Nephrogenic shuga insipidus

Nephrogenic diabetes insipidus (NDI) ndi vuto lomwe chilema m'machubu yaying'ono (tubules) mu impso chimapangitsa kuti munthu adutse mkodzo wambiri ndikutaya madzi ochulukirapo.

Nthawi zambiri, ma tubules a impso amalola kuti madzi ambiri m'magazi azisefedwa ndikubwezeretsedwanso m'magazi.

NDI imachitika ma tubules a impso samayankha mahomoni amthupi omwe amatchedwa antidiuretic hormone (ADH), omwe amatchedwanso vasopressin. ADH nthawi zambiri imayambitsa impso kuti mkodzo ukhale wambiri.

Chifukwa chosayankha chizindikiro cha ADH, impso zimatulutsa madzi ochuluka mkodzo. Izi zimapangitsa kuti thupi lipange mkodzo wambiri wosungunuka.

NDI ndizosowa kwambiri. Kobadwa nako nephrogenic shuga insipidus kumakhalapo pobadwa. Ndi chifukwa cha vuto lomwe limadutsa m'mabanja. Amuna nthawi zambiri amakhudzidwa, ngakhale azimayi amatha kupatsira ana awo chibadwa ichi.

Nthawi zambiri, NDI imayamba chifukwa cha zifukwa zina. Izi zimatchedwa matenda omwe amapezeka. Zinthu zomwe zingayambitse mawonekedwe omwe amapezeka ndi awa:

• Kutsekedwa kwamitsempha yamikodzo
• Mulingo wambiri wa calcium
• Potaziyamu otsika
• Kugwiritsa ntchito mankhwala ena (lithiamu, demeclocycline, amphotericin B)

Mutha kukhala ndi ludzu lalikulu kapena losalamulirika, ndipo mumalakalaka madzi oundana.

Mudzatulutsa mkodzo wambiri, nthawi zambiri wopitilira 3 malita, mpaka 15 malita patsiku. Mkodzo umachepetsa kwambiri ndipo umawoneka ngati madzi. Muyenera kukodza ola lililonse kapena kupitilira apo, ngakhale usiku pamene simukudya kapena kumwa kwambiri.

Ngati simumamwa madzi okwanira, kumatha kuchepa kwa madzi m'thupi. Zizindikiro zimaphatikizapo:

• Ziwalo zam'mimba zowuma
• Khungu louma
• Kuwoneka modetsa nkhawa
• Sunken fontanelles (malo ofewa) mwa makanda
• Kusintha kwa kukumbukira kapena kusamala

Zizindikiro zina zomwe zimatha kuchitika chifukwa chosowa madzi, zomwe zimayambitsa kuchepa kwa madzi m'thupi, zimaphatikizapo:

• Kutopa, kufooka
• Mutu
• Kukwiya
• Kutentha kwa thupi
• Kupweteka kwa minofu
• Kuthamanga kwa mtima mwachangu
• Kuchepetsa thupi
• Kusintha kwa kukhala tcheru, ngakhalenso kukomoka

Wothandizira zaumoyo adzakufufuzirani ndikufunsani za zizindikiro zanu kapena za mwana wanu.

Kuyezetsa thupi kumatha kuwulula:

• Kuthamanga kwa magazi
• Kutentha mwachangu
• Chodabwitsa
• Zizindikiro zakusowa madzi m'thupi

Mayeso atha kuwulula:

• Mkulu seramu osmolality
• Kutulutsa mkodzo wapamwamba, mosasamala kanthu za kuchuluka kwa madzi omwe mumamwa
• Impso sizimayang'ana mkodzo mukapatsidwa ADH (nthawi zambiri mankhwala omwe amatchedwa desmopressin)
• Mkodzo wotsika kwambiri
• Mulingo wokhazikika kapena wapamwamba wa ADH

Mayesero ena omwe angachitike ndi awa:

• Kuyesedwa kwa magazi
• Mkodzo voliyumu yamaola 24
• Mayeso am'mitsempha
• Mkodzo mphamvu yokoka
• Kuyesedwa koyesedwa kwamadzi
  

Cholinga cha chithandizo ndikuwongolera kuchuluka kwa madzimadzi amthupi. Madzi ambiri adzaperekedwa. Kuchuluka kwake kuyenera kukhala kofanana ndi kuchuluka kwa madzi omwe atayika mumkodzo.

Ngati vutoli lachitika chifukwa cha mankhwala enaake, kuletsa mankhwalawa kumatha kusintha zizindikilo. Koma, osasiya kumwa mankhwala osalankhula ndi omwe akukuthandizani.

Mankhwala atha kuperekedwa kuti athetse vuto pochepetsa mkodzo.

Ngati munthu amwa madzi okwanira, vutoli silimakhudza kwambiri kuchuluka kwa madzi kapena maelekitirodi m'thupi. Nthawi zina, kudutsa mkodzo wambiri kwa nthawi yayitali kumatha kuyambitsa mavuto ena a electrolyte.

Ngati munthuyo samamwa madzi okwanira, kutulutsa mkodzo wokwanira kumatha kuyambitsa kuchepa kwa madzi m'thupi komanso kuchuluka kwa sodium m'magazi.

NDI yomwe imakhalapo pobadwa ndi chikhalidwe chanthawi yayitali chofunikira chithandizo chamoyo wonse.

Osachiritsidwa, NDI atha kuyambitsa izi:

• Kuchepetsa ma ureters ndi chikhodzodzo
• Magazi a sodium (hypernatremia)
• Kutaya madzi m'thupi kwambiri
• Chodabwitsa
• Coma

Itanani omwe akukuthandizani ngati inu kapena mwana wanu muli ndi zizindikiro za matendawa.

Congenital NDI sangathe kupewedwa.

Kuthana ndi zovuta zomwe zingayambitse mawonekedwe omwe atchulidwa kungalepheretse kuti zisachitike nthawi zina.

Matenda a shuga a insipidus; Anapeza nephrogenic shuga insipidus; Kobadwa nako nephrogenic shuga insipidus; NDI

• Njira yamikodzo yamwamuna

Bockenhauer D. Fluid, electrolyte, ndi acid-base base ana. Mu: Yu ASL, Chertow GM, Luyckx VA, Marsden PA, Skorecki K, Taal MW, olemba. Brenner ndi Rector a Impso. 11th ed. Philadelphia, PA: Elsevier; 2020: chap 73.

Wopuma DT, Majzoub JA. Matenda a shuga. 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 574.

Hannon MJ, Thompson CJ. Vasopressin, matenda a shuga insipidus, ndi matenda a antidiuresis osayenera. Mu: Jameson JL, De Groot LJ, de Kretser DM, et al, olemba. Endocrinology: Akuluakulu ndi Ana. Wachisanu ndi chiwiri. Philadelphia, PA: Elsevier Saunders; 2016: mutu 18.

Scheinman SJ. Matenda opatsirana poyambitsa impso. Mu: Gilbert SJ, Weiner DE, olemba., Eds. Primer pa Matenda a Impso a National Kidney Foundation. Wachisanu ndi chiwiri. Philadelphia, PA: Elsevier; 2018: mutu 38.