Kev kho tus nqi siab 2 lab rub nws mus rau hauv qhov tob ntawm Uremia!

Serum creatinine was 1340µmol/L and hemoglobin was 53g/L. This is the test result of a 43-year-old female patient with kidney disease. Serum creatinine >700μmol / L raug kuaj pom tias yog uremia. Tus neeg mob no yog undoubtedly uremia, thiab kuj muaj mob raum anemia, lub raum kub siab 180/100mmHg, mob metabolic acidosis, plawv tsis ua hauj lwm, complexion Paleness, qaug zog, kiv taub hau, xeev siab, thiab poob qab los noj mov yog cov tsos mob ntawm uremia.

Tab sis tus neeg mob no tsis tau mob ntev thiab tsis tau cuam tshuam kev kho mob. Tau ntau xyoo, nws tau siv ntau dua 2 lab yuan rau kev kho mob. Tab sis yog vim li cas nws thiaj tuaj deb no?

Nyem mus yuav cistanche rau mob raum

Xya xyoo dhau los, tus neeg mob tau mus rau hauv tsev kho mob rau kev kuaj mob vim tias o ntawm txhais ceg thiab pom tias cov zis muaj protein ntau yog 3 ntxiv thiab cov ntshav siab yog 180/100mmHg, uas yuav tsum yog nephrotic syndrome thiab lub raum kub siab. Lub sijhawm ntawd, tus kws kho mob xav ua lub raum puncture rau nws kom paub meej qhov ua rau, tab sis nws tsis kam, yog li nws tau kho nrog tshuaj xws li tshuaj sartan antihypertensive. Txij thaum ntawd los, tus mob tau zoo thiab tsis zoo, cov zis cov protein tau khaws cia ntawm 2 ntxiv ~ 3 ntxiv, thiab cov ntshav siab tau poob me ntsis, tab sis nws tsis tau poob mus rau qhov qub.

Ob xyoos dhau los, cov ntshav creatinine tau pom tias nce siab, thiab cov ntshav creatinine yog 150 μmol / L. Kev nce hauv cov ntshav creatinine txhais tau tias txo qis hauv lub raum ua haujlwm. Nws ntxhov siab me ntsis, yog li nws nrhiav kev kho mob txhua qhov chaw kom txo nws cov ntshav creatinine.

Thaum kuaj ib nrab xyoo dhau los, nws tau pom tias nws cov ntshav creatinine yog 800 μmol / L, uas yog uremia. Lub tsev kho mob loj tau hais tias nws tau lim ntshav, tab sis tus neeg mob tsis kam thiab txuas ntxiv mus ntxiv cov tshuaj "tshwj xeeb". Tsis ntev los no, kuv muaj mob hawb pob, pw tsis tsaug zog, noj tsis taus, tuav tsis tau ntxiv lawm, kuv thiaj tuaj rau peb lub tsev kho mob kho mob.

Tus neeg mob nyob hauv nroog thiab muaj txoj haujlwm zoo heev, tab sis tsis yog nrhiav kev kho mob hauv tsev kho mob loj hauv Tianjin, nws mus ncig thoob tebchaws thiab thaj chaw ib puag ncig, nrhiav cov kws kho mob zoo nkauj, tshuaj kho mob, thiab tshuaj tshwj xeeb. Nws tus txiv tau hais tias ob peb xyoos dhau los, nws tau siv tag nrho nws cov peev txheej los kho tus kabmob, siv tag nrho ntau dua 2 lab yuan. Nws tsis xav kom qhov kawg no.

Kuv hais tias, "Yog tias koj tsis tau ua ib qho kev kho mob hauv ob xyoos dhau los, koj yuav tsis muaj uremia sai heev. Tsis yog 2 lab yuan xwb tsis kho tus kab mob, tab sis nws thawb koj mus rau hauv abyss."

Nephrotic syndrome

Tus neeg mob tau ploj mus nrog cov txiaj ntsig ntawm kev sim los ntawm 7 xyoo dhau los. Raws li cov tsos mob ntawm cov zis protein 3 ntxiv thiab edema, nws tau kwv yees tias nws yuav tsum yog nephrotic syndrome, thiab muaj lub raum kub siab tib lub sijhawm.

Nephrotic syndrome tsis yog kab mob, tab sis ib qho tshwm sim ntawm ntau yam kab mob raum. Glomerulonephritis yuav ua rau mob nephrotic, mob ntshav qab zib nephropathy, lupus nephritis, purpuric nephritis, kab mob me me vasculitis nephritis, thiab lwm yam yuav tshwm sim nephrotic syndrome. Txawm li cas los xij, ntau yam ua rau xav tau kev kho mob sib txawv. Thaum pib, tus kws kho mob tau qhia tus neeg mob kom muaj lub raum puncture kom paub meej qhov ua rau thiab kho nws qhov tseeb. Tab sis nws tsis kam, thiab tus kws kho mob tsuas yog siv sartan antihypertensive tshuaj thiab lwm yam kev kho mob.

Uremia

Yog tias kab mob raum tsis tswj tau zoo, ntau thiab ntau dua glomeruli yuav raug puas tsuaj thiab lub raum ua haujlwm yuav poob qis. Ob xyoos dhau los, tus neeg mob cov ntshav creatinine nce ntxiv, thiab lub raum ua haujlwm tau poob qis. Nws tau kwv yees tias ntau tshaj ib nrab ntawm cov glomeruli tau necrotic thaum lub sijhawm ntawd.

Yog tias ntau tshaj ib nrab ntawm cov glomeruli yog necrotic, lub nra ntawm cov glomeruli ntxiv yuav hnyav dua thiab hnyav dua. Yog tias tus kab mob hauv lub raum tsis tau tswj tau zoo nyob rau lub sijhawm no, tus nqi ntawm glomerular puas yuav ua sai dua thiab sai dua, thiab lub raum ua haujlwm yuav hnyav zuj zus mus txog thaum nws loj hlob mus rau hauv uremia.

Cov tsos mob ntawm tus kab mob raum yog dab tsi?

Lub raum muaj ob txoj haujlwm tseem ceeb: pom kev ua haujlwm thiab kev ua haujlwm endocrine. Ob txoj haujlwm no tuaj yeem tso cov co toxins tawm hauv tib neeg lub cev, tswj dej, sib npaug ntawm electrolyte, thiab acid-base tshuav nyiaj li cas, tswj cov ntshav siab, txhawb kev tsim cov ntshav liab, thiab tswj qhov sib npaug ntawm phosphorus metabolism.

Hauv cov kab mob raum tsis zoo, ob qho tib si ntawm cov haujlwm no tsis zoo. Cov tsos mob ntawm tus kab mob raum ntev feem ntau muaj xws li proteinuria, hematuria, kub siab, edema, nce ntshav creatinine, metabolic acidosis, hyperkalemia, anemia, hypocalcemia, thiab hyperphosphatemia.

Thaum lub glomerular filtration membrane yog me ntsis puas, albumin hauv cov ntshav nkag mus rau hauv cov zis los tsim proteinuria. Kev kuaj zis niaj hnub yuav pom cov zis protein (ntxiv), ntau dua (ntxiv), qhov kev puas tsuaj loj dua. Qhov ntau cov zis tso zis tso zis, cov ntshav albumin qis dua.

Thaum cov zis muaj protein ntau dua lossis sib npaug li 3.5g / d, thiab ntshav albumin<35g ,="" it="" is="" called="" nephrotic="" syndrome.="" the="" kidney="" is="" an="" important="" organ="" for="" blood="" pressure="" regulation,="" and="" high="" blood="" pressure="" will="" occur="" after="" kidney="" damage,="" which="" is="" called="" renal="" hypertension.="" anemia,="" hypocalcemia,="" and="" hyperphosphatemia="" may="" occur="" after="" renal="">

Proteinuria, ntshav siab, ntshav ntshav, ntshav siab phosphorus, thiab lwm yam yog tag nrho cov txiaj ntsig ntawm lub raum puas, tab sis yog tias tsis tswj tau, lawv yuav ua rau lub raum puas tsuaj.

Yuav kho mob raum li cas?

1. Kev kho mob rau qhov ua rau.

Rau qhov ntau ntawm cov proteinuria, nws yog ib qho tsim nyog yuav tau "plug lub xau". Raws li qhov ua rau, cov tshuaj hormones yuav tsum tau siv, cov tshuaj tiv thaiv kab mob yuav tsum tau siv, cov tshuaj tiv thaiv kab mob yuav tsum tau siv, thiab cov tshuaj hypoglycemic yuav tsum tau siv.

2. Txo cov ntshav siab thiab txo cov zis protein.

Antihypertensive thiab tso zis protein-txo txoj kev kho yuav tsum tau nqa tawm thoob plaws hauv kev kho mob ntawm lub raum, ntshav siab yuav tsum tau tswj nyob rau hauv qis dua 130/80mmHg, thiab cov zis ntau protein yuav tsum tau tswj hauv qab no 0.3g/d.

Cov tshuaj ntshiab thiab muaj txiaj ntsig zoo yog sartan antihypertensive tshuaj thiab cov tshuaj puli antihypertensive. Ntxiv nrog rau ntshav siab, ob cov tshuaj no muaj cov txiaj ntsig ntawm kev txo cov zis protein thiab tiv thaiv lub raum. Tsis tas li ntawd, ntxiv rau kev txo cov ntshav qab zib, cov tshuaj hypoglycemic ntawm Litholine cov chav kawm kuj muaj cov txiaj ntsig ntawm kev txo qis cov protein thiab tiv thaiv lub raum thiab kuj tau txais kev pom zoo rau kev kho mob ntawm cov neeg mob uas tsis yog mob ntshav qab zib nephropathy.

Qhov kev tiv thaiv lub raum tsuas yog ncua sijhawm rau lub raum puas, tsis yog "tshem tawm hauv paus." Tsis muaj tshuaj nyob hauv lub ntiaj teb uas tuaj yeem "tua" lossis "kho" kab mob raum.

3. kev kho mob.

Cov tsos mob xws li edema, lub plawv tsis ua hauj lwm, cov tsos mob ntawm plab hnyuv, thiab calcium thiab phosphorus metabolism yuav tsum tau kho kom nquag plias. Tsis tas li ntawd, nco ntsoov kho lub raum tsis zoo. Anemia yog qhov tshwm sim ntawm lub raum tsis ua haujlwm thiab, yog tias tsis kho, dhau los, ua kom lub raum tsis ua haujlwm. Kev tswj ntshav qab zib rau tus qauv tuaj yeem ncua qhov kev loj hlob ntawm lub raum tsis ua haujlwm.

Tus neeg mob no, uas nws cov hemoglobin tsuas yog 52g / L, twb mob hnyav heev thiab xav tau kev hloov ntshav. Hauv cov neeg mob lub raum tsis ua haujlwm ntev, hemoglobin yuav tsum tswj hwm ntawm 100-130 g / L. Vim li cas cov "cov kws kho mob txawj ntse" uas them 2 lab yuan rau kev kho mob tso cov mob ntshav qab zib hnyav tsis tuaj yeem saib xyuas?

Tsis tas li ntawd, cov kab mob raum ntev yuav tsum tsis txhob siv yam tsis saib xyuas. Tsis txhob xav tias koj noj tshuaj ntau dua, nws yuav zoo dua. Qee cov tshuaj, tsis tsuas yog tsis muaj kev kho mob nkaus xwb tab sis ua rau lub raum puas tsuaj thiab ua rau lub raum tsis ua haujlwm. Feem ntau hais lus, yog tias qhov glomerular pom tus nqi tau lees tias yuav txo qis dua 2ml / min hauv ib xyoos, kev kho mob ua tiav; Yog hais tias lub glomerular pom tus nqi txo qis dua 5ml / min hauv ib xyoos, qhov kev kho mob tsis zoo.

Kev mob ntawm lub raum tsis ua haujlwm yog tsis tu ncua. Noj cov IgA nephropathy feem ntau ua rau lub raum tsis ua haujlwm ua piv txwv, qee cov ntaub ntawv qhia tias 30 feem pua ​​​​ntawm IgA nephropathy yuav loj hlob mus rau hauv uremia, uas yuav siv sijhawm li 20 xyoo. Yog tias pom IgA nephropathy thiab tsis tau kuaj xyuas, qhov glomerular pom tus nqi poob qis ntawm tus nqi ntawm 5ml / min, thiab uremia yuav tsis loj hlob rau 7 xyoo.

Yog tias siv cov tshuaj hormones rationally, ntshav siab thiab zis protein tswj tau nquag, thiab ntshav siab thiab zis protein raug tswj raws li tus qauv, lub raum tsis ua haujlwm yuav tsis tshwm sim. Tus neeg mob cov ntshav creatinine yog 150 μmol / L ob xyoos dhau los, thiab glomerular pom tus nqi tsawg kawg yog 45 ml / min. Tom qab ib thiab ib nrab xyoo ntawm kev kho mob, cov ntshav creatinine nce mus rau 800 μmol / L, thiab glomerular pom tus nqi tsawg dua 8 ml / min. min, txo los ntawm 37ml / min hauv ib xyoos thiab ib nrab xyoo thiab txo los ntawm 24ml / min hauv ib xyoos ntawm qhov nruab nrab. Qhov ntawd yog hais tias, txawm tias tsis siv 2 lab thiab tsis muaj kev kho mob, lub raum kev ua haujlwm yuav tsis poob sai sai.

Qhov ntawd yog hais tias, cov kev kho mob hu ua "txuag nws", tab sis ncaws nws mus rau hauv lub abyss. Tsis muaj kev kho nyob rau hauv lub ntiaj teb no, thiab tsis muaj "folk magician". Cov kws kho mob zoo tshaj plaws thiab ntsuas kev kho mob zoo tshaj plaws yog nyob hauv tsev kho mob tsis tu ncua. Txhua qhov teeb meem ntawm uremia yog kev ntxhov siab, qee qhov vim tsis saib xyuas kev kho mob, thiab qee qhov yog vim kev kho ntau dhau thiab kev kho mob tsis zoo. Kev tshawb fawb hauv ntiaj teb nto moo Hopkins Tsev Kho Mob tau tshawb pom tias kev ua tsis zoo yog ib qho ntawm cov laj thawj tseem ceeb rau kev loj hlob ntawm uremia hauv cov neeg mob hluas uas muaj kab mob raum, thiab qhov tsis ua raws cai yog siab txog 34.5 feem pua.

Kev tsis ua raws cai yog hais txog kev tsis ua raws li tus kws kho mob pom zoo, kev coj ua raws li kev coj noj coj ua, tsis yog los ntawm kev kho nws lossis los ntawm kev noj tshuaj tsis raug cai. Tus neeg mob no nyob rau tom kawg. Kuv vam tias qhov xwm txheej no tsis tshwm sim dua.

Yog xav paub ntxiv:ali.ma@wecistanche.com