Poyerekeza aimpso tubular acidosis

Proximal renal tubular acidosis ndi matenda omwe amapezeka pamene impso sizimachotsa bwino zidulo zamagazi mumkodzo. Zotsatira zake, asidi wambiri amakhalabe m'magazi (otchedwa acidosis).

Thupi likagwira ntchito zake zonse, limatulutsa asidi. Asidiyu akapanda kuchotsedwa kapena kuthetsedwa, magaziwo amakhala acidic kwambiri. Izi zitha kubweretsa kusamvana kwama electrolyte m'magazi. Zingathenso kuyambitsa mavuto ndi magwiridwe antchito am'maselo ena.

Impso zimathandiza kuchepetsa asidi m'thupi pochotsa asidi m'magazi ndikuwatulutsa mumkodzo. Zinthu zamadzimadzi mthupi zimasokonezedwa ndi zinthu zamchere, makamaka bicarbonate.

Proximal renal tubular acidosis (mtundu wachiwiri wa RTA) umachitika pomwe bicarbonate siyikubwezeretsedwanso bwino ndi fyuluta ya impso.

Mtundu Wachiwiri wa RTA ndiwofala kwambiri kuposa mtundu I RTA. Mtundu I umatchedwanso distal renal tubular acidosis. Mtundu wachiwiri nthawi zambiri umachitika akadali wakhanda ndipo amatha okha.

Zomwe zimayambitsa mtundu wachiwiri wa RTA ndi monga:

• Cystinosis (thupi silimatha kuwononga cysteine)
• Mankhwala monga ifosfamide (mankhwala a chemotherapy), maantibayotiki ena omwe sagwiritsidwanso ntchito kwambiri (tetracycline), kapena acetazolamide
• Matenda a Fanconi, matenda amachubu ya impso momwe zinthu zina zomwe zimalowa m'magazi ndi impso zimatulutsidwa mumkodzo m'malo mwake
• Kusalolera kwa fructose, vuto lomwe limasowa mapuloteni omwe amafunikira kuti athane ndi chipatso cha shuga fructose
• Multiple myeloma, mtundu wa khansa yamagazi
• Pulayimale hyperparathyroidism, vuto lomwe zopangitsa za parathyroid m'khosi zimatulutsa mahomoni ochulukirapo
• Matenda a Sjögren, matenda omwe amachititsa kuti misozi ndi misozi ziwonongeke
• Matenda a Wilson, matenda obadwa nawo momwe mumakhala mkuwa wochuluka mthupi la munthu
• Kulephera kwa Vitamini D

Zizindikiro za kufalikira kwa impso tubular acidosis ndi izi:

• Kusokonezeka kapena kuchepa kukhala tcheru
• Kutaya madzi m'thupi
• Kutopa
• Kuchuluka kwa kupuma
• Osteomalacia (kuchepetsa mafupa)
• Kupweteka kwa minofu
• Kufooka

Zizindikiro zina zitha kuphatikiza:

• Kuchepetsa mkodzo
• Kuchuluka kwa kugunda kwa mtima kapena kugunda kwamtima kosasinthasintha
• Kupweteka kwa minofu
• Kupweteka m'mafupa, kumbuyo, kumbuyo, kapena m'mimba
• Zofooka za mafupa

Wothandizira zaumoyo adzayesa thupi ndikufunsa za zizindikiro.

Mayeso omwe atha kulamulidwa ndi awa:

• Magazi amitsempha yamagazi
• Magazi amadzimadzi
• Mulingo wa pH wamagazi
• Mkodzo pH ndi kuyesa kutsitsa acid
• Kupenda kwamadzi

Cholinga ndikubwezeretsa mulingo wabwinobwino wa asidi komanso kuchuluka kwa ma electrolyte mthupi. Izi zithandizira kukonza kusokonezeka kwa mafupa ndikuchepetsa chiopsezo cha osteomalacia ndi osteopenia mwa akulu.

Akuluakulu ena sangasowe chithandizo. Ana onse amafunikira mankhwala amchere monga potaziyamu citrate ndi sodium bicarbonate. Awa ndi mankhwala omwe amathandizira kukonza acidic m'thupi. Mankhwalawa amathandiza kupewa matenda am'mafupa omwe amadza chifukwa cha asidi wambiri, monga ma rickets, ndikulola kukula bwino.

Thiazide diuretics amagwiritsidwanso ntchito kusunga bicarbonate mthupi.

Zomwe zimayambitsa kufooka kwa impso za tubular necrosis ziyenera kukonzedwa ngati zingapezeke.

Vitamini D ndi calcium zowonjezera zowonjezera zitha kuthandizidwa kuti muchepetse mafupa am'matumbo omwe amadza chifukwa cha osteomalacia.

Ngakhale chomwe chimayambitsa renal renal tubular acidosis chitha chokha, zovuta ndi zovuta zake zitha kukhala zosatha kapena zoopseza moyo. Chithandizo chimakhala chopambana.

Itanani omwe akukuthandizani ngati muli ndi zizindikilo za aimpso ya acidic.

Pezani chithandizo chamankhwala nthawi yomweyo ngati izi zikuwoneka mwadzidzidzi:

• Kuchepetsa kuchepa kapena kusokonezeka
• Kuchepetsa chidziwitso
• Kugwidwa

Zambiri mwazovuta zomwe zimayambitsa kufalikira kwa impso tubular acidosis sizitetezedwa.

Aimpso tubular acidosis - proximal; Lembani II RTA; RTA - proximal; Aimpso tubular acidosis mtundu wachiwiri

• Matenda a impso
• Impso - kutuluka magazi ndi mkodzo

Bushinsky DA. Miyala ya impso. Mu: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, olemba. Buku la Williams la Endocrinology. Wolemba 14th. Philadelphia, PA: Elsevier; 2020: chap 32.

Dixon BP. Aimpso tubular acidosis. Mu: Kliegman RM, St Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, olemba. Nelson Textbook of Pediatrics. Wolemba 21. Philadelphia, PA: Elsevier; 2020: chap 547.

Seifter JL. Mavuto amadzimadzi. Mu: Goldman L, Schafer AI, olemba. Mankhwala a Goldman-Cecil. 26 wa. Philadelphia, PA: Elsevier; 2020: chap 110.