Tib neeg kev noj qab haus huv yog qhov tsis yooj yim, thiab feem ntau qee cov kab mob ua rau muaj lwm yam kab mob hnyav thiab nyuaj. Ib qho ntawm cov kab mob no yog glomerulonephritis - lub raum puas, uas yog tshwm sim los ntawm kev kis kab mob yooj yim, feem ntau ua rau lub raum tsis ua haujlwm, thiab tom qab kev tsis taus.
Pathogenesis
Kev hloov pauv pathogenetic ua rau tsim cov kab mob glomerular nephritis, hauv 70% ntawm cov neeg mob muaj cov kev hloov pauv ntawm lub cev tiv thaiv kab mob, uas yog cov tshuaj hormonal.
Tus kab mob no tshwm sim los ntawm kev puas tsuaj los ntawm kev tiv thaiv kab mob ntawm cov ntshav mus rau glomeruli ntawm ob lub raum, nrog rau cov txheej txheem physiological ntawm excretion ntawm cov tshuaj lom thiab cov khoom lwj los ntawm lub raum. Cov khoom zoo li no dhau los ntawm cov ntaub hauv qab daus hauv lub raum glomeruli, uas cov immunocomplexes sib sau. Tom ntej no, tshwj xeebib qho kev sib txuas ntxiv uas cov tshuaj vasoactive (polymorphonuclear, nephritic thiab cov ntshav coagulation Cheebtsam) raug tso tawm, uas yog lub luag haujlwm rau qhov pib mob hnyav..
Kev faib tawm
Lub pathogenesis thiab etiology ntawm glomerulonephritis yog qhov nyuaj heev, yog li lawv cov txheej txheem tseem ceeb yog cov cim qhia ntawm kev ua txhaum ntawm cov qauv thiab cov duab ntawm lub raum glomeruli, yog li tus yam ntxwv ntawm cov kab mob. Tsis tshua muaj txaus, tab sis tseem qhov teeb meem muaj ib tug congenital daim ntawv, nrhiav tau ntawm pathology yog ntau ntau.
hom kab mob tseem ceeb yog cov tsos mob hauv qab no:
- Daim ntawv mob hnyav - dhau latently, zais lossis sluggish hauv qhov xwm txheej, kuj muaj qhov tshwm sim tshwm sim.
- Daim ntawv sai sai, tseem hu ua subacute, yog daim ntawv txaus ntshai tshaj plaws ntawm lub raum puas.
- Lub etiology thiab pathogenesis ntawm diffuse glomerulonephritis yog qhov hnyav. Cov txheej txheem pathological ntes tsis tau tsuas yog cov capillaries nyob rau hauv lub glomeruli ntawm ob lub raum, tab sis kuj cov hlab ntsha ntawm lwm yam ntaub so ntswg thiab lub cev, uas yog, vim li ntawd, muaj ib tug dav vascular lesion. Feem ntau tshwm sim tom qab mob kis kab mob (pneumonia, tonsillitis, otitis media, scarlet fever). Nws kuj tshwm sim hais tias tus kab mob no yog tsim los ntawm pharyngitis, laryngitis, septic endocarditis thiab typhus.
- Post-streptococcal - tsim muaj teeb meem tom qab tus kab mob streptococcal.
- Mesangiocapillary - pathology yog tsim los ntawm kev nce ntawm cov cell endothelial thiab mesangial.
- Mesangioproliferative - kev loj hlobpib tom qab kev nce ntau dhau ntawm cov kab mob raum proliferating - glomerulus.
- Idiopathic glomerulonephritis - tus kab mob ntawm tus kab mob no tseem tsis tau txheeb xyuas thiab feem ntau tshwm sim thaum muaj hnub nyoog 8-30 xyoo.
- mob - yog tias tus kab mob tsis kho tau ntau tshaj ib xyoos, nws hloov mus rau hauv daim ntawv no thiab kho nyuaj.
Txhua daim ntawv mob tuaj yeem rov ua dua ib ntus, thiab tom qab ntawd nws ib nrab lossis tag nrho pib nrog kev mob hnyav. Exacerbations yog raws caij nyoog nyob rau hauv xwm - nyob rau hauv lub caij nplooj zeeg thiab caij nplooj ntoos hlav.
Symptoms
Lub etiology thiab pathogenesis ntawm glomerulonephritis yog tsim nyob rau hauv xws li ib txoj kev uas kev kho mob ntawm tus kab mob pib thaum twb muaj cov tsos mob ntawm tus kab mob. Feem ntau tshwm sim tawm tsam keeb kwm ntawm tus kab mob sib kis, tom qab 1-3 lub lis piam thiab tshwm sim los ntawm streptococci.
Cov cim tseem ceeb ntawm kev mob muaj xws li:
- nce puffiness, tshwj xeeb tshaj yog ntawm daim tawv muag, ko taw thiab sab ceg;
- muaj ntshav hauv cov zis thiab nws cov xim hloov mus rau xim av tsaus;
- txo qis hauv cov zis ntim;
- siab nce;
- mob taub hau;
- tsis muaj zog;
- xeev siab thiab ntuav;
- poob qab los;
- nqhis dej tas li;
- nce lub cev kub;
- ua tsis taus pa;
- hnyav nce.
Edema
qhov teeb meem no tshwm sim nyob rau hauv ob qho tib si mob thiab mob hnyav.
Lub pathogenesis ntawm edema hauv glomerulonephritis yog qhov nyuaj heev thiabsuav nrog cov txheej txheem no.
1. Kev mob ntawm glomeruli tshwm sim raws li cov qauv hauv qab no:
- stagnation ntawm cov ntshav hauv cov hlab ntsha ntawm lub raum;
- hypoxia nyob rau hauv lub juxtaglomerular apparatus;
- keeb kwm ntawm renin-angiotensin system;
- aldosterone secretion;
- qeeb hauv lub cev ntawm sodium thiab nce ntshav osmotic siab;
- edema.
2. Cov laj thawj tom ntej ntawm qhov mob yog:
- hloov lub raum ncig;
- txo qis hauv glomerular pom tus nqi;
- sodium tuav;
- edema.
3. Qhov laj thawj kawg yog:
- nce hauv lub raum permeability lim;
- Yproteinuria;
- hypoproteinemia;
- edema.
Yog vim li cas
Cov kab mob ntawm glomerulonephritis feem ntau yog tsim vim muaj kab mob streptococcal hauv lub cev. Feem ntau tus kab mob no tshwm sim vim muaj teeb meem kev noj qab haus huv yav dhau los:
- pneumonia;
- angina;
- scarlet fever;
- tonsillitis;
- measles;
- streptoderma;
- ARVI (tus kab mob ua pa nyuaj);
- kab mob qhua pias.
Ntau zaus cov kab mob ntawm tus mob glomerulonephritis mob thiab mob ntev yog txuam nrog cov kab mob kis:
- meningitis;
- toxoplasma;
YStreptococcus thiab Staphylococcus aureus.
Ua kom muaj qhov tshwm sim ntawm qhov teeb meem, tuaj yeem ua rau muaj kev cuam tshuam nyob rau hauv qhov txias thiab nyob rau hauv high humidity. Cov xwm txheej no hloov pauv lub cev tiv thaiv kab mob thiab txo cov ntshav mus rau lub raum.
Kev nyuaj siab
Cov kab mob ntawm tus mob glomerulonephritis feem ntau ua rau muaj mob hnyav dua thiab txawm tias muaj kev phom sij rau lub neej, suav nrog:
- lub plawv thiab lub raum tsis ua haujlwm;
- b hlwb hemorrhage;
- raum encephalopathy hauv daim ntawv hypertensive;
- pom teeb meem;
- hemorrhagic stroke;
- kev hloov pauv ntawm malaise mus rau hauv daim ntawv mob ntev nrog kev rov tshwm sim tas li.
Diagnosis
txhawm rau kuaj pom muaj tus kab mob, cov kws kho mob tau sau ntau qhov kev sim. Glomerulonephritis yog tus cwj pwm los ntawm qee yam kev hloov pauv hauv lub cev.
- Macro- thiab microhematuria - muaj cov zis hloov mus rau xim dub lossis xim av tsaus. Kev kuaj zis ua rau thawj hnub ntawm tus kab mob tuaj yeem muaj cov qe ntshav liab tshiab, tom qab ntawd lawv hloov mus rau hauv daim ntawv leached.
- Albuminuria - hauv thawj 2-3 hnub, cov protein tau pom nyob rau hauv qhov nruab nrab txog li 6%. Kev tshuaj xyuas microscopic ntawm cov zis tso zis qhia pom granular thiab hyaline lossis erythrocyte casts.
- Nycturia - nyob rau hauv cov ntaub ntawv ntawm Zimnitsky xeem, muaj qhov txo qis hauv diuresis. Los ntawm kev tshuaj xyuas creatinine tshem tawm, ib tus tuaj yeem pom qhov txo qis hauv kev lim dej ntawm lub raum.
- Kev suav cov ntshav tseem ua tiav, uas qhia txog qhov nce hauv ESR (erythrocyte sedimentation rate) thiab leukocytes.
- Biochemical tsom xam qhia qhov nce ntxivQhov ntim ntawm creatinine, urea thiab roj cholesterol.
YAcute glomerulonephritis
Kho mob glomerulonephritis, etiology thiab pathogenesis nyob ntawm daim ntawv ntawm nws cov chav kawm. Highlight:
- Cyclic - tus yam ntxwv los ntawm lub chaw kho mob tau hais thiab pib sai ntawm txhua tus tsos mob loj.
- Acyclic (latent) - muaj cov ntaub ntawv tshem tawm ntawm chav kawm nrog qhov pib mob me me thiab cov tsos mob me.
Kev kho ntawm daim ntawv latent yog qhov nyuaj heev los ntawm kev kuaj mob lig vim qhov pom ntawm qhov muag tsis pom. Vim li no, tus kab mob feem ntau dhau mus ntev. Nyob rau hauv cov ntaub ntawv ntawm ib tug txaus nyiam thiab kev kho mob raws sij hawm ntawm daim ntawv mob, tag nrho cov tsos mob ntawm tus kab mob no ploj tom qab 2-3 lub lis piam ntawm active therapy.
Lub sijhawm ntawm kev ua tshuaj tshuaj yog nyob ntawm kev kuaj mob raws sijhawm. Qhov nruab nrab, tag nrho rov qab los ntawm patent tuaj yeem hais tau tom qab 2-3 lub hlis.
Chronic form
Lub etiology thiab pathogenesis ntawm tus mob glomerulonephritis feem ntau tshwm sim los ntawm tus kab mob nyob rau hauv ib tug mob, txawm hais tias nws yuav tshwm sim raws li ib tug cais kab mob. Kev kuaj mob zoo li no yog tsim los thaum cov kev mob hnyav tsis tau raug tshem tawm thoob plaws hauv lub xyoo.
Kev kho tus kab mob ntev yog nyob ntawm daim ntawv xau:
- Nefritic - tag nrho cov txheej txheem inflammatory hauv ob lub raum ua ke nrog nephritic syndrome thiab suav tias yog thawj. Cov tsos mob ntawm kub siab thiab raum tsis ua haujlwm tshwm sim tom qab.
- Hypertensive - cov tsos mob tseem ceeb ntawm tus kab mob yog ntshav siab. Qhov txawv txav hauv cov zis tau qhiaqaug zog. Daim foos no feem ntau tshwm tom qab daim ntawv latent.
- Sib xyaw - hypertensive thiab nephritic cov tsos mob tau ua ke sib npaug thaum muaj mob.
- Hematuric glomerulonephritis - lub pathogenesis ntawm tus kab mob no yog muaj cov ntshav impurities nyob rau hauv cov zis, thaum lub protein muaj nyob rau hauv me me los yog tsis tag nrho.
- Latent - cov tsos mob ntawm tus kab mob yog me me, tsis muaj kev ua txhaum ntawm ntshav siab thiab o. Cov chav kawm ntawm tus kab mob nyob rau hauv daim ntawv no yuav ntev heev, mus txog 20 xyoo. Qhov no ib txwm ua rau lub raum tsis ua haujlwm.
Txawm li cas los xij, txawm li cas los xij ntawm cov kab mob ntawm cov kab mob glomerulonephritis ntev, qhov tob zuj zus ntawm tus kab mob nrog cov tsos mob ntawm cov tsos mob tshwm sim tuaj yeem ua tau. Vim li no, kev kho mob ntawm cov mob ntev heev zoo ib yam li daim ntawv mob. Thaum lub sij hawm, cov exacerbations ua rau lub raum tsis ua hauj lwm thiab mus rau "lub raum shrunken" syndrome.
chaw kho mob
Lub etiology thiab pathogenesis ntawm glomerulonephritis tej zaum yuav txawv, tab sis kev kho tus kab mob yog ua raws li tib lub tswv yim:
- Ua raws li lub txaj so, tshwj xeeb tshaj yog thaum muaj kev qaug zog, ua npaws thiab mob taub hau tsis txaus.
- Kev noj zaub mov raws li cov ntsev tsawg, kua dej, thiab cov zaub mov muaj protein ntau. Cov zaub mov no yuav txo tau lub nra ntawm lub raum cuam tshuam.
- Yuav tsum tau noj cov tshuaj anticoagulant, lawv pab txo cov ntshav txhaws, nrog rau cov tshuaj tiv thaiv kab mob,txhim kho ntshav khiav.
- cov tshuaj uas tsis yog tshuaj steroid yog tshuaj tiv thaiv cov txheej txheem inflammatory, tsuas yog nyob rau hauv kev saib xyuas nruj ntawm tus kws kho mob.
- Immunosuppressive therapy yog qhov yuav tsum tau ua. Cov tshuaj nyob rau hauv pab pawg no yog tsom rau kev tiv thaiv lub cev tiv thaiv kab mob los tiv thaiv kev tsim cov tshuaj tiv thaiv. Feem ntau siv yog glucocorticosteroids thiab cytostatics.
- Txoj kev kho mob ntshav siab tau ua, uas cov tshuaj siv los txo cov ntshav siab thaum muaj cov tsos mob ntawm arterial hypertension.
- tshuaj diuretic tau sau tseg kom tshem tawm edema thiab ua kom cov kua dej tso tawm.
- Cov tshuaj tua kab mob tau muab tshuaj yog tias tsim nyog los tshem tawm cov txheej txheem sib kis, thiab thaum siv cov tshuaj tiv thaiv kab mob. Qhov no yog ua los tiv thaiv kab mob los ntawm lub cev.
- Kev kho kom muaj zog yog qhov yuav tsum tau ua.
Txhua cov tshuaj txhawm rau tshem tawm cov kab mob ntawm cov kab mob glomerulonephritis yog muab los ntawm tus kws kho mob urologist ib leeg, nyob ntawm qhov chaw kho mob ntawm tus kab mob, nrog rau qhov hnyav ntawm qee yam tsos mob. Cov txheej txheem kho mob tau ua nyob rau hauv tsev kho mob, kom txog rau thaum lub chaw kuaj mob ua tiav. Tom qab ntawd, kev saib xyuas tus neeg mob sab nraud ntawm tus neeg mob yog qhov yuav tsum tau ua, thiab, yog tias tsim nyog, kev kho mob ntxiv.
Khoom noj
Qhov tseem ceeb rau cov neeg mob uas muaj glomerulonephritis, tsis hais seb yuav ua li cas, yog qhov nruj.ua raws li kev noj haus cov lus pom zoo los ntawm tus kws kho mob. Ua raws li kev noj zaub mov kom txo tau cov dej thiab ntsev, nrog rau cov zaub mov muaj protein ntau.
Cov kws kho mob pom zoo kom haus tsis pub ntau tshaj 2 grams ntsev ib hnub twg. Yooj yim digestible tsiaj proteins yuav tsum muaj nyob rau hauv tus neeg mob cov zaub mov; rau qhov no, noj qe dawb thiab tsev cheese yuav zoo tagnrho. Kua zaub nyob rau hauv nqaij broth yog heev undesirable thaum lub sij hawm muaj mob. Kev haus dej ntau tshaj ib hnub yuav tsum yog 600-1000 ml thiab txog li 50 grams rog.
tseem ceeb heev rau kev kho kom zoo yog nrhiav kev pab kho mob raws sij hawm. Txawm hais tias tom qab ua tiav tiav, tus neeg mob yuav tsum nyob rau hauv kev saib xyuas ntawm kws kho mob ntev thiab ua raws li kev noj haus rau ib xyoos tom qab rov zoo. Tib yam uas koj ua tau yog ua kom koj cov kua dej ntau ntxiv.
Recommendations
Rau kev kho mob zoo ntawm cov kab mob ntawm cov kab mob glomerulonephritis, cov tswv yim ntawm cov lus pom zoo yuav tsum tau ua kom siab tshaj plaws, vim tias qhov ua tiav ntawm tus neeg mob yuav nyob ntawm qhov no. Tsuas yog vim li no, txhua tus neeg mob tau mus pw hauv tsev kho mob tam sim ntawd thiab muab tag nrho lub txaj so. Thaum lub sijhawm txiav txim siab txog theem ntawm tus kabmob, nws yuav siv sijhawm li 2-6 lub lis piam los kho, uas yuav tsum tau siv hauv txaj. Lub txaj so yuav ua kom muaj kev sib faib ntawm cov cua sov, uas yuav muaj txiaj ntsig zoo rau cov hlab ntsha, uas tuaj yeem nthuav dav, uas yuav ua rau kom ntshav txaus hauv txhua lub cev, tshwj xeeb tshaj yog nyob rau hauv lub raum. Vim li no, nws muaj peev xwm ua tiav qhov kev tshem tawm ntawm puffiness, nce pom thiabnce hauv kev ua haujlwm ntawm tag nrho cov kab ke ntawm cov kab mob genitourinary.
Yog tias koj ua raws li tag nrho cov lus pom zoo los ntawm tus kws kho mob urologist, nrog rau ua raws li kev noj zaub mov tag nrho, koj tuaj yeem ua tiav cov txiaj ntsig zoo thiab rov ua tiav.
