2026年iCatCare关于猫慢性肾病诊断和管理的共识指南

摘要(中文译文)

慢性肾病（CKD）在老年猫中很常见。早期诊断有助于实施干预措施，以减缓疾病进展并尽量减少临床症状。根据国际肾病学会（IRIS）CKD分期系统进行管理，可以延长患病猫的生存时间并使其保持优良的生活质量。《2026 iCatCare慢性肾病诊断与管理共识指南》提供了关于CKD发病机制的信息、做出诊断和疾病分期的指导，以及医学和营养治疗方面的实用内容。指南还讨论了如何优化家庭和兽医诊所环境以积极影响心理健康，进而促进身体健康，以及与整个兽医团队和照护者合作以减缓疾病进展并最大化生活质量。患病猫在CKD早期可能表现出极少或没有临床症状，这可能导致诊断延迟。该病通常是进行性的，管理需要综合考虑多种因素以解决临床症状。可能出现的并发症如高钙血症、高血压、蛋白尿和贫血，需要进行治疗。此外，由于高龄是CKD的风险因素，猫可能患有重要的合并症，需要权衡这些合并症对肾脏的影响。照护患有CKD的猫可能会给照护者带来负担。因此，支持照护者、根据个体猫的情况制定监测方案，以及让兽医和护理团队共同参与非常重要。本指南由国际猫科护理组织（iCatCare）兽医学会召集的专家小组制定。信息基于现有文献、专家意见和小组成员的经验。特定缩写：ACE = 血管紧张素转换酶；ACKD = 慢性肾病急性加重；AKI = 急性肾损伤；ARB = 血管紧张素受体阻滞剂；CKD = 慢性肾病；CKD-MBD = 慢性肾病-矿物质和骨异常；FGF23 = 成纤维细胞生长因子23；GFR = 肾小球滤过率；iCa = 离子钙；ICGN = 免疫复合物性肾小球肾炎；IRIS = 国际肾病学会；PTH = 甲状旁腺激素；SDMA = 对称二甲基精氨酸。

Abstract

Chronic kidney disease (CKD) is common in senior cats. Early diagnosis can facilitate interventions to slow progression and minimise clinical signs. Management according to the International Renal Interest Society (IRIS) staging system for CKD can lead to prolonged survival and an excellent quality of life for affected cats. The '2026 iCatCare consensus guidelines on the diagnosis and management of chronic kidney disease in cats' provide information on the pathogenesis of CKD, guidance on making a diagnosis and staging of disease, and practical content on medical and nutritional treatment. They also discuss optimising the home and veterinary clinic environment to positively influence mental wellbeing and, in turn, physical health, as well as working with the whole veterinary team and caregivers to slow disease progression and maximise quality of life. Affected cats may show minimal or no clinical signs in the early stages of CKD, which can result in a delay in diagnosis. The condition is generally progressive and management requires consideration of multiple factors in order to address clinical signs. Complications such as hypercalcaemia, hypertension, proteinuria and anaemia may develop, requiring treatment. Moreover, as advancing age is a risk factor for CKD, cats may have important comorbidities that need to be balanced, with impacts on the kidney. Caring for a cat with CKD can result in caregiver burden. Hence, supporting caregivers, contextualising monitoring to the individual cat, and involving both the veterinary and nursing teams is important. These Guidelines have been created by a panel of experts brought together by International Cat Care (iCatCare) Veterinary Society. Information is based on the available literature, expert opinion and the panel members' experience.Specific abbreviations:ACE = angiotensin-converting enzyme; ACKD = acute-on-chronic kidney disease; AKI = acute kidney injury; ARB = angiotensin receptor blocker; CKD = chronic kidney disease; CKD-MBD = CKD-mineral and bone disorder; FGF23 = fibroblast growth factor 23; GFR = glomerular filtration rate; iCa = ionised calcium; ICGN = immune-complex glomerulonephritis; IRIS = International Renal Interest Society; PTH = parathyroid hormone; SDMA = symmetric dimethylarginine.

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