Matenda a Nephrotic ndi matupi a thupi, omwe amawonongeka ndi impso ndipo amadziwika ndi zizindikiro zina zachipatala ndi ma laboratory. Kawirikawiri vuto lalikulu la matendawa amapezeka mwa anthu akuluakulu omwe sanakwanitse zaka 35.
Zifukwa za matenda a nephrotic
Nthenda ya nephrotic imadziwika ndi kugonjetsedwa kwa chipangizo cha glomerular cha impso, zomwe zimagwirizanitsidwa ndi magulu a nephrons (machitidwe a ma impso) omwe amagawidwa magazi ndi kupanga mkodzo. Pali kusintha kwa makoma a glomerular capillaries ndi kuwonjezeka kwa kuperewera kwao, zomwe zimayambitsa kusokonezeka mu mapuloteni ndi mafuta a metabolism, omwe akutsatiridwa ndi:
- Kuphwanya mavitamini a puloteni komanso kulowa mkodzo (proteinuria);
- kuchepa kwakukulu kwa mapuloteni m'magazi a magazi (hypoproteinemia);
- kuchepa kwa gawo la albumin la mapuloteni a plasma (hypoalbuminemia);
- kuwonjezeka mu magazi a cholesterol, triglycerides ndi phospholipids (hyperlipidemia), ndi zina zotero.
Ngati zovuta zimachitika mwadzidzidzi ndipo zalembedwa koyamba, matenda a nephrotic amayamba, ndipo kusintha kosavuta kumakhala kosavuta. Zomwe zimayambitsa matendawa sizinayambe, koma lingaliro lodziwika bwino komanso lodziwika bwino la tizilombo toyambitsa matenda ndilo lingaliro laumunthu. Nthano iyi imalongosola kukula kwa kusintha kwa matenda chifukwa cha kuyankha kwa chitetezo cha mthupi kuchitidwa kwa mitundu yosiyanasiyana ya antigen m'magazi.
Mwachiyambi, matenda a nephrotic amagawidwa pachiyambi (monga chisonyezero cha matenda a impso odziimira) ndi chachiwiri (chifukwa cha matenda opatsirana ndi impso yachiwiri). Monga choyambirira, chikhoza kukhalapo pamatenda monga:
- Lipoid nephrosis;
- chisamaliro cha amayi apakati;
- amyloidosis a impso;
- chiwonongeko;
- pyelonephritis;
- glomerulonephritis;
- zilonda za impso.
Matenda achiwiri angapangidwe kumbuyo kwa zilonda zotsatirazi:
- systemic lupus erythematosus;
- pre-eclampsia;
- mpweya wothamanga;
- shuga;
- amyloidosis;
- scleroderma;
- kupuma kwa mapapo;
- hepatitis B;
- hepatitis C;
- myeloma;
- chifuwa chachikulu;
- syphilis;
- malaria;
- poizoni ndi zitsulo zolemera;
- njoka za njoka, ndi zina zotero.
Matenda a Nephrotic ndi glomerulonephritis
Kawirikawiri pali diso la glomerulonephritis ndi matenda a nephrotic, omwe amtundu wotchedwa glomeruli amadziwika ndi kutupa kwapatsirana, zomwe zimayambitsa streptococci kapena tizilombo toyambitsa matenda. Chotsatira chake, chitetezo cha mthupi chimapanga tizilombo toyambitsa matenda omwe, tikamagwiritsidwa ntchito ku antigen, timakhala pamtunda wa glomerular ndikuyipitsa.
Matenda a Nephrotic ndi amyloidosis
Matenda oyambirira (idiopathic) nephrotic omwe amagwirizanitsidwa ndi amyloidosis ndi chifukwa chakuti m'mitsempha ya impso pali mavitamini a polysaccharide omwe amachititsa kuti thupi lisagwire ntchito. Pali kuphulika kwapang'onopang'ono kwa nephrons komwe kumapezeka kwambiri, kuchepa kwa epithelium ya tubules, ndipo impso zikukula kukula.
Matenda a Nephrotic ndi pyelonephritis
Matenda opatsirana komanso opweteka kwambiri a nkhumba zamphongo, calyx ndi renal parenchyma, omwe amachititsa kuti E. coli, asakhale ndi chithandizo chokwanira, amatha kusokoneza ntchito yowonongeka. Pankhaniyi, nthawi zambiri imakhala ndi matenda aakulu a nephrotic omwe amawopsa kwambiri.
Matenda a Nephrotic - zizindikiro
Edema mu matenda a nephrotic ndiwo mawonetseredwe aakulu a chipatala. Choyamba, kudzikuza kumawonekera pamaso (nthawi zambiri pansi pa maso), m'manja ndi m'mapazi, m'derali. Pambuyo pake, madzi amadziwika mu minofu yapansi ya thupi lonse. Zizindikiro zina zingakhalepo:
- khungu ndi khungu la khungu;
- ludzu;
- ululu pamutu;
- kusala kudya;
- kukhetsa;
- zovuta;
- kukopa zovuta mu dera la lumbar;
- kupweteka kwa minofu;
- kuchepa kwa mkodzo;
- phokoso;
- tsitsi lophwanyika ndi misomali;
- kupuma pang'ono, ndi zina zotero.
Ma laboratory akuluakulu a matenda a nephrotic akuwonetsedwa mu kuyesa mkodzo ndi magazi potsatira zizindikiro:
- kuchuluka kwa mapuloteni mu mkodzo - oposa 3 g / tsiku;
- kuchuluka kwa seramu albumin ndizosakwana 27 g / l;
- mlingo wa mapuloteni m'magazi amagazi - pansi pa 60-50 g / l;
- cholesterol wokhudzana ndi magazi ndi oposa 6.5 mmol / l.
Matenda a Nephrotic - matenda osiyanasiyana
Pofuna kudziwa kuwonongeka kwa ziwalo, kuzindikiritsa zovuta, kuphatikiza pa kafukufuku wochuluka wa nephrologist ndi anamnesis, matenda a nephrotic syndrome akuphatikizapo maphunziro angapo othandiza ndi ma laboratory:
- kusanthula kwakukulu kwa magazi ndi mkodzo;
- mkondwe mu Zimnitskiy;
- matenda;
- kusanthula kwa magazi ndi mkodzo;
- kuyembekezera mwazi kuti zithetse;
- mafoni;
- Ultrasonography ya impso ndi dopplerography;
- nephroscintigraphy;
- Impso zokhudzana ndi zovuta zazikulu.
Matenda a Nephrotic - urinalysis
Pamene pali kukayikira kwa matenda a nephrotic, mayeserowa amapereka mpata woti athe kutsimikizira kuti ali ndi matenda, komanso kuti adziwe njira zamankhwala. Chimodzi mwa zovumbulutsidwa kwambiri ndi kugometsa, kumene, kuphatikizapo kukhala ndi mapuloteni okwezeka, magawo otsatirawa akuwonekera m'matenda awa:
- mkodzo wosasunthika;
- kuwonjezeka kwakukulu;
- chithandizo;
- kukhalapo kwa leukocyte ndi erythrocytes;
- kukhalapo kwa chitofu ndi zitsulo za sera;
- kukhalapo kwa mitsempha ya cholesterol;
- chiwerengero chachikulu cha matupi a tizilombo toyambitsa matenda.
Kuchiza kwa matenda a nephrotic
Ngati matenda a nephrotic akupezeka, chithandizochi chiyenera kuchitidwa kuchipatala kuti dokotala akhoze kuyang'anitsitsa mkhalidwe wa wodwalayo ndi mankhwala achiritsi, ngati kuli koyenera kusintha. Chofunikira kwambiri ndi chithandizo cha matenda oyambirira ndi matenda ena achilengedwe, omwe angapangitse matenda a nephrotic. Odwala amalimbikitsidwa kuti azichita masewera olimbitsa thupi kuti athe kupewa chitukuko cha thrombosis.
Pogwiritsa ntchito mankhwala osokoneza bongo, njira yowonjezera yowonjezereka ya mapuloteni imatha, komanso magulu otsatirawa:
- glucocorticoids (Prednisone, Dexazon, Urbazon) - ndi atopic, lupus, membranous ndi mitundu ina ya nthenda;
- cytostatics (Azathioprine, Cyclophosphamide, Leukeran) - ndi lymphogranulomatosis , sarcoidosis, matenda a Wegener, etc;
- Anticoagulants (Heparin) - ndi diso la glomerulonephritis loopsa kwambiri, lopweteka, lopweteketsa, ndi impso zowawa, pre-eclampsia, etc;
- diuretics (Furosemide, Etakrinaic acid, Veroshpiron) - ndi kutchula kutupa;
- immunosuppressants (Azathioprine, Cyclosporine) - pakupezeka kwa matenda okhaokha;
- maantibayotiki (Ampicillin, Doxycycline, Cefazolin) - pamene njira zowonjezera zimapezeka.
Cytostatics mu nephrotic syndrome
Mankhwala a nephrotic syndrome omwe ali ndi mankhwala osokoneza bongo amafunika nthawi zambiri ngati palibe mankhwala a glucocorticosteroid kapena kuti palibe. Nthawi zina amagwiritsidwa ntchito mofanana ndi mankhwala a mahomoni, omwe amakulolani kuchepetsa mlingo ndi kuopsa kwa zotsatira zake. Mankhwala awa amachita pa maselo ogawanika, kuwalepheretsa iwo kugawanitsa. Simungathe kutenga cytostatics mu mimba, cytopenia, nephropathy popanda zizindikiro za ntchito, kukhalapo kwa matenda opatsirana.
Kudya ndi matenda a nephrotic
Kutulukira kwa "nephrotic syndrome" - chizindikiro cha kukhazikitsidwa kwa nambala yachisanu ndi chiwiri, chomwe chimagwiritsidwa ntchito poyendetsa kayendedwe kabwino ka mitsempha ndi mkodzo, kuchepetsa edema. Mfundo zazikuluzikulu zokhudzana ndi chakudya ndi izi:
- 5-6 amadya tsiku;
- Kusamalidwa mchere kapena kulepheretsa 2-4 g pa tsiku;
- kugwiritsa ntchito mbale zophikidwa pa steamed, yophika, stewed;
- Zakudya zapuloteni zimagwiritsidwa ntchito pa 1-2 g pa kilogalamu yolemera;
- chakudya chochuluka cha potaziyamu (amondi, apricots zouma, soya);
- kuchepetsa kugwiritsira ntchito mankhwala omwe amaphatikizapo chakudya chosavuta (mkate woyera, mbatata, mpunga woyera);
- kuchepetsa kudya kwa mafuta a nyama (nyama, nsomba zonenepa, mazira);
- Kuletsedwa kwa kugwiritsiridwa ntchito kwa madzi (kuganizira tsiku lonse la mkodzo).
Zovuta za matenda a nephrotic
Matenda a nephrotic syndrome sangathe kokha chifukwa chosanyalanyaza njira zomwe zimapangitsa munthu kuti asatengere, kuperewera kwabwino, komanso chifukwa cha kugwiritsa ntchito mankhwala ena. Matenda omwe amafala kwambiri pa matenda a nephrotic ndi awa:
- pulobothrombosis;
- pneumococcal peritonitis;
- chibayo;
- pleurisy ;
- thromboembolism ya mitsempha ya pulmonary;
- impso yopanda;
- kupweteka kwa ubongo;
- vuto la nephrotic;
- ululu;
- mawonetseredwe otsutsa;
- matenda a shuga ndi ena.