Lupus nephritis: chirwere, kurapwa, kudya

Lupus nephritis ndechimwe chezvinhu kakawanda matambudziko ose chinonzi systemic lupus erythematosus. UYU - chinhu autoimmune chirwere kunokonzerwa chimiro antibodies pamuviri, izvo kugamuchira mapuroteni "chizvarwa" sezvo dzimwe. Somugumisiro, kukura aseptic kuzvimba munzvimbo dzakasiyana-siyana dzomuviri. Kusanganisira netsvo.

tsananguro

Lupus nephritis, lupus nephritis, kana - rinorema cheitsvo mune chinonzi systemic lupus erythematosus. Kuwanda chirwere ichi muna vemo, paavhareji vanhu makumi mana chete namazana vanogara. Most vanotambura vamiririri akanaka hafu pakati pemakore makumi maviri kusvika makumi mana namaviri. Kakawanda, zvokurwara unowanika Afro-Caribbean vanhu.

The chirwere zvinogona kukonzerwa-siyana zvinoita, kubva Kushapira kusukuta matehwe, kuti nemagene zvirwere, saka zviri zvikuru nguva kuteerera zviratidzo uye kuona chiremba. Pashure pezvose, nokukurumidza kurapwa iri atanga, nani fungidziro upenyu murwere uye utano.

etiology

Lupus nephritis zvinogona kukonzerwa refu zuva dzokupisa chenguva (chitandadzo solarium kana kugara kuine nzvimbo), nezvimwe zvinhu kuti mishonga, zvachose mupfungwa uye kunyange pamuviri (fetus kunonzwisiswa kuva muviri vavatorwa zvirwere anotanga kurwisa masero mai).

Uyezve, kukura yokugara zvirwere zvazvinoita muropa, kuvapo hormone imbalances, kakawanda utachiona zvirwere (utachiona revatema kupinda muchitokisi muviri, vachisiya kwavo pamusoro maantigen uye vakandizvidza ayo saka zvirwere response). Mukana kuva chirwere iri pedyo nehama kanoverengeka kupfuura avhareji nokuda kwevanhu.

pathogenesis

Lupus nephritis chikamu chiratidzo kuti ikabuda chinonzi systemic lupus erythematosus. Autoantibodies kuva pakutanga kusvika chizvarwa DNA uye kubatana kwayo pamwe histones, kuti mapuroteni ari mukwanisi emuviri uye cardiolipin. Chikonzero utsinye hwakadaro - akaderedza achishivirira kuzvida maantigen, kuremara mu B uye T lymphocytes.

Zvakananga chokuita kukura nephritis mukuti antigen-antibody zvivako tropic kuti munyama ari renal tubules. Kamwe yakadaro puroteni Morekuru wanamatira muchitokisi pamusoro, izvozvo zvinokonzera kupindana nokukanganisika siyana kuti kuguma achisunungura zvinoshingaira zvinhu, yakarukutika sero. Izviwo, anoita chinhu anogumbura maitiro, izvo chete exacerbates kukuvara.

kukuvadzwa anatomi

Lupus nephritis muna SLE vangava siyana morphological kuratidzwa. Panovhurwa varwere vaiva kuchinja membranes ari itsvo glomeruli, vanoshingaira weboka masero, pakuwedzera mesangium, vascular sclerosis, zvishwe uye zvakawanda. kuratidzwa izvi zvingava zvose chimwe uye glomeruli dzinoverengeka.

Chinonyanya chaicho lupus nephritis riri fibrinoid necrosis rirambe richibvira loop pamusoro Henle, uye histologically detectable karyopyknosis uye karyorrhexis (kuparadzana uye lysis foni nuclei). Uyezve, imwe pathognomonic shanduko glomerular bhesimendi Kamudzira se "waya muzvishwe" uye kuvapo hyaline thrombi ari lumen pakati capillaries pamusana deposition kuti masoja zvivako.

kupatsanura

Akaora uye morphologically vari matanho akawanda izvo kunosvika lupus nephritis. Kupatsanura weWorld Health Organization sezvinotevera:

1. First Class: glomeruli vane hwandaiva yakarongeka.
2. kirasi yechipiri: kune akarurama Kuchinja iri mesangium.
3. Kirasi Third: glomerulonephritis pamwe lesion pakati nehafu glomeruli.
4. mugwaro rechina: diffuse glomerulonephritis.
5. giredhi Wechishanu: membranous glomerulonephritis.
6. mugiredhi rechitanhatu: chinonzi sclerosing glomerulonephritis.

Panewo kupatsanura Serova, pazviri allocates zvatichiri, diffuse, membranous, mesangioproliferative, mesangiocapillary glomerulonephritis uye fibroplastic.

zviratidzo

Membranous lupus nephritis zvichikanganisa unosungira uye facultative zviratidzo. Mumwe kuratidzwa aro fanira proteinuria, kureva, kuvapo mapuroteni iri weti. Uyewo, unogona vanowanzoona hematuria, leuco - uye limfotsituriyu. Zviratidzo izvi anoratidza pamberi kuzvimba ari itsvo uye anogona kuva kwete SLE.

With kuchinja ari autoimmune muitiro iri kuwedzera zviratidzo renal kukundikana kunoratidzwa yakawedzera creatinine yomuropa muropa uye weti, utera, lethargy murefu soporous inoti.

Ko zvishoma nezvishoma mberi uye nokukurumidza mberi nephritis. Kana chirwere hwapedyo zvishoma nezvishoma, ukakunda weti uye nephrotic syndrome. Uyezve, lupus nephritis anogona kuitwa nenzira basa kana Isimba rakadini rinogona kubudiswa chimiro, kana vose zviratidzo aripo chete zviduku proteinuria.

Nokukurumidza mberi lupus nephritis zvikuru zvakafanana ainakidza glomerulonephritis. Renal kukundikana iri kukura nokukurumidza, pane zvakakomba hematuria, wakawedzera BP, uye nephrotic syndrome. In Muzviitiko zvakaipisisa vanogona kuva neakangwara intravascular coagulation (DIC).

Lupus nephritis muvana

Muna 1/5 varwere chinonzi systemic lupus erythematosus wokutanga zviratidzo kuoneka muuduku. In vana vaduku nemakore 10, izvozvo anenge zvikasaitika, asi pane tsanangudzo Muzviitiko SLE ari mwana uye nemwedzi nehafu.

Kukura chirwere muvana hakusi akasiyana vakura. The mufananidzo kurapwa zvinogona dzaisiyana: kubva asymptomatic nokukurumidza mberi. Chenjera renal kukundikana hariwanikwi.

Several vakasiyana zviratidzo SLE ari mwana:

• erythema kumeso;
• discoid mapundu pamusoro muviri;
• aikanganiswa chiedza chezuva;
• mucosal ulceration;
• kuzvimba mapfundo;
• cheitsvo;
• kutyora nechepakati tsinga;
• zvakawedzera svota;
• immunological zvirwere;
• kuvapo antinuclear antibodies.

Kana kiriniki ane zvinhu zvinenge zvina kubva pasi rino, tinogona kutaura nechivimbo kuti mwana ane chinonzi systemic lupus erythematosus. kukuvara itsvo muvana kashoma kuuya yakatsviriridza. Kazhinji, zviratidzo ingabva glomerulonephritis kuti kuratidzwa pamusoro antiphospholipid syndrome.

Achatanda okukura zvirwere muvana nani.. Makore gumi pashure Pfungwa kuti dialysis nechirwere kunoda muzana chete 10 varwere.

Diagnostics

Chii anopa chiremba ane chikonzero kufungidzira lupus nephritis? Chirwere kakawanda kwakavakirwa raivapo kurapwa uye rabhoritari-akasimbisa mashoko pamusoro SLE:

• Kurwadziwa uye kuzvimba majoini;
• rashes paganda chiso ari muchimiro shavishavi;
• pamberi effusion munhoroondo mhango (pleurisy, pericarditis);
• Kutsanya uremu, muviri.

The vakawanda Kuongororwa ropa vakachengeta kupererwa, ungaderedza maplatelet, vakawedzera erythrocyte sedimentation zvazvingava, ungaderedza mukwanisi mapurotini. Nokuti chirwere kunokosha kuziva antibodies kuti chizvarwa DNA.

Kazhinji, izvi zvakakwana kuti chirwere kuti chinonzi systemic lupus erythematosus uye, sezvo migumisiro lupus nephritis. Zvisinei, chakaita mapuroteni ari weti inogona yakanonoka imwe kana maviri kubva pakatanga chirwere. Pakadaro, chiremba rinoshandisa enzayemu immunoassay uye vasabatwa antibodies. Kana asina kwakaitika Murabhoritari data, zvinokosha kuramba chirwere kutsvaka, kunyanya varwere makono, nokuti nosology kwavo, ndizvo kushoma.

Kusiyanisa lupus nephritis muna SLE varwere kwemabhakitiriya endocarditis, chenjera exacerbations okuremadzwa chearthritis, multiple myeloma, chisingaperi, hepatitis B, uye amyloidosis chirwere, Enoki-Schonlein purpura.

Danho rokutanga kurapwa

Mabatirwo lupus nephritis - refu uye richikunetesa muitiro kuti kazhinji ndedzoupenyu hwose. Zvinotora nzvimbo mumatanho maviri. In wokutanga Danho yacho exacerbation. Vavariro kurapwa - kuzadzisa igadzikane ruregerero, kana kuderedza zvekuchipatara kuratidzwa.

Mishonga inofanira kutanga nekukurumidza kubva panguva nechirwere. Zvose zvinoitika nokukurumidza zvokuti kunyange mashanu nomwe mazuva kunonoka kunogona kuva nengozi chikanganiso. Kana muitiro basa yakaderera (payo tigokuzivisai antibody titers), chiremba anogona kungogumira kushandisa corticosteroids pamatunhu mishonga kwenguva kwemwedzi miviri, zvichiteverwa zvishoma kuderera chipimo chemushonga (payakakurudzirwa kukanzura mushonga havagoni kuva, angaramba adrenal mumasero).

Kana zvimwe nokukurumidza nzira hosha, mukuwedzera kune steroids, nomutsinga dzakabatwa yakakwirira mishonga pakati cytostatics. Izvi kupomba kurapa rinoitwa mukati memwedzi mitanhatu. Chete pashure iyi inogona kutanga kuderedza dose mishonga, uye uchatamisa murwere mishonga isina nemumuromo.

Usakanganwa kuti varwere SLE vanowanzopedzisira vava neakangwara intravascular coagulation, saka Zvinokurudzirwa kutora matanho, zvinoti:

• kuisira ropa uye yenhengo dzayo;
• intravenous "Trental";
• subcutaneous kwokubatsira 2,5 inokwana zviyero zviuru "heparin".

Danho Rechipiri pakurapwa

Lupus nephritis muna SLE rechipiri chikuva zvakare kubatwa steroids uye zvinodhaka cytotoxic. Chete dose ivo duku zvikuru. Zvishoma nezvishoma, pamusoro mina kusvika kumitanhatu, kuti dose "Prednisolone" titrated 10 milligrams muzana kilogram kurema muviri. Cytotoxic yomuchipatara yakagadzwawo bolus mishonga kamwe ose mitatu, uye kana zvakanaka rinomutsa nehosha, ipapo anozodzidza chete jekiseni mwedzi mitanhatu ose.

Nokuraramisa kurapa kwakadaro kunogona kwemakore. Nokufamba kwenguva, zvinonzi akawedzera (kana zvakakodzera) kudzivirira divi anokonzerwa zvinodhaka uye symptomatic kurapwa.

Asi kunyange panguva yakakodzera atanga kurapwa nenguva gumi muzana varwere vachiri kutanga itsvo kukundikana. Muchiitiko chino, anogona chete kubatsira hemodialysis kana itsvo transplantation. Zvinosuruvarisa, kurapa izvi hazvisi kuwanikwa zvevoruzhinji.

Diet nokuti lupus nephritis

Kuti tirambe renal mashandiro pamwe lupus nephritis varwere vanofanira kuomerera zvimwe mitemo:

1. Inwa zvinwiwa patsime dzinobvisa ropa uye kuramba padanho muviri.
2. Zvokudya zvinofanira ane zviduku yakawanda potassium, phosphorus uye mapuroteni, sezvo zvinhu izvi zvine kunambwa wakaremara neitsvo.
3. Tipei tsika dzakaipa.
4. Rovedza chiedza muviri.
5. Kugara neBP yako.
6. Kushomeka yaunodya kuti mafuta zvokudya.
7. Musatora NSAIDs nokuti vane kunambwa neitsvo.

Kana murwere zvinotevera kunenge izvi, kunaka upenyu yekudyidzana hwakavandudzika uye kupona fungidziro zvikuru zvinovimbisa.

mataridzikiro

Kushurudzira pakurapa lupus nephritis membranous zvinoenderana sei zvikuru sei itsvo uye kutanga mishonga. Kwokutanga murwere anoenda chiremba, zvikuru mukana wokuti yakanaka mugumisiro.

Makore makumi mana akapfuura, asi tsama imwe varwere lupus nephritis vakararama kupfuura gore kubva kuongorora chirwere. Nemhaka nzira ano kurapwa uye nechirwere, varwere vanogona kutarisira-gore mashanu kupfuura lifespan.