I-Nephrotic syndrome yimeko yempilo yomzimba, inxulumene nesonakalo sezintso kwaye ibonakaliswe yimpawu ezithile zeklinikhi kunye neebhoratri. Ngokuqhelekileyo le nkathazo yeengxaki ifunyanwe kubantu abadala abangazange bafikelele kwiminyaka engama-35.
Izizathu ze-nephrotic syndrome
Kuba i-nephrotic syndrome ibonakala ngokutshatyalaliswa kwezixhobo ze-glomerula zezintso, ezihlanganiswe ngamaqela e-nephron (iinqununu zengqondo) apho i-filtration yegazi iqhutyelwa ngayo kunye nokwenziwa kwamanzi emzimbeni. Kukho utshintsho kwiindonga ze-capillaries ze-glomerular kunye nokwanda kwimizimba yazo, ekhokelela ekuphazamiseni kwiprotheni kunye ne-fatabetism ye-fat, ehambelana nayo:
- ukuphulwa kweprotein kunye nokungena kumchamo (proteinuria);
- ukwehla okukhulu kwiprotheni yokuxinwa kwi-plasma yegazi (hypoproteinemia);
- ukwehla kwincinane ye-albumin yeprotheni ye-plasma (hypoalbuminemia);
- ukwanda kwi-cholesterol yegazi, i-triglycerides kunye ne-phospholipids (hyperlipidemia), njl njl.
Ukuba ukungaqhelekanga kwenzeka ngokukhawuleza kwaye kubhalwe okokuqala ngqa, i-nephrotic syndrome iyenzeka, kwaye kunye nokutshintshwa okulandelelanayo kwiimeko ezinzima kunye nokukhutshwa, inkqubo iyaqwalaselwa ingapheliyo. Izizathu ezisemthethweni zesifo asikaze zenziwe, kodwa ingqondo eqhelekileyo kunye nengqiqo ye-pathogenesis yayo i-immunological. Le ngcamango ichaza ukuphuhliswa kweenguqu zezifo ngenxa yokuphendula komzimba kwisenzo se-antigen ejikelezayo kwigazi.
Ngokwemvelaphi, i-nephrotic syndrome ihlukaniswe yiprayimari (njengokubonakaliswa kwesifo sezintso ezizimeleyo) kunye nesibini (ngenxa yezifo zesistim ngokubandakanyeka kwesebe). Eyona nto ephambili, inokuthi ibekho kwiipathologi ezifana:
- Lipoid nephrosis;
- nephropathy yabafazi abakhulelweyo;
- i-amyloidosis yeentso;
- nephropathy;
- pyelonephritis;
- glomerulonephritis;
- izifo zeengso.
Izifo zesibini ziyakhula malunga nemvelaphi yezilonda ezilandelayo:
- lupus erythematosus;
- pre-eclampsia;
- vasculitis;
- isifo sikashukela;
- amyloidosis;
- scleroderma;
- ukungabikho kwemiphunga;
- i-hepatitis B;
- i-hepatitis C;
- myeloma;
- isifo sofuba;
- i-syphilis;
- malariya;
- utyhefu ngezinyithi ezinzima;
- inyoka,
I-Nephrotic syndrome kunye ne-glomerulonephritis
Ngokuqhelekileyo kukho i- glomerulonephritis enesifo se-nephrotic syndrome, apho i-glomeruli ye-renal ibonakaliswa kukuvuvukala, okubangelwa yi-streptococci okanye ezinye izifo. Ngenxa yoko, i-immune system ivelisa amanqwelombazana apho, xa iboshwe kwii-antigen, zihlala kwisibilini se-glomerular kwaye zichaphazele.
I-Nephrotic syndrome ne-amyloidosis
I-primary (idiopathic) ye-nephrotic syndrome ehambelana ne- amyloidosis ingenxa yokuba iifom zezintso zikhona idiphozi yeeprotheni-polysaccharide iimveliso ezibangela ukungasebenzi kwelungu. Kukho ukuhamba ngokukhawuleza kweephrononi ezikufutshane, ukuchithwa kwe-epithelium yee-tubules, kunye neentso zisanda ngobukhulu.
I-Nephrotic syndrome ne-pyelonephritis
Izilonda ezithintekayo nezivuthayo ze-pelal pelvis, i-calyx kunye ne-renal parenchyma, echukunyiswayo kwiimeko ezininzi nge-E. coli, ngokungabikho kwonyango olwaneleyo kunokukhokelela ngokukhawuleza ukuphulwa komsebenzi we-excretory kunye nokuhlunga. Kule meko, ngokuphindaphindiweyo ivelisa i-nephrotic syndrome engapheliyo.
I-Nephrotic syndrome - iimpawu
I-Edema kwi-nephrotic syndrome yiyona nto ibonakaliso oluphambili lwekliniki. Okokuqala, ubuqhophololo bubonakala kwindawo ebusweni (ngokuphindaphindiweyo phantsi kwamehlo), ezandleni nasezinyaweni, kwingingqi ye-lumbar. Emva koko, umbane uqokelela kwiisishu zangaphantsi zomzimba wonke. Ezinye iimpawu zingabandakanya:
- ukugquma kunye nokomisa kwesikhumba;
- unxaniwe;
- intlungu entloko;
- ngxamele ukutya;
- ukucima;
- iziphazamiso zesitopu;
- ukutshatyalaliswa kwintsimi ye-lumbar;
- intlungu;
- ukukhutshwa komchamo we-urine;
- zixhala;
- izinwele ezinobumba kunye nezipikili;
- ukuphefumula, njl njl
Iimpawu eziphambili zebhoratri ze-nephrotic syndrome zibonakaliswa ekuhlaleni umchamo kunye negazi emva kwezibonisi:
- inani leprotheni kumchamo - ngaphezulu kwama-3 g / ngosuku;
- inani le-album ye-serum lingaphantsi kwama-27 g / l;
- kwinqanaba leprotheni kwinxalenye yamanzi yegazi-ngaphantsi kwe-60-50 g / l;
- umxholo we-cholesterol egazini ungaphezu kwe-6.5 mmol / l.
I-Nephrotic syndrome - ukuxilongwa ngokungafani
Ukufumanisa ubunzima bomonakalo wombutho, ukuchonga izizathu ezibangeleyo, ngaphezu kovavanyo oluqhelekileyo lwe-nephrologist kunye ne-anamnesis, ukuxilongwa kwe-nephrotic syndrome kubandakanya uphando lwezixhobo kunye neelabhoratri:
- Ukuhlalutya ngokubanzi kwegazi kunye nomchamo;
- uhlalutyo lomchamo eZimnitskiy;
- uhlalutyo lwe-bacteriological umchamo;
- hlalutyo lwegazi kunye nomchamo;
- uvavanyo lwegazi lokucima;
- electrocardiography;
- Ultrasonography yeentso kunye ne-dopplerography;
- nephroscintigraphy;
- iinjongo ze-biopsy ngeemviwo ezincinci.
I-Nephrotic syndrome - urinalysis
Xa kukho ukukrokra kwe-nephrotic syndrome, iimvavanyo zinikeza ithuba lokuqinisekisa ukuxilongwa, kodwa ukufumana iinkqubo zonyango. Enye yeyona nto ibonakalisa ukonakala kwamanzi, apho, ngaphezu kokuba nenqanaba eliphezulu lamaprotheni, iiparameter zilandelayo zibonakaliswe kule nkalo:
- umchamo ocolileyo;
- ukwanda ko buninzi;
- i-alkaline reaction;
- ubukho be-leukocyte kunye ne-erythrocyte;
- ubukho beesitofu kunye neesilinda;
- ubukho beekristolol;
- inani elikhulu lamagumbi ezincinci.
Unyango lwe-nephrotic syndrome
Ukuba i-nephrotic syndrome ifunyenwe, unyango kufuneka lwenziwe kwisibhedlele esibhedlele ukuze ugqirha abeke esweni imeko yesigulane kunye ne-regimen yokwelapha, ukuba kuyimfuneko ukuyilungisa. Okubaluleka ngokubalulekayo yonyango lwezilwanyana eziphambili kunye nezinye izifo ezivela kummandla, ezingabangela ukuba i-nephrotic syndrome ibe nzima. Izigulane zikhuthazwa ukuba zivivinye umzimba ukuze kuphephe ukuphuhliswa kwe-thrombosis.
Kwisakhelo sonyango lweziyobisi, i-injection injection ye-protein izisombululo ezinokwenzeka, kunye namaqela alandelayo eziyobisi:
- i-glucocorticoids (i-Prednisone, i-Dexazon, i-Urbazon) - nge-atopic, lupus, membranous kunye nezinye iintlobo ze-nephropathy;
- i-cytostatics (Azathioprine, i-Cyclophosphamide, i-Leukeran) - ne- lymphogranulomatosis , i-sarcoidosis, i-Wegener's syndrome, njl.;
- i-anticoagulants (i-Heparin) - kunye ne-glomerulonephritis enoxinzelelo olubi, olubi kakhulu, olunzima, ngeentso eziphazamisayo, i-pre-eclampsia, njl.;
- i-diuretics (iFurosemide, i-Etakrinaic acid, i-Veroshpiron) - kunye nokuvuvukala;
- i-immunosuppressants (Azathioprine, i-Cyclosporine) - ekufumaneni izifo ezizimele;
- i-antibiotics (iAmpicillin, i-Doxycycline, iCefazolin) - xa iinkqubo ezithathelwanayo zifunyanwa.
I-Cytostatics kwi-nephrotic syndrome
Ulwaphulo lwe-nephrotic syndrome elinamayeza e-cytostatic lufuneka rhoqo kwiimeko zokungabikho kwe-glucocorticosteroid okanye unyango olungekho. Ngamanye amaxesha asetyenziswa ngokufana nemithi ye-hormone, evumela ukuba unciphise umlinganiselo kunye nokukhawuleza kwemiphumo emibi. Ezi zi yobisi zisebenza kwiiseli ezahlula, zithintela ukuba zihlukane. Awukwazi ukuthatha i-cytostatics ekukhulelweni, i-cytopenia, i-nephropathy ngaphandle kwempawu zento, ubukho be-infection ephambili.
Ukutya ne-nephrotic syndrome
Ukuxilongwa kwe-"nephrotic syndrome" - inkcazo yokutyunjwa kwenani lokutya elisixhenxe, ekujoliswe kwindlela yokucwangcisa imveliso kunye nokuvelisa umchamo, ukunciphisa i-edema. Iingcebiso eziphambili zokutya zilandelayo:
- 5-6 ukutya ngosuku;
- Ukukhutshwa kweetyuwa ukungena okanye ukukhawulelwa ku-2-4 g ngosuku;
- ukusebenzisa izitya eziphekwe kwi-steamed, ephekiweyo, ezityiweyo;
- Ukutya kwiprotheni kusetyenziswa kwisixa esingu-1-2 g nganye kilogram yesisindo;
- ukwandiswa kokutya kokuzityebi kwi-potassium (i-almonds, i-apricots ezomileyo, i-soya);
- ukunciphisa ekusebenziseni iimveliso ezibandakanya i-carbohydrate elula (isonka esimhlophe, iitapile, ilayisi emhlophe);
- ukunciphisa ukutya kwezilwanyana zezilwanyana (inyama, intlanzi enamafutha, amaqanda);
- umda wokusetyenziswa kobutyebi (ukuqwalasela umva wamanzi ngosuku).
Iingxaki ze-nephrotic syndrome
Iingxaki ze-nephrotic syndrome ayikwazi nje kuphela ngenxa yokunyanzeliswa kwenkqubo yokugula, ukunyanga okwaneleyo, kodwa nangenxa yokusetyenziswa kwamachiza athile. Iingxaki eziqhelekileyo ze-nephrotic syndrome zi:
- i-phlebothrombosis;
- pneumococcal peritonitis;
- pneumonia;
- pleurisy ;
- i-thromboembolism ye-pulmonary artery;
- ezingenayo isifo;
- ukuphazamiseka kwengqondo;
- ingxaki ye-nephrotic;
- isilonda sesilonda;
- ukubonakaliswa kwempawu;
- isifo sikashukela kunye nabanye.