound and formal ultrasound performed. Cats were grouped into obstructed and non-obstructed groups based on formal specialist ultrasound and pyelography. Point-of-care ultrasound findings were described, including renal size and symmetry, renal pelvis dilation, perinephric fluid, and visualisation of the proximal ureter or calculi. Univariate analysis was performed to identify historical, biochemical and point-of-care ultrasound findings associated with ureteral obstruction before multivariate analysis.
One hundred twenty-two azotaemic cats met the inclusion criteria. Seventy-four cats were included in the obstructed azotaemic group and 48 cats in the non-obstructed azotaemic groups. Point-of-care ultrasound abnormalities were detected in 60 of 74 (81.1%) obstructed cats and 18 of 48 (37.5%) non-obstructed cats. Renal pelvis dilation (odds ratio 38.8; 95% confidence interval 2.9 to 515), hyporexia (odds ratio 5.9; 95% confidence interval 1.15 to 30.13), hypercalcaemia (odds ratio 16.6; 95% confidence interval 1.2 to 223.0) and hypokalaemia (odds ratio 21.7; 1.33 to 354.62) were more likely to be associated with ureteral obstruction than non-obstructive disease.
Point-of-care ultrasound abnormalities are documented frequently in azotaemic cats with ureteral obstruction. Cats with renal pelvis dilation were 39 times more likely to have ureteral obstruction than non-obstructive acute kidney injury.
输尿管梗阻是猫发生氮血症的常见肾后原因。本研究的目的是描述可能增加怀疑输尿管梗阻的氮血症猫的临床病理和即时超声检查结果。
对一家转诊教学医院急诊室就诊的氮血症猫进行回顾性病例对照研究。如果氮血症猫进行了即时超声检查和常规超声检查，则将其纳入研究。根据常规专家超声和肾盂造影结果将猫分为梗阻组和非梗阻组。描述即时超声检查结果，包括肾脏大小和对称性、肾盂扩张、肾周积液以及近端输尿管或结石的可视化。在进行多变量分析之前，对历史、生化和即时超声检查结果进行单变量分析，以确定与输尿管梗阻相关的因素。
符合纳入标准的氮血症猫共有 122 只。74 只猫纳入梗阻性氮血症组，48 只猫纳入非梗阻性氮血症组。74 只梗阻性氮血症猫中有 60 只（81.1%）和 48 只非梗阻性氮血症猫中有 18 只（37.5%）存在即时超声检查异常。肾盂扩张（优势比 38.8；95%置信区间 2.9 至 515）、食欲减退（优势比 5.9；95%置信区间 1.15 至 30.13）、高钙血症（优势比 16.6；95%置信区间 1.2 至 223.0）和低钾血症（优势比 21.7；1.33 至 354.62）更可能与输尿管梗阻有关，而非非梗阻性急性肾损伤。
即时超声检查异常在患有输尿管梗阻的氮血症猫中经常被发现。肾盂扩张的猫发生输尿管梗阻的可能性是无梗阻性急性肾损伤的 39 倍。
