Glomerulonephritis yog ib qho kab mob autoimmune ntawm qhov mob, uas muaj qhov txhab ntawm lub raum glomeruli, thiab lub raum tubules kuj raug cuam tshuam. Qhov kev txiav txim yog nrog los ntawm kev tsis tso tawm ntawm cov kua thiab ntsev los ntawm lub cev raws li qhov tshwm sim ntawm kev tsim cov kab mob thib ob hauv lub cev, uas nyob rau hauv qhov kawg tshwm sim feem ntau ua rau lub siab surges thiab kua ntau dhau.
YMuab nws yooj yim, glomerulonephritis yog ib qho mob ntawm lub raum glomeruli lossis, raws li lawv kuj hu ua, glomerulus. Lwm lub npe rau tus kab mob yog glomerular nephritis. Tus kab mob tuaj yeem nthuav tawm hauv ntau hom: mob raum tsis ua haujlwm, nephrotic syndrome, lossis hauv daim ntawv ntawm cov proteinuria cais thiab / lossis hematuria. Cov xeev uas tau teev tseg tau muab faib ua pawg loj hlob lossis tsis muaj kev loj hlob. Lawv kuj muaj cov pab pawg sib txawv. Nws yog ib qho tsim nyog xav txog ntau yam kev faib tawm ntawm cov kab mob glomerulonephritis, ICD code uas yog N03.
Kab mob mob hnyav
Spicydiffuse glomerulonephritis muaj peb yam tseem ceeb: edematous, hypertensive thiab tso zis.
Muaj mob heev. Cov neeg mob qhia ua npaws, impotence, o ntawm lub ntsej muag, mob taub hau, txo diuresis.
Edema yog suav tias yog qhov taw qhia ntxov ntawm tus kabmob. Lawv tshwm sim hauv 80-90% ntawm cov neeg mob, nyob rau ntau qhov ntawm lub ntsej muag thiab daim ntawv, ua ke nrog pallor ntawm daim tawv nqaij, ib tug yam ntxwv lub ntsej muag rau ib tug nephritic. Feem ntau, cov kua dej accumulates hauv cov kab noj hniav (pleural, plab, thiab pericardial kab noj hniav). Qhov nce hauv qhov hnyav vim edema nce mus txog 15-20 kilograms los yog ntau tshaj nyob rau hauv ib lub sij hawm luv luv. Raws li txoj cai, lawv ploj tom qab 2-3 lub lis piam.
Ib qho ntawm cov cim tseem ceeb ntawm kev mob glomerulonephritis yog kab mob ntshav siab, uas tau pom nyob rau hauv 70-90% ntawm cov neeg mob thiab cuam tshuam nrog pathology ntawm cov ntshav muab rau lub raum. Feem ntau, cov ntshav siab tsis ncav cuag tus lej tseem ceeb thiab tsis tshua muaj systolic siab tshaj 180 millimeters mercury. Art., thiab diastolic - 120 millimeters mercury. Art. Txoj kev loj hlob ntawm arterial hypertension no cuam tshuam rau kev ua haujlwm ntawm lub plawv thiab tuaj yeem tshwm sim hauv lub plawv tsis ua haujlwm, tshwj xeeb tshaj yog sab laug ventricular tsis ua haujlwm, feem ntau ua rau ua tsis taus pa, hnoos thiab ua rau mob hawb pob. Hypertrophy ntawm sab laug ventricle ntawm lub plawv yog tsim.
Ib qho ntawm thawj cov cim qhia ntawm tus mob nephritis yog qhov txo qis hauv cov zis tso zis, qee qhov mob anuria tuaj yeem taug qab. Qhov txo qis hauv cov zis tso zis yog cuam tshuam nrog kev hloov pauv hauv glomeruli, uas ua rau txo qis hauv kev pom hauv lawv. Hauv qhov no, raws li txoj cai, tsis muaj qhov txo qis hauv cov txheeb zezis hnyav hnyav.
Los ntawm cov yam ntxwv kho mob, nws muab faib ua 2 daim ntawv:
- thawj hom - daim ntawv cyclic - los nrawm. Edema, ua tsis taus pa luv, mob taub hau, mob nraub qaum tshwm sim, cov zis txo qis. Muaj qhov tseem ceeb albuminuria thiab hematuria. Ua kom ntshav siab. Edema tsis ploj mus rau ib nrab ib hlis, thiab tom qab ntawd qhov tawg pib ntawm tus txheej txheem ntawm tus kab mob, polyuria tsim thiab ntshav siab txo. Lub sijhawm kho tuaj yeem nrog hypostenuria. Tab sis feem ntau, nrog kev noj qab haus huv zoo ntawm cov neeg mob thiab yuav luag tag nrho rov ua haujlwm ntawm lub peev xwm, proteinuria tuaj yeem tshwm sim tau ntev, rau lub hlis, me me - 0.03-0.1% o thiab hematuria residual.
- Hom thib ob ntawm tus mob nephritis yog latent. Nws tshwm sim ntau zaus thiab tseem ceeb heev, vim nws feem ntau hloov mus rau hauv daim ntawv nyuaj dua. Cov qauv no yog tus cwj pwm los ntawm qhov pib maj mam yam tsis muaj cov cim qhia ntawm tus kheej thiab tsuas yog qhia los ntawm kev ua tsis taus pa me ntsis lossis o ntawm ob txhais ceg. Hom nephritis no tsuas yog kuaj tau nrog kev kuaj zis tsis tu ncua. Lub sijhawm, hais txog lub sijhawm ua haujlwm, nyob rau hauv cov txheej txheem ntawm mob glomerulonephritis tuaj yeem yog qhov tseem ceeb - los ntawm 2 mus rau 6 lub hlis.
YNtaus glomerulonephritis
Tus kab mob glomerulonephritis (ICD N03) txhim kho qeeb heev. Ntau tus neeg mob tsis tuaj yeem hais meej meej thaum twg tus kab mob pib. Hauv cov mob glomerulonephritis ntev, cov zis tso zis txo qis. Nws muaj cov protein thiab ntshav. Qhov no yog nrog los ntawm o, thaum lawv tuaj yeem yog ob qho tib si me me, yuav luag tsis pom, thiab pom tau zoo heev. o tuaj yeem tsuas yog ntsej muag, lossis cov ntaub so ntswg subcutaneous thiab cov kabmob sab hauv. Nrog rau tus mob ntawm tus mob glomerulonephritis ntev, tus neeg mob ib txwm xav pw, tsis tu ncua nkees, nws lub cev kub nce, ntshav siab nce, ua tsis taus pa, thiab tsis pom kev. Feem ntau, cov neeg mob los ntawm tus kab mob no nqhis dej, thiab thaum exhalation nws muaj peev xwm hnov tsw zis.
WHO hauv kev faib cov kab mob glomerulonephritis ntev faib cov kab mob rau hauv:
- Nephritic - tus cwj pwm los ntawm qhov tseeb tias lub ntsiab mob yog nephritic nrog cov tsos mob ntawm lub raum o.
- Hypertensive - yog tus cwj pwm los ntawm kev tswj hwm ntawm txhua tus kab mob raws li qhov no.
- sib xyaw lossis nephritic-hypertensive. Muaj ob peb daim ntawv hauv qhov xwm txheej no.
- Lam. Yuav luag tsis muaj daim duab kho mob pom tseeb, tshwj tsis yog qhov tshwm sim tsis txaus ntawm cov zis. Daim ntawv no ntawm tus mob nephritis feem ntau dhau mus ntev.
- Hematuria, uas tsuas yog qhia los ntawm qhov muaj hematuria.
Txhua yam mob tuaj yeem mob hnyav dua. Lub sijhawm no, cov tsos mob ntawm tus kab mob zoo ib yam li cov mob glomerulonephritis. Raws li kev faib tawm morphological ntawm cov kab mob glomerulonephritis ntev, daim ntawv subacute malignant kuj txawv. Nws yog tus cwj pwm los ntawm kub siab, ua npaws, tsis tu ncua edema, thiab plawv pathologies. Qee zaum, nws tuaj yeem ua rau hnyav heev thiab tig mus rau qhov nyuaj dua.
Mob ntxovtxawm lig dhau los ua rau muaj kev tsim ntawm ob lub raum shrunken thiab lub raum tsis ua haujlwm ntev.
nrawm nrawm glomerulonephritis
Raws li etiology thiab pathogenesis, nyob rau hauv morphological kev faib tawm ntawm glomerulonephritis ntev, muaj ob hom:
- Primary - tsim los ntawm kev puas tsuaj morphological ncaj qha ntawm lub cev.
- Secondary, uas yog suav tias yog qhov tshwm sim ntawm tus kab mob hauv qab. Qhov no suav nrog kev sib kis los ntawm cov kab mob, cov kab mob microbes thiab lwm yam kab mob, cov khoom tsis zoo, qog nqaij hlav lossis kab mob hauv lub cev, piv txwv li, kab mob lupus erythematosus, vasculitis, thiab lwm yam.
Focal segmental glomerular nephritis
Kev kuaj mob ntawm tus mob glomerulonephritis ntev yog qhov tshwm sim los ntawm kev nthuav tawm qee yam kab mob sclerotic hauv cov hlab ntsha capillary. Feem ntau ntawm tag nrho cov, hom glomerulonephritis no yog tsim los ntawm lub sij hawm ntev los yog / thiab siv cov parenteral hnyav, los yog muaj kab mob HIV, AIDS. Tus kab mob no qhia nyob rau hauv daim ntawv ntawm ib tug nephrotic syndrome los yog nyob rau hauv daim ntawv ntawm tsis tu ncua proteinuria. Lawv feem ntau ua ke nrog arterial hypertension thiab erythrocyturia. Cov chav kawm ntawm tus kab mob yog heev zuj zus, thiab kev saib xyuas yog heev tsis zoo. Nws yuav tsum raug sau tseg tias qhov no yog qhov tsis zoo tshaj plaws ntawm tag nrho cov morphological variants ntawm tus kab mob. Tsis tas li ntawd, nws tsis tshua teb rau kev kho mob hnyav heev.
YMembranous glomerulonephritis
Hom kab mob glomerular nephritis no yog tus cwj pwm los ntawm qhov pom ntawm diffuse thickening nyob rau hauv cov phab ntsa ntawm glomerular capillaries nrog lawv splitting thiab ntxiv ob npaug. Thiab tseem muaj cov tsim loj loj nyob rau hauv qab daus daim nyias nyias ntawm glomeruli nyob rau sab epithelial ntawm lub cev tiv thaiv complexes. Nws yuav tsum raug sau tseg tias hauv peb caug feem pua ntawm cov neeg mob tuaj yeem txiav txim siab txog kev sib raug zoo ntawm membranous nephropathy thiab tus kab mob siab B, qee yam tshuaj, thiab cov qog nqaij hlav malignant. Cov neeg mob uas muaj membranous glomerulonephritis yog ib qho tseem ceeb heev uas yuav tsum tau kuaj xyuas kom meej tias muaj kab mob siab B lossis qog nqaij hlav. Hom glomerulonephritis no tau nthuav tawm los ntawm kev tsim ntawm nephrotic syndrome, thiab tsuas yog 15-30% ntawm cov neeg mob muaj ntshav siab thiab hematuria. Cov neeg sawv cev ntawm kev sib deev muaj zog yog qhov muaj feem cuam tshuam rau tus kab mob, tab sis cov poj niam tsawg dua, nws yog qhov xav paub tias qhov kev mob tshwm sim rau kev kho mob zoo dua rau cov poj niam. Feem ntau, tsuas yog tsib caug feem pua ntawm cov neeg mob tsim lub raum tsis ua haujlwm.
Mesangioproliferative glomerular nephritis
Qhov no yog hom kab mob glomerulonephritis feem ntau. Tsis zoo li cov teev saum toj no, hom no ua tau raws li tag nrho cov txheej txheem rau immunoinflammatory glomerulonephritis. Nws manifests nws tus kheej nyob rau hauv daim ntawv ntawm expansion ntawm lub mesangium, proliferation ntawm nws cov hlwb thiab deposition ntawm lub cev tsis muaj zog complexes nyob rau hauv lub endothelium thiab nyob rau hauv nws. Cov tsos mob tseem ceeb yog hematuria thiab / lossis proteinuria. Feem ntau tsawg tsawg, ntshav siab tau tsim.
Nrog muaj cov tshuaj immunoglobulin A hauv glomeruli
Nws tuaj yeem ua tau raws li lub npe Berger's disease lossis IgA-nephritis. Tus kab mob no cuam tshuam rau cov tub ntxhais hluas tiam neeg. Cov tsos mob tseem ceeb yog hematuria. Thiab tsib caug feem pua ntawm cov neeg mob muaj hematuria tag nrho. Nyob rau hauv cov xwm txheej uas xws li lub nra hnyav xws li nephrotic syndrome lossis kub siab tsis tau koom nrog cov txheej txheem, ces qhov kev cia siab ntawm kev kho yog qhov zoo.
Mesangiocapillary glomerulonephritis
Qhov no yog ib qho ntawm qhov tsis zoo tshaj plaws glomerular nephritis nyob rau hauv cov nqe lus ntawm kev soj ntsuam, tus cwj pwm los ntawm kev loj hlob ntawm mesangial hlwb nrog ntxeem tau ntawm lub raum glomeruli. Yog li ntawd, lub lobulation ntawm lub glomeruli, uas yog txawv rau hom no, thiab ib tug nce nyob rau hauv lub basal daim nyias nyias yog tsim. Feem ntau, kev sib raug zoo ntawm tus kab mob nrog cryoglobulinemia los yog, ntau zaus, nrog tus kab mob siab C tau tshwm sim. Vim li no, kev mob siab rau txhawm rau kuaj kab mob siab C lossis cryoglobulinemia yog qhov tseem ceeb heev. Hom glomerular nephritis feem ntau tshwm sim nrog hematuria thiab proteinuria. Tsis tas li ntawd, feem ntau tsim nephrotic syndrome, kub siab, uas tsis kho.
Kev kho mob
Nws tsim nyog xav txog cov lus pom zoo ntawm kev kho mob glomerulonephritis. Kev kho mob yog txiav txim los ntawm daim ntawv ntawm tus kab mob, yam uas ua rau nws tsim thiab qhov hnyav ntawm cov tsos mob. Hauv daim ntawv mob hnyav nrog cov duab kho mob muaj yeeb yuj, kho glomerulonephritis inevitably suav nrog kev hnyav hnyav hauv tsev kho mob. Cov neeg mob zoo li no tau muab tshuaj tua kab mob rau 7-10 hnub,txwv ntsev thiab kua, nrog edema manifested, diuretics yog muab. Kev nce ntshav siab yuav xav tau kev teem sijhawm ntawm cov tshuaj antihypertensive. Lub hom phiaj tseem ceeb ntawm kev kho mob glomerulonephritis ntev yog los tiv thaiv lub raum cov ntaub so ntswg los ntawm kev puas tsuaj tom qab. Vim li no, nrog rau kev kawm nyuaj thiab muaj kev pheej hmoo siab ntawm kev tsim lub raum tsis ua haujlwm, cov tshuaj tiv thaiv kab mob tau muab tshuaj. Kev kho mob rau glomerulonephritis tsis yog tsuas yog kho cov tshuaj tiv thaiv kab mob xwb. Txhawm rau kom ruaj khov ntawm chav kawm hauv txhua hom kev mob glomerulonephritis, kev kho tsis muaj zog nephroprotective yog siv. Raws li kev faib tawm ntawm cov mob glomerulonephritis ntev, cov txheej txheem kho mob qhia tau hais tias cov neeg mob tau muab tshuaj sib txawv rau lub hom phiaj no. Ib qho tseem ceeb heev ntawm kev kho glomerulonephritis yog kev noj zaub mov nrog txo cov ntsev kom tsawg, uas ua rau nws tuaj yeem txo cov ntshav siab thiab txo cov dej tuav hauv lub cev. Kev kho mob ntawm glomerulonephritis yuav tsum tau siv cov kev hloov kho. Cov neeg mob theem kawg tau xaiv tau txais kev hloov raum.
Kev nyuaj siab
Kev nce qib ntawm cov kab mob glomerulonephritis ntev, cuam tshuam nrog hemodynamic ntshawv siab, proteinuria thiab metabolic ntshawv siab, nws thiaj li ua rau txo qis ntawm cov nephrons ua haujlwm thiab tuaj yeem ua rau lub raum tsis ua haujlwm ntawm lub raum. Vim li no, ob hom mob raum tsis ua haujlwm yog lub nra hnyav dua ntawm glomerulonephritis. Tsis tas li ntawd, kev nce hauv cov hlab ntshaLub siab ua rau muaj kev pheej hmoo ntawm kev tsim kab mob ntawm lub paj hlwb thiab myocardial infarction hauv cov neeg mob glomerulonephritis. Kuj tseem muaj kev pheej hmoo ntawm kev tsim cov kab mob thrombotic keeb kwm. Ib qho teeb meem loj ntawm glomerulonephritis yog suav tias yog ib qho teeb meem nephrotic, uas yog tus cwj pwm los ntawm: qhov kub thiab txias, tshwm sim ntawm qhov mob hnyav ntawm lub plab thiab qhov liab ntawm daim tawv nqaij.
Nws tuaj yeem xaus tias tus kab mob no muaj kev phom sij ntau. Thaum thawj cov tsos mob, koj yuav tsum mus ntsib kws kho mob tam sim ntawd kom paub meej lossis tsis suav nrog kev kuaj mob. Nws yuav sau tag nrho cov kev xeem tsim nyog uas yuav tsum tau ua. Thiab tom qab daim ntawv txiav txim siab, nws yuav sau ib qho kev kho mob zoo. Tau kawg, nrog rau kev noj zaub mov nruj 5.
