TOP >ゴントープロトコールGonto Protocol 2015 日本語訳


ゴントープロトコールGonto Protocol 2015 日本語訳

Fanconi Disease Management Protocol for Veterinarians


by Steve Gonto, MMSc, PhD, Medical Sciences

スティーブ ゴントー 医師  医学博士 著

Revised 2015



日本語訳 黒田美奈子 獣医師



Definition: Renal Fanconi Disease is a unique disorder distinct and unrelated to Fanconi Anemia. Renal Fanconi is a reabsorption failure in the nephrons causing bicarbonate, proteins and amino acids; as well as sodium, potassium, calcium, phosphorus and glucose, to be lost via urine excretion. The resultant solute diuresis can cause dehydration, electrolyte imbalances, vitamin and mineral deficiencies and metabolic acidosis. Left uncorrected, these imbalances can result in multi-system failure and death. Renal Fanconi can be genetic in origin, as seen frequently in Basenjis, Norwegian Elkhounds and certain “fancy silver “Cocker Spaniels. The gene can also be found more rarely in any mammal (including humans). Additionally, it can be induced or aacquired, as has been the case with many different breeds of dogs, cats and horses over the last few years. The AVMA speculates this is due to ingestion of tainted treats (primarily Chicken or Duck). Consult the AVMA website for updates.




腎疾患であるファンコーニ症候群は、ファンコーニ貧血とは全く関連性のない特異的な障害である。腎性ファンコーニは、ネフロンにおける重炭酸、タンパク、アミノ酸がNa, K, Ca, Phos,そして糖の再吸収障害を引き起こし、尿中へ排泄され喪失する。結果として生じる溶質利尿は、脱水、電解質のアンバランス、ビタミン、ミネラルの欠乏、代謝性アシドーシスを引き起こす可能性がある。これらを放置すると、これらのアンバランスは多臓器不全や死に至る。


AVMA(American Veterinary Medical Association: 米国獣医師学会)は、汚染されたトリーツの経口摂取(主にチキン、カモ)によるのではと推察している。これについてのアップデイトはAVMAウェブサイトで見ていただきたい。



Induced Fanconi and genetic Fanconi present with the same symptoms, and respond successfully to the same therapy. With genetic Fanconi, the disease is usually progressive, but with appropriate treatment, the statistics indicate a dog can live their normal life expectancy if their deficiencies and acidosis are addressed. With induced Fanconi we have found a number of dogs and cats, if supported through the life- threatening period of the event, can regain some, or all, normal renal function; and many have weaned partially or fully of Protocol support within a year, based on improving follow up lab studies.




Diagnosing Fanconi: In a Basenji, Norwegian Elkhound or Cocker Spaniels, PU/PD with glycosuria, on URINALYSIS, in the absence of elevate blood glucose, is almost always Fanconi, unless proven otherwise. In approximately 3000 canine cases, only twice, to date, was the glycosuria caused by another issue (one a renal tumor, another was insecticide toxicity). In other breeds of dog, or in cats, with these findings, ingestion of chicken “jerky” or breast” treats”, should be investigated and discontinued if in use. Other possible causes of “acquired” or induced Fanconi include zinc toxicity, such as from constant licking of zinc coated fence material, ingesting outdated tetracycline, or exposure to high levels of organophosphate insecticides. Fortunately, blood gas and chemistry results are essentially the same for genetic and acquired Fanconi, and both respond equally well to the same Replacement Protocol Management.



遺伝性である、バセンジー、ノルウェジャンエルクハウンド、非常に稀だがシルバーコッカスパニエルにおけるファンコーニの診断は、PUPDを伴い、血糖値の上昇を伴わない尿検査における尿糖検出でほとんど診断可能であり、その他は必須ではない。おおよそ3,000頭にわたる犬の症例ではこれまでたった2頭だけが、他の原因からの尿糖陽性だった。(一例が腎腫瘍、もう一例は殺虫剤による中毒だった) またこれらの所見を伴う他の品種の犬猫においては、チキン”ジャーキー”や胸肉の”トリーツ”の経口摂取の有無を調べ、もし与えていたら中止すべきである。その他に考えうる誘発性および”後天性”ファンコーニは、フェンスに塗装されている亜鉛を含む塗料を継続的に舐めているような亜鉛中毒、期限切れのテトラサイクリンの経口投与、高濃度の有機リン系殺虫剤への曝露が考えられる。幸運にも、血液ガス検査や血液生化学検査は、遺伝性、後天性ファンコーニで基本的な違いはなく、どちらも同じ補充管理プロトコールで充分対処できる。


The absolute diagnostic and therapy defining test is a VENOUS BLOOD GAS. No other test has been shown to provide the needed information to both diagnose and treat this disorder. Blood gas technique will be discussed later in this Protocol.




A Fanconi-afflicted patient, be they canine, feline, equine, human or any other mammal, will show a lowered HCO3 value on their blood gas panel (normal HCO3 being 24), and a negative Base Excess (normal being 0), indicating bicarbonate loss.


ファンコーニ罹患した患者は、犬であれ猫、馬であれ、人であれ、その他の哺乳類であっても血液ガス検査でHCO3: 重炭酸値が低下する。(重炭酸 HCO3標準値は24)、さらにBE(過剰塩基)の低下(正常値は0)もまた、重炭酸値の喪失を示している。


Normal physiology is designed to compensate for acidosis in multiple ways in order to maintain a normal pH level, and thus a normal pH is not indicative of the absence of Fanconi. In cases where your blood gas analyzer only provides a pH and pvCO2, you can go online and find many free Henderson-Hasselbalch calculators which allow you to calculate an HCO3 and Base Excess.




正常な生理機能では、pHを正常に維持するために様々な方法でアシドーシスを代償する能力が備わっている。そしてそのように正常なpHを示しているからと言って、ファンコーニではないと示しているわけではない。これらの症例では、血液ガス検査だけがpH, pvCO2(静脈血炭酸ガス分圧)を測定でき、インターネットで無料のHenderson-Hasselbalch calculators(ヘンダーソン・ハッセルバルヒの式)を探し計測値を求める。この式を用いるとHCO3やBEを計算式で求めることができる(訳注: 現在日本で使用されている各社の血液ガス検査機では、自動的にこれらの値は計算され表示されていることが多く、自分で計算する必要はないと思われる)




Also indicated would be a BLOOD CHEMISTRY panel which includes calcium, potassium, phosphorus, BUN, and creatinine.


また、血液生化学検査値では、Ca, K, Phos, BUN, Creを測定する必要がある。


Fanconi pets diagnosed and treated early will usually have normal BUN and Creatinine values; whereas those diagnosed later in their disease will show some azotemia which may require modification of the Protocol to address both the Fanconi (failure to reabsorb solutes from the urine) and renal insufficiency (failure to lose toxic solutes in the urine), which are “opposing clinical disorders”.




For Basenjis, a genetic test is offered by the Missouri College of Veterinary Medicine, through the Orthopedic Foundation for Animals. Links to this test, as well as to other Fanconi related topics, including this Protocol, can be found via the American Kennel Club Canine Health Foundation website at: http://www.akcchf.org.


バセンジーにとっては、遺伝子検査が、OFA(Orthopedic Foundation for Animals: 動物整形外科財団)を通して、ミッソーリ獣医科大学によって、提供されている。このウェブサイトへのリンクは、他のファンコーニ関連の情報やプロトコールも同様に下記のアメリカケンネルクラブ犬の健康財団 ウェブサイトから見つけることができる。

American Kennel Club Canine Health Foundation website     http://www.akcchf.org.



Even a negative genetic test in a Basenji is not 100% accurate, so any Basenji should still be watched for potential symptoms of Fanconi. A positive genetic test in a Basenji is reason to perform a “baseline” VENOUS blood gas (never arterial), as we have found some dogs spilling bicarbonate at six months of age. This is far earlier than the earliest onset of glucosuria we have seen, which was at three years of age. Dogs testing positive for the Fanconi gene, but having a normal baseline blood gas, should be followed at home with monthly urine glucose/ketone test strips, and a blood gas and chemistry repeated immediately if urine glucose is detected. Ideally, annual venous blood gasses can be done as part of their routine health visit, to detect possible bicarbonate loss even earlier.




Treatment Goals and Clinical Efficacy: Our therapy goal is to eliminate the metabolic acidosis by supplementing a replacement dose of bicarbonate, thus eliminating the metabolic workload of a “respiratory compensation for metabolic acidosis”. The pet will be using this supplementation to keep their pH normalized for as long as possible. We will also seek to normalize the pet’s electrolyte, vitamin and protein levels by compensating for the losses. In short, we are replacing the losses to achieve a normal functional set of lab values, and in doing so we either arrest, or dramatically slow any further progression of the disease or disorder. One peer-reviewed article in the AVMA journal established that dogs treated with the Protocol lived essentially normal lifespans, with a high quality of life, whereas without treatment, dogs succumbed to Fanconi in approximately eighteen months after onset of symptoms.









Treatment Recommendations: A Basenji-size dog (Appx 30 lbs or 13.6 Kg), after diagnosing Fanconi via loss of bicarbonate on a Venous blood Gas panel, would begin with the following eight step regiment;



バセンジーサイズの犬 (約15kgまたは13.6kg)で、血液ガス検査による重炭酸喪失でファンコーニと診断された場合、以下の8項目を進行段階に応じて実施する。


  1. Three ten-grain SODIUM BICARBONATE ANTACID TABLETS (650 mg each) BID, given intact in a small food treat. (Recommended starting doses for other size pets is listed below). Soft cheese slices, peanut butter rolled into balls, cream cheese, small quantities of cat food or cooked meat are all fine for pill-hiding. More pill-hiding ideas from the Fanconidogs support group can be found at:




  • 10グレイン(約650mg)の重炭酸ナトリウム制吐剤(重層 )3錠 1日2回を少量のフードとともにそのまま割らずに投与する。(他のサイズのペットの場合の推奨開始投与量は下記に述べている)






“Pill Pockets” brand pill-hiding treats, while useful in many situations, blocks bicarbonate absorption, and should not be used here. Below is a home-made pill hiding formula that can be safely used with bicarbonate, and all Fanconi supplements. It is easily made, can be formed into small, easily swallowed “balls” around pills, and tends to be well accepted by canine patients.


Two tablespoons of all-purpose flour

One tablespoon of milk

One Tablespoon of smooth peanut butter


Mix together in glass or metal bowl, then finish by kneading like dough in hands until evenly blended. This dough can be kept in a sealed container in the refrigerator to make small pill hiding balls.






小麦粉 大さじ2

ミルク 大さじ1

ピーナッツバター スムースタイプ 大さじ1





Recommended Sodium Bicarbonate Starting Dose-Canine and Feline

(upon Venous Blood Gas confirmed Fanconi Diagnosis)





Pet Body Weight—————– Starting Dose of Sodium Bicarbonate

ペットの体重                    重炭酸ナトリウム剤(重曹)の投与開始量


0-5 lbs (0-2.27 Kg)———————– 1 ten grain tablet (650 mg) P.O. BID

2.27kg以下                                     650mg BID 経口投与

6-10 lbs (2.28-4.45 Kg)——————2 ten grain tablets (1300 mg) P.O. BID

2.28-4.45kg                                   1300mg BID 経口投与

11-35 lbs (5-15.91 Kg)——————-3 ten grain tablets (1950 mg) P.O. BID

5-15.91kg                                     1950mg BID 経口投与

36-55 lbs (16.36-25 Kg)—————-4 ten grain tablets (2600 mg) P.O. BID

16.36-25kg                                    2600mg BID 経口投与

56-90 lbs (25.45-40.9 Kg)————-5 ten grain tablets (3250 mg) P.O. BID

25.45-40.9kg                                 3250mg BID 経口投与

>91 lbs (>41.36 Kg)———————6 ten grain tablets (3900 mg) P.O. BID

41.36kg以上                            3900mg BID 経口投与


Horses can be started on 10 ten grain tablets (6500 mg) P.O. BID (hidden in apple slices)


馬は6500mg BID経口投与で開始する(薄く切ったリンゴに隠すと良い)


In dogs who are very athletic, or involved in activities such as lure coursing, an additional bicarbonate tablet can be given half an hour prior to the activity and another single tablet given immediately afterwards, to help the body compensate for the additional CO2 and lactic acid loads.


From this starting dose we will recheck a VENOUS blood gas in approximately two weeks, aiming for a “window” of between six and eight hours after the last bicarbonate dose, to avoid peaks and troughs.

We are aiming for our goal of a 20-22 mEq/L (same as mmol/L) reading on the HCO3. You can titrate the Sodium Bicarbonate dose up or down to achieve this goal range, adding or subtracting one bicarbonate tablet BID, as needed. We try and keep all dosing BID to maintain stable blood levels of our supplements.

Sodium bicarbonate is OTC and best obtained in 1000-count bottles, which are very low in cost. While I don’t endorse brands, we have found RUGBY to be very” bioavailable” and easily dissolved in canine GI tracts. Likewise Lily and URL have been used with success in our patient population.







** Please note: CITRATES, such as UroCit-K have been postulated in the literature as a treatment for metabolic acidosis. In many early trials we had zero success with these techniques. Only Sodium Bicarbonate worked effectively as a buffer to the metabolic acidosis of Fanconi.





Additional CRITICAL components of the Protocol are based on almost 30 years of experiencing all the different permutations and losses that can occur with this disorder. Omission of any component can have unforeseen consequences.






  1. 2. Any complete canine or feline vitamin/mineral replacement product given BID. Example, PET TABS AF (Advanced Formula). This was previously Pet Tabs Plus.


2) 犬用猫用のビタミン/ミネラルの総合サプリメントは全てBIDで与える。例えば、ペットタブAF(高濃度処方)。これは以前はペットタブ プラスと呼ばれていたものと同製品である。(訳注: 現在日本ではペットタブは入手できるが、ペットタブ プラスは入手できない。ペットタブはペットタブプラス、ペットタブAFの半分の濃度なので、2倍量与えることで同量となる)


  1. 3. Any calcium/vitamin D/phosphorus replacement product (usually sold for lactating females), BID. Example, PET TABS CF (calcium formula), previously Pet Cal. This is given even if the measured blood labs show normal calcium or phosphorus levels, since we know these are lost in Fanconi, and the measured levels are due to sequestration out of bone and tissue. We only withhold this supplement in cases of renal insufficiency, where phosphorus levels tend to rise. Smaller dogs and cats can get a half-dose BID. Larger dogs do NOT need more than the one tab BID.


3) Ca/ビタミンD/リンのサプリメント(大抵は授乳中のメス用に販売されている)もまた、必ずBIDで与える。例えば、ペットタブ CF (PET TABS CF: Ca製剤)は以前 PET CALと呼ばれていた製品だが、これは血液検査でCa値やリンの値が正常範囲内であったとしても、ファンコーニでこれらが喪失するということが明らかなので、与えておくべきということになった。通常測定値が正常であっても、骨や組織中の貯蔵場所から喪失分が補われているからだ。しかし、血中リンの値が上昇する傾向がある腎不全の症例にだけは、このような補充は見合わせている。




  1. 4. One tablet or teaspoon of human “complete body building amino acid” formulation WEEKLY. Example, Amino 1000 (formerly Amino Fuel) by Twinlabs.


4) 人用の“総合アミノ酸製剤”を週に1、1錠または小さじ1杯与える。例えば、Twinlabs社から販売されているアミノ1000 (Amino 1000:以前は Amino Fuelという名称)



  1. 5. One complete “human” vitamin WEEKLY to cover for trace element losses we have seen in Fanconi dogs, but which are not included in most canine or feline formula’s.


5) 人用のビタミン剤を、ファンコーニ犬でよく見られるような電解質喪失をカバーするため、



Example, CENTRUM COMPLETE, or Flintstones Complete vitamins. The canine or feline multivitamin doses can be skipped on the day the human vitamin is given. The Amino Acid and Complete Vitamins can be given on the same day of the week for ease of compliance. Smaller dogs and cats can receive half of a tablet weekly, but larger dogs do NOT need more than the one tablet weekly.


例えば、CENTRUM COMPLETEや Flintstones Completeビタミンなどが適している。犬猫用のマルチビタミン製剤は、人用のビタミン剤を投与した日には与えなくてよい。 アミノ酸や総合ビタミン剤は、コンプライアンスを簡単にするために、週に1回同じ日に与える。小型犬や猫は、週に1回半錠でよいが、大型犬でも週に1回、1錠で十分である。


  1. Fresh water should always be available. Filtered water is best. Any in date refrigerator filter, tap-end filter, such as Brita, Pur or Culligan is fine, as are filter pitchers.


6) 新鮮な水は常に飲めるようたっぷりと用意しておく。ろ過した水は最もよい。BritaやPur、Culligenなどの”有効期限内”のフィルター、冷蔵庫に設置の浄水装置、水道蛇口の浄水器、フィルター付きのピッチャー、水さしでもよい。



  1. Unless the dog shows azotemia, a good quality, higher protein dog food is optimal to address the protein losses inherent with Fanconi. Usually something in the 21-28% crude protein level for dry, is optimal. Examples include Wellness, Natural Balance, Merricks, etc. Avoid foods higher than 28% in Basenjis, as BUN/creatinine elevations have been noted just from feeding these ultra high protein foods. In addition to this dry food, please add at least a can a week of wet meat based food, to add additional long-chain amino acids and phosphorus. Again, many good quality foods are available – or cooked meat may be used as well.


7) 犬が高窒素血症を呈していない限り、高品質の高タンパクのドッグフードを遺伝性ファンコーニには与える。通常は粗タンパク21-28%が最適なドライフード指標である。例えば、Wellness, Natural Balance, Merricksなどがこれにあたる。バセンジーでは、粗タンパク28%以上のフードは避けたほうが良い。バセンジーにおいては、このような非常にタンパク含有率の高いフードを与えているだけで、BUN/Creの血中濃度が上昇するということも報告されている。



  1. 8. Supplementation of the multivitamins will correct the issue. If hypokalemia persists on the follow-up lab work, then potassium supplementation may be needed. OTC potassium gluconate tablets, which are safe and inexpensive, often suffice for increasing levels to normal. In the USA, OTC potassium gluconate tablets contain 99mg of potassium (regardless of the potency listed on the front of the bottle) may be used. (Always check the back ingredient list). Starting dose would be one tablet BID, and can be increased to three BID as needed to restore normal blood potassium levels. If the OTC preparation does not bring the levels up sufficiently, then prescription Tumil K (2 mEq /tab) or UroCit-K, (5 mEq /tab) sustained release tablet (do not cut these), can be used. Some dogs have taken up to three UroCit-K BID to achieve normokalemia.


8) マルチビタミン(総合ビタミン)の補充は、状態の改善に役立つ。低カリウム血症が血液検査で持続していたら、カリウムの補充が欠かせない。OTC(薬局などで買える)のグルコン酸カリウム錠は安全で安価である。正常値まで増加すれば十分である。米国では、OTCのグルコン酸カリウム錠は99mg(訳注:2.5mEq)のカリウムが含有されている (ボトルの正面ラベルに明示されていなくても)製剤が使われている。(必ずボトルの背面の成分をチェックする)


初期開始投与量は、1錠BIDでよいが、正常血中カリウム濃度に戻るまで、必要であれば、3錠BIDまでは増量してよい。もし、OTCでは正常血中濃度に達しないようなら、Tumil K (2 mEq /tab) 又はUroCit-K, (5 mEq /tab)徐放剤が使えるが、これらは決して錠剤を分割してはいけない。

血中カリウム濃度を正常範囲に維持するためには、UroCit-K最高で 3錠BIDが必要だった犬の症例もあった。


By following these eight simple steps, we have achieved remarkable success in the long term, healthy maintenance of pets with this previously fatal illness.


After initial blood-work and starting on the Protocol, a repeat venous blood gas and blood chemistry panel is recommended at two weeks for dogs with severe symptoms, or eight to ten weeks for dogs whose symptoms are minor. Again, wait six to eight hours after the last bicarbonate dose to draw the Venous Blood Gas for accuracy. No” fasting” is needed for any Fanconi follow-ups.





Once stable, many dogs and cats get blood-work repeated only during their six month health checkups, or as symptoms dictate. A pet whose blood-work is returned to relatively normal, should have no issues until reaching the renal insufficiency inherent with old age, and that is dealt with exactly as with the” renal insufficiency” Protocol addendum below.




Renal Insufficiency Hybrid Protocol :Dogs or cats with elevated BUN/creatinine levels should remain on the” standard “+Protocol, listed above, with the following modifications;





  1. Due to decreased renal flow or urine concentration, pets often have a decreasing loss of bicarbonate, so a reduction of their bicarbonate dose, based on the measured Venous Blood Gas HCO3 level may be indicated to keep them in the 20-22 range.


  1. 腎還流や尿濃縮能の低下のために、動物たちはしばしば重炭酸喪失が逆に減少することがおこる。それで血液ガス検査のHCO3値に基づき、HCO3値を20-22の範囲に維持するために、重炭酸投与量を減らすよう指示しなくてはならないこともある。


  1. Due to increasing phosphorus levels, we stop the calcium/phosphorus supplement in these pets.


2, リン血中レベルの増加により、Ca/リンのサプリメントをこれらの動物たちでは中止する。


  1. Lower protein foods may be indicated, but rarely do we need to use the more poorly tolerated “full renal diets” (such as Hills K/D, or Purina NF). Instead, we have found the lower protein levels (approximately 17-18% crude protein) in some senior, weight loss or sedentary diets is sufficiently low in protein to level out or reverse the azotemia. The protein load in these foods can be cut even further by the use of “fillers” such as cooked rice, and cooked carrots and peas added to the diet.


  1. このような動物たちには低タンパク食を指示するが、Hills K/DやPurina NFのような”完全な腎処方食”はタンパク含有量が低すぎるのであまり勧めていない。その代替として、シニア用フードや減量用、低活動用のフードの低タンパク含有量(おおよそ粗タンパク17-18%)が、高窒素血症を改善するに十分な低タンパク含有量だということを発見した。これらのフードのタンパク負荷は、調理した米(ご飯)や火を通したニンジン、豆類などを“混ぜて”フードに加えることでさらに抑えることができる。


  1. All vitamin doses, such as the daily canine or feline vitamin/mineral administration as well as the weekly higher potency human vitamin dose, can be cut in half in these dogs and cats. (half a tab BID for most dogs, a quarter tablet BID for smaller dogs and cats).


4.全てのビタミン投与量、毎日の犬猫用ビタミン/ミネラル剤や、週に1回与える高濃度の人用ビタミン剤などは、これら腎不全併発犬猫の場合は半量に落とす。(ほとんどの犬では半錠 BID、小型犬や猫では1/4錠BID)


  1. Amino Acids weekly remain the same and may even be increased to twice a week if any loss of muscle tone or mass is seen.


  1. 週に1回のアミノ酸投与は変更せずそのまま継続し、筋肉の正常緊張状態が損なわれたり、筋肉量の減少が見られたら、むしろ週2回に増量するほうがよい。


  1. In cases of high or worsening BUN/creatinine levels, a full renal diet may be needed. Some dogs have needed IV fluid diuresis, in serious cases and others have been maintained on Sub-Q fluids at home. Some pets have stabilized after single IV diuresis treatments, others need monthly maintenance treatments.


  1. BUN/Creが重度に増加又は悪化している場合では、完全な腎処方食を与える必要があるかもしれない。犬によっては利尿を促すための静脈点滴療法が必要となる。重症例や他の場合でも、自宅での皮下点滴で維持する方法もある。1回の静脈点滴による利尿療法だけで改善した症例もあるし、1ヶ月にわたる維持療法が必要だった症例もある。


Other Medical Issues to Note In Fanconi Dogs: Many Fanconi dogs show extremely high liver enzyme levels. Alk phos, SGOT, cholesterol, SGPT and triglycerides should be followed, but even in cases, for instance, where alk phos was noted at over 900, in only a few cases was liver disease ever seen, and in those cases, it was cancer each time. These elevations have not been noted as significant in feline patients.



多くのファンコーニ犬たちは、極端に高い肝酵素値示す。ALP, SGOT, コレステロール,



T4 Levels. It is worth doing a thyroid check on these dogs, as many Basenjis are hypothyroid, but please wait to do your T4 level until after the acid/base balance has been restored, as uncontrolled Fanconi can lead to inaccurate” false positives” for thyroid disease.






Surgical Management in these dogs and cats is unchanged from an unafflicted pet, except their emergence from general anesthesia may be prolonged and hypoxia and hypercarbia can both create a severe stress on the kidney, worsening their Fanconi. Thus, I recommend allowing the dog or cat to wake up on some supplemental oxygen and not extubating the patient until they have strong breathing patterns to avoid hypercarbia from hypoventilation. With prolonged (>48 hour) NPO situations, the addition of IV sodium bicarbonate to maintenance IV fluids should be considered to prevent recurrence of acidosis from bicarbonate loss. Sodium Bicarbonate 8.4% (1 mEq/ml of bicarbonate) can be added to IV fluid and infused at 2 to 5 mEq per Kg of body weight over 4 to 8 hours to address acidosis.



ファンコーニを持つ犬猫の外科手術管理については、ファンコーニを持たない犬猫たちとなんら変わりはない。しかし、通常の麻酔状態から緊急事態が発生した時には通常より長引く可能性があり、低酸素状態、高炭酸ガス状態が腎還流に対し大きなストレスをかけ、ファンコーニが悪化する。それ故、私自身は、このような犬猫の麻酔では、より長く酸素化した状態で覚醒させること、低換気状態からの炭酸ガス過剰状態を回避するため、しっかりとした自発呼吸までは、患者の抜管をしないこと推奨している。より長期のNPO(訳注: Nil per os: 飲食制限)状態(48時間以上)が続く時には、重炭酸喪失によるアシドーシス再発防止のために、さらに重炭酸ナトリウムの静脈投与を考慮しなければならない。重炭酸ナトリウム8.4%(重炭酸1mEq/ml)を静脈投与し、体重1kgあたり2-5mEqの濃度に調節して、アシドーシスに注意しながら、4-8時間以上かけて投与する。


Medical Management of Fanconi pets, once controlled, is the same as any other pet. There are no medical or pharmacological considerations.


ファンコーニ動物の医療管理は、一旦良好にコントロールできれば 、他の健康な動物と(身体的にも行動的にも)同じである。それ以上の医学的あるいは薬学的検討は必要ない。


UTI Prevention. Many Fanconi dogs have benefitted from the addition of a” human” cranberry extract capsule (O.T.C. product, administered daily, as it acidifies the urine (which is overly alkaline due to the lost bicarbonate load. This has been a great adjunct in preventing UTI’s, in dogs with this chronic problem, and may be considered in all Fanconi dogs as an additional therapy.



多くのファンコーニの犬が”人用の”クランベリー抽出カプセル(OTC製品) の投与で効果がある。毎日投与し、尿を酸性化する。重炭酸喪失で尿がアルカリに傾くからだ。これは、尿路感染症の予防に大きな効果を発揮するサプリメントだ。特に慢性的な尿路感染症をもつ犬や、ファンコーニを持つ犬の全症例で考慮してもよいだろう。


UTI Treatment. While “best practice” in medicine is to only prescribe antibiotics when a bacterial infection has been confirmed, this does not apply in cases of Fanconi, where a thickened and trebeculated bladder wall, as well as thickened renal parenchymal tissue can lead to loculated (walled-off) micro-infections. These pinhead-size infections have been documented on MRI of Fanconi dogs kidneys, but are nearly impossible to document in the standard office setting. Since these micro infection sites are walled off they may shed no casts or cells to be seen on urinalysis, and even a C/S may come out negative, even though the pet is symptomatic for UTI (urgency, increased thirst, pain, frequency of urination, leaking at night). Thus, best practice in a Fanconi dog is to treat anything that symptomatically is a UTI as if it is one. Employ whatever broad spectrum antibiotic you would usually use to treat a UTI, for a seven- to ten-day run. If there is an infection present, it should resolve starting, on average, in 48 hours. If it does not resolve, then it is time to use other diagnostics to check for tumors, etc. If it resolves and returns after the antibiotics are completed, then we know it was an infection and needs another run of a different class of antibiotics due to incomplete “kill” of the organism.




これらの細菌感染部位が、壁に囲まれた中に隠れているので、尿検査で見られるような細胞や円柱が見つからない。動物が膀胱炎の症状(切迫感、喉の渇きの増加、痛み、頻尿、夜間の排尿失敗)を呈していても、尿検査でC/S( 訳注:culture/sensitivity: 培養/ケトン/感受性試験)すら陰性になる。ファンコーニの犬の最も良い治療は、尿路感染のような症状を呈しているものはなんでも治療するということである。通常使っている広域スペクトラムの抗生物質をなんでもいいので、7-10日間投与する。感染が存在する場合は、投与開始後平均48時間で効果が見られるはずだ。それでも改善しなければ、腫瘍などを疑い他の検査を行うべきだ。抗生物質が終了して一旦完治したがまた再発する時には、それは確かに感染症だったが、まだ”抗生剤が効いていない細菌を“殺す”ために他の種類の抗生物質の投与が必要であるとわかる。


Note that dogs” leaking” urine should first be treated for potential UTI, but if leaking persists, treatment with a single dose of Phenylpropanolamine (PPM) an hour before bed has helped many dogs (and owners) sleep through the night, without” accidents”.






GME-Granulomatous Meningio encephalitis – This is a multi-site spinal cord and/or brain tumor we have seen in some cases of Fanconi. It may or may not be related. This disease can manifest in many ways, but the visual cortex is one site often affected, thus visual/musculo-skeletal weakness or pain can be early indicators. CT scan with contrast can “illuminate the tumors, although newer diagnostic techniques exist. Treatment with prednisone has slowed the progress of this fast growing lesion, but if GME is suspected, please contact a veterinary neurologist, as new and better treatment options may be available.


GME: 肉芽腫性髄膜脳炎



Other Seizure Activity- Since azotemia, uremia, dehydration, metabolic acidosis and electrolyte disturbances can all contribute to seizure activity in dogs, we have encountered both isolated event, as well as epileptic llifetime seizure activity in our Fanconi patient population. Our observation is that while phenobarbital has been a proven and inexpensive treatment modality, it is both sedating and over time, hepatotoxic. Potassium Bromide has been used with less effect, in some dogs. Our observations indicate that the administration of OTC B6 (pyridoxine) given 100mg BID (Only B6, not a B Complex Vitamin) can increase the circulating GABA in the brain and thus increase the seizure threshold.



高窒素血症、尿毒症、脱水、代謝性アシドーシスや電解質異常のどれもが犬に対しひきつけ発作を起こす原因となりうる。我々は、ファンコーニの患者で“生涯にわたる”てんかん発作を持つ犬や、単発に発作を起こした症例のどちらも経験している。我々の所見では、フェノバルビタールが安価で効果が確認された治療法であるのだが、その作用は鎮静作用であり、また同時に長期投与では肝毒性がある。臭化カリウムは効果はやや落ちるが、使っている犬もいる。我々は、OTCのB6(ピリドキシン)100mg BID(ビタミンB6だけで総合ビタミンB剤ではない)が脳内を循環するGABA(ギャバ)を増加させることができ、その結果発作の閾値を上昇させることができると考えている。


B6, in combination with newer anti-seizure medications, such as Zonisamide (dosed 5mg/kg BID), is more effective, non sedating and has not revealed any hepatotoxic effects. It has been considered safe for cats as well, but with less apparent efficacy. As of this publication, other new medications are available, such as Felbamate, Levetiracetam (Keppra). (Both non-sedating), and even Gabapentine are being used successfully for treating seizures. Always consult with a veterinary neurologist, however, as new and effective anti-seizure medicines are being added to the list frequently.


ビタミンB6 と最新の抗てんかん薬、たとえばゾニサミド(5mg/kg)との併用はより効果的で、これは鎮静するのではなく、肝毒性もない。猫にも安全だが、やや効果は少ないように見える。今ここに述べている薬以外にも、フェルバメイト(Felbamate)やレベティラセタム(Levetiracetam)(Keppra)もまた使うことができる。どちらの薬も鎮静ではなく、ギャバペンティン(Gabapentine)も発作治療に使われ、効果がある。しかし常に新しいより効果的な治療薬が治療リストに加えられていっているので、脳神経専門の獣医師に相談するべきである。



Venous Blood Gas Technique: Since Venous Blood Gas analysis is crucial to diagnosing and treating this disorder, I want to refresh all clinicians on some basic technique facts.





  1. Always use a specific dry lithium heparin syringe or one that has had a drop of heparin pulled in, swished about and squirted back out. (Heparin “wash” technique).




  1. After drawing venous blood (never arterial) into the syringe, expel all air, roll syringe barrel in your hands for ten seconds to mix in the heparin, then run the sample in the machine or cap it airtight.


2) 静脈からシリンジへ採血し(動脈でないこと)、空気を全て押し出し、ヘパリンを十分混和するために手の中でシリンジの筒を10秒間転がす。その後測定器の中に血液サンプルを注入するか気密状態で密閉する。


  1. Normal VENOUS values should be pvO2 of about 30-55, normal pvCO2 of 45, normal HCO3 of 24, and Base Excess of 0.


pvO2 静脈酸素分圧の正常値は30-55で、pvCO2 静脈二酸化炭素分圧正常値は45、HCO324、BE (塩基過剰)はゼロである。


If your sample cannot go directly from dog to machine, then cap the barrel airtight, place it inside a Ziplock-type bag, and immerse the bag in a cup of freezing ice water and ice. This should keep the sample viable and accurate for up to 35-40 minutes.




Additional Links: Some veterinarians feel more comfortable having a sample blood sent to PennGen Laboratories at the University Of Pennsylvania School Of Veterinary Medicine to confirm the specific amino acid losses in their patients. If you choose to do this, but already have a dog with bicarbonate losses seen on a venous blood gas, please DO NOT delay onset of treatment pending the PennGen test. These additional weeks of delay can result in additional, and permanent, renal impairment.







There is an online “owner support group” for those treating ANY Fanconi pet. A lot of good information, help and support is available through its approximately 250 members with Fanconi dogs of many breeds. You may wish to provide the link to your patients owners: fanconidogs-owner@yahoogroups.com


オンラインでファンコーニのどのような動物の”飼い主もサポートしているグループ”もある。多くの有用な情報、サポートが、多岐にわたる犬種のファンコーニに関わるおよそ250人の会員から得られる。もし飼い主に対し、このリンクを教えてあげたいと考えるなら、下記のアドレスにアクセスするよう伝えると良い : fanconidogs-owner@yahoogroups.com




Basenji Companions has several articles on Fanconi Syndrome, which would apply to all pets:



Basenji Companionsバセンジーコンパニオンズはファンコーニの幾つかの論文を掲載している。これは全てのペットに適応できるものである。




The Basenji Club of America has information in their section on Basenji health:



Basenji Club of Americaアメリカ バセンジークラブは、Basenji health(バセンジーの健康)というセクションで情報を提供している。



Since nutrition is critical in managing Fanconi, here are three superb sites which review pet food quality




http://www.dogfoodadvisor.com/ (also includes information on pet food recalls)







http://www.dogfoodadvisor.com/ (also includes information on pet food recalls)





Assistance Policy: Please be aware that specific treatment advice and suggestions can only be offered directly to veterinary doctors and their staffs. Dr. Gonto cannot offer any medical information directly to owners and has no wish to come between any owner and their veterinarian. Dr. Gonto is exclusively a free-information resource to the veterinary community, sharing the information gleaned from observing thousands of cases over almost three decades.





The prior Protocol is available on multiple websites and has been veterinarian-translated into many languages including Japanese, German, and Russian. I freely welcome the translation of this new Protocol in any language needed, so long as it is accurate and complete in the new language.




Contact Information: Dr. Gonto is always available to assist with a Fanconi case, on a voluntary basis, and is best reached via email at outdoc@aol.com.



Gonto医師は、いつでもファンコーニの症例のサポートが可能です。これはGonto医師の純粋なる好意によるもので、Gonto医師と連絡を取りたい場合、emailで(訳注 英語で)下記のアドレスにお願い致します。



In a” dire” emergency, he can be reached via phone, between 6-8 p.m. EST. at (912) 598-5067



午後6-8時(EST アメリカ東部標準時間) 電話番号:(912)598-5067


IMPORTANT NOTICE-This Protocol card is intended ONLY as a tool for qualified veterinarians to use as an aid in diagnosing and treating Fanconi. It is shared with owners and breeders only for the purpose of providing it to their veterinary professional. In NO CASE should anyone attempt to diagnose or treat Fanconi on their own, without the specific guidance of their veterinarian. Fanconi is a potentially fatal illness and should be treated as so, by a qualified veterinarian only. Any attempt by an untrained individual to treat their dog using the outlined therapies here can result in catastrophic results for their pet. Also, please note your vet may choose not to use any or all of the recommendations herein, as they are most familiar with your pets unique medical needs and situation.





Legal Disclaimer; the author assumes no liability for the results or issues resulting from the use of any of the recommendations made in this Protocol. No medical or treatment advice is being offered directly to owner or breeders. No expectation of performance, nor guaranteed result or outcome is either promised or implied. The information here represents both the current best practices in veterinary medicine combined with the authors accumulated data, based on years of experience assisting veterinarians with Fanconi cases, accumulating input from various veterinary and human specialists, as well as working with his own Fanconi dogs. A great deal of knowledge has been obtained based on the lab work and clinical feedback from many veterinarians treating pets using the Protocol recommendations worldwide for almost three decades. The information here is shared freely in all cases, and is provided on a totally voluntary basis as an aid and informational resource to veterinarians, who are expected to make their own calculations, use their own clinical knowledge, and judgment, as well as obtaining their own findings in treating their Fanconi patients.






Acknowledgements: I wish to recognize with limitless gratitude the patience of my, wonderful, multi-talented wife in supporting, and participating, in the untold hours spent helping owners and veterinarians over the last three decades. As many who have called my contact number (our home phone) at all hours of the day and night can attest, she has become quite the expert at Fanconi management in her own right, and I have received many compliments, over the years, about her caring advice, so freely offered.





I must also recognize my lovely daughter, who missed many hours of quality” dad tim”e, as I would be glued to the phone or later the computer, assisting on Fanconi cases from all over the globe, seven days a week, and at some very odd hours (in our time zone, anyway). I must admit, however, that her exposure to my work with Fanconi was at least partially responsible for sparking her interest in science and medicine. One example was her ability to care for our non-Fanconi Basenji, who did suffer from severe epilepsy. One morning, when she was no more than ten years old, she greeted us with, “good morningh, by the way, Topper had a seizure last night. I made sure he was safe, and his airway was clear. Once it passed I let him go outside, then sent him back to bed. I didn’t think it was worth waking you up for just that”. She continues to amaze us with her skill and prowess, as she works treating autistic children.





I wish to also recognize Betsy Polglase, a pillar in the Basenji community, with great appreciation for her time, writing expertise, sharp eye and bright mind, and decade’s long friendship, in helping make the Protocol a useful tool from the very beginning, with her generously volunteered, and most expert editing. Betsy was founder and President of Basenji Companions, a wonderful, international support and friendship group for pet Basenji owners. Using that forum, she also started compiling Fanconi Protocol survival data, not only on Basenjis, but open to owners of all afflicted pets. Mrs. Polglase was also a founder and past president of the Bay State Basenji Club, and over the years was involved in obedience, agility work, as well as Basenji rescue and adoption. Her commitment to this breed and to pet痴 health in general has been clearly demonstrated by her incredible effort in helping monitor and support Fanconi pet owners online, as well as her great effort in helping make the various iterations of this Protocol a much more readable and useful aid for veterinarians to use, worldwide.


私はまたBetsy Polglase,にも謝意を表したい。彼女はバセンジー飼い主のコミュニテイの中で中心的存在で、鋭い視点と聡明な心、長年にわたる友情で、非常に早い時期からプロトコールを有用な治療法として普及させるため、専門的な知見を書いてくれた。彼女は喜んで無償で引き受けてくれた上、最も優秀な編集者でもあった。BestyはまたBasenji Companionsという団体の設立者でもあり、会長でもあった。Basenji Companionsは、バセンジーの飼い主を国境を越えて心からサポートしてくれる素晴らしい団体だ。そのフォーラムの場で、彼女はファンコーニにプロトコールを用いた場合の生存期間のデータを収集し始めた。しかもバセンジーに限らず、全てのファンコーニに罹患している動物の飼い主に広く門戸を開いた。

Polglase 夫人(Mrs. Polglase)もまたthe Bay State Basenji Clubの設立者であり元会長で、何年にもわたりアジリティの普及に努め、同時にバセンジーの保護や譲渡にも力を注いだ。彼女はこの犬種やペット全般の健康に関心を持ち、ファンコーニ動物の飼い主たちをオンラインでサポートやモニターの手助けすることに心血を注いだ。彼女はまた様々な方法で繰り返しこのプロトコールを世界中の獣医師にもっと読んでもらえるように、利用してもらえるようにと努力を惜しまなかった。


None of this work would have been possible without the initial information and invaluable contributions of the late Dr. Kenneth Bovee of University of Pennsylvania School of Veterinary Medicine, and an early pioneer in defining Fanconi, of the University of Georgia School of Veterinary Medicine, whose guidance and assistance with Benjis’ care and the early Fanconi research, helped put the final pieces in the” Fanconi puzzle”, and finally, Dr. Jerry Case, a superb veterinarian and great friend, who worked tirelessly to bring clinical reality to my theories and ideas. Even in his retirement, his daughter Dr. Carla Case McCorvey continues to advance the work of veterinary care and helps me care for my current Fanconi fur kids, thus allowing me to further polish this Protocol to the benefit of all Fanconi patients.


ペンシルベニア獣医科大学のKenneth Bovee 先生(Dr. Kenneth Bovee)による初期の情報や言葉に尽くせないほどの貢献無くして、この大きな作業の何も成しえなかった。そしてファンコーニの定義における初期のパイオニア、ジョージア獣医科大学のJeanne Barsanti先生, (Dr. Jeanne Barsanti)のバセンジーのケアやファンコーニの初期のリサーチへの指導や援助、“ファンコーニというパズル”の最後のピースを埋める作業を手伝って頂いた。そして最後に優秀な獣医師でもあり、友人でもあるJerry Case先生( Dr. Jerry Case)が精力的に私の理論や考えに臨床的な裏付けを与えてくれた。彼が現役を退いても、彼の娘、Carla Case McCorve先生(Dr. Carla Case McCorve)が獣医療における治療法の研究を続けて、私のしっぽのついた小さなファンコーニ患者たちのケアのためのサポートを続けてくれた。このことがさらにファンコーニのプロトコールを改善させてくれることになり、すべてのファンコーニの患者がその恩恵を受けていることだろう。


Finally, I must recognize Cenji (Little Miss Satin Cenji), a calm, patient and most long suffering, but never fussing, gentle soul of a Basenji, for whom this Protocol was developed. Had she not been such a good sport and a fierce, but stoic fighter against Fanconi, this Protocol would never have come into being. Rarely has one dog痴 life touched so many pets and humans across the globe.


最後に、忘れてはならないのが、”Cenji”(Little Miss Satin Cenji)だ。彼女は穏やかで忍耐強く、最も長い闘病だったが、決して我々を煩わせることもなく、バセンジーの心優しい魂を持っていた。このプロトコールは彼女がいたからこそできあがったのだ。彼女はとても協力的でファンコーニという病気と闘う強い戦士だったからこそ、このプロトコールを開発することができた。彼女のようにこんなにも多くの世界中の動物や人に影響を与えるような一生を送った犬なんてそういないだろう。



Feel free to copy, print, translate, share, upload, download or link to this Protocol. It may be added to any website, and translated into any language. The only request is that ALL the information contained herein is shared ACCURATELY and IN COMPLETE FORM, and is reproduced LEGIBLY.
このプロトコールをコピー、印刷、翻訳、共有、アップロード、ダウンロード、リンクなどにどうぞ自由に使っていただきたい。ウェブサイトに転載したり、いろいろな言語に翻訳されるかもしれない。私からの要望はただ一つ、それはこのプロトコールにあるあらゆる情報を全て正確に完全な形で、そして わかりやすく読みやすい形で書いてほしいということだけです。





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