Tubulointerstitial nephritis, mitundu pachimake ndi aakulu: Zizindikiro, Zoyambitsa ndi Chithandizo

nephritis Tubulointerstitial a wamba matenda a impso ndi matenda njira zikubweretsa kuwonongeka kwa ntchito limba. Matendawa ali ndi makhalidwe oipa kusintha m'zinthu zambiri kapangidwe ka impso minofu interstitial. Pali mitundu iwiri ya matenda - pachimake ndi aakulu. Mu chilangizo cha mankhwala ambiri akubwera mu thupi la munthu, akutchula kuti mankhwala inathetsedwa kudzera impso. Ndipo mosaganizira kusalankhula phwando mankhwala chimayambitsa matenda chifukwa ndi ziwengo kuti mankhwala ena kapena mankhwala azitsamba. matenda likugwiritsidwanso monga chotsatira tinasamukira matenda.

Kudziwa tubulointerstitial nephritis, kugwiritsa ntchito njira zamakono kafukufuku wa thupi, ndicho ultrasound, mkodzo ndi mayesero magazi, deta mbiri zachipatala deta ya impso biopsy. Kutsiliza za reversibility matenda zachokera choopsa zoipa ndi nthawi yofuna kuchipatala.

The zimayambitsa matenda

Nthawi zina phwando mankhwala kapena mankhwala ena odana ndi yotupa lidakali kwa nthawi yaitali. Ndipo impso kuwonongeka zikadzatha amphamvu mankhwala poizoni, zitsulo. Makamaka yowononga ndi Mowa nthunzi. Tubulointerstitial nephritis angayambe chifukwa zifukwa zambiri:

• pambuyo akukumana ndi tizilombo - 46% milandu;
• mawonetseredwe poizoni zoyambitsa matenda awo sagwirizana mu 28,3%;
• matenda kagayidwe kachakudya mu thupi kulimbikitsa zosayembekezereka wa matenda 13.9%;
• matenda a magazi ntchito ureters - 8,8%;
• zimayambitsa majini ndi chitetezo - 0,9% ya matenda;
• zifukwa zingapo pa nthawi ina mu 2.5% ya milandu.

mitundu aakulu matendawa amayambika kuswa wa cytomembranes kukhulupirika, aimpso dysplasia minofu kusintha kagayidwe kachakudya, anomalies kobadwa nako ndi ureters zinazake.

matenda

Iwo imachitika maphunziro ambiri a khalidwe la thupi ndi zasayansi. Ndiyeno yekha matenda ndi zolondola. Tubulointerstitial nephritis chikuyembekezeka mu mtima ndi zikamera zizindikiro limaonetseratu amapezeka osiyana kuonekera kwathupi.

chikhalidwe aakulu a matenda chifukwa cha kusalola ndi manja a ngalande mu thupi la munthu kwa nthawi yaitali. limba ntchito imathetsa pang'onopang'ono - zaka zingapo. Wodwala amapita kwa dokotala pamene pali zizindikiro zosasangalatsa, monga kupweteka impso, tizilonda ta pakhungu, ndipo ena. Iwo nampereka kwambiri nkhawa. Matenda amakhudza kuwonongeka awiri kapena impso yekha.

Kuphunzira choyezera, mkodzo uric kuoneka bwino precipitate ndi okhutira mkulu wa erythrocytes ndi leukocytes. Pa nthawi yomweyo pali anasiya erythrocytes dismorfnogo mtundu ndi koma chionetsero ka hematuria. Pamaso pa eosinophils mu mkodzo si yodziwika ndi kukhalapo kwa matenda, popeza% 50 okha milandu ali ndi zotsatira za matendawa. Ngati kulibe konse, ndiye ameneyu kukusonyeza kuti matenda palibe. Proteinuria wapezeka ntchito osachepera, koma ngati thupi kale njira glomerular kudwala chifukwa cha ntchito mankhwala, pamene chithunzi lino mlingo nephrotic.

Mu kusanthula magazi pachimake tubulointerstitial nephritis kumaonekera hypercalcemia. Kulakwila ntchito njira kuyambitsa acidosis kagayidwe kachakudya. Pamene ultrasound zambiri chinawonjezeka mlingo echogenicity chifukwa cha thupi kutupa ndi ndondomeko kusalola. US chikusonyeza kuwonjezeka impso kukula kuchuluka index nyukiliya gallium ndi leukocytes m'kaundula pa radionuclides. A positive jambulani chifukwa limasonyeza tubulointerstitial nephritis. Diagnostics, kuwululidwa chifukwa zoipa, njira zina ayenera kuperekedwa.

symptomatology matendawa

Mu magawo oyambirira a matenda alibe zizindikiro. Odwala ena sadziwa za kudwala osauka. Magawowa patapita wa Inde matenda zimakhudzanso mbali limaonetseratu:

• totupa kuonekera pang'ono kapena padziko lonse la thupi kubala kuyabwa khalidwe;
• ukuwonjezeka Small mu kutentha osiyanasiyana, Zikavuta amalembedwa ndi malungo;
• ululu impso ndi anamva zonse kapena pafupipafupi kudutsa kuukira;
• kuchuluka kutopa, wodwala akumva masikono tulo;
• kuthamanga kukakhala zimachitika popanda chifukwa chenicheni;
• pali polyuria.

mawonetseredwe osiyanasiyana amalembedwa tubulointerstitial nephritis. Zizindikiro anati mu mawonekedwe a malungo ndi zotupa, koma ena kusintha mu thupi singakwane matenda. The totupa kumachitika mwezi umodzi pambuyo zochita za poizoni kapena masiku 3-6. Izi zimadalira mkhalidwe lake ndi yankho yake allergen lapansi. Amowabu kuwonda, kumva kupweteka m'mimba ndi kumbuyo pamwamba matako a.

The matenda, wadutsa mu gawo aakulu osiyana m'nyengo ya zizindikiro wofatsa, kumalimbitsa ndi nthawi. Anthu ena kukhala polyuria ndi nocturia. Kuthamanga magazi ndi kutupa miyendo ndi anati malinga mpaka aimpso kulephera. Zizindikiro anafotokoza mu mndandanda, ndi khalidwe la siteji pachimake cha matenda.

brightism

matenda amakhala aakulu pambuyo Inde pachimake. Koma Zikatero n'zochepa. Nthawi zambiri, nephritis aakulu kukhala pambuyo likufa matenda, matenda kagayidwe kachakudya kulimbikira thupi, zonse mankhwala kuledzera. Tubuloinsterstitsialnye nephritis aakulu pa ultrasound anasonyeza glomeruli mu chikhalidwe yachibadwa kapena kuwonongedwa. Tubules ali kwina palimodzi kapena olumala. Buku zovuta zosiyanasiyana njira - kuchokera mwapang'ono chachikulu nembanemba homogeneous.

Aimpso minofu ndi atengeke fibrosis ndi kutupa. Ngati fibrosis ambiri palibe, ndi parenchyma zikuwoneka pafupifupi wathanzi. Atrophied impso ndi kukula yaing'ono ndi zizindikiro za asymmetry. Zizindikiro za nephritis aakulu ofanana ndi amene akupezeka mu gawo pachimake, koma ndi mawonetseredwe zochepa omveka. Leukocytosis ndi kuchuluka erythrocytes n'zochepa. Matenda Inde matendawa ndi oopsa kwambiri, kotero muyenera kumvetsera zolankhula zizindikiro mu magawo oyambirira a matenda. Kuchedwa mankhwala atsogolere bwino impso, amene ana amakumana ndi mavuto ambiri.

The pachimake maphunziro a matenda

Nthawi zambiri kumachitika chifukwa zosayenera kudziletsa mankhwala popanda kufunsa dokotala. Kulephera kwa impso limayenera maonekedwe a njira pachimake yotupa kuonekera patatha nthawi kugwiritsira ntchito mankhwalawa mankhwala beta-laktamidnyh.

Pachimake nephropathy amakhala ndi pamaso pa edema zotumphukira ndi yotupa kusalola. Iwo athandize minofu aimpso. Nthawi zina zimatenga masabata pang'ono maonekedwe zizindikiro mwadzidzidzi. Ndiye kukhala kovuta aimpso kulephera, amene amayamba ndi mwadzidzidzi mwambo wa mankhwala komanso kukhudzana mosaleka irritant ndi.

ana jades

Luso kupewa chitukuko cha matenda ana amakhala ulendo yake kwa dokotala vuto la matenda aliwonse, kuyambira chimfine. Kudzimvera zosatheka okha ochita dokotala adzasankha mankhwala kuti musawononge mwana si anapanga wa chitetezo cha m'thupi.

Tubulointerstitial nephritis ana ankachitira kuyang'aniridwa ndi katswiri. Pamodzi anatumizidwa zakudya achire, popanda zomwe zotsatira zabwino ndi akwaniritsa kovuta. Pankhani ya akuthamanga nephritis impso matenda mankhwala si zotheka, ndiye anadza ku limba kupatsidwa zina. Pakuti Dokotala khalidwe undulating zochita za matenda ndi yaitali kachedwedwe nthawi.

madokotala ananena zawo

Pamene ntchito impso ndi makutu chifukwa ntchito mankhwala, tubulointerstitial nephritis amapezeka. Chithandizo milandu wofatsa n'kofunika. Siyani kumwa mankhwalawo, ndipo masamba anayamba ntchito yachibadwa mu miyezi 2-2.5. Nthawi zina chodabwitsa yotsalira ndi kukhalapo kwa amamuyambitsa timabala. Pamene matenda a etiology wina kuthetsa chifukwa, koma matenda ndi kusintha. Zikavuta ndi kulephera aimpso ndi fibrosis.

Kuneneratu aakulu a mtundu nephritis zimadalira liwiro la kudziwika ndi kuchepetsa kudwala pamaso ati apange sizingasinthe fibrosis. Ngati simungathe kukonza majini, poizoni ndi kagayidwe kachakudya kusintha, matenda zipita kulephera matenthedwe aimpso.

chithandizo matenda

Pamene zizindikiro woyamba wa matenda ayenera kuonana ndi dokotala. iye yekha adzatola olondola ndi woyenera chithandizo. Therapy kwa wodwala aliyense ndi munthu. Koma, mwachitsanzo, kuti imathandizira kumasuka ku gawo pachimake cha matenda, ndi ntchito zina aakulu glucocorticoid. Phwando ndondomeko kumabwezera mmbuyo zoletsa angiotensin.

A biopsy impso

Ndondomeko ikugwilizirana zikunena matenda kudziwa matenda a impso. Ndi kuchotsa magawo minofu kufufuza tosaoneka. Kudzera woonda syringe singano kupita ping'ono zinthu aimpso. phunziro zimathandiza bwino kudziwa mipweya ya minofu ndi kusankha chithandizo mulingo woyenera.

Zikuonetsa kuti ndondomeko biopsy

Njira yophunzirira biopsy akapatsidwa milandu zotsatirazi:

• Mpaka kumapeto akulephera kupeza chifukwa cha matenda aakulu kapena pachimake.
• Kodi amaganiziridwa nephritis.
• Mofulumira mwapang'onopang'ono aimpso kulephera.
• Pali zovuta opatsirana aetiology.
• Zasayansi maphunziro a mkodzo wapezeka kusakanizikana kwa magazi ndi mapuloteni.
• atayezetsa limasonyeza kuchuluka kwa asidi uric, creatinine, urea.
• Amaganiziridwa Oncology.
• Kuziika impso ntchito mavuto.
• Pakufunika kudziwa mmene kuwonongeka.
• Kuwayang'anira patsogolo chithandizo.

mitundu biopsy

Ndondomeko zichitidwe mwa khungu. Iwo ikuchitika jekeseni ya impso ndi umalamulidwa ndi X-ray kapena ultrasound. Magawowa malo thupi anaikapo mu mtsempha wa kusiyana mu mtundu ndale mankhwala. Open ndondomeko biopsy amakhala ndi mpanda wa pang'ono minofu mwachindunji pa opaleshoni. Mwachitsanzo, mukamafinya mipita neoplasms Cancer. Limatisonyeza mmene anthu amene magazi kapena pali impso mmodzi yekha ntchito. Izi zachitika kuchepetsa wakhudzana ndi izo.

Olowa cystoscopy ndi biopsy ikuchitika mu nkhani ya kukhalapo kwa miyala ureter kapena mafupa a chiuno aimpso. Iyo yachita mu chipinda opaleshoni ndipo lili kumayambiriro chubu kusintha kwa anayendera mkati mwa ureter lapansi. Transjugular view biopsy ndi chiyambi cha catheter mu mtsempha anasankha aimpso. Izo ntchito odwala ndi kunenepa, aakulu kupuma insufficiency ndi osauka magazi clotting pamene palibe njira pamwamba si ikuchitika chifukwa anaopseza kuti moyo ndipo alibe kudziwa tubulointerstitial nephritis.

Pomaliza, tiyenera anati, kuti matenda yooneka ngati asymptomatic, osati kusokoneza mtima kwenikweni amafunika nthawi kuzindikira. Ndipo zovuta ndi Popanda kuchitapo kanthu nephritis ntchito kumawononga impso ndi kuyambitsa zotsatira sizingasinthe.