Lupus nephritis: uphethwe, ukuphathwa, ekudleni

Lupus nephritis ingenye yezinkinga njalo iningi omzimba izicubu erythematosus. SCR - kuyinto isifo sokuhlasela kwamasosha omzimba kubangelwa ukubukeka amasosha omzimba emzimbeni, ethola amaprotheni "bomdabu" njengoba angaphandle. Ngenxa yalokho, ukuthuthukisa ukuvuvukala aseptic ezingxenyeni ezihlukahlukene zomzimba. Kubandakanya e nezinso.

definition

Lupus nephritis, lupus nephritis, noma - elisindayo isifo sezinso e omzimba izicubu erythematosus. Ukwanda lesi sifo emphakathini, ngokwesilinganiso abantu amane ngayinye likhulu lamawaka labantu. Iningi uhlushwa abameleli isigamu enhle eneminyaka ephakathi kwengu-engamashumi amabili kuya amane. Ngokuvamile, zokugula itholakala imiphakathi Afro-Caribbean.

Lesi sifo kungadalwa ezihlukahlukene izici, kusukela ngokweqile ukushuka, ukuze izifo ezibangelwa ufuzo, ngakho-ke isikhathi kubaluleke kakhulu ukuba sinake izimpawu ubone udokotela. Phela, ukuphathwa ngokushesha waqala, ngcono onalesi sifo ukuphila lesiguli kanye nezempilo.

omsakazo

Lupus nephritis kungenziwa senziwa eside elangeni njalo (wokuzilibazisa solarium noma uhlale ezindaweni libalele), umzimba wakho uxabana imithi, ukucindezeleka unomphela ngisho ngokukhulelwa (i-fetus ibonwa njengoba nomzimba angaphandle futhi izivikeli mzimba iqala ukuhlasela amaseli umama).

Ngaphezu kwalokho, ukuthuthukiswa izifo zofuzo umuntu ezithinta ukulutheka, khona ukungalingani hormone, njalo igciwane izifo (igciwane bafakwe umzimba cell, kusale e ezindaweni zawo antigen nokuvuselela ngaleyo ndlela impendulo kwamasosha omzimba esilwane). Ithuba ekuthuthukiseni lesi sifo izihlobo eduze izikhathi eziningana njengoba ingaphezulu kuka for labantu.

pathogenesis

Lupus nephritis kuyingxenye uphawu ukuthi yenzeka omzimba izicubu erythematosus. Autoantibodies ukuthuthukisa kwasekuqaleni kuze kube-DNA bomdabu kanye uxhumo lwayo histones, ngamaprotheni kohlelo umphelelisi futhi cardiolipin. Isizathu yolaka ezinjalo - encishisiwe ukubekezelelana enothi antigen, yokulimala B ne-T lymphocyte.

Ezihlobene ngokuqondile ukuthuthukiswa nephritis e ukuthi izakhiwo antigen-omzimba utho ukuba izicubu tubules kwezinso. Uma i-molecule amaprotheni enjalo unamathele ebusweni iseli, kubangela ukuxubana ukusabela kwamakhemikhali kuholele idedela izinto esebenzayo, kwancibilika cell. Lokhu, kubangela ukusabela ukuvuvukala, okwenza kukhule umonakalo kuphela.

anatomy okukhwantabalisayo

Lupus nephritis e SLE kungase kudingeke okunhlobonhlobo morphological. Nge kuvulwa iziguli kwakufanele izinguquko ulwelwesi we glomeruli izinso, division asebenzayo amaseli, ukunwetshwa mesangium, ukuqina kwamathishu semithambo, loops nokuningi. Lezi kubonakaliswa kungenzeka kokubili kwelinye futhi glomeruli eziningana.

I ethize kakhulu lupus nephritis kuyinto fibrinoid necrosis capillary iluphu of Henle, futhi histologically selitholakala karyopyknosis futhi karyorrhexis (ngokwahlukana lysis weseli nuclei). Ngaphezu kwalokho, ushintsho pathognomonic e glomerular engaphansi ulwelwesi njengoba "wire izihibe" futhi khona hyaline thrombi e mafutha anciphisa isikhala esingaphakathi we-capillary ngenxa sebethule izakhiwo mzimba.

ngezigaba

Emtholampilo futhi morphologically izigaba eziningana ezisabalele lupus nephritis. Ukwahlukanisa-World Health Organization kanje:

1. Ikilasi lokuqala: glomeruli akheke evamile.
2. isigaba sesibili: kukhona nje eshintsha kule mesangium.
3. ekilasini Okwesithathu: glomerulonephritis nge lesion kwesigamu the glomeruli.
4. grade Okwesine: ehlasela umzimba glomerulonephritis.
5. Ebangeni lesithathu: glomerulonephritis membranous.
6. lesithupha: sclerosing glomerulonephritis.

Kukhona ngezigaba Serova, lapho inike ebalulekile, ehlasela umzimba wonke, membranous, mesangioproliferative, glomerulonephritis mesangiocapillary futhi fibroplastic.

izimpawu

Membranous lupus nephritis has kokubili izimpawu baphoqwe futhi facultative. Omunye zako kuyinto proteinuria saziso, okungukuthi, ukuba khona amaprotheni ku umchamo. Futhi, ungakwazi ngokuvamile ukuthola hematuria, leuco - futhi limfotsituriyu. Lezizibonakaliso ibonisa ukuvuvukala e nezinso kungaba hhayi kuphela e SLE.

Nge ukuqhubeka inqubo sokuhlasela kwamasosha omzimba liyakhula izimpawu yokwehluleka kwezinso livezwa anda creatinine amazinga e egazi noma omchamo, ubuthakathaka, ukucobeka nesineke uthi soporous.

Ingabe kancane intuthuko futhi ngokushesha nephritis ezithuthukayo. Uma lesi sifo eba kancane, busa umchamo kanye nephrotic syndrome. Ngaphezu kwalokho, i-lupus nephritis ingenziwa ngendlela abangasebenzi noma esicashile, lapho babe nazo zonke izimpawu likhona proteinuria ezincane kuphela.

Ngokushesha okuqhubekayo lupus nephritis kufana kakhulu glomerulonephritis zakudala. ukwehluleka kwezinso likhula ngokushesha, kukhona hematuria cwe, kukhuphuke blood pressure, futhi nephrotic syndrome. Ezimweni ezimbi kakhulu ingaqala eqonda coagulation intravascular (DIC).

Lupus nephritis ezinganeni

Ngo 1/5 iziguli systemic lupus erythematosus izimpawu zokuqala avele ebuntwaneni. Ngo ezingaphansi kweminyaka engu-iminyaka engu-10, ke cishe ingekho, kodwa kukhona incazelo amacala SLE e ingane nezinyanga nengxenye ubudala.

Ukuthuthukiswa sifo izingane akuyona sihlukile abadala. Isithombe emitholampilo kungase nhlobonhlobo: kusukela asymptomatic ngokushesha ezithuthukayo. Ukwehluleka oyingozi kwezinso akuvamile.

izimpawu eziningana elikhethiwe SLE ku ingane:

• erythema ebusweni;
• ukuqubuka discoid emzimbeni;
• luvelo kwelanga;
• ulceration mucosal;
• ukuvuvukala emalungeni;
• isifo sezinso;
• kuphula umthetho we isimiso sezinzwa esiyinhloko;
• ukopha owandiswayo;
• iziyaluyalu immunological;
• khona amasosha omzimba antinuclear.

Uma umtholampilo inezici okungenani ezine kusuka kulolu hlu, singasho kugcwale umlomo ukuthi ingane ine omzimba izicubu erythematosus. ukulimala kwezinso ezinganeni akuvamile ziqokonyiswe. Ngokuvamile, izimpawu kungaba isukela glomerulonephritis ukuba ukubonakaliswa we antiphospholipid syndrome.

Isibikezelo ukuthuthukiswa isifo ezinganeni izindawo ezingconywana. ngemva ekwakhiweni zelashwe uphethwe Eminyakeni eyishumi kudinga amaphesenti 10 kuphela eziguli.

ukuhlola

Yini eyenza udokotela isizathu sokusola lupus nephritis? Sifo ngokuvamile esekelwe ekhona idatha emitholampilo laboratory-ukuqinisekisile SLE:

• Ubuhlungu nokuvuvukala kwamalunga;
• ukuqubuka esikhumbeni ebusweni ngesimo uvemvane;
• ebukhoneni umlando effusion kule ingaphakathi (pleurisy, pericarditis);
• isisindo fast ukulahleka, imfiva.

Uhlaziyo jikelele igazi waphawula kwegazi, kwehle zegazi, kukhuphuke erythrocyte sedimentation isilinganiso, kwehle umphelelisi amaprotheni. Ukuze uphethwe kubalulekile ukukhomba amasosha DNA bomdabu.

Ngokuvamile, lokhu kwanele ukwenza sitholakele omzimba izicubu erythematosus futhi, ngenxa lupus nephritis. Nokho, ukubukeka amaprotheni ku umchamo zingase zephuze iminyaka elilodwa noma amabili ukusuka ekuthomeni lesi sifo. Esimweni esinjalo, udokotela uncika enzyme immunoassay futhi ukuthola amasosha omzimba. Uma kungenjalo kuqinisekiswa idatha laboratory, kubalulekile ukuthi aqhubeke nemizamo lokuxilonga, ikakhulukazi iziguli owesilisa, ngoba nosology yabo, lokhu ezingavamile.

Ukuhlukanisa i-lupus nephritis e SLE iziguli ezine endocarditis webhaktheriya, exacerbations okukhulu samathambo, myeloma amaningi, ukusha kwesibindi kohlobo B, kanye amyloidosis syndrome, Henoch-Schonlein purpura.

Isigaba sokuqala ukwelashwa

Ukwelashwa nokuvikelwa lupus nephritis - inqubo eside futhi eyisicefe ukuthi ngokuvamile siyinguganaboya. Kuthatha indawo ngezigaba ezimbili. Ngo esigabeni sokuqala iboshiwe exacerbation. Umgomo yokwelashwa - ukufeza ukuthethelelwa ezinzile, noma okungenani banciphise ukubonakaliswa emtholampilo.

Imithi kufanele kuqale ngokushesha ngangokunokwenzeka kusuka ngesikhathi uphethwe. Konke kwenzeka ngokushesha ukuze izinsuku ngisho eziyisihlanu kuya kweziyisikhombisa kokulibala kungaba iphutha elibi kakhulu. Uma lo msebenzi nqubo ongaphakeme (sizobonisa titers omzimba), udokotela angase abe nomkhawulo ukusetshenziswa corticosteroids ebulilini isikhathi izinyanga ezimbili, kulandele ukwehla kancane umthamo (evele ukukhansela izidakamizwa akukwazi ongaphika nezindlala adrenal).

Uma inkambo ngokushesha lesi sifo, ngaphezu steroid, ngemithambo yegazi iqondiswa ebulilini cytostatics. Lokhu ukwelashwa ishayela wenziwa phakathi nezinyanga eziyisithupha. Kuphela ngemva kwalesi sikhathi usungaqala ukunciphisa umthamo izidakamizwa, futhi udlulise isiguli imithi ngomlomo.

Ungakhohlwa ukuthi in iziguli SLE ngokuvamile bathuthukise eqonda coagulation intravascular, ngakho-ke Kunconywa ukuthatha izinyathelo zokuvimbela, okuyilezi:

• ukumpontshelwa igazi futhi izingxenye zalo;
• emthanjeni "Trental";
• ekuphathweni ongama-2.5 amayunithi ezinkulungwane "heparin".

isigaba sesibili sokwelashwa

Lupus nephritis e SLE esigabeni sesibili futhi ziphathwe steroid nezidakamizwa cytotoxic. umthamo kuphela mancane kakhulu. kancane kakhulu, phezu kwezinyanga ezine kuya kweziyisithupha, umthamo "Prednisolone" titrated-10 angu amakhilogramu esisindo ngayinye. ejenti cytotoxic wamisa bolus ngemithamo kanye njalo ezinyangeni ezintathu, futhi uma Dynamics omuhle isifo, khona-ke udlulela umjovo owodwa njalo ngemva kwezinyanga eziyisithupha.

ukwelashwa yesondlo enjalo ingase ihlale iminyaka. Ngokuhamba kwesikhathi, it is wanezela (uma kunesidingo) zokuvimbela yemiphumela emibi yemithi kanye nokwelashwa lingaze.

Kodwa ngisho ne okufika ngesikhathi kuqalile ukwelashwa amaphesenti ayishumi nanhlanu iziguli namanje ukuthuthukisa nokwehluleka ukusebenza kwezinso. Kulokhu, angasiza hemodialysis noma izinso ukufakelwa. Ngeshwa, lokhu kwelashwa azitholakali umphakathi.

Ukudla lupus nephritis

Ukuze alondoloze umsebenzi kwezinso neziguli lupus nephritis kumele zithobele imithetho ethile:

1. Phuza amanzi amaningi ukuze ukuhlunga kahle igazi kanye nokugcina ezingeni lokugayeka kokudla.
2. Ukudla kufanele ibe amanani amancane potassium, phosphorus kanye amaprotheni, kusukela lezi zinto ibe nomphumela ongemuhle izinso lilimele.
3. Dedela imikhuba emibi.
4. Vivinya umzimba ukukhanya.
5. Ngokuvamile hlola blood pressure yakho.
6. Beka umkhawulo edonsa ukudla okunamafutha.
7. Ungathathi ama-NSAID ngoba ibe nomphumela ongemuhle izinso.

Uma isiguli kulandela lezi zincomo, ikhwalithi yokuphila ngcono kakhulu, futhi onalesi sifo sokusinda liyathembisa ngaphezulu.

ukuba nombono ongafani ngeke

Isibikezelo ekwelapheni lupus nephritis membranous kuxhomeke endleleni kukulimaze nezinso ukuqala ukwelashwa. I ngaphambili isiguli uya kudokotela futhi, aba maningi amathuba umphumela omuhle.

Kuthethe iminyaka ematjhumi amane edlule, kukhona kuphela ukhweshe iziguli-lupus nephritis abaye baphila isikhathi esingaphezu konyaka kusukela uphethwe. Ngenxa yezindlela zesimanje ukwelashwa kanye uphethwe, iziguli bangalindela yempilo engu emihlanu ezingaphezu kuka.