Lupus nephritis: matenda, mankhwala, chakudya

Lupus nephritis ndi limodzi mwa mavuto ambiri kuja zokhudza zonse lupus erythematosus. SCR - ndi matenda autoimmune chifukwa cha maonekedwe a chitetezo mu thupi, amene kulandira "nzika" mapuloteni kunja. Chifukwa, osauka aseptic kutupa mu madera osiyana a thupi. Kuphatikizapo mu impso.

tanthauzo

Lupus nephritis, lupus nephritis, kapena - matenda katundu impso mu zokhudza zonse lupus erythematosus. Kuchuluka kwa matenda pa anthu, pafupifupi anthu makumi anai pa zana chikwi anthu. Ambiri amadwala oimira theka wokongola zaka zapakati pa zaka makumi awiri ndi anai. Nthawi zambiri, kudwala ndicho anthu Afro-Caribbean.

Matendawa akhoza kuyamba chifukwa cha zosiyanasiyana zinthu, ku muyeso wa khungu, kuti matenda chibadwa, kotero ndikofunika kwambiri nthawi kulabadira zizindikiro ndi kuwona dotolo. Ndipotu chithandizo mwamsanga ali anayamba bwino kuti madokotala ananena zawo moyo wa wodwala ndi thanzi.

etiology

Lupus nephritis akhoza zidzayambike ndi yaitali dzuwa kukhudzana zonse (chizolowezi solarium kapena kukhala mu malo dzuwa), chifuwa kuti mankhwala, maganizo okhazikika ngakhalenso mimba (ndi mwana wosabadwayo amaona ngati thupi ena ndi chitetezo cha m'thupi amayamba kuukira maselo mayi).

Komanso chitukuko cha matenda majini bwanji mwauchidakwa, pamaso pa imbalances m'thupi, pafupipafupi matenda HIV (kachilombo Integrated mu thupi khungu, kusiya mu antigens awo pamwamba ndi zoyambitsa zake Motero ayankhe mthupi). Chance wa kukulitsa matenda achibale kangapo kuposa pafupifupi kwa anthu.

pathogenesis

Lupus nephritis ndi mbali ya chizindikiro kuti akufotokozera mu zokhudza zonse lupus erythematosus. Autoantibodies kukhala mu malo oyamba kwa DNA mbadwa ndi kugwirizana kwake ndi histones, kuti mapuloteni a dongosolo womuyenerera ndi cardiolipin. Chifukwa chiwawa ngati - yafupika wololera kwa antigens kudzikonda, zopindika B ndipo T lymphocytes.

Mwachindunji ndi chitukuko cha nephritis chakuti Antigen-oteteza maofesi lotentha kwa zimakhala za tubules ndi aimpso. Kamodzi mapuloteni oterowo molekyulu amamangiriridwa pamwamba selo, izo akapsa ndi kugwa mosiyanasiyana amuzolengedwa kuti zotsatira potulutsa yogwira, anasungunuka selo. Zimenezi, zimayambitsa yotupa anachita, zomwe okha pofuna kukwaniritsa zolinga kuwonongeka.

kuvulazidwa thunthu

Lupus nephritis mu SLE mwina mawonetseredwe zosiyanasiyana morphological. Ndi kutsegula kwa odwala anali kusintha mu nembanemba wa glomeruli impso, yogwira kugawikana kwa maselo, patsogolo mesangium ndi mtima sclerosis, zingwe zopota ndi zambiri. mawonetseredwe awa akhoza kukhala mu umodzi ndi glomeruli angapo.

The zenizeni kwambiri kwa lupus nephritis ndi fibrinoid necrosis capillary kuzungulira wa Henle, ndi histologically zimadziŵika karyopyknosis ndi karyorrhexis (kulekana ndi lysis a mtima khungu). Komanso, kusintha pathognomonic mu glomerular chapansi Kakhungu monga "zingwe zopota waya" ndi kukhalapo kwa hyaline thrombi mu lumen wa capillaries ndi chifukwa cha mafunsidwe a maofesi m'thupi.

Gawo

Kukomoka ndi morphologically magawo angapo chimene chimafika lupus nephritis. Gulu la World Health Organization motere:

1. Maphunziro oyamba: glomeruli ndi dongosolo yachibadwa.
2. m'kalasi yachiwiri: pali asintha mesangium lapansi.
3. Chachitatu kalasi: glomerulonephritis ndi chotupa hafu ya glomeruli lapansi.
4. kalasi chachinayi: akakufunsani glomerulonephritis.
5. Chachisanu kalasi: membranous glomerulonephritis.
6. Chimodzi kalasi: matenda glomerulonephritis.

Palinso gulu Serova, umene allocates focal, akakufunsani, membranous, mesangioproliferative, mesangiocapillary glomerulonephritis ndi fibroplastic.

zizindikiro

Membranous lupus nephritis ali ndi zizindikiro zonse ziyenera ndipo facultative. Mmodzi wa mawonetseredwe ake ndi kuvomerezedwa proteinuria, ndiye kukhalapo kwa mapuloteni mu mkodzo. Komanso, inu mukhoza zambiri hematuria, leuco - ndi limfotsituriyu. Zizindikiro izi zikusonyeza pamaso kutupa mu impso ndi kungakhale osati SLE.

Ndi kupitirira za ndondomeko autoimmune zikuchulukirachulukira zizindikiro za kulephera aimpso akuwonetseredwa ndi kuchuluka misinkhu creatinine mu magazi ndi mkodzo, kufooka, ulesi mtima limati soporous.

Kodi pang'onopang'ono patsogolo komanso mofulumira mwapang'onopang'ono nephritis. Ngati matenda akufotokozera pang'onopang'ono paliponse mkodzo ndi matenda nephrotic. Komanso, lupus nephritis zikhoza kuchitikira mu ozilala kapena zobisika mawonekedwe, pamene zizindikiro alipo chabe proteinuria.

Mofulumira mwapang'onopang'ono lupus nephritis ndi ofanana kwambiri kwa glomerulonephritis tingachipeze powerenga. Aimpso kulephera ikukula mofulumira, pali aakulu hematuria, kuthamanga magazi, ndipo syndrome nephrotic. Zikavuta angathe mwiniwakeyo intravascular coagulation (DIC).

Lupus nephritis ana

Mu 1/5 odwala ndi zizindikiro woyamba zokhudza zonse lupus erythematosus kuwonekera mwana. Ana osakwana zaka 10, iwo pafupifupi zimachokeradi, koma pali kufotokoza milandu SLE mwana ndi theka miyezi.

Kukula kwa matenda ana si wosiyana ndi wa akuluakulu. Chithunzi matenda akhoza zosiyanasiyana: kuchokera asymptomatic kuti mofulumira pang'onopang'ono. Pachimake aimpso kulephera ali osowa.

Zizindikiro angapo osiyana a SLE mwana:

• erythema pa nkhope;
• discoid zidzolo pa thupi;
• tilinazo dzuwa;
• mucosal ulceration;
• kutupa m'malo olumikizirana mafupa ndi;
• matenda a impso;
• kuphwanya chapakati mantha dongosolo;
• chinawonjezeka magazi;
• matenda immunological;
• kukhalapo kwa chitetezo antinuclear.

Ngati chipatala ali mbali zinayi kuchokera mndandanda, tingakhulupirire kuti mwanayo ali zokhudza zonse lupus erythematosus. impso kuwonongeka ana kawirikawiri aonekere. Kawirikawiri, zizindikiro akhoza osiyanasiyana monga glomerulonephritis kuti mawonetseredwe a syndrome antiphospholipid.

Mapa chitukuko cha matenda ana abwino kwambiri. zaka khumi pambuyo chiphunzitso cha matenda dialysis kumafuna 10 peresenti zokha odwala.

diagnostics

Kodi amapereka dokotala chifukwa kuganiza lupus nephritis? Matendawa nthawi zochokera alipo deta matenda ndi zasayansi-anatsimikizira pa SLE:

• Ululu ndi kutupa mu malo;
• totupa pakhungu la nkhope mu mawonekedwe a Gulugufe;
• pamaso pa mbiri effusion mu M'mimbamo (pleurisy, pericarditis);
• imfa kudya thupi, malungo.

The kusanthula ambiri a magazi anati magazi m'thupi, kuchepa othandiza magazi kuundana, kuonjezera ndalama erythrocyte sedimentation, utachepa yothandizana mapuloteni. Pakuti matenda Nkofunika kudziwa chitetezo kwa DNA mbadwa.

Kawirikawiri, izi ndi kokwanira kuti munthu matenda a zokhudza zonse lupus erythematosus ndipo, monga chotsatira cha lupus nephritis. Komabe, maonekedwe a mapuloteni mu mkodzo akhoza anachedwa kwa zaka imodzi kapena ziwiri ku isanayambike matenda. Zikatero, dokotala amadalira enzyme immunoassay ndi kudziwika chitetezo. Ngati si anatsimikizira ndi deta choyezera, m'pofunika kupitiriza kufufuza matenda makamaka odwala mwamuna, pakuti nosology awo, ichi ndi chosowa.

Kusiyanitsa lupus nephritis mu SLE odwala ndi endocarditis bakiteriya, pachimake exacerbations a nyamakazi, myeloma angapo, aakulu chiwindi B, ndi matenda amyloidosis, Henoch-Schonlein purpura.

Gawo loyamba la mankhwala

Chithandizo cha lupus nephritis - yaitali ndiponso yosasangalatsa ndondomeko zomwe nthawi zambiri kumatenga moyo. Izo zikuchitika mu magawo awiri. Mu gawo loyamba atazikocheza exacerbation. Cholinga cha njira - kukwaniritsa chikhululukiro khola, kapena kuchepetsa maonekedwe matenda.

Mankhwala ayenera kuyamba posachedwapa kuchokera pamene matenda. Chilichonse chimachitika mofulumira moti masiku ngakhale awiri a kuchedwa akhoza kukhala oopsa kulakwitsa. Ngati ndondomeko ntchito ndi otsika (Adzawauza kusonyeza oteteza titers), adokotala akhoza okha ntchito corticosteroids mu mlingo waukulu kwa miyezi iwiri, kenako kuchepa pang'onopang'ono mu mlingo (mwadzidzidzi kuletsa mankhwala sangakhale, akhoza kukana zopangitsa adrenal).

Ngati njira zambiri mofulumira matenda, kuwonjezera mankhwala, m'nsinga kutumikiridwa mlingo waukulu wa cytostatics. mankhwala Izi zimachitika ikuchitika pasanathe miyezi sikisi. Only itatha nthawi iyi mukhoza kuyamba kuchepetsa mlingo wa mankhwala, ndi kusamutsa wodwalayo mankhwala ndi m'kamwa.

Musaiwale kuti odwala ndi SLE zambiri azitha mwiniwakeyo intravascular coagulation, choncho tikulimbikitsidwa kuti kutenga njira zodzitetezera, akuti:

• kuikidwa magazi ndi zigawo zake;
• mtsempha "Trental";
• Dongosolo subcutaneous mayunitsi 2.5 ambiri a "heparin".

Gawo lachiwiri la mankhwala

Lupus nephritis mu SLE mu gawo lachiwiri amadziwikanso ankachitira ndi mankhwala ozunguza bongo cytotoxic. Only mlingo iwo ali ang'onoang'ono kwambiri. pang'onopang'ono pa miyezi inayi mpaka isanu ndi umodzi, mlingo "Prednisolone" titrated kuti mamiligalamu 10 pa kilogalamu ya kulemera kwa thupi. wothandizila Cytotoxic anasankhanso Mlingo bolus kamodzi miyezi itatu iliyonse, ndipo ngati mphamvu zabwino matenda, pite ku jekeseni limodzi miyezi sikisi iliyonse.

Chotero yokonza mankhwala akhoza mzaka. Pa nthawi, anawonjezera (ngati n'koyenera) kupewa mavuto a mankhwala ndi mankhwala symptomatic.

Koma ngakhale ndi yake wayamba chithandizo pa peresenti khumi odwala kudwala impso kulephera. Pankhaniyi, likhoza kuthandiza hemodialysis kapena impso kupatsidwa zina. Mwatsoka, mankhwala palibe kugulu.

Kudya lupus nephritis

Pofuna kukhala ntchito aimpso ndi odwala lupus nephritis ayenera kutsata malamulo ena:

1. Kumamwa kowirikiza madzi ndi bwino zosefera magazi komanso kukhala mlingo wa kagayidwe.
2. Chakudya ayenera kukhala ndi ndalama zazing'ono potaziyamu phosphorous ndi thupi, kuyambira zinthu izi ndi zotsatira zoipa impso kuonongeka.
3. Kusiya zizolowezi zoipa.
4. Muzichita zinthu zolimbitsa thupi kuwala.
5. Kumaona magazi anu.
6. Kuchepetsa kudya zakudya mafuta.
7. Musamalandire NSAIDs chifukwa iwo ndi zoyipa pa impso.

Ngati wodwala motere malangizo awa, mkhalidwe wa moyo kwambiri bwino, ndi kupulumuka madokotala ananena zawo zambiri zingamuthandize.

kaonedwe

Mapa kuchitira lupus nephritis membranous zimadalira m'mene kudwala impso ndi chiyambi cha mankhwala. The kale wodwala amapita kwa dokotala, wamkulu mosavuta ndi zotsatira zabwino.

zaka makumi anayi zapitazo, ochepa odwala lupus nephritis ankakhala kuposa chaka ku matenda. Ndiyamika njira zamakono za mankhwala ndi matenda, odwala akhoza kuyembekezera zoposa zisanu chaka utali wamoyo.