Nephrotic Syndrome waa xaalad jireed oo jidhka ah, oo la xidhiidha waxyeelada kelyaha waxaana lagu gartaa calaamadaha bukaan-socodka iyo shaybaarka qaarkood. Badanaa xaaladdan cilladahan waxaa lagu ogaadaa dadka waaweyn oo aan gaarin da'da 35 sano.
Sababaha xanuunka nephrotic
Neefsashada cudurka neefrotic waxaa lagu gartaa jabinta qalabka glomerular ee kelyaha, kuwaas oo ku biira kooxo nephrons (unugyada dhismaha ee kelyaha) iyada oo sifeynta dhiigga la sameeyo iyada oo la sameeyo kaabis dheeraad ah ee kaadida. Waxaa jira isbeddel ku dhaca darbiyada xididada glomerular leh iyada oo la kordhiyo suurtogalnimada, taasoo horseedi karta carqaladeynta borotiinka iyo dheef-shiid kiimikaad, oo ay la socdaan:
- Ku xadgudubka borotiinka ee nuugista iyo soo galitaanka kaadida (proteinuria);
- hoos u dhac weyn oo ah xoojinta borotiinka ee ku jira plasma dhiigga (hypoproteinemia);
- hoos u dhac ku yimaadda qaybta albumin ee borotiinka plasma (hypoalbuminemia);
- korodhka dhiigga ee dufanka, triglycerides iyo phospholipids (hyperlipidemia), iwm.
Haddii cilladaha aan caadi ahayn ay si lama filaan ah u dhacaan isla markaan la diiwaangeliyo markii ugu horeysay, cillad nephrotic ah oo dhacda, iyo isbeddel ku-yimaad ka sii daridda iyo dhibaatooyinka, habka waxaa loo tixgeliyaa daba-dheer. Sababaha dhabta ah ee cudurka cilladda ma wali la dhicin, laakiin fikradda ugu caansan oo macquul ah ee cudurkeenaha ayaa ah midda immunological. Naqshadani waxay sharraxaysaa horumarinta isbeddellada pathological ee sababtuna tahay jawaab celinta difaaca ee ficilka antigen-ka wareegyada kala duwan ee dhiigga.
Asal ahaan, cudurka neefrotic wuxuu u qeybsamaa koowaad (sida muuqaalka cudurka kelyaha madaxa banaan) iyo labaad (natiijo ka mid ah cudurrada nidaamka leh ee ku lug leh labaad ee kelyaha). Iyada koowaad, waxay ku jiri kartaa cudurada sida:
- Nephrois lipoid;
- nephropathy ee haweenka uurka leh;
- amyloidosis ee kelyaha;
- nephropathy xagasha;
- pyelonephritis;
- glomerulonephritis;
- burooyinka kalyaha.
Calaamadaha kale ee asaasiga ah waxay ka hor imaan karaan asalka astaamaha soo socda:
- habdhiska lupus ee leryerka;
- pre-eclampsia;
- xummad dhiig ah;
- diabetes mellitus;
- amyloidosis;
- scleroderma;
- xannuunka sambabada;
- Cagaarshow B;
- cagaarshowga C;
- myeloma;
- qaaxada;
- waraabowga;
- duumada;
- ku sumo leh birta culus;
- qaniinyada maskaxda, iwm.
Nephrotic syndrome leh glomerulonephritis
Badanaa waxaa jira glomerulonephritis ba'an oo leh nephrotic syndrome, kaas oo renal glomeruli uu ku dhaco infakshanka infakshanka, badanaa keena cudurka streptococci ama cudurada kale. Sidaas awgeed, habka difaaca jirka waxay soo saartaa unugyada difaaca jirka, marka la isku xidho antigens, oo ku dhejiso xuubka glomerular waxayna saameyn ku yeelataa.
Cudurka Nephrotic ee leh amyloidosis
Cudurka neefrotigga ee 'nephrotic' ee la xidhiidha amyloidosis ayaa sabab u ah xaqiiqda ah in unugyada kelyaha ay jiraan maadooyin ah xeryahooda borotiinka-polysaccharide taas oo keenaysa qaladka jirka. Waxaa jira tartiib tartiib tartiib ah oo ka baxsan nephrons oo qotodheer ah, ka sii darista epithelium ee tubbada, kelyuhu waxay kordhiyaan cabbirka.
Nephrotic syndrome leh pyelonephritis
Cudurka faafa ee infakshanka kalyaha, calyx iyo cillada kelyaha, oo kiciya xaaladaha badi by E. coli, iyada oo maqnaanshaha daaweyn ku filan si deg deg ah u horseedi karto xadgudub ah oo ka yimaadda shaqeynta suuxdinta iyo faylkaba. Xaaladdan oo kale, badanaa waxay ku dhacdaa cillad nephrotic syndrome ah oo leh jahwareer joogto ah.
Nephrotic Syndrome - calaamadaha
Cudurka nephrotic syndrome-ka waa muujinta ugu weyn ee kiliinikada. Marka hore, duufaan ayaa lagu arkay meelo wejiga ah (inta badan indhaha hoosteeda), gacmaha iyo cagaha, gobolka lumbar. Dabadeedna, dareeraha wuxuu ku ururaa nudaha subcutaneous ee jirka oo dhan. Calaamadaha kale waxaa ka mid ah:
- miisaan iyo maqaarka;
- harraad;
- xanuunka madaxa;
- cunto xumo;
- garaacid;
- xanuunka saxarada;
- riixida raaxo darrada gobolka lumbar;
- muruq xanuun;
- yaraanta kaadida;
- gariir;
- timo jilicsan iyo ciddiyaha;
- neefta gaaban, iwm.
Calaamadaha ugu weyn ee shaybaarada ee nephrotic syndrome ayaa lagu muujiyey falanqaynta kaadida iyo dhiigga soo socda tilmaamayaasha:
- qadarka borotiinka kaadida - in ka badan 3 g / maalin;
- xaddiga xiniinyaha sanbabada ayaa ka yar 27 g / l;
- heerka protein ee qaybta dareeraha ee dhiigga - ka hooseeya 60-50 g / l;
- daroogada dhiigga ee dhiigga ayaa ka badan 6.5 mmol / l.
Calaamadaha Nephrotic - Ciladaha kala duwan
Si loo go'aamiyo ciladda dhaawaca xubnaha, si loo ogaado sababaha keena keenista, marka lagu daro baaritaanka guud ee nephrologist iyo anamnesis, ciladda nephrotic syndrome-ka waxaa ka mid ah tiro daraasado qalabeed iyo shaybaar:
- falanqaynta guud ee dhiigga iyo kaadida;
- falanqaynta kaadida ee Zimnitskiy;
- falanqaynta bakteeriyada ee kaadida;
- falanqaynta biochemical ee dhiig iyo kaadida;
- baaritaanka dhiigga ee xinjirta;
- farshaxanka sawirka;
- Ultrasonography ee kelyaha qaba dopplerography;
- nephroscintigraphy;
- Kiniiniga laga soo saaro kelyaha oo la socdo baaritaanka mikroscopic.
Nephrotic syndrome - kaadiheysta
Marka uu jiro shaki ah cilladda nephrotic, tijaabooyinku waxay bixiyaan fursad aan lagu xaqiijin oo kaliya xaqiijinta cudurka, laakiin sidoo kale si loo ogaado xeeladaha daaweynta. Mid ka mid ah waxyaabaha ugu caansan waa kaadiheysta, taas oo intaa dheer, marka lagu daro heer sare oo ah borotiinka, xuduudaha soo socda ayaa lagu muujiyay cudurkan:
- kiniiniga cilladda leh;
- Cufnaanta kordhay;
- alkaline reaction;
- joogitaanka leukocytes iyo erythrocytes;
- joogitaanka jikada iyo boodhka;
- joogitaanka kalluunka shubanka;
- tiro badan oo ah meydad microbial.
Daaweynta cudurka neefrotic
Haddii la ogaado calaamadaha neefrototiga, daaweynta waa in lagu sameeyaa goobta isbitaalka si dhakhtarku u kormeero xaaladda bukaan socodka iyo habka daweynta, haddii loo baahdo waa inuu isbeddelaa. Muhiimada ugu muhiimsan waa daaweynta cudurada asaasiga ah iyo cudurrada kale ee asaasiga ah, kuwaas oo adkeyn kara cudurka neefrotic. Bukaan-socodka waxaa lagula talinayaa in lagu sameeyo jimicsi jireed si looga fogaado horumarinta thrombosis.
Marka la eego qaabka daaweynta daroogada, duritaanka xididada ee xakameynta borotiinka waa suurtogal, iyo sidoo kale kooxaha daroogooyinka soo socda:
- glucocorticoids (Prednisone, Dexazon, Urbazon) - oo leh atopic, lupus, membranous iyo noocyo kale oo ah nephropathy;
- cytostatics (Azathioprine, Cyclophosphamide, Leukeran) - leh lymphogranulomatosis , sarkhoosis, Wegener's syndrom, iwm;
- daawada xinjirowga lidka ku ah (Heparin) - oo leh glomerulonephritis hypertensive, malignantare, daal, oo leh kalyo shuban, pre-eclampsia, iwm;
- diuretics (furosemide, Etakrinaic acid, Veroshpiron) - oo leh barar lagu garto;
- difaaca jirka (Azathioprine, Cyclosporine) - si loo ogaado cudurrada ootimaalka;
- antibiotics (Ampicillin, Doxycycline, Cefazolin) - marka hababka faafa la ogaado.
Cytostatics ee nephrotic syndrome
Daaweynta nephrotic syndrome oo leh daawooyinka cytostatic ayaa badanaaba looga baahan yahay xaaladaha ka dhalan la'aanta daaweynta glucocorticosteroid ama maqnaanshaha saameyntiisa. Mararka qaarkood waxaa loo isticmaalaa daawooyinka hoormoonada, taas oo kuu ogolaaneysa inaad yareyso qiyaasta iyo darnaanta dhibaatooyinka soo raaca. Daawooyinkani waxay ku dhaqmaan unugyada kala qaybinta, iyaga oo ka hortagaya in ay qaybiyaan. Uma qaadi kartid xayawaan-xinjirowga xilliga uurka, cytopenia, nephropathy iyada oo aan lahayn calaamadaha waxqabadka, joogitaanka infekshanka focal.
Cuntada leh nephrotic syndrome
Cilimaadka 'neefrotic syndrome' - waa tilmaam loogu talagalay magacaabida lambarka cunnada ee toddoba, oo loogu talagalay inay caadi tahay hababka dheef-shiid kiimikaad iyo kaadida, yareynta bararka. Talooyinka ugu muhiimsan ee cunnooyinka waa sida soo socota:
- 5-6 cunto maalintii;
- Ka-reebitaanka qaadashada cusbada ama xaddidaadda ilaa 2-4 g maalintii;
- isticmaalka suxuunta la kariyey ee caadka la kariyey, la kariyey, la kariyey;
- Cuntada borotiinka waxaa loo isticmaalaa qiyaasta 1-2 g halkii kiilo oo culus;
- Kordhinta cuntooyinka hodanka ah ee potassium (yicib, ubax, khudradda cagaaran);
- yaraynta isticmaalka alaabooyinka ay ku jiraan carbohydrates fudud (rootiga cad, baradhada, bariiska cad);
- yaraynta dufanka xoolaha (hilibka, kalluunka dufanka, ukunta);
- xaddidaadda isticmaalka dheecaanka (iyada oo la tixgelinayo xisaabinta maalin kasta ee kaadida).
Dhibaatooyinka cudurka nephrotic Syndrome
Dhibaatooyinka nephrotic syndrome-ka waa mid dhib badan maaha oo kaliya sababtoo ah dayacaadda geedi-socodka hawada, daaweyn aan ku filneyn, laakiin sidoo kale sababtoo ah isticmaalka daawooyinka qaarkood. Dhibaatooyinka ugu badan ee nephrotic syndrome waa:
- phlebothrombosis;
- pneumococcal peritonitis;
- oof-wareen;
- sheyga ;
- Tromboembolism of artery pulmonary;
- infarct kelyaha;
- garaaca maskaxda;
- dhibaatooyinka nephrotic;
- boogta faafa;
- Jaantusyada xasaasiyadda;
- diabetes mellitus iyo kuwa kale.