I-Nephrotic syndrome iyimvelo yomzimba, ehlotshaniswa nokulimala kwezinso futhi ibonakala ngezibonakaliso ezithile zemitholampilo kanye nelabhoratri. Ngokuvamile lokhu kuyinkimbinkimbi yezinkinga kutholakala kubantu abadala abangakafiki eminyakeni engu-35.
Izimbangela ze-nephrotic syndrome
Ngoba i-nephrotic syndrome ibonakala ngokunqotshwa kwezixhobo ze-glomerular zezinso, ezihlanganiswa ngamaqembu we-nephrons (izingxenye zesakhiwo ezinama-kidneys) lapho ukuhlunga kwegazi kuqhutshwa khona ngokwengeziwe ukwakhiwa komchamo. Kukhona ushintsho ezindongeni ze-capillariyo ye-glomerular enyuka ekumenikeni kwazo, okuholela ekuphazanyisweni kwamaprotheni namafutha we-metabolism, ahambisana nalokhu:
- ukwephulwa kwamaprotheni ukungena kanye nokungena kumchamo (proteinuria);
- ukwehla okuphawulekayo kwamaprotheni okuhlushwa eplasma yegazi (hypoproteinemia);
- ukwehla kwengxenyana ye-albumin ye-protein yamaplasma (hypoalbuminemia);
- ukwanda kwi-cholesterol yegazi, i-triglycerides ne-phospholipids (i-hyperlipidemia), njll.
Uma ukungalungile kwenzeka ngokuzumayo futhi kubhaliwe okokuqala, i-nephrotic syndrome ephawulekayo yenzeke, futhi ngokushintshwa okulandelanayo ekukhusheni nasekukhusheni, inqubo ibhekwa ingapheli. Izimbangela eziqondile ze-syndrome azange zisungulwe, kodwa umqondo ovame kakhulu futhi ozwakalayo we-pathogenesis yayo yi-immunological one. Le ncazelo ichaza ukuthuthukiswa kwezinguquko ze-pathological ngenxa yempendulo ye-immune ekusebenzeni kwe-antigens ehlukahlukene ejikelezayo egazini.
Ngokwemvelaphi, i-nephrotic syndrome ihlukaniswe eyinhloko (njengokubonakaliswa kwesifo sezinso esizimele) nesesibili (ngenxa yezifo zesistimu ngokubandakanyeka kwezinhlangothi ezimbili). Njengokuyinhloko, ingaba khona kumathambo njengalawa:
- Lipoid nephrosis;
- ukungahloniphi kahle kwabesifazane abakhulelwe;
- i-amyloidosis yezinso;
- i-nephropathy ye-membranous;
- i-pyelonephritis;
- i-glomerulonephritis;
- izimpungushe zezinso.
I-syndrome yesibili ingathuthuka ngokumelene nesizinda sezilonda ezilandelayo:
- i-systemic lupus erythematosus;
- i-pre-eclampsia;
- i-vasculitis enegazi;
- isifo sikashukela mellitus;
- amyloidosis;
- i-scleroderma;
- i-abscess yamaphaphu;
- ukushisa kwesibindi B;
- i-hepatitis C;
- i-myeloma;
- isifo sofuba;
- i-syphilis;
- i-malaria;
- uketshezi ngezinsimbi ezinzima;
- izinyoka, njll
I-Nephrotic syndrome ene-glomerulonephritis
Ngokuvamile kukhona i- glomerulonephritis enamandla ene-nephrotic syndrome, lapho i-glomeruli yamazinyo evezwa khona ukuvuvukala okubhebhethekayo, ngokuvamile okubangelwa yi-streptococci noma ezinye izifo. Ngenxa yalokho, isimiso somzimba samasosha omzimba sikhiqiza izifo ezithathelwana ngamagciwane ukuthi, uma ziboshelwe ama-antigens, zihlala embundeni we-glomerular futhi ziwuthinte.
I-Nephrotic syndrome ene-amyloidosis
I-primary (idiopathic) nephrotic syndrome ehlotshaniswa ne- amyloidosis ingenxa yokuthi emathisheni ezinso ezinama-protein-polysaccharide amakhemikhali abangela ukungasebenzi komzimba. Kuhamba kancane kancane kwezingubo ze-nephronia ezijulile, ukuwohloka kwe-epithelium ye-tubules, futhi izinso zanda ngesayizi.
I-Nephrotic syndrome ene-pyelonephritis
Izilonda ezithathelwanayo nezivuvuzelayo ze-renal pelvis, i-calyx ne-renal parenchyma, ekhishwa ngamacala amaningi ngo-E. coli, ngokungabikho kokwelashwa okwanele kungaholela ekuphukeni komsebenzi owenziwe ngokweqile kanye nokuhlunga. Kulokhu, ngokuvamile kudala i-nephrotic syndrome engapheli ngezikhathi ezithile.
I-Nephrotic syndrome - izimpawu
I-Edema ku-nephrotic syndrome iyimbonakaliso esemtholampilo esemqoka. Okokuqala, ukuzikhukhumeza kubonakala endaweni ebusweni (ngokuvamile ngaphansi kwamehlo), ezandleni nasezinyaweni, esifundeni se-lumbar. Ngokulandelayo, uketshezi luhlanganisa izicubu ezingaphansi komzimba wonke. Ezinye izimpawu zingabandakanya:
- ukuphuza nokuma kwesikhumba;
- ukoma;
- ubuhlungu ekhanda;
- ukudla okumbi;
- ukuvula;
- izinkinga zesitoreji;
- ukudubula kabi esifundeni se-lumbar;
- ubuhlungu besisu;
- ukwehla komchamo we-urine;
- ukuxubha;
- izinwele ezibuhlungu nezipikili;
- ukuphefumula, njll
Izimpawu ezibalulekile ze-laboratory ze-nephrotic syndrome zibonakala ekuhlaziyweni komchamo negazi ngemva kwezinkomba:
- inani lamaprotheni emcimbini - okungaphezu kuka-3 g / ngosuku;
- inani le-album ye-serum lingaphansi kuka-27 g / l;
- izinga lamaprotheni engxenyeni egazini yegazi - engaphansi kuka 60-50 g / l;
- okuqukethwe kwe-cholesterol egazini kungaphezu kuka-6.5 mmol / l.
I-Nephrotic syndrome - ukuxilongwa okuhlukile
Ukuze kutholakale ukulimala komzimba, ukuveza izimbangela ezibangelwayo, ngaphezu kokuhlolwa okujwayelekile kwe-nephrologist ne-anamnesis, ukuxilongwa kwe-nephrotic syndrome kuhlanganisa izifundo eziningi zezinsimbi nezifundo:
- ukuhlaziywa okujwayelekile kwegazi nomchamo;
- ukuhlaziywa komchamo eZimnitskiy;
- ukuhlaziywa kwe-bacteriological umchamo;
- ukuhlaziywa kwemvelo yegazi kanye nomchamo;
- ukuhlolwa kwegazi ukuvala i-clotting;
- i-electrocardiography;
- Ultrasonography yezinso nge-dopplerography;
- i-nephroscintigraphy;
- i-kidney biopsy ngokuhlolwa okukhulu kakhulu.
I-Nephrotic syndrome - i-urinalysis
Uma kukhona ukusola kwe-nephrotic syndrome, ukuhlolwa kuhlinzeka ithuba lokuqinisekisa ukuthi ukuxilongwa, kodwa futhi ukucacisa amaqhinga okwelapha. Enye yezinto ezivezwe kakhulu yi-urinalysis, lapho, ngaphezu kokuba nezinga eliphakeme leprotheyini, le mingcele elandelayo ibonakalisiwe kule ngozi:
- umchamo ogqamile;
- ukuphakama kwabantu;
- ukuphendula kwe-alkaline;
- ukuba khona kwama-leukocyte nama-erythrocyte;
- ukutholakala kwesitofu nama-cylinders;
- ukutholakala kwamakhebuli e-cholesterol;
- inqwaba yezindikimba ezincane.
Ukwelashwa kwe-nephrotic syndrome
Uma ngabe i-nephrotic syndrome itholakale, ukwelashwa kufanele kwenziwe esiteshini sesibhedlela ukuze udokotela angakwazi ukuqapha isimo sesiguli kanye nomgomo wokwelashwa, uma kunesidingo ukulungisa. Ukubaluleka okuyinhloko ukwelashwa kwezifo eziyinhloko nezinye izifo ezingemuva, okungenza kube nzima ukushaya i-nephrotic syndrome. Iziguli zinconywa ukuthi zivivinya umzimba ukuze zigweme ukuthuthukiswa kwe-thrombosis.
Emkhakheni wezokwelapha izidakamizwa, ukwelashwa okune-proravenous amaprotheni kungenzeka, kanye namaqembu alandelayo wezidakamizwa:
- i-glucocorticoids (i-Prednisone, i-Dexazon, i-Urbazon) - nge-atopic, lupus, membranous nezinye izinhlobo ze-nephropathy;
- i-cytostatics (Azathioprine, i-Cyclophosphamide, i-Leukeran) - nge- lymphogranulomatosis , i-sarcoidosis, i-Wegener's syndrome, njll;
- ama-anticoagulants (i-Heparin) - ene-glomerulonephritis enegazi eliphakeme, elibi kakhulu, elimnandi, ngezinsolo ezishisayo, pre-eclampsia, njll;
- ama-diuretics (i-Furosemide, i-Etakrinaic acid, i-Veroshpiron) - ngokusho ukuvuvukala;
- ama-immunosuppressants (Azathioprine, i-Cyclosporine) - ekutholeni izifo ezizimele;
- ama-antibiotics (Ampicillin, Doxycycline, Cefazolin) - uma kutholakala izinqubo ezithathelwanayo.
I-Cytostatics e-nephrotic syndrome
Ukwelapha kwe-nephrotic syndrome enezidakamizwa ze-cytostatic kuvame ukudingeka uma kungenakuphika kwe-glucocorticosteroid therapy noma ukungabikho komphumela wayo. Ngezinye izikhathi zisetshenziselwa ukufana nemithi ye-hormonal, okukuvumela ukuba unciphise umthamo nokuqina kwemiphumela emibi. Lezi zidakamizwa zisebenza kumaseli ahlukanisayo, ezivimbela ukuba zingahlukanisi. Awukwazi ukuthatha i-cytostatics ekukhulelwe, i-cytopenia, i-nephropathy ngaphandle kwezibonakaliso zomsebenzi, ukutholakala kokutheleleka okugxile.
Ukudla nge-nephrotic syndrome
Ukuxilongwa kwe- "nephrotic syndrome" - isibonakaliso sokuqokwa kwenombolo yokudla eyisikhombisa, okuhloswe ukuba kusetshenziswe indlela yokucubungula umzimba kanye nokukhipha umchamo, ukunciphisa i-edema. Izincomo eziyinhloko zokudla zilandelayo:
- 5-6 ukudla ngosuku;
- Ukukhipha usawoti ukungenisa noma ukuvinjelwa ku-2-4 g ngosuku;
- ukusetshenziswa kwezitsha eziphekwe ku-steamed, abilisiwe, ziphekwe;
- Ukudla kwamaprotheni kusetshenziselwa inani 1-2 g kilogram yesisindo;
- ukwandisa ukudla okucebile nge-potassium (ama-alimondi, ama-apricot omisiwe, isoya);
- ukunciphisa ukusetshenziswa kwemikhiqizo ehlanganisa ama-carbohydrate alula (isinkwa esimhlophe, amazambane, ilayisi elimhlophe);
- ukunciphisa ekudleni kwamafutha esilwane (inyama, izinhlanzi ezinamafutha, amaqanda);
- ukuvinjelwa kokusetshenziswa ketshezi (kucatshangelwa ukuphuma kwansuku zonke komchamo).
Izinkinga ze-nephrotic syndrome
Izinkinga ze-nephrotic syndrome azikwazi nje kuphela ngenxa yokunganakwa kwenqubo ye-pathological, ukwelashwa okunganele, kodwa futhi ngenxa yokusetshenziswa kwemithi ethile. Izinkinga ezivame kakhulu ze-nephrotic syndrome yizo:
- i-phlebothrombosis;
- i-peritonitis ye-pneumococcal;
- i-pneumonia;
- pleurisy ;
- i-thromboembolism yomshini we-pulmonary;
- izinso ezingenayo;
- ukushaywa kobuchopho;
- Inkinga ye-nephrotic;
- i-peptic ulcer;
- ukubonakaliswa kwe-allergen;
- isifo sikashukela kanye nabanye.