Nephrogenic shuga insipidus ndimatenda omwe wodwalayo akuwonetsa kulephera kwa mayendedwe am'madzi chifukwa amachepetsa mayendedwe a impso ku mahomoni antidiuretic.
Zotsatira zake, mkodzo wambiri wosapangika umapangidwa. Izi, zimatha kuyipa m'mavuto a wodwalayo ndikupangitsa impso kuwonongeka.
Matendawa monga matenda a nephrogenic ali ndi mitundu ingapo, pomwe onsewa amadziwika ndi kuphwanya kwakukulu kwa impso, chifukwa chake kusintha kwa mchere wamchere kumaonekera mthupi la munthu. Ngati titenga chidziwitso cha mankhwala ndi zamankhwala zokha, ndiye kuti titha kuzindikira kudumphadumpha kwa wodwala pamagazi a m'magazi.
Hyperelectrolythemia ikhoza kukhalanso, momwe kuchuluka kwa sodium m'madzi a m'magazi kumatha kuwonjezeka pazovuta za 180 meq / l, ndi chlorine mpaka 160 meq / l. Panthawi imeneyi, wodwalayo amamva kukodza pafupipafupi. Zotsatira za izi zitha kukhala kukula kwa kuchepa kwa thupi komanso kawirikawiri toxosis.
Mitundu yayikulu yamatenda
Ngati tikunena za mitundu ya nthendayi yomwe tafotokozayi, ndiye kuti matenda a shuga a impso amatengedwa ndipo amatengera cholowa. Matendawa amatha kupezeka pokhapokha ngati wodwala ali ndi vuto laubongo chifukwa chovulala ndipo mphamvu yake ya m'magazi itasokonekera, zomwe zimapangitsa impso kukhala zosamveka kwa ADH. Makamaka omwe amapezeka kuti ali ndi mtundu wofanana wa matenda opatsirana a shuga a mtundu uwu ndi odwala okalamba, komanso odwala omwe ali ndi vuto lofooka kapena odwala aimpso.
Mtundu wachiwiri wa matendawa ndi cholowa ndipo amatanthauza kukhalapo kwa matenda obadwa nawo kwambiri mwa wodwala, ndiko kuti, vuto la vasopressin arginine receptor gene. Kuphatikiza apo, mtundu uwu wa shuga ungayambitse masinthidwe amitundu yosiyanasiyana, okhudza jini la aquaporin-2. Komanso, kutengera mtundu wa izi kapena matenda obadwa nawo, odwala amatha kukhala omvera komanso osaganizira za ADH.
Tiyeneranso kukumbukira kuti pali matenda omwe ali ndi zizindikiro zofanana ndi nephrogenic shuga insipidus. Mwachitsanzo, shuga insipidus mwa amayi apakati, momwe placenta imabisala vasopressinase mu theka lachiwiri la kutenga pakati. Kuphatikiza apo, chithunzi chofananacho chitha kuonedwa pambuyo pakuchita opaleshoni pazomera.
Kuti mutha kusiyanitsa mtundu kapena mtundu wina wa matenda omwe wapatsidwa, ndikofunikira kudziwa bwino zizindikiro zake. Pokhapokha pokhapokha pokhapokha ngati mungathe kupereka chithandizo chokwanira ndikuletsa kukula kwa matendawa kuchokera pachimake mpaka chovuta.
Chithandizo chopanda tanthauzo chimangokulitsa mtundu uwu wa matenda ashuga.
Zizindikiro za matenda ndi kuwazindikira
Mu nephrogenic shuga insipidus, zizindikiro zimatchulidwa momveka bwino, ngati zizindikiro zenizeni za matendawa zikuwonekera, muyenera kufunsa dokotala. Mwachitsanzo, chizindikiro chachikulu cha matendawa ndiko kupangika kwa mkodzo wa hypotonic mu madzi okwanira malita atatu mpaka makumi awiri patsiku. Zotsatira zake, wodwalayo amayamba kumva ludzu kwambiri pomwe kuchuluka kwa sodium sodium kumakhalabe kwabwinobwino.
Ngati matendawa adakula mwa odwala omwe sangathe kupeza madzi momasuka, mwachitsanzo, ana okalamba kapena ana, ndiye chifukwa chake amatha kukhala ndi hypernatremia. Mawonekedwe ake akunja atha kukhala chikumbumtima, kukhumudwa kwambiri, kukomoka kapena kukomoka. Ana aang'ono omwe akuvutika ndi mtundu wofotokozedwa wamatenda a shuga amatha kuonongeka kwa ubongo chifukwa cha kukula kwa matendawa, limodzi ndi kuchepa kwa luntha, komwe sikungasinthe, atha kupezeka ndi kuchepa kwa thupi.
Ponena za njira zodziwira matenda, matenda a nephrogenic amatsimikizika mwa wodwala pogwiritsa ntchito njira zotsatirazi:
- kuwerenga kwamkodzo kamodzi patsiku kwa osmolality, komanso kutsimikizira kuchuluka kwake;
- Kuyang'ana seramu yamagazi pama electrolyte;
- zitsanzo ndi kudya kowuma.
Akatswiri azachipatala amalimbikitsa kuti odwala onse omwe amadandaula ndi polyuria atengedwe kuti akalandire chithandizo. Poyamba, mkodzo umatengedwa kuchokera kwa iwo poyesa kangapo patsiku. Kutengera ndi zotsatira za maphunziro, mayeso owonjezera atha kutumizidwa.
Kupezeka kwa NNDM kumadziwika ndi kutulutsa mkodzo wa wodwalayo mwa 50 ml / kg patsiku, pomwe osmolality yake imakhala yochepera 200 mOsm / kg. Mulimonsemo, dokotala adzafunika kupatula zifukwa zina zomwe zimapangitsa wodwalayo kuti azichita. Pokhapokha pokhapokha amatha kudziwa kudalirika kwa chithandizo chomwe amupatsa.
Ponena za mayeso ena, nthawi zambiri shuga amatsimikiziridwa pamene seramu sodium imakwezedwa mpaka 145 mEq / L. Kuphatikiza apo, poyesa kudya pouma patatha maola asanu ndi limodzi kukana madzi, mkodzo wonyansa uyenera kulembedwa. Komanso, kuyesaku kuyenera kutsimikiziridwa ndi zotsatira za maphunziro ena.
Popanda kudutsa mayeso onse omwe atchulidwa pamwambapa, ndikosatheka kuyambitsa chithandizo cholondola, ndipo, izi, zimatha kudzetsa imfa ya wodwala kuchokera ku madzi ofunika. Chifukwa chake, ngati pali vuto la matenda ashuga, muyenera kupewa kupita kumadera omwe kumatentha nthawi yayitali.
Pakadali pano, simuyenera kukonzekera kuchitapo kanthu opaleshoni komanso kuletsa nthawi yake kutukuka kwa mavuto.
Njira zazikulu zamankhwala
Wodwala akapezeka kuti ali ndi matenda a shuga a nephrogenic ndipo amazindikira momveka bwino, ndikofunikira kuyamba kulandira chithandizo pambuyo pochita maphunziro oyenera. Kwenikweni, imakhala mu kukonzanso kusintha kwa madzi. Ngati mankhwalawa apambana, ndiye kuti zitheka kuthetsa pafupifupi nephrotoxins iliyonse ndikusintha kuchuluka kwa madzimadzi omwe amamwa tsiku lililonse.
Kuchepetsa diuresis, thiazide diuretics nthawi zambiri amagwiritsidwa ntchito kuti achepetse kuchuluka kwa madzi omwe amaperekedwa ku malo omwe amakhala ndi chidwi ndi ma ADH. Wodwala adzapindula ndi zakudya zochepa zama protein. Wodwala ayenera kuchepetsa kuchuluka kwa mchere womwe umamwetsa tsiku lililonse.
Kuphatikiza apo, ngati wodwalayo adawulula chizindikiro chimodzi chazomwe zafotokozedwazo, akulangizidwa kuti azitsatira nthawi zonse zomwe zikuwonetsa kuchuluka kwa acid-m'magazi pomwe akuyang'anira kuchuluka kwa potaziyamu. Kuyesedwa koteroko kumakupatsani mwayi kuti muwone kuyambika kwa matendawa munthawi yake ndikuletsa, chifukwa chake, impso ya wodwalayo singavutike nayo kwambiri.
Mwambiri, zakutsogolo kwa mankhwalawa kumatenda odwala ndikwabwino, chifukwa chake, musataye mtima pochitika kuti NNDS ipezeka. Ngati wodwala amatsatira njira zamankhwala ndi upangiri wa dokotala, ndizotheka kuti kuchira kwathunthu kumabwera. Mulimonsemo, chithandizo chamankhwala chapanthawi yake chikaperekedwa, odwala sakhala pachiwopsezo cha kufa.
Pakadali pano, musatengedwe pakudzipangira nokha mankhwala, chifukwa mtundu uliwonse wa matenda ashuga uli ndi ake ndipo ngati mankhwala amodzi atathandizira mu vuto lina, wina sangathe kuthandiza. Ngati wodwalayo amakonda mankhwala omwe amadzichitira nokha, ndiye kuti matendawo atha kudwala kwambiri. Izi siziyenera kuloledwa, chifukwa zovuta zazikulu zimayambira limodzi ndi matenda a shuga.
Pankhani yopewa, anthu omwe amakonda matenda amtunduwu amalangizidwa kuti aphunzire maphunziro amtsogolo. Popewa kukula kwa matendawa, muyenera kuyesetsa kupewa kupewetsa matenda osiyanasiyana opatsirana omwe angayambitse kukula kwa NNDS.
Kuti muchite izi, ndikofunikira kuyendera dokotala ndikutsatira malangizo ake.
Kuchiza ndi wowerengeka azitsamba
Wodwala akaganiza zochizira matenda a shuga a nephrogenic, amalephera, chithandizo choterocho chiyenera kutsagana ndi mankhwala othandizira. Izi zipititsa patsogolo phindu lomwe limapezeka chifukwa cha mankhwalawa, komanso, pakapita nthawi, pafupifupi kukana kumwa mankhwala konse. Zotsatira zake, wodwalayo amalandira chithandizo chamankhwala popanda kuwononga thupi lake chifukwa chomwa mankhwala.
Njira zotchuka kwambiri zochizira matenda ndi kugwiritsa ntchito mankhwala azitsamba osiyanasiyana. Mwachitsanzo, mutha kugwiritsa ntchito muzu wa valerian wosakanikirana ndi vuto ndi mbewu za fennel ndi cyanosis buluu. Kuphatikiza apo, osakaniza akuphatikiza ndi thyme, veronica, meadowsweet.
Kusakaniza kumathiridwa ndi madzi otentha ndikupanga mu thermos usiku. Kukonzekera kulowetsedwa, tengani supuni ya osakaniza, kutsanulira 0,5 l madzi otentha ndikusiya mu thermos pakuumirira. Mutha kumwa mankhwalawa tsiku lotsatira mumadontho atatu pafupifupi theka la ola musanadye. Njira yonse ya chithandizo sichimaposa miyezi itatu.
Malingana ndi chiwembu chomwecho, chophatikiza cha chamomile, muzu wosakanikirana ndi nthangala za katsabola zimapangidwa ndikugwiritsidwa ntchito, komwe mandorice muzu ndi oregano amawonjezeredwa. Nthawi yomweyo, mankhwala onse azitsamba amatha kusungidwa palokha, kapena kuti mugulidwe ku pharmacy okonzeka. Njira yotsatirayi ndiyabwino chifukwa simuyenera kutaya nthawi yanu kufunafuna ndi kusakaniza mankhwala opangira mankhwala, kuphatikiza apo, ndalama zogulitsa muchipatala zimasungidwa nthawi yayitali kuposa zomwe zimatengedwa palokha.
Zambiri zokhudzana ndi matenda a shuga insipidus zimaperekedwa mu kanema munkhaniyi.
