腎囊腫

四林繁

何種疾病會造成豬隻屠體腎囊腫，在飼養管理中要如何管理才能改善，並減少腎囊腫的發生。
  期望各位前輩不吝指教，謝謝。:074

程嘉華(Jessie)

先看看人醫怎麼說：http://www.kmuh.org.tw/www/kmcj/data/9010/4810.htm

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腎囊腫知多少

腎臟內科　郭弘典主治醫師(90年10月)


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腎囊腫在腎臟科門診時常可見到，俗稱為水泡或水瘤，也就是腎臟出現內含液體的囊泡。許多患者在經醫師告知腎臟出現囊腫時，常會疑惑這個情形是否對身體健康有重大影響？會不會轉變成惡性腫瘤？需不需要開刀治療？事實上腎囊腫可區分為相當多種類，有些具有遺傳性，有些沒有；有些始終是良性也不會對身體造成影響，有些可能合併感染，有些會導致日後腎功能惡化，甚至某些種類的腎囊腫有轉變成癌症的可能，因此有必要細心加以區分。在此簡單介紹幾種不同類型的腎囊腫。

單純性腎囊腫

這是最常見的腎囊腫，可能只出現一個或同時出現多個囊腫，可能只出現在一側的腎臟也可能兩邊腎臟都有。單純性腎囊腫很少發生於小孩或年輕人，通常在成年後才慢慢出現，其發生率隨著年齡而增加。單純性腎囊腫通常是在體檢時被意外發現，很少引起特別的症狀，也不會轉變成惡性腫瘤，腎功能通常不受影響。少數患者可能因併發細菌感染需給予抗生素治療，有時因腎囊腫太大，造成疼痛或壓迫腎血管等情形時可能需要加以引流或手術治療，大部分單純性腎囊腫不需要特別治療，只要定期接受超音波追蹤檢查即可。

後天性囊腫腎疾

這是發生於腎衰竭患者的腎囊腫，腎衰竭發生的時間愈久(包括接受透析的時間)，出現後天性囊腫的比例愈高，有些患者接受腎臟移植後這些腎囊腫會消失。這一類的腎囊腫大部分沒有症狀，有些時候也可能造成疼痛、血尿或合併感染。要小心的是有一部份後天性囊腫可能轉變為腎細胞癌，此類患者發生腎細胞癌的機會是正常人的五十倍，因此腎衰竭後腎臟發生後天性囊腫的患者(通常是洗腎患者)應接受定期超音波追蹤，必要時安排電腦斷層檢查，若有癌變的可能則應儘早手術治療。

自體顯性遺傳多囊腎

這是遺傳性腎囊腫中最常見的一種，在西方人的發生率約為1/400至1/1000。其特色是雙側腎臟漸次出現許多個囊腫，最後大部分腎臟組織均被囊腫所佔據，腎臟明顯變大，可能導致腎功能惡化。在六十歲前有百分之五十的患者腎功能惡化至尿毒階段以致需接受洗腎，七十歲前則有百分之七十五的患者需接受洗腎。

這種疾病常見的腎臟相關症狀包括腰痛、血尿、合併感染及結石等，但此類多囊腎很少轉變成惡性腫瘤，而高血壓在此類患者相當常見。除了腎臟之外，自體顯性遺傳多囊腎的患者在肝臟、卵巢、胰臟、脾臟等器官也可能有囊腫出現。約四分之一患者可能合併有心臟僧帽辦脫垂。百分之五至十之患者可能合併腦內血管瘤，腦內血管瘤若破裂則造成腦出血。這種疾病是基因異常造成，具有遺傳性，患者的子女約有一半機會遺傳到異常基因，因此我們鼓勵此疾病患者的親屬接受超音波檢查。

目前並沒有方法可以使患者的腎臟不再出現腎囊腫。治療的重點在於有效的血壓控制以及低蛋白飲食，希望能使腎功能盡量不惡化。患者若有合併感染或出血的情形，則需要針對症狀積極加以治療。有時囊腫太大，造成疼痛或壓迫等情形時，可加以引流或手術治療，並可考慮對增大過速的囊腫注射酒精以防止其繼續增大。

自體隱性遺傳多囊腎

這是一種少見的遺傳性腎囊腫，在幼兒時期(通常在一歲內)即出現多囊腎的情形，且時常有高血壓，約百分之七十的患者腎功能異常，且可能進展至尿毒。患者的肝臟在幼兒時期即出現不等程度的肝纖維化，嚴重時造成肝門脈高壓，對於這類遺傳疾病目前並沒有根治的方法。

除了以上幾種疾病之外還有不少種其他原因可能造成腎囊腫，但因為較罕見在此不多描述。總而言之，得知有腎囊腫應先讓腎臟專科醫師確認其種類，若是屬於單純性腎囊腫則不必太擔心，只要根據醫囑定期作超音波追蹤檢查即可。若是經判斷屬於比較複雜的情形，則應接受醫師的建議，根據病情作適當的治療，以維持腎臟功能及盡量避免嚴重併發症的發生。

程嘉華(Jessie)

Inherited renal cysts in pigs: results of breeding experiments.

A landrace boar with a previous history of siring progeny with cystic kidneys was bred to five unrelated large white sows. Thirty-eight of 61 progeny (62 per cent) were affected with renal cysts. This incidence does not differ significantly from that expected with autosomal dominant inheritance. Three of the dams and the boar were found at post mortem examination to have renal cysts. The number of cysts may be determined by polygenic inheritance. Study of the pathology of the cysts in one-day-old, 25- to 32-day-old and 370-day-old progeny indicated a complex pathogenesis including probable recruitment to the cyst population throughout the period studied. The syndrome studied did not resemble previously described polycystic syndromes of the pig nor was it closely comparable to any of the well described polycystic syndromes and renal cystic disorders of man.

http://www.ncbi.nlm.nih.gov/pubmed/7445348

程嘉華(Jessie)

Renal cysts in pigs: prevalence and pathology in slaughtered pigs from a single herd.

An abattoir investigation into kidney condemnations due to renal cysts in pork pigs from one producer showed a prevalence of 47.5 per cent. Affected pigs were the progeny of a landrace boar. Similar cysts found in a small sample of day-old piglets sired by the same boar indicated a congenital origin. A marked variation in size and frequency of cysts in the kidneys of slaughtered pigs was seen, some resembling the severity of polycystic kidneys. Histologically cysts appeared to be of tubular origin. The prevalence of affected pigs in slaughter groups from the single herd could be genetically determined. If this were so the data would be consistent with autosomal dominant inheritance. A breeding experiment to examine this hypothesis is in progress.

http://www.ncbi.nlm.nih.gov/pubmed/7434522

程嘉華(Jessie)

RENAL CYSTS

Renal cysts are thin-walled fluid filled structures which develop in the renal parenchyma. They vary in size from barely visible to very large, often exceeding the size of the affected kidney. They may be solitary or multiple. Most often, they are a congenital anomaly; however, some develop postnatally. They have been reported in all species but they seem to occur most commonly in swine. Renal cysts can arise in any part of the nephron or in collecting tubules and most congenital cysts are not caused by an obstructive lesion. There may be some association between renal dysplasia and the formation of renal cysts because most dysplastic kidneys also have cysts. In some cases, polycystic kidney disease is also associated with cystic bile ducts, bile duct proliferation, and cystic pancreatic ducts. In severe cases of congenital polycystic kidneys, there is usually stillbirth or early neonatal death due to kidney failure.

http://compepid.tuskegee.edu/syl ... cpath/chapter6.html

程嘉華(Jessie)

怎麼減少喔？請參考『臍赫尼亞手術』的討論

https://taiwan-swine.com/redirec ... o=lastpost#lastpost

四林繁

程姐依您的看法是否懷疑是來至於遺傳嗎？本場上市肉豬經防檢局回傳的豬隻健康報告，得知豬隻腎囊腫甚多，造成腎臟廢棄，經詢問獸醫師，獸醫師說是用藥不當所引起的，謝謝程姐給予另一方面的思考及防治方向，目前本場五爪和隱睪稍多，正在查詢是那隻公豬造成。