介紹2譯pu pd esavs final多飲尿

PolyuriaandDr.AstridWehner,Dipl.ECVIM-ESAVS,FelineMedicineandSurgery4–EndocrinologyandReproductionShanghai,Sept.22nd–26th,2014Verificationofpolydipsia:≥100ml/kg/day(perdefinition–farto polyuria:50ml/kg/day多尿50ml/kg/ifUSG:≥1.035(cat),thenNOPU/PD如果尿:≥1.035(貓),那么沒有出現(xiàn)多飲多behavioraldisorder(urinespraying)行為紊（Waterandsaltbalancewater-andsaltbalancearesaltintakeisfollowedbywatersmaosmolalityismaintainedbetween280–310血漿滲透壓維持在280310regulatedvia:waterintake(thirst水（渴感機制waterexcretion(urinethirstmechanism:reaseofsmaosmolarity(centralosmoreceptors)anddecreaseofcirculatingbloodvolume(peripheral減少（外周感受器osmoreceptors:stimulationvia hypovolemia:activationofhypervolemia:inhibitionofADH,natriuresis(via透壓 口的waterexcretion水的排泄regulatedviaADH(antidiuretichormone= reasespermeabilityviaV2-cAMP-dependentreceptorsintheepithelialcellsofthecollectingductintheaquaporinesarebuiltupwithintheluminalmembrane,whichchannelwaterintothehypertonicmedullaryinterstitialspace近遠 質(zhì)

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臟primaryPD stimulationofthirstcenter(hyperthyroidism,liverfailure,渴感中樞的刺激(甲狀腺機能肝衰，紅血球增多癥 primaryPU 性多尿（常見osmoticdiuresis(Diabetesmellitus,renalglucosuria,postobstructivediuresis,CKD)lackofADH(centralDiabetesprimarynephrogenicDiabetessecondarynephrogenicDiabetesE.coliinfectionoftheurogenitaltract(Pyelonephritis,尿生殖道的大腸桿菌（腎盂腎炎，炎primaryPU ↓concentrationgradientinrenalmedulla liverfailure/portosystemicshunt肝衰/?medullarywashout“(diuretics,consequenceoflong-lastingPU/ reaseofanticonvulsantsCatsDiabetesmellitusDiabetesinsipidus Diagnosticstepsinworkhistory/PEdrugs,dermatologicabnormalities,polyphagia,weightloss,fever,urinalysisandcultureUSG,glucosuria,pyuria/bacteriuria,尿，糖尿，膿尿/菌尿，蛋白尿bloodwork toryleukogram,Biochemistryazotemia,↑AP,↑Glu,liverElectrolytesNodiagnosis X光，B超 SBA,氨adrenalglandfunction(hypo-andACTH-stimtest,LDDStestwaterdeprivationtestordiagn.treatmentwithCorrelationofcreatininewithGFRMeasurementofmostprecisemethodtoevaluatekidneycorrelateswithfunctionalrenalindirectlyassessedwithclearance iple:applicationofmarkermeasuresmaconcentrationsofdeclining(GFRml/min/kg=100xinj.measureurineconcentrationofmarkerpertimeunit(GFRml/min=UxV/P)測量每個時間單位標志的尿濃度(GFRml/minUxVExogenouscreatininesmapatienthastobewell6hfasted6accesstowatertimepoint0:Bloodsampleforendogenouscreatinine,applicationof2g/m2BSAcreatinineIVtimepoint1:2.bloodsample3htimepoint2,3:2.and3.bloodsampleswithin4–8h,atleast1Case1病例signalment:DSHm/n,10years特征：家養(yǎng)短毛貓，雄性絕育，10history:elevatedcreatininefor3特征：波斯，Casesignalment:DLH,m/n,8history:elevatedcreatininefor6

內(nèi)源性肌酐：188（正AssessmentofbloodpressureIndirectdopplersonography超Protocolregularcalibrationofdevicepatientneedstosettle5-10min)動物需要安定（5-10分鐘ventralor lrecumbencyuseappropriatecuff(30-40%oflimbdiscard1stmeasurement,obtain5consecutivems,Assessmentofbloodpressuresystolic(SAP)anddiastolic(DAP)dependentonheart meanBP(MAP)平均血壓perfusion continuingBPinthe shouldbe>60<100應該是60100timeofdiastole>>timeofMAP=(SAP–DAP)Directbloodpressureintraarterialmeasurement(catheter cementofdorsalpedalartery, emetry(catheter cementofaortaand emetrydevicein orsubcutis)Indirect:oszillometryarterialpulsationismeasured,ifcuffisevacuated(pressurewithinthecuffismeasured)如果袖套是排空的，測量主動脈脈動（測量袖套內(nèi)的Indirect: 間接highdefinition cuff,device(manometer+assessmentofbloodflowinthedistalartery),computer袖套，裝置（器+評估遠端動脈的血流?realtimemeasurement“ofpulsewaveundertheveryfast8-15sec)很快（8-15秒Indirect: I間接:HaccuratemeasurementofSAPMAPandDAPSAP,MAP和DAP的準確測量visualconfirmationof cuffdeflation accuratemeasurementofBPinhighheartIndirect:dopplersonographycuffonfrontlimb,leveloftheseatingpositiondependingofexaminersIndirect:dopplersonography間接:超聲Idopplerpr iple–onecrystalemitsanultrasoundsignal,whichisreflectedbythemovingarterialwalltoasecondcrystaldifferentwavelengthsareconvertedtoanacousticpulsesoundfalsepositivereadingswith↑heartratenoreliableindicator(syst.SBD160mmHgandnoTODrepeatin7daysSBD≥160mmHg以及沒有TOD→在7天內(nèi)重復bloodpressureattwooccasionselevated→hypertensionSBD≥160mmHganddiseasewith↑prevalenceof→hypertensionSBD160mmHg以及高血壓患病率SBD≥180mmHg→?whitecoateffect“unlikely,hypertensionSBD180mmHg不像“白袍效應”Managementofhypertension–generalapproachdiagnoseandtreatunderlying treathypertensionwithfirstlinemedication運用一線藥物治療高avoidhighdietaryNaClintake避免日糧中高re-evaluatein7-10d(1-3inemergencynormotensive:re-evaluate1-3m hypotensive:decreasedosageorinterdoseintervalorchangetherapeutic