I-Nephrogenic sikashukela i-insipidus yisifo lapho isiguli sikhombisa ukungakwazi kohlelo lwe-excretory ukubuyisa ukumanzisa uketshezi ngenxa yokuthi kunciphisa ukusabela kwama-rebu tubules ku-hormone ye-antidiuretic.
Ngenxa yalokhu, kukhiqizwa inani elikhulu lomchamo ongagxiliwe. Lokhu, kungaholela ekuwohlokeni kwesimo sesiguli futhi kudale ukonakala kwezinso.
Isifo esifana nesifo sikashukela se-nephrogenic sinezinhlobonhlobo ezithile, kuyilapho zonke zibonakaliswa ukwephulwa okukhulu komsebenzi wezinso okwenziwa ekhaya, ngenxa yalokho kuguqulwa kweleveli yokulinganisa kwamanzi nosawoti emzimbeni womuntu. Uma sithatha kuphela izinkomba zamakhemikhali nezokuzalwa, lapho-ke singabona ukugxuma kwesiguli ekucindezelweni kwe-osmotic ye-plasma yegazi.
I-Hyperelectrolythemia nayo ingahle ibe khona, lapho ukugcwala kwe-sodium ku-plasma yegazi kungakhuphuka kumanani abucayi we-180 meq / l, ne-chlorine kuya ku-160 meq / l. Kulesi simo, isiguli sizwa ukuchama kaningi. Umphumela walokhu kungaba ukukhula komzimba kanye ne-toxicosis ejwayelekile.
Izinhlobo eziphambili zesifo
Uma sikhuluma ngezinhlobonhlobo zesifo esichaziwe, khona-ke ukutholwa kwesifo sikashukela se-renal siyatholakala futhi kube nefa. Isifo esinjalo singatholakala kuphela uma isiguli silimaze into yobuchopho kanye namandla okuxineka, okwenza izinso zingazwakali ku-ADH. Ikakhulu othambekele lapho kuvela ifomu elinganiselwe lesifo sikashukela esitholwayo salolu hlobo yiziguli esezikhulile, kanye neziguli eziwohlokile neziguli ezihluleka ngokweqile noma ezingapheliyo sezinso.
Uhlobo lwesibili lwalesi sifo lofuzo futhi lisho ukuba khona kwesifo esijwayeleke kakhulu esenzakalweni esivela ezigulini, okungukuthi, isici se-vasopressin arginine receptor gene. Ngaphezu kwalokho, lolu hlobo lwesifo sikashukela lungadala ukuguquka kwezimo ezahlukahlukene, kuthinte uhlobo lwe-aquaporin-2 gene. Ngaphezu kwalokho, kuya ngohlobo lwalesi sifo noma sofuzo, iziguli zingazwela futhi zingazweli ku-ADH.
Kufanele futhi kukhunjulwe ukuthi kukhona izifo ezinezimpawu ezifana ne-nephrogenicabetes insipidus. Isibonelo, isifo sikashukela i-insipidus kwabesifazane abakhulelwe, lapho i-placenta imisa i-vasopressinase engxenyeni yesibili yokukhulelwa. Ngaphezu kwalokho, isithombe esifanayo singabonakala ngemuva kokuhlinzwa kwi-pituitary gland.
Ukuze ukwazi ukwahlukanisa uhlobo noma uhlobo lwesifo esithile, kuyadingeka ukwazi izimpawu zalo kahle. Kulesi simo kuphela lapho uzokwazi ukunquma ukwelashwa okuyikho futhi umise ukuthuthukiswa kwalesi sifo kusuka esigabeni esibi kuya kwesinye esingamahlalakhona.
Ukwelashwa okungahambi kahle kungangeza lolu hlobo sikashukela kuphela.
Izimpawu zesifo nokuxilongwa
Ku-nephrogenic sikashukela insipidus, izimpawu zishiwo ngokucacile, uma kuvela izimpawu ezithile zalesi sifo, kufanele uthintane nodokotela ngokushesha. Isibonelo, uphawu oluphambili lwalesi sifo ukwakheka komchamo we-hypotonic ngenani lamalitha amathathu kuya kwamashumi amabili ngosuku. Njengomphumela wale nqubo, isiguli siqala ukuzizwa somile kakhulu ngenkathi izinga le-sodium sodium lihlala lilijwayelekile.
Uma lesi sifo sivele kulezi ziguli ezingakwazi ukufinyelela mahhala emanzini, isibonelo, izingane esezikhulile noma ezincane, ngenxa yalokho zingaba ne-hypernatremia. Ukubonakaliswa kwayo kwangaphandle kungaba ukulahlekelwa ukwazi, ukuphazamiseka okuphezulu kwe-neuromuscular, i-coma noma i-epileptic. Izingane ezincane ezihlushwa uhlobo oluchaziwe lwesifo sikashukela i-mellitus zingathola ukulimala kobuchopho ngenxa yokuthuthuka kwalesi sifo, kuhambisana nokuncipha kobuhlakani, okungalungiseki, kungatholakala ukuthi sibambezeleka ngokubanzi ekukhuleni komzimba.
Ngokuqondene nezindlela zokuxilonga, isifo sikashukela se-nephrogenic sinqunywa esigulini sisebenzisa izindlela ezilandelayo:
- ukutadisha umchamo kanye ngosuku ukuthola osmolality, kanye nesitifiketi somthamo wayo;
- ukubheka i-serum yegazi kuma-electrolyte;
- amasampula ngokudla owomile.
Ochwepheshe bezokwelapha bancomela ukuthi zonke iziguli ezikhononda nge-polyuria zithathwe ukuze zinakekelwe. Ekuqaleni, umchamo uthathwa kubo ukuze uhlolwe kaningana ngosuku. Ngokusekelwe emiphumeleni yezifundo, kungahlolwa ezinye izivivinyo.
Ukuba khona kwe-NNDM kubonakaliswa yisikhamo somchamo wesiguli ngesilinganiso esingama-50 ml / kg ngosuku, kanti ama-osmolality aso angaphansi kwama-200 mOsm / kg. Kunoma ikuphi, udokotela uzodinga ukukhipha ezinye izimbangela zokuguliswa yisiguli. Kulesi simo kuphela lapho angabheka ukunemba nokusebenza ngempumelelo kokwelashwa anikezwe kona.
Ngokuqondene nezinye izivivinyo, imvamisa lesi sifo sikashukela siqinisekiswa lapho i-serum sodium inyuswa ibe ngu-145 mEq / L. Ngaphezu kwalokho, ngesivivinyo sokudla esomile ngemuva kwamahora ayisithupha kwenqatshwa uketshezi, kufanele kubhalwe phansi i-osmolality yomchamo ongafanele. Ngaphezu kwalokho, lolu vivinyo kuzodingeka ukuthi luqinisekiswe yimiphumela yolunye ucwaningo.
Ngaphandle kokudlula zonke izivivinyo ezingenhla, akunakwenzeka ukuqala ukwelashwa okufanele, futhi lokhu, kungaholela ekufeni kwesiguli kusuka ekuphepheni komzimba. Ngakho-ke, uma kunokuphambuka kwesifo sikashukela, kufanele wenqabe ukuya ezifundeni ezinesimo sezulu esishisayo ngesikhathi sokwanda kwesifo.
Ngalesi sikhathi, akufanele uhlele ukungenelela kokuhlinzwa futhi uvikele ngesikhathi esifanele ukuthuthukiswa kwezimo ezibuthaka.
Izindlela eziphambili zokwelashwa
Uma isiguli sitholakala sine-nephrogenic sikashukela i-insipidus futhi izimpawu zayo zivezwa ngokucacile, kuyadingeka ukuqala ukwelashwa ngemuva kokwenza izifundo ezifanele. Ngokuyisisekelo, liqukethe ekulinganiseni inqubo yokubuyiselwa kwamanzi. Uma ukwelashwa kuphumelela, khona-ke kuyokwazi ukuqeda cishe noma iyiphi i-nephrotoxins futhi kulungiswe umthamo wamanzi ophethwe isiguli phakathi nosuku.
Ukunciphisa i-diuresis, i-thiazide diuretics ijwayele ukusetshenziswa, okunciphisa inani lamanzi elethwe ezingxenyeni ezibuthaka ze-ADH zama-tubules. Isiguli sizohlomula ngokudla okuphansi kwamaprotheni. Isiguli kufanele sinciphise inani likasawoti elidla nsuku zonke.
Ngaphezu kwalokho, uma isiguli siveze okungenani uphawu olulodwa lwesifo esichaziwe, siyelulekwa ukuthi siqaphe njalo izinkomba zokulinganisa kwe-acid-base egazini ngenkathi kuqashwa izinga le-potassium. Ukuhlolwa okunjalo kukuvumela ukuthi uqaphele ukuqala kwalesi sifo ngesikhathi futhi sikuvimbe, ngenxa yalokho, izinso sesiguli ngeke sihlupheke kakhulu ngaso.
Ngokuvamile, i-prognosis yokwelashwa kwalesi sifo ezigulini iyathandeka, ngakho-ke, ungapheli ithemba lapho kutholakala i-NNDS. Uma isiguli sinamathela enkambisweni yokwelashwa nezeluleko zikadokotela, kungenzeka ukuthi ukululama okugcwele kuzofika. Kunoma yikuphi, inikezwe ukunakekelwa kwezokwelapha okufika ngesikhathi, iziguli azikho engcupheni yokufa.
Kulokhu, ungazibandakanyi ekwelashweni ngokwakho, ngoba uhlobo ngalunye lwesifo sikashukela lunezimpawu zalo futhi uma umuthi owodwa usizile kwelinye icala, kolunye ngeke nje ukwazi ukusiza. Uma isiguli sikuthanda ukuzelapha, lesi sifo singangena esigabeni esingelapheki. Lokhu akufanele kuvunyelwe, ngoba izinkinga ezingathí sina zingavela kanye noshukela.
Mayelana nokuvinjezelwa, abantu abathambekele kulolu hlobo lwesifo sikashukela bayalulekwa ukuthi benze ucwaningo lokuthola kuqala ifa. Ukuvikela ukukhula kwesifo, kufanele ulwele ukugwema ukuthuthukiswa kwezifo ezahlukahlukene ezithathelanayo ezingadala ukukhula kanye nokuqhubeka kwe-NNDS.
Ukuze wenze lokhu, kufanele uvakashele udokotela ngezikhathi ezithile futhi ulandele izincomo zakhe.
Ukwelashwa ngemithi yabantu
Uma isiguli sinquma ukwelapha i-nephrogenic sikashukela insipidus ngemithi yabantu, nakanjani, ukwelashwa okunjalo kufanele kuhambisane nokwelashwa kwendabuko kwendabuko. Lokhu kuzothuthukisa umphumela otholwe ekwelashweni okunjalo, futhi futhi, ngokuhamba kwesikhathi, cishe kunqabe ngokuphelele ukuphuza umuthi. Ngenxa yalokho, isiguli sizothola umphumela wokwelapha ngaphandle kokulimaza umzimba wakhe ngokwengeziwe ekuthatheni amakhemikhali.
Izindlela ezaziwa kakhulu zokwelapha isifo ukugula kwamakhambi ukuqanjwa okuhlukahlukene. Isibonelo, ungasebenzisa ingxube yezimpande ze-valerian kanye ne-magazus ngembewu ye-fennel ne-cyanosis eluhlaza okwesibhakabhaka. Ngaphezu kwalokho, ingxube ifaka i-thyme, i-veronica, i-meadowsweet.
Ingxube ithululelwa ngamanzi abilayo futhi yenziwe ku-thermos ubusuku bonke. Ukuze ulungiselele ukumnika, thatha isipuni sengxube, uthele u-0.5 l wamanzi abilayo bese ushiya ku-thermos yokugcizelela. Ungaphuza umuthi ngakusasa ngemithamo emithathu cishe isigamu sehora ngaphambi kokudla. Yonke le ndlela yokwelashwa ihlala isikhathi esingaphansi kwezinyanga ezintathu.
Ngokwesikimu esifanayo, iqoqo le-chamomile, impande enephunga elimnandi kanye ne-dill liyabhalwa futhi lusetshenziswe, lapho kufakwa khona impande ye-licorice ne-oregano. Ngasikhathi sinye, wonke amalungiselelo e-herbal angaqoqwa ngokuzimela, noma angathengwa ekhemisi selivele lenziwe. Inketho yokugcina ilungile ngoba akudingeki uchithe isikhathi sakho usesha futhi uqoqa izinto zokwelapha zokwelapha, ngaphezu kwalokho, imali yamakhemisi igcinwa isikhathi eside kakhulu kunaleyo eqoqwe ngokuzimela.
Imininingwane nge-insipidus yesifo sikashukela inikezwe kuvidiyo ekulesi sihloko.
