Okuläre Veränderungen bei chronischer Niereninsuffizienz und/oder systemischer Hypertension der Katze

 

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Zusammenfassung

Ziel

der Studie war zu prüfen, ob der Grad der Niereninsuffizienz bzw. die Höhe des Blutdrucks bei Katzen mit chronischer Niereninsuffizienz (CNI) eine Aussage hinsichtlich der Ausprägung von Fundusveränderungen zulässt und ob die Blutdruckhöhe bei verschiedenen mit Hypertension assoziierten Erkrankungen differiert.

Material und Methode

Bei Katzen mit CNI und/oder hypertensiver Retinopathie sowie gesunden Katzen erfolgten eine klinische Allgemeinuntersuchung, eine ophthalmologische Untersuchung, eine Blutdruckmessung mittels Doppler-Sonographie, eine Blutuntersuchung inklusive Bestimmung der T4-Konzentration, eine Harnuntersuchung und eine Ultraschalluntersuchung von Herz und Abdomen.

Ergebnisse

Insgesamt wurden 69 erkrankte und 24 gesunde Katzen untersucht. 53/69 Katzen wiesen Veränderungen am Augenhintergrund, 17/69 eine Uveitis anterior und 4/69 ein Hyphäma auf. Die Kontrolltiere zeigten bei einem mittleren nicht altersabhängigen systolischen Blutdruck von 134 ± 6,7 mmHg keine okulären Befunde. Bei den niereninsuffizienten Katzen bestand zwischen dem Grad der Niereninsuffizienz und dem Grad der Fundusveränderungen sowie der Blutdruckhöhe eine geringgradige negative Korrelation, die jedoch keine biologische Relevanz hatte. Die Blutdruckhöhe war mit dem Grad der Fundusveränderungen und mit dem Alter signifikant positiv korreliert. Katzen mit systemischer Hypertension, die ausschließlich an einer CNI erkrankt waren, hatten einen signifikant niedrigeren Blutdruck als Katzen, die zusätzlich an einer linksventrikulären Hypertrophie (LVH) erkrankt waren oder ausschließlich an einer LVH, einer Hyperthyreose oder einer primären Hypertension litten.

Schlussfolgerung und klinische Relevanz

Der Grad der Niereninsuffizienz ist kein zuverlässiger prognostischer Faktor hinsichtlich des Auftretens und des Grades von Fundusveränderungen. Der Blutdruck liegt bei hypertensiven Katzen mit CNI ohne Begleiterkrankung niedriger als bei hypertensiven Katzen mit CNI und zusätzlicher LVH, LVH allein, Hyperthyreose oder primärer Hypertension.

Summary

Objective

The aim of this study was to evaluate whether the degree of renal insufficiency and/or high blood pressure in cats with chronic renal insufficiency (CRI) is related to the degree of change in the fundus and whether there are differences in blood pressure between the different accompanying diseases.

Material and methods

In cats with CRI and/or hypertensive retinopathy and healthy cats, the following examinations were carried out: physical examination, ophthalmic examination, measurement of the blood pressure using Doppler ultrasonography, complete blood count, serum biochemical analyses, including serum thyroxine (T4) concentration, urinalysis and ultrasonography of the heart and abdomen.

Results

A total of 69 diseased and 24 healthy cats were examined. 53/69 cats displayed changes of the fundus, 17/69 cats had uveitis and 4/69 had hyphaema. Cats of the control group had no ocular changes and a mean systolic blood pressure of 13 ± 6.7 mmHg, which was not related to age. The degree of the CRI was negligibly negatively correlated with the degree of fundic changes and blood pressure. The blood pressure was significantly positively correlated with the degree of fundus changes and age. Cats with systemic hypertension, which only suffered from CRI, had a significantly lower blood pressure than cats with an additional left ventricular hypertrophy or only a left ventricular hypertrophy, hyperthyroidism or primary hypertension.

Conclusion and clinical relevance

According to the results of the present study, the degree of the CRI is not a reliable prognostic factor for the development and the degree of fundic change. The blood pressure in hypertensive cats with CRI without additional diseases is lower compared to hypertensive cats with CRI and left ventricular hypertrophy, left ventricular hypertrophy alone, hyperthyroidism or primary hypertension.

• Literatur

• 1 Belew AM, Bartlett T, Brown SA. Evaluation of the white-coat effect in cats. J Vet Intern Med 1999; 13: 143-142.
  PubMedGoogle Scholar
• 2 Binns SH, Sisson DD, Buoscio DA, Schaeffer DJ. Doppler ultrasonographic, oscillometric sphygmomanometric and photoplethysmographic techniques for noninvasive blood pressure measurement in anesthetized cats. J Vet Intern Med 1995; 09: 405-414.
  CrossrefPubMedGoogle Scholar
• 3 Bodey AR, Sansom J. Epidemiological study of blood pressure in domestic cats. J Small Anim Pract 1998; 39: 567-573.
  CrossrefPubMedGoogle Scholar
• 4 Brown S, Atkins C, Bagley R, Carr A, Cowgill L, Davidson M, Egner B, Elliott J, Henik R, Labato M, Littman M, Polzin D, Ross L, Snyder P, Stepien R. Guidelines for the identification, evaluation, and management of systemic hypertension in dogs and cats. J Vet Intern Med 2007; 21: 542-558.
  CrossrefPubMedGoogle Scholar
• 5 Brown S, Haberman C, Morgan J. Evaluation of Doppler ultrasonic and oscillometric estimates of blood pressure in cats. ACVIM Abstracts. 2003
  PubMedGoogle Scholar
• 6 Caulcett NA, Cantwell SL, Houston DM. A comparison of indirect blood pressure monitoring techniques in anesthetized cats. Vet Surg 1998; 27: 370-377.
  CrossrefPubMedGoogle Scholar
• 7 Chetboul V, Lefebvre HP, Pinhas C, Clerc B, Boussouff M, Pouchelon JL. Spontaneous feline hypertension: clinical and echocardiographic abnormalities, and survival rate. J Vet Intern Med 2003; 17: 89-95.
  CrossrefPubMedGoogle Scholar
• 8 Crispin SM, Mould JRB. Systemic hypertension disease and the feline fundus. Vet Ophthalmol 2001; 04: 131-140.
  CrossrefPubMedGoogle Scholar
• 9 Dibartola SP, Rutgers HC, Zack PM, Tarr MJ. Clinicopathological findings associated with chronic renal disease in cats: 74 cases (1973-1984). J Am Vet Med Assoc 1987; 09: 1196-1202.
  PubMedGoogle Scholar
• 10 Elliott J, Barber PJ. Feline chronic renal failure: clinical findings in 80 cases between 1992 and 1995. J Small Anim Pract 1998; 39: 78-85.
  CrossrefPubMedGoogle Scholar
• 11 Elliott J, Barber PJ, Syme HM, Rawlings JM, Markwell PJ. Feline hypertension: clinical findings and response to antihypertensive therapy. J Small Anim Pract 2001; 42: 122-129.
  CrossrefPubMedGoogle Scholar
• 12 Elliott J, Fletcher M, Syme HM. Idiopathic feline hypertension: epidemiological study. ESVIM Abstracts. 2003: 754.
  PubMedGoogle Scholar
• 13 Flood SM, Randolph JF, Gelzer AR. et al. Primary hyperaldosteronism in two cats. J Am Anim Hosp Assoc 1999; 35: 411-416.
  CrossrefPubMedGoogle Scholar
• 14 Forster van MHijfte. Feline hypertension: pathophysiology, clinical signs and treatment options. In Pract 2002; 24: 590-594.
  CrossrefPubMedGoogle Scholar
• 15 Grandy JL, Dunlop CI, Hodgson CR, Curtis CR, Chapman PL. Evaluation of the Doppler ultrasonic method of measuring systolic arterial blood pressure in cats. Am J Vet Res 1992; 53: 1166-1169.
  PubMedGoogle Scholar
• 16 Henik RA, Stepien RL, Bortnowksi HB. Spectrum of M-Mode echocardiographic abnormalities in 75 cats with systemic hypertension. J Am Anim Hosp Assoc 2004; 40: 359-363.
  CrossrefPubMedGoogle Scholar
• 17 Henry CJ, Brewer WG, Montgomery RD. Adrenal pheochromocytoma in a cat. J Vet Intern Med 1993; 14: 208-213.
  PubMedGoogle Scholar
• 18 International renal interest society (IRIS). Staging of CKD 2006. www.iris.com.
  PubMedGoogle Scholar
• 19 Jensen J, Henik RA, Brownfield M, Armstrong J. Plasma renin activity and angiotensin I and aldosterone concentrations in cats with hypertension associated with chronic renal disease. Am J Vet Res 1997; 58: 535-541.
  PubMedGoogle Scholar
• 20 Jepson RE, Hartley V, Mendl M, Caney SME, Gould DJ. A comparison of CAT Doppler and oscillometric Memoprint machines for non-invasive blood pressure measurement in conscious cats. J Feline Med Surg 2005; 07: 147-152.
  CrossrefPubMedGoogle Scholar
• 21 Jepson R. Feline systemic hypertension classification and pathogenesis. J Feline Med Surg 2011; 13: 25-34.
  CrossrefPubMedGoogle Scholar
• 22 King JN, Tasker S, Gunn-Moore DA, Strehlau G. BENRIC Study Group prognostic factors in cats with chronic kidney disease. J Vet Intern Med 2007; 21: 906-916.
  CrossrefPubMedGoogle Scholar
• 23 Klevans LR, Hirkaler G, Kovacs JL. Indirect blood pressure determination by Doppler technique in renal hypertensive cats. Am J Physiol 1979; 237: H720-H723.
  PubMedGoogle Scholar
• 24 Kobayashi DL, Peterson ME, Graves TK, Lessner M, Nichols CE. Hypertension in cats with chronic renal failure or hyperthyroidism. J Vet Intern Med 1990; 04: 58-62.
  CrossrefPubMedGoogle Scholar
• 25 Komaromy A, Andrew SE, Denis HM, Brooks DE, Gelatt KN. Hypertensive retinopathy and choroidopathy in a cat. Vet Ophthalmol 2004; 07: 3-9.
  CrossrefPubMedGoogle Scholar
• 26 Kraft W. Schilddrüsenkrankheiten. In: Kleintierkrankheiten, Band 1, Innere Medizin, 3. Aufl. Kraft W, Hirschberger J. Hrsg. Stuttgart: Ulmer; 2000: 781-806.
  Google Scholar
• 27 Lin C-H, Yan C-J, Lien Y-H, Huang HP. Systolic blood pressure of clinically normal and conscious cats determined by an indirect Doppler method in a clinical setting. J Vet Med Sci 2006; 68: 827-832.
  CrossrefPubMedGoogle Scholar
• 28 Littman MP. Spontaneous systemic hypertension in 24 cats. J Vet Intern Med 1994; 08: 79-86.
  CrossrefPubMedGoogle Scholar
• 29 Lulich JP, Osborne CA, O’Brien TD, Polzin DJ. Feline renal failure: questions, answers, questions. Comp Cont Educ Pract 1992; 14: 127-153.
  PubMedGoogle Scholar
• 30 Maggio F, Defrancesco TC, Atkins CE, Pizzirani S, Gilger BC, Davidson MG. Ocular lesions associated with systemic hypertension in cats: 69 cases (1985-1998). J Am Vet Med Assoc 2000; 217: 695-702.
  CrossrefPubMedGoogle Scholar
• 31 Maher ER. Pheochromocytoma in dogs and cats. Vet Clin North Am Small Anim Pract 1997; 27: 359-380.
  CrossrefPubMedGoogle Scholar
• 32 Mathur S, Brown CA, Dietrich UM, Munday JS, Newell MA, Sheldon SE, Cartier LM, Brown SA. Evaluation of a technique of inducing hypertensive renal insufficiency in cats. Am J Vet Res 2004; 65: 1006-1013.
  CrossrefPubMedGoogle Scholar
• 33 Miller RH, Smeak DD, Lehmkuhl LB, Brown SA, DiBartola SP. Radiotelemetry catheter implantation: surgical technique and results in cats. Contemp Top Lab Anim Sci 2000; 39: 34-39.
  PubMedGoogle Scholar
• 34 Mishina M, Watanabe T, Fujii K, Maeda H, Wakao Y, Takahashi M. Noninvasive blood pressure measurement in cats: clinical significance of hypertension associated with chronic renal failure. J Vet Med Sci 1998; 60: 805-808.
  CrossrefPubMedGoogle Scholar
• 35 Nelson OL, Reidesel E, Ware WA, Christensen WF. Echocardiographic and radiographic changes associated with systemic hypertension in cats. J Vet Intern Med 2002; 16: 418-425.
  CrossrefPubMedGoogle Scholar
• 36 Remillard RL, Ros JN, Eddy JB. Variance of indirect blood pressure measurements and prevalence of hypertension in clinically normal dogs. Am J Vet Res 1991; 52: 561-565.
  PubMedGoogle Scholar
• 37 Sampedrano CC, Chetboul V, Gonni V, Nicolle AP, Pouchelon J-L, Tissier R. Systolic and diastolic myocardial dysfunction in cats with hypertrophic cardiomyopathy or systemic hypertension. J Vet Intern Med 2006; 20: 1106-1115.
  CrossrefPubMedGoogle Scholar
• 38 Sander C, Hörauf A, Reusch C. Indirekte Blutdruckmessung bei Katzen mit Diabetes mellitus, chronischer Nephropathie und hypertropher Kardiomyopathie. Tierärztl Prax 1998; 26 (K): 110-118.
  PubMedGoogle Scholar
• 39 Sansom J, Rogers K, Wood JLN. Blood pressure assessment in healthy cats and cats with hypertensive retinopathy. Am J Vet Res 2004; 65: 245-252.
  CrossrefPubMedGoogle Scholar
• 40 Sennelo KA, Schulman RL, Prosek R, Siegel AM. Systolic blood pressure in cats with diabetes mellitus. J Am Vet Med Assoc 2003; 223: 198-201.
  CrossrefPubMedGoogle Scholar
• 41 Skrodzki M. Arterielle Hypertonie. In: Kleintierkardiologie kompakt. Skrodzki M, Tobias R, Schneider M. Hrsg. Hannover: Schlütersche; 2008: 113-119.
  Google Scholar
• 42 Sparkes AH, Caney SMA, King MCA, Gruffyd-Jones TJ. Inter-and intraindividual variation in Doppler ultrasonic indirect blood pressure measurements in healthy cats. J Vet Intern Med 1999; 13: 314-318.
  PubMedGoogle Scholar
• 43 Stepien RL. Pathophysiology of systemic hypertension and blood pressure assessment. In: Textbook of Veterinary Internal Medicine. Ettinger SJ, Feldman EC. eds. St. Louis, Missouri: Saunders Elsevier; 2010: 577-582.
  Google Scholar
• 44 Stepien RL, Rapoport GS, Henik RA, Sartor LL, Wenholz L. Effect of measurement method on blood pressure findings in cats before and after therapy for hyperthyroidism. ESVIM. 2003 Abstracts, 754.
  PubMedGoogle Scholar
• 45 Stiles J, Polzin DJ, Bistner SI. The prevalence of retinopathy in cats with systemic hypertension and chronic renal failure or hyperthyroidism. J Am Anim Hosp Assoc 1994; 30: 564-572.
  PubMedGoogle Scholar
• 46 Stiles J, Townsend WM. Feline ophthalmology. In: Veterinary Ophthalmology. 4th. ed. Ames, Iowa: Blackwell; 2007: 1095-1165.
  Google Scholar
• 47 Syme H, Barber PJ, Markwell PJ, Elliott J. Prevalence of systolic hypertension in cats with chronic renal failure. J Am Anim Med Assoc 2002; 220: 1799-1804.
  PubMedGoogle Scholar
• 48 Syme HM, Elliott J. The prevalence of hypertension in hyperthyroid cats at diagnosis and following treatment. ESVIM 2003 Abstracts. 754.
  PubMedGoogle Scholar
• 49 Syme HM, Markwell PJ, Elliott J. Aldosterone and plasma renin activity in cats with hypertension and/or chronic renal failure. J Vet Intern Med 2003; 16: 354.
  PubMedGoogle Scholar
• 50 Van der Woerdt A, Peterson ME. Prevalence of ocular abnormalities in cats with hyperthyreodism. J Vet Intern Med 2000; 14: 202-203.
  CrossrefPubMedGoogle Scholar