I-proximal renal tubular acidosis

I-proximal renal tubular acidosis yisifo esenzeka lapho izinso zingasusi kahle ama-asidi egazini ziye emchameni. Ngenxa yalokho, i-asidi eningi isala egazini (elibizwa nge-acidosis).

Lapho umzimba wenza imisebenzi yawo ejwayelekile, ukhiqiza i-asidi. Uma le asidi ingasuswa noma inciphiswe, igazi lizoba ne-asidi kakhulu. Lokhu kungaholela ekungalingani kwe-electrolyte egazini. Kungadala nezinkinga ngokusebenza okujwayelekile kwamanye amaseli.

Izinso zisiza ukulawula izinga le-asidi yomzimba ngokususa i-asidi egazini nokuyikhiphela emchameni. Izinto ezinomsoco emzimbeni zincishiswa izinto ezinama-alkaline, ikakhulukazi i-bicarbonate.

I-proximal renal tubular acidosis (uhlobo II RTA) yenzeka lapho i-bicarbonate ingabuyiswanga kahle ngohlelo lokuhlunga izinso.

Uhlobo II RTA aluvamile kakhulu kunohlobo I RTA. Uhlobo I lubizwa nangokuthi i-distal renal tubular acidosis. Uhlobo II luvame ukwenzeka ngesikhathi siseyinsana futhi lungahamba lodwa.

Izimbangela zohlobo II RTA zifaka:

• I-cystinosis (umzimba awukwazi ukwehlisa i-cysteine ​​yezinto)
• Izidakamizwa ezifana ne-ifosfamide (umuthi we-chemotherapy), ama-antibiotic athile angasasetshenziswa kakhulu (tetracycline), noma i-acetazolamide
• I-Fanconi syndrome, ukuphazamiseka kwamashubhu ezinso lapho izinto ezithile zivamise ukungena egazini ngezinso zikhishelwa emchameni esikhundleni
• Ukungabekezelelani ngefa le-fructose, ukuphazamiseka lapho kukhona ukuntuleka kweprotheni okudingekayo ukuze kudilizwe izithelo ushukela i-fructose
• I-myeloma eminingi, uhlobo lomdlavuza wegazi
• I-hyperparathyroidism eyinhloko, ukuphazamiseka lapho izindlala ze-parathyroid entanyeni zikhiqiza khona i-hormone eningi kakhulu
• I-Sjögren syndrome, isifo se-autoimmune lapho izindlala ezikhiqiza izinyembezi namathe zibhujiswa khona
• Isifo i-Wilson, ukuphazamiseka okuzuzwe njengefa lapho kunethusi eliningi kakhulu ezicutshini zomzimba
• Ukushoda kukavithamini D

Izimpawu zokuqina kwe-renal tubular acidosis zifaka phakathi noma yikuphi okulandelayo:

• Ukudideka noma ukwehla kokuqwashisa
• Ukuphela kwamanzi emzimbeni
• Ukukhathala
• Izinga lokuphefumula lenyuke
• I-Osteomalacia (ukuthambisa amathambo)
• Ubuhlungu bemisipha
• Ubuthakathaka

Ezinye izimpawu zingabandakanya:

• Ukwehla kokukhishwa komchamo
• Ukunyuka kwenhliziyo noma ukushaya kwenhliziyo okungajwayelekile
• Amajaqamba emisipha
• Ubuhlungu emathanjeni, emuva, ohlangothini, noma esiswini
• Ukukhubazeka kwamathambo

Umhlinzeki wezokunakekelwa kwempilo uzokwenza ukuhlolwa komzimba abuze ngezimpawu.

Izivivinyo ezinga-odwa zifaka:

• Igazi legazi lomzimba
• Amakhemikhali egazi
• Izinga le-pH yegazi
• I-urine pH nokuhlolwa kokulayisha i-acid
• Ukuhlolwa komchamo

Umgomo ukubuyisela izinga le-asidi ejwayelekile kanye nebhalansi ye-electrolyte emzimbeni. Lokhu kuzosiza ukulungisa ukuphazamiseka kwethambo futhi kunciphise ubungozi be-osteomalacia ne-osteopenia kubantu abadala.

Abanye abantu abadala kungenzeka bangadingi ukwelashwa. Zonke izingane zidinga umuthi we-alkaline njenge-potassium citrate ne-sodium bicarbonate. Lo ngumuthi osiza ukulungisa isimo se-asidi yomzimba. Umuthi usiza ukuvikela izifo zamathambo ezibangelwa yi-asidi eningi, njengama-rickets, nokuvumela ukukhula okujwayelekile.

I-Thiazide diuretics nayo isetshenziswa kaningi ukugcina i-bicarbonate emzimbeni.

Imbangela eyimbangela ye-proximal renal tubular necrosis kufanele ilungiswe uma ingatholakala.

Izithako ze-Vitamin D ne-calcium zingadingeka ukusiza ukunciphisa ukukhubazeka kwamathambo okubangelwa i-osteomalacia.

Yize imbangela eyimbangela yokuqina kwe-renal tubular acidosis ingahamba yodwa, imiphumela kanye nezinkinga zingaba unomphela noma zisongela impilo. Ukwelashwa kuvame ukuphumelela.

Shayela umhlinzeki wakho uma unezimpawu ze-proximal renal tubular acidosis.

Thola usizo lwezokwelapha ngokushesha uma kuba nalezi zimpawu eziphuthumayo ezilandelayo:

• Ukwehla kokuqwashisa noma ukudideka
• Ukwehla kokuqonda
• Ukuquleka

Iningi lezinkinga ezibanga ukuthi i-proximal renal tubular acidosis ayinakuvinjelwa.

I-renal tubular acidosis - isondele; Uhlobo II RTA; RTA - proximal; I-renal tubular acidosis uhlobo II

• Ukwakheka kwezinso
• Izinso - ukugeleza kwegazi nomchamo

UBushinsky DA. Amatshe ezinso. Ku: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, abahleli. Incwadi kaWilliams ye-Endocrinology. Umhlaka 14. IPhiladelphia, PA: Elsevier; 2020: isahluko 32.

I-Dixon BP. I-acidosis tubular yezinso. Ku: Kliegman RM, St Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Incwadi kaNelson Yezingane. Umhlaka 21. IPhiladelphia, PA: Elsevier; 2020: isahluko 547.

Seifter JL. Izinkinga ze-acid-base. Ku: IGoldman L, iSchafer AI, ama-eds. Imithi yeGoldman-Cecil. Umhla ka-26. IPhiladelphia, PA: Elsevier; 2020: isahluko 110.