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December 23, 2016

貓膀胱炎和膀胱/腎臟結石


Feline Cystitis and Bladder/Kidney Stones
貓膀胱炎和膀胱/腎臟結石

Last Updated on Saturday, January 30, 2016 06:32 PM
Published on Tuesday, April 28, 2009 11:38 AM
Written by Lisa A. Pierson, DVM
 
最近更新:2016年1月30日
原始刊出日:2009年4月28日
作者:獸醫麗莎.皮爾森 (Lisa A. Pierson, DVM)
 
原文出處連結:http://feline-nutrition.org/health/feline-cystitis-and-bladderkidney-stones

 
Cystitis and stones are extremely common in the cat and can be very painful and life-threatening. Cystitis can lead to inappropriate urination — urinating outside of the litter box — and stones can cause a fatal rupture of the bladder by blocking the outflow of urine.
 
膀胱炎和結石是極為常見的貓病,不但很痛而且可能威脅生命。膀胱炎會造成貓尿在不該尿的地方,而結石可能會讓膀胱破裂而致命,因為尿液被堵住無法排出。
 
Any cat that is repeatedly entering the litter box but not voiding any urine is in need of immediate medical attention. It is important to note, however, that "crystals" are not the same thing as stones. Crystals are often a normal finding in a cat's urine and it is not appropriate to put the cat on a "special urinary tract" formula when these are found in the urine. I often see too much clinical significance placed on the identification of crystals in the urine without regard to how the urine sample was handled. It is very important to understand that crystals will often form once outside of the body within a very short period of time, as little as one hour. If the veterinarian does not examine the urine right away and either sends it to an outside laboratory or uses a free-catch sample that the owner brought from home, an erroneous diagnosis of crystals may be made. This is called a "false positive" report and results in unnecessary worry on the part of the owner and often leads to the cat being placed on an inappropriate diet.
 
當貓頻繁的進出貓沙盆,但卻沒有排尿時,就需要立刻就醫。不過要注意的是,「結晶」並不等於結石。貓尿中有結晶很多時候是正常現象,沒有必要因為尿中有結晶,就開始餵貓吃「泌尿道處方食品」,這麼做並不恰當。常見到大家在斤斤計較結晶屬性,全然沒有注意到尿液樣本的取得方式。當尿液排出體外後,會在很短的時間內(短至一小時)就形成結晶。如果獸醫沒有立刻檢查尿液,而是送去外面的實驗室,或是使用飼主在家自行收集的尿液,很可能做出尿液中有結晶的錯誤診斷。這種「偽陽性」報告不但可能會給飼主帶來不必要的操心,而且常導致貓開始吃不恰當的食物。
 
With regard to overall kidney and bladder health, I cannot stress strongly enough how important water, water, water is in both the prevention and treatment of diseases involving this organ system.
 
關於維持腎臟和膀胱的健康,不管是在預防還是治療相關疾病,最重要的重點是水水水。
 
When a cat is on a diet of water-depleted dry food, they produce a more highly concentrated urine, with higher urine specific gravity, and they produce a lower volume of urine which means that a higher concentration of crystals will be present in the urine. This increases the chance of these crystals forming life-threatening stones. The concentrated urine and the lack of volume production can also be very irritating to the lining of the bladder wall predisposing them to painful cystitis.
 
當貓吃的是含水量很低的食品時,會排出高度濃縮的尿液,尿比重高,而且尿量少,表示尿液中有較多的結晶。結晶形成威脅生命的結石的機率因此而提高。濃縮的尿液以及尿量少,對膀胱內壁極為刺激,因此容易造成疼痛的膀胱炎。
 
Please keep in mind that a cat has a very low thirst drive and is designed to get water with their food. A diet of canned food will keep a proper amount of water flowing through the urinary tract system and help maintain its health.
 
別忘了貓是不愛喝水的動物,天性使然水分的攝取主要來自於食物。罐頭中的水分提供適當的水量以通過泌尿道,幫助維持泌尿道健康。
 
Urine pH is also often considered when discussing urinary tract problems but we really need to stop focusing on pH. Again, a proper amount of water in the diet is the important issue here - not urine pH. Many of the so-called feline lower urinary tract diets are formulated to make the urine acidic but it is thought that these low magnesium, acidifying diets may actually exacerbate painful cystitis. Also, these acidifying diets, which are so often prescribed, may end up promoting calcium oxylate stones and hypokalemia.
 
在討論泌尿道問題時,尿液酸鹼值往往也被列入考量,但我們真的需要停止糾結在酸醶值了。食物中適當的含水量才是重點,不是尿液酸醶值。許多所謂的貓下泌尿道食品,當中的成分會造成酸性尿,但這些加了酸化劑的低鎂食品,其實會讓膀胱炎惡化。再者這些常被獸醫當做治療方式的處方酸化食品,可能會促成草酸鈣結石的形成,以及造成低血鉀。
 
It is also important to note - for those people still stuck on worrying about the urine pH - that there are many factors which determine the pH of urine and only one of them is diet.
 
糾結在尿液酸鹼值中無法自拔的人,必須注意到一個重點,那就是尿液酸醶值受到許多因素的影響,而食物只是其中之一。
 
With regard to dry food and urinary tract health, aside from the lack of water in this type of diet, there is also a correlation between the consumption of a high carbohydrate diet and the formation of struvite crystals as shown by a study published in February 2004 in the American Journal of Veterinary Research. Veterinarians often prescribe Science Diet® dry c/d® and x/d® for urinary tract problems but again, these diets are only ten percent water and contain a high level of species-inappropriate ingredients and questionable preservatives. They are also very high in carbohydrates with dry c/d® containing 42 percent of its weight as carbohydrates. Please note the first few ingredients in c/d while remembering that your cat is a carnivore:
 
關於乾飼料和泌尿道健康之間的關係,一份刊登在二零零四年美國獸醫研究期刊的報告指出,高碳水食品和磷酸銨鎂結晶的形成有關連。針對泌尿道問題,獸醫常要求飼主餵希爾斯的c/d或x/d,這些乾飼料不但僅有百分之十的含水量,而且有許多不適合貓吃的食材,和令人質疑的防腐劑。c/d乾飼料中的碳水化合物含量甚至高達百分之四十二。以下是c/d包裝列出的食材表,當你在閱讀時,別忘了貓是絕對肉食動物。
 
Brewers rice, chicken by-product meal, corn gluten meal, pork fat (preserved with mixed tocopherols E and citric acid), chicken liver flavor, taurine, preserved with BHT and BHA.
 
糙米、雞肉副產品粉、玉米粉、豬油(保存於生育酚〔維他命E〕和檸檬酸的混合物中)、雞肝調味料、牛磺酸、防腐劑BHT和BHA
 
Diet is not the only issue involved with cystitis but it is an important one and one that we can control. Stress is also thought to play a very significant role in cystitis and even cats that are fed a 100 percent canned food diet may experience bouts of cystitis. This is a very frustrating disease to deal with and one that the veterinary community does not have all the answers for. What we do know is that decreasing stress and increasing the water content of the diet are the most important management issues to address. The water content of the diet is easy to control. The stress issue is another matter and is not always easy to address since cats can be very sensitive and are often "silent" in their stress.
 
食物不是唯一和膀胱炎有關的因素,不過卻是一個非常重要,而且是我們能自行控制的因素。壓力也扮演了一個重要的角色,而且全濕食的貓也有可能會有復發的膀胱炎。這是一個令人備感挫折的疾病,獸醫界並還沒有找到這個問題的所有答案。在治療這個問題時,我們知道的兩個重點是:減少壓力來源以及提高水量。食物中的水分很容易控制。壓力的問題有時比較不易解決,因為貓很敏感,而且往往不會「告訴主人」壓力來源。
 
Cystitis can be extremely painful and it is very important to address pain management in these cats. Remember pain = stress and we are trying to minimize the stress in these patients. Buprinex® is a good choice for a pain medication. This is superior to Torbugesic® which has been used for pain management in the cat in the past. Buprinex® is a prescription medication that you must get from your veterinarian. Unfortunately, many veterinarians overlook pain medications as a very important part of the treatment of this common feline problem.
 
膀胱炎可能會很痛,所以疼痛管理極為重要。記住疼痛等於壓力,而膀胱炎病貓的壓力必須降到最低。Buprinex®是止痛藥的好選擇,優於過去一向被用來治療貓疼痛的Torbugesic®。Buprinex®是處方用藥,必須從獸醫處取得。很可惜的是,許多獸醫在治療這個常見的貓病時,常會忽略疼痛管理也是治療重點之一。

譯註:
貓友指正 Buprinex 的正確拼法是 buprenex; 我找到以下的連結說 buprenex 常被拼錯成 buprinex。連結:http://pain.emedtv.com/buprenex/buprinex.html
 
A note on antibiotic usage in these cases. Most cases of cystitis are sterile. In other words, they are not the result of an infection and should not be placed on antibiotics.
 
抗生素治療須知。大部分的膀胱炎並沒有細菌存在。換句話說不是感染所造成,所以不應該使用抗生素。
 
Only ~1% of cats with cystitis that are under 10 years of age have a urinary tract infection, yet many veterinarians place these patients on antibiotics when these drugs are not warranted. Most cats under 10 years of age produce a very concentrated urine — USG greater than 1.030 — and bacteria do not grow well in concentrated urine.
 
十歲以下的膀胱炎病貓中,最多只有百分之一有尿道感染,然而卻有許多獸醫使用抗生素治療膀胱炎。大多數十歲以下的貓尿液極為濃縮,尿比重大於1.030,是細菌不易生長茁壯的濃度。
 
In cats over 10 years of age, infections are more common but that still does not mean that older cats with cystitis should automatically be put on antibiotics. The reason that an older cat is more prone to urinary tract infections is because kidney disease is more common in this age group and so these cats will have a more dilute urine which is not as hostile to bacterial growth. Diabetes is also more common in cats over 10 years of age and diabetes makes a cat more prone to urinary tract infections.
 
十歲以上的貓比較常見有感染,但並不表示有膀胱炎的老貓就應該吃抗生素。年紀較大的貓較容易有泌尿道感染是因為腎病比較常見於此年齡層,所以這些貓的尿液比較稀釋,比較容易滋生細菌。糖尿病也較常見於十歲以上的貓,而糖尿病會讓貓的泌尿道比較容易受到感染。
 
A urine culture and sensitivity (C & S) should be run to check for an infection if the patient has a low urine specific gravity or is diabetic. It must be kept in mind that even with a low USG, most cases of cystitis are not due to an infection. This is why it is important to run a C & S before placing the patient on antibiotics. Antibiotics should only be used when the presence of an infection can be established.
 
如果病貓尿比重低或是有糖尿病,應該要進行尿液培養和敏感測試(簡稱C&S),以確定是否有感染。切記,即使尿比重低,大多數的膀胱炎並不是感染引起。這也就是為什麼在給病貓服用抗生素之前,必須先進行C&S。確定有細菌感染時,才需要服用抗生素。
 
A C & S test identifies the bacteria if present and tells the veterinarian which antibiotic is appropriate. The urine for a C & S needs to be obtained by way of cystocentesis which involves using a syringe and needle to obtain urine directly from the bladder. This is not a painful procedure for the cat and this method is the only way to obtain a sample for accurate information in order to properly treat with antibiotics. One problem, however, is that a sample may be difficult to obtain without waiting a few hours since cats with cystitis urinate frequently and often do not have enough urine in their bladder to get a good sample.
 
C&S檢驗可以判斷有無細菌,讓獸醫知道採用何種抗生素。做C&S檢驗的尿液必須由膀胱穿刺取得,把針頭刺進膀胱以直接取得尿液。膀胱穿刺不會造成貓的疼痛,而且是唯一取得精確尿液樣本的方式,以便在使用抗生素治療時提供確切的訊息。不過此種採尿方式有一個問題,那就是膀胱炎貓的膀胱中,往往沒有足夠的尿液,常常要等幾個小時才能收集到足夠的尿液樣本。
 
To get around this problem, some veterinarians will give the patient a dose of subcutaneous fluids. The cat is then put into a cage without a litter box. Within a few hours, the bladder is usually full enough to obtain a urine sample via cystocentesis. This usually only takes a few hours.
 
為了解決這個問題,有些獸醫會給貓皮下輸液。然後把貓關在籠子中,不提供貓砂盆。幾個小時內,膀胱中通常會累積到足夠的尿量以進行膀胱穿刺,獲得尿液樣本。整個過程通常只需要幾個小時。
 
We have to stop treating all cases of cystitis with antibiotics without supporting evidence of an infection!
 
在沒有獲得感染的充分證據前,我們先須停止用抗生素來治療所有的膀胱炎。
 
Cystitis will often recur in these patients and this painful health problem can be very frustrating to deal with. On a good note, most cats will have their clinical signs spontaneously resolve even without any treatment. In fact, it has often been said, somewhat jokingly, that a cat with cystitis will get well in seven days with treatment and in one week without treatment.
 
這些病貓的膀胱炎時常會復發,而且處理這個帶來疼痛的健康問題往往令人備感挫折。好處是,大多數的貓在還沒有開始治療前,臨床症狀就自行消失。事實上曾有人打趣說,膀胱炎的貓如果有進行治療七天內會好,沒有治療一個禮拜會好。
 
(全文完)
 
譯註:

養貓人都會遇到貓生病。關於生病這件事,我的看法是貓主人要對常見的貓病有基本的認識,如果是跟食物有關的病,我們知道要怎麼做以避免。帶去給醫生看,當醫生做出不是很妥當的治療時,我們才有基本的判斷能力。如果不是跟食物有關的病,最好的狀況是找出病因,對症下藥;最差的狀況是找不出病因,那主人和醫生也只能盡力照顧貓,其他一切交給上天安排。但是找不出病因時,如果是重病,務必要尋找第二意見,而且要找經驗豐富的醫生,因為沒有任何獸醫是全知的,不是嗎?
 
當你對常見的貓病有基本的瞭解後,比較能夠判斷醫生的治療方式是否妥當。例如假設你的貓尿不出來,醫生A說要吃處方乾料,而且要吃一輩子。醫生B說先吃處方乾料,利用酸性物質溶解結石,問題解決後儘量餵貓吃濕食。在你讀這篇文章前,你可能會不知道要聽醫生A還是B的話。但是讀完這篇文章後,你會知道要聽醫生B的話。
 
我們許多貓主人在遇到一個不適任的醫生時,往往當下無法判斷醫生的不適任。我們要在遇到另一個適任的醫生後,才知道原來之前那位醫生不應該那麼治療。以我的百吉為例,第一個醫生完全不知道磷是治療腎貓的關鍵,當然沒有開降磷藥給貓吃。我換醫生後,第一次就診醫生就開降磷藥,雖然百吉當時的磷指數還在正常值內。在正常值內要如何使用降磷藥我們只能依靠醫生來做判斷。第二個醫生說病貓更需要優良的蛋白質,腎貓要注意的是磷的攝取量,而不是蛋白質。當時的我聽了似懂非懂,但後來我陸續又讀到一些獸醫寫的文章,才明白磷的控制對腎貓之重要。如果今天我有一隻老貓腎臟指數已經高出標準值,但是醫生的重點依然放在蛋白質,不知道磷才是關鍵,而沒有驗磷指數,那麼我可以根據我所獲得的基本知識做出兩個選項:第一是換醫生,第二是請醫生驗磷指數。如果我選擇了第二,我還是會很不安,因為一個不知道磷才是關鍵的醫生,會在適當的時機開降磷藥給貓吃嗎?這一點我會抱著懷疑,所以我最後的選擇會是換醫生。
 
我們的貓以後會生什麼病我們當然不會知道。但在貓健康時我們可以做的是對貓常見的病有基本的瞭解,這樣貓生病就醫時,我們才有一些能力判斷醫生的處理妥當與否。
 
祝各位週末愉快
 
Lisa Pierson graduated from UC Davis School of Veterinary Medicine in 1984. Her passion for feline nutrition and how feline diseases relate to species-inappropriate diets, came about in 2002 while researching feline nutrition for her cat "Robbie" who experienced severe intestinal problems. Her practice is now limited to consulting work on such health issues she as kidney disease, diabetes, urinary tract problems, inflammatory bowel disease and obesity — all with strong ties to unhealthy diets. "Cystitis (Bladder Inflammation) and Bladder/Kidney Stones" originally appeared on CatInfo.org and is re-posted here with Dr. Pierson's kind permission.


本文作者獸醫麗莎.皮爾森一九八四年畢業於加州大學戴維斯分校獸醫學院。她對貓科營養的興趣以及和食物有關的貓病,起源於二零零二年,當她為她的貓「羅比」研究貓科營養的資料時,因為羅比有嚴重的腸道問題。她目前的執業僅限於接受線上收費諮詢,回答貓的健康問題,例如腎臟病、糖尿病、泌尿道問題、炎症性腸病以及過度肥胖-全都是和不健康的食物有強烈關聯的疾病。本文原本刊登於皮爾森醫生的個人貓網頁(CatInfo.org),在獲得她的同意後轉載於此。
 
 


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