Nephrotic syndrome ke boemo bo botle ba 'mele, bo amanang le tšenyo ea liphio' me bo khetholloa ke matšoao a mang a litsebi le a laboratori. Hangata bothata bona ba mathata bo fumanoa ho batho ba baholo ba sa kang ba fihlela lilemo tse 35.
Mabaka a lefu la nephrotic
Bakeng sa lefu la nephrotic le khetholloa ka ho hlōloa ha lisebelisoa tsa glomerular tsa liphio, tse kopantsoeng ka lihlopha tsa nephrone (lihlopha tsa liphio) tseo ho tsona ho tšeloang mali ho etsoang ka mokhoa o tsoelang pele oa ho etsa motsoako. Ho na le phetoho marakong a glomerular capillaries e nang le keketseho ea ho itšireletsa ha tsona, e lebisang ho ferekanyang ka protheine le mafura a metabolism, a tsamaeang le:
- ho tlōla ho kenngoa ha protheine le ho kenella motsong (proteinuria);
- ho fokotseha ho hoholo ha liprotheine tse kenngoeng ke mali a mali (hypoproteinemia);
- ho fokotseha ha karolo ea albumin ea protheine ea mali (hypoalbuminemia);
- ho eketsa k'holeseterole ea mali, triglycerides le phospholipids (hyperlipidemia), joalo-joalo.
Haeba boemo bo sa tloaelehang bo etsahala ka tšohanyetso 'me bo ngotsoe ka lekhetlo la pele, lefu la nephrotic le thata le hlaha,' me ka liphetoho tse latellanang ho matlafatsa le ho fokotsa lintho, mokhoa ona o nkoa e le o sa foleng. Lisosa tse hlileng li bakang lefu lena ha li e-s'o thehoe, empa khopolo e tloaelehileng ka ho fetisisa le e utloahalang ea pathogenis ea eona ke ea immunological. Khopolo ena e hlalosa tsoelo-pele ea liphetoho tsa mafu ka lebaka la karabelo ea 'mele ea ho itšireletsa mafung ka liketso tsa li-antigens tse sa tšoaneng tse potolohang maling.
Ka tlhaho, lefu la nephrotic le arotsoe ka sehloohong (e le pontšo ea mafu a liphio a ikemetseng) le ea bobeli (phello ea mafu a tloaelehileng a nang le liphio tsa bobeli). E le ntho e ka sehloohong, e ka ba teng maemong a tšoaetsanoang a kang:
- Lipoid nephrosis;
- ho se tsotelle ha basali ba baimana;
- amyloidosis ea liphio;
- sefahleho sa liphate;
- pyelonephritis;
- glomerulonephritis;
- likokoanyana tsa liphio.
Matšoao a bobeli a ka hlahella ho latela mokokotlo oa lisola tse latelang:
- systemic lupus erythematosus;
- pele-eclampsia;
- vasculitis ea hemorrhagic;
- lefu la tsoekere;
- amyloidosis;
- scleroderma;
- ho siea ha matšoafo;
- hepatitis B;
- hepatitis C;
- myeloma;
- lefuba;
- sephiri;
- malaria;
- chefo ka lisebelisoa tse boima;
- ho loma linoha, joalo-joalo.
Nephrotic syndrome e nang le glomerulonephritis
Hangata ho na le glomerulonephritis e nang le lefu le nang le lefu la nephrotic, moo maromolu a renal a pepesehang ho ruruha ho tšoaetsanoang, hangata ho bakoang ke streptococci kapa likokoana-hloko tse ling. Ka lebaka leo, tsamaiso ea 'mele ea' mele ea ho itšireletsa mafung e hlahisa lithibela-mafu tseo, ha li tlamehile ho li-antigens, li lula holim'a lehare la glomerular le ho li ama.
Nephrotic syndrome e nang le amyloidosis
Ntho e ka sehloohong (idiopathic) nephrotic syndrome e amanang le amyloidosis e bakoa ke taba ea hore meleng ea liphio ho na le likheo tsa liprotheine-polysaccharide metsoako tse bakang tšenyo ea litho. Ho na le li-nefronone tse fumanehang sebakeng seo, butle-butle ea li-epithelium tsa tubules, 'me liphio lia eketseha ka boholo.
Nephrotic syndrome e nang le pyelonephritis
Likokoana-hloko tse tšoaetsanoang le tse fokolang tsa pelal pelvin, calyx le renal parenchyma, hangata maemong a mangata ke E. coli, ha ho se na phekolo e lekaneng ho ka lebisa ho tlōla ha mosebetsi o hlophisitsoeng le o hloekisang oa setho. Tabeng ena, hangata e hlahisa lefu le sa foleng la nephrotic le ho tepella nako le nako.
Nehrotic syndrome - matšoao
Edema ka nephrotic syndrome ke kakaretso ea kliniki ea pontšo. Ntlha ea pele, ho ikhohomosa hoa bonahala sebakeng sa sefahleho (hangata tlas'a mahlo), matsohong le maotong, sebakeng sa lumbar. Ka mor'a moo, mokelikeli o bokellana ka metsoako e tlaase ea 'mele oohle. Matšoao a mang a ka kenyeletsa:
- ho fifala le ho omella ha letlalo;
- ho nyoroa;
- bohloko bo hloohong;
- ho hloka takatso ea lijo;
- ho senya;
- mathata a likoti;
- ho hula hampe sebakeng sa lumbar;
- bohloko ba mesifa;
- ho fokotseha ha tlhahiso ea urine;
- ho tepella;
- moriri o phatsimang le lipekere;
- phefumoloho e khutšoanyane, joalo-joalo.
Matšoao a maholo a laboratori ea nephrotic syndrome a bonahala ha ho hlahlojoa motsoako le mali ka mor'a lits'ebetso:
- palo ea protheine meleng - e fetang 3 g / letsatsi;
- palo ea serum albumin e ka tlaase ho 27 g / l;
- tekanyo ea protheine e karolong ea metsi - tlasa 60-50 g / l;
- cheleseterole tse nang le mali li feta 6,5 mmol / l.
Nephrotic syndrome - ho khetholla ho fapaneng
E le hore ho khethoe matla a tšenyo ea 'mele, ho khetholla mabaka a bakang, ho phaella tlhahlobo e akaretsang ea nephrologist le anamnesis, ho hlahlojoa ha nephrotic syndrome ho kenyelletsa lithuto tse ngata tsa lipatlisiso le tsa laboratori:
- tlhahlobo e tloaelehileng ea mali le moroto;
- urine analysis in Zimnitskiy;
- tlhahlobo ea baktheria ea urine;
- tlhahlobo ea lik'hemik'hale tsa mali le moroto;
- teko ea mali bakeng sa ho koala;
- electrocardiography;
- Ultrasonography ea liphio le dopplerography;
- nephroscintigraphy;
- ho hlajoa ha liphio ka tlhahlobo e nyenyane.
Nephrotic syndrome - urinalysis
Ha ho na le lipelaelo tsa nephrotic syndrome, liteko ha li fane ka monyetla oa ho tiisa hore na o fumanoa joang, empa hape ho fumana mekhoa ea phekolo. E 'ngoe ea lintho tse hlalosang ka ho fetisisa ke ho hloekisa, eo, ntle le ho ba le bophahamo ba protheine e phahameng, litekanyo tse latelang li senoloa bothateng bona:
- urine e phatsimang;
- bongata bo eketsehileng;
- alkaline mohato;
- boteng ba leukocyte le erythrocyte;
- ho ba teng ha setofo le li-cylinders;
- boteng ba likristale tsa k'holeseterole;
- palo e kholo ea mefuta e mengata ea microbial.
Kalafo ea lefu la nephrotic
Haeba lefu la nephrotic le fumanoa, phekolo e lokela ho etsoa sebakeng sa sepetlele e le hore ngaka e khona ho shebella boemo ba mokuli le tsamaiso ea bongaka, haeba ho hlokahala hore e lokisoe. Ntho ea bohlokoa ka ho fetisisa ke phekolo ea mafu a mantlha le maloetse a mang a mokokotlo, e leng ho ka kenyang lefu la nephrotic. Bakuli ba kgothaletswa ho ikoetlisa bakeng sa ho ikoetlisa bakeng sa ho qoba ntlafatso ea thrombosis.
Ka moralo oa phekolo ea lithethefatsi, ho kenngoa likokoana-hloko tsa liprotheine ho na le likokoana-hloko tse ka tšoaetsanoang, hammoho le lihlopha tse latelang tsa lithethefatsi:
- li-glucocorticoids (Prednisone, Dexazon, Urbazon) - ka li-atopic, lupus, membranous le mefuta e meng ea nephropathy;
- cytostatics (Azathioprine, Cyclophosphamide, Leukeran) - ka lymphogranulomatosis , sarcoidosis, syndrome ea Wegener, joalo-joalo;
- li-anticoagulants (Heparin) - tse nang le li-glomerulonephritis tse nang le khatello e matla ea mali, tse kotsi, tse bohloko, liphio tse tšoenyang, pele-eclampsia, joalo-joalo;
- diuretics (Furosemide, Etakrinaic acid, Veroshpiron) - le ho phatlalatsa ho ruruha;
- immunosuppressants (Azathioprine, Cyclosporine) - ho fumanoa ke maloetse a mangata;
- lithibela-mafu (Ampicillin, Doxycycline, Cefazolin) - ha mehato e tšoaetsanoang e fumanoa.
Cytostatics ka nephrotic syndrome
Phekolo ea lefu la nephrotic syndrome e nang le lithethefatsi tsa cytostatic hangata e hlokahalang ha ho se na phekolo ea phekolo ea glucocorticosteroid kapa ho se be le phello ea eona. Ka linako tse ling li sebelisetsoa ho fapana le meriana ea li-hormone, e leng se u lumellang ho fokotsa tekanyo le matla a litla-morao. Lithethefatsi tsena li sebetsa lisele tse arohanang, li ba thibela ho arola. U ke ke ua nka cytostatics nakong ea bokhachane, cytopenia, nephropathy ntle le matšoao a mosebetsi, boteng ba tšoaetso e kholo.
Lijoe ka lefu la nephrotic
Ho fumanoa ha "nephrotic syndrome" - e leng pontšo ea ho khethoa ha nomoro ea lijo tse supileng, e leng ho ikemiselitse ho etsa mekhoa e metle ea lik'hemik'hale le motsoako oa motsoako, ho fokotsa edema. Lintlha tse ka sehloohong tse khothalletsoang bakeng sa lijo ke tse latelang:
- 5-6 lijo ka letsatsi;
- Ho qoba ho noa letsoai kapa thibelo ho 2-4 g ka letsatsi;
- tšebeliso ea lijana tse phehiloeng ka mouoane, li phehiloeng, li phethiloe;
- Lijo tsa protheine li sebelisoa ka li-1-2 g ho kilogram ea boima ba 'mele;
- ho ja lijo tse ngata tse nang le potassium (lialmonde, apricots tse omisitsoeng, soya);
- ho fokotsa tšebeliso ea lihlahisoa tse akarelletsang lik'habohaedreite tse bonolo (bohobe bo tšoeu, litapole, raese e tšoeu);
- ho fokotsa ho kenngoa ha mefuta ea liphoofolo (nama, tlhapi e mafura, mahe);
- thibelo ea tšebeliso ea metsi (ho nahanngoa ka letsatsi le leng le le leng la mocheso).
Mathata a lefu la nephrotic
Mathata a nephrotic syndrome a ka ba thata ka lebaka la ho hlokomoloha mokhoa oa ho kula, ho se tšoanelehe kalafo, empa hape ka lebaka la tšebeliso ea meriana e itseng. Mathata a tloaelehileng ka ho fetisisa a lefu la nephrotic ke:
- phlebothrombosis;
- pneumococcal peritonitis;
- pneumonia;
- pleurisy ;
- thromboembolism ea methapo ea pulmonary;
- liphio tse senyehileng;
- ho otloa ha boko;
- lefu la nephrotic;
- seso sa peptic;
- litšoantšiso tse fokolang;
- lefu la tsoekere le ba bang.