猫慢性肾病（CKD）：早筛、分期与日常管理
2026/10/3· 约 5 分钟读完· 28 个要点
老年猫最常见的"沉默疾病"。这篇讲清为什么血肌酐正常也不代表没事、筛查要查哪几项、分期在分什么，以及日常管理里真正能延缓进展的几件事。附近年早期诊断与治疗时机的综述证据。
一、为什么它叫"沉默疾病"
猫慢性肾病（CKD）早期常常没有明显症状。等到出现明显消瘦、厌食、呕吐时，往往已损失了相当比例的肾功能。近年综述专门讨论了"什么时候该开始治疗"以及氮质血症前期干预的证据[1]——核心观点是：等到肌酐明显升高才处理，已经错过了最有效的窗口。
二、早期信号（家里就能观察）
- 多饮多尿（水碗见底变快、尿团明显变大/变多）；
- 体重下降（尤其腰线变明显、肌肉流失）；
- 被毛变粗糙、梳理减少、口气加重；
- 食欲波动、偶发呕吐、夜间烦躁；
- 老年猫高血压可表现为突发眼内出血/视力变化（急症）。
三、筛查：查哪几项才够
只查血肌酐是不够的，完整的初筛通常包括：
- 血液：肌酐 + SDMA（SDMA 往往更早升高）、尿素氮、磷、电解质；
- 尿液：尿比重（USG）是极重要的早期信号，配合尿蛋白、尿沉渣、UPC（尿蛋白肌酐比）；
- 血压：CKD 与高血压互为因果；
- 影像：超声评估肾脏形态，排除梗阻/结石/结构异常。
一项研究比较了猫 CKD 的生化分期与组织病理分期，提示临床分期与真实病理改变之间存在差异[2]——这也是为什么要多指标联合 + 动态复查
科研依据与原文（可直接查看）
下列每条都是本文引用的同行评议文献，本站已把原文摘要抓下来，点「展开原文摘要」即可在站内阅读； 需要看全文时可点 PubMed / Europe PMC / DOI 任一入口（多条备选，避免单点打不开）。
- 1
When should we start to treat feline CKD: A narrative review of early diagnosis and the evidence for pre-azotaemic intervention
Bestwick JP, Geddes RF · Veterinary journal (London, England : 1997) · 2025
👉 早期诊断与干预时机综述，支撑"别等肌酐明显升高才处理"。
展开原文摘要（英文，1217 字）
Chronic kidney disease (CKD) is a common and important disease in ageing cats. Increased awareness and availability of a novel biomarker for detecting glomerular filtration rate reduction (symmetric dimethylarginine), alongside efforts by the International Renal Interest Society to standardise diagnosis and staging, have led to earlier detection of CKD and an ability to study and trial interventions in sub-populations based on disease severity. As weight loss and phosphorus dyshomeostasis are present in non-azotaemic cats, and progression to azotaemic CKD may occur over time, earlier diagnosis and management represent a compelling opportunity for optimising management of this disease. To date, however, dietary modification (particularly protein- and phosphorus-restriction) in cats with azotaemic CKD is the only intervention demonstrating robust evidence for improving survival times and slowing disease progression. The purpose of this article is to review the available literature supporting criteria currently used to diagnose non-azotaemic CKD and evidence for early intervention, with a focus on dietary modification. Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.
📚延伸阅读
本站内容为养宠科普与用品选购参考，不构成兽医诊疗建议；商品交易最终发生在淘宝，售后、发货咨询请前往淘宝商家。