Lupus nephritis:ʻike, lapaʻau,ʻai

Lupus nephritis o kekahi o ka loa pinepine complications o systemic lupus erythematosus. SCR - mea he autoimmune mai, kena ae la ma keʻano o nā mea'aʻaʻa i loko o ke kino, i loaa i ka "maoli" nā polokina like haole. E like me ka hopena, ulu aseptic li nui i loko o nā wahi likeʻole o ke kino. A me loko o nā puʻupaʻa.

ka wehewehena

Lupus nephritis, lupus nephritis, a - he kaumaha hakuʻala maʻi i loko o systemic lupus erythematosus. Ke prevalence o kēia maʻi i loko o ka heluna kanaka, ma ka awelika kanaha kanaka no haneri tausani kanaka. Loa e ae mai ka poeikohoia o ka nani hapalua ma waena o nā makahiki o ka iwakalua a hiki i na makahiki hookahi kanaha. Loa pinepine, i ka pathology ua loaʻa i loko o Afro-Caribbean populations.

Ka maʻi hiki e kena ae la ma ke ākeaʻano o nā kumumea, mai overuse o tanning, i aaiaoe kāna hana, no laila ia mea paʻakikī nui manawa e hoʻolohe i symptoms, a ike i ke kauka. Ma hope o nā mea a pau, i ka koke ia lapaʻau ua hoʻomaka ', i ka maikaʻi o ka prognosis no ka hoʻomanawanui i ka ola a me ka ola.

etiology

Lupus nephritis hiki ke triggered e lōʻihi-makahiki la waiū a eia i (Hobby solarium a noho ma ka lā wahi), allergies i ka lapaʻauʻia, paʻa stress a hiki hāpai keiki (i ka fetus ua ike like me ka haole kino, a me ka'ōnaehana paleʻea nenoaia hoʻomaka e hoouka aku i ka makuahine aeee).

Eia hou, i ka ulu ana o ka aaiaoe mai lakou aloha ia 'ino, i ke alo o hormonal imbalances, pinepine mea hoʻomaʻi maʻi (mea hoʻomaʻi noniakahi i loko o ka halepaahao kino, a waiho i loko o kā lākou' ilikai antigens, a hoʻonāukiuki kona pela ka'ōnaehana paleʻea muli o). Chance o ulu i ka maʻi i loko o pili hoahanau kekahi mau manawa ma luna ma mua o ka awelika no ka heluna.

pathogenesis

Lupus nephritis He hapa o ka symptom e hoʻomōhala ana i loko o systemic lupus erythematosus. Autoantibodies hoʻomōhala ma ka mua wahi a hiki i ka oiwi DNA a me kona pili me histones, i nā polokina o ka hoʻokō'ōnaehana a me ka cardiolipin. Ke kumu no ka aggression - hoemi ia ke ahonui, i ka pakiko antigens, mā ma ka B a me T lymphocytes.

'Ana a me ka hooulu ana o ka nephritis i loko o ia ka antigen-lāʻau lapaʻau kino eiiieaenu koaʻe i na nā'aʻaʻa o kaʻaʻa puʻuwai tubules pili. Once ia he kumuʻiʻo lātoma ua pili i ka halepaahao luna, ka mea triggers he cascade o biochemical reactions i ka hopena ma ka ho opa i ka hana waiwai, hehee aeea. Kēia, ma ka huli, e hookomo ana i ka hoʻoʻino naoh, a exacerbates wale i ka poino.

morbid'anatomia

Lupus nephritis ma SLE e i likeʻole morphological hoike ana. Me ka weheʻana o ka hoʻomanawanuiʻana i nā loli i nā membranes o ka hakuʻala glomeruli,ʻeleu mahele o aeee, ke anoe o ka mesangium, vascular sclerosis, puka lou a oi. Mau hoikeana i e nā loko o kekahi, a me kekahi mau glomeruli.

I ka loa i ho'ākāka 'no ka lupus nephritis mea fibrinoid necrosis capillary loop o Henle, a histologically detectable karyopyknosis a me ka karyorrhexis (kaawale, a lysis o aeea nuclei). Eia hou kekahi, he pathognomonic loli ma glomerular hale ilaloʻili lahilahi like me ka "uea puka lou" a me ke alo o ke hyaline thrombi i loko o ka lumen o na capillaries like me ka hopena o ka palapala moʻopane o ka'ōnaehana paleʻea eiiieaenu.

Mea Maluna

Clinically a morphologically i kekahi mau kahua o ka hoʻonaʻauao i kŰlń ao lupus nephritis. Mea Maluna o ka World Health Organization like penei:

1. First Class: glomeruli i ka maʻamau 'ole.
2. Apana papa: he mea pono hoʻololi i loko o ka mesangium.
3. Ekolu papa: glomerulonephritis me ka lesion o ka hapalua o ka glomeruli.
4. Ha o ka papa: eiei? Glomerulonephritis.
5. Lima o ka papa: membranous glomerulonephritis.
6. Ono o ka papa: sclerosing glomerulonephritis.

Aia mea no hoi i ka Mea Maluna Serova, ma i ka mea allocates mea nui, eiei, membranous, mesangioproliferative, mesangiocapillary glomerulonephritis a me ka fibroplastic.

symptoms

Membranous lupus nephritis i nā obligate a me ka facultative symptoms. Kekahi o kona hoike ana mai i OAXA proteinuria, i mea, i ke alo o ke kumuʻiʻo i loko o ka mimi. No hoi, e hiki pinepine loaʻa hematuria, leuco - a me ka limfotsituriyu. Mau hoailona hōʻike i ke alo o ka li nui i loko o nā puʻupaʻa, a hiki e ole wale ma SLE.

Me ka Holomua o ka autoimmune kaʻina ua mahuahua symptoms o kaʻaʻa puʻuwai hoʻokō 'ole' ua hoikea mai oia, e mahuahua creatinine pae i loko o ke koko a me ka mimi, nawaliwali, lethargy hoʻomanawanui soporous Hawaii.

Ua lohi e holumua ai a me ka hikiwawe loa e holumua ai nephritis. Inā ka maʻi e hoʻomōhala ana i lohi, lanakila mimi a me nephrotic maʻi pale. A, lupus nephritis hiki ke mālama 'ia i loko o ka AEeOEXAaI paha latent palapala, i ka wa a pau o na symptoms mea keia nīnūnē liʻiliʻi wale nō proteinuria.

Hoʻomaka koke e holumua ai lupus nephritis ka mea i like loa me ka Classic glomerulonephritis. ʻaʻa puʻuwai ole ua ulu hikiwawe loa, he mea manoanoa hoi hematuria, mahuahua ke koko, a me ka nephrotic maʻi pale. I loa na hiki hoʻomōhala ke kaʻana like 'intravascular coagulation (DIC).

Lupus nephritis i keiki

I ka 1/5 o nā mea maʻi me ka systemic lupus erythematosus mua symptomsʻikeʻia i loko o kamaliʻi. Ma na keiki kaikaina ma mua o 10 makahiki, ia aneane aole e hana, akā, he mea he ho'ākāka 'ana o ka hihia o SLE i loko o ke keiki, a me ka hapalua mahina kahiko.

Ka hooulu ana o ka maʻi i loko o nā keiki mea i okoa mai ia o nā mākua. Ka lapaʻau kiʻi i ke e lauwili: mai asymptomatic i ka hikiwawe loa e holumua ai. Huʻiʻaʻa puʻuwai ole mea pohihihi keia.

Kekahi mau okoa hoailona o SLE i loko o ke keiki:

• erythema ma luna o ka maka;
• discoid poʻe noʻonoʻoʻole ma luna o ke kino;
• pā lonoaʻili i ka Map;
• mucosal ulceration;
• li nui o na ami;
• hakuʻala maʻi;
• i ka 'aʻe' ana o ka Central ko mākou hopohopo oihana;
• mahuahua kahe ana ke koko;
• immunological kāna hana;
• i ke alo o antinuclear nā mea'aʻaʻa.

Inā ka? Aaieou i ma ka liʻiliʻi eha hiʻona mai keia papa, ua hiki, he olelo i ke keiki loaʻa systemic lupus erythematosus. hakuʻala pōʻino i loko o nā keiki kākaʻikahi hele mai i ka mua. IeAUPIIe, IAa IO, symptoms make i mai glomerulonephritis i ka hoike ana mai o antiphospholipid maʻi pale.

Ei o? Acaeoey o ka maʻi i loko o nā keiki hou maikaʻi. He umi makahiki ma hope o ka hoʻomanaʻo o ke dialysisʻike, pono wale 10 pakeneka o ka hoʻomanawanui iki mai.

lapaʻau '

He aha haawi ke kauka i kekahi kumu e manao lupus nephritis? ʻike, ua ana me ka nānā 'ana i na lapaʻau a me keʻena hoʻokolohua-hookupaa iho la iaʻikepili ma SLE:

• Pain a me ka li nui i loko o na ami;
• rashes ma luna o kaʻili o ka maka i ke ano o ka hahai;
• ma ke alo o ka effusion mōʻaukala i loko o ka lua (pleurisy, pericarditis);
• hookeai kaumaha poho, kuni.

Ke mau Ikepili o ke koko malama anaemia, ua hoʻemi platelets, mahuahua erythrocyte sedimentation ana, ua hoʻemi hoʻokō nā polokina. No kaʻike, e kuhikuhi i nā mea'aʻaʻa i ka oiwi DNA mea nui.

IeAUPIIe, IAa IO, keia mea nui ia e kaʻike, o systemic lupus erythematosus, a, me ka a no o ke lupus nephritis. Naʻe, i ka helehelena o ke kumuʻiʻo i loko o ka mimi i ke hoopanee no kekahi paha mau makahiki, mai ka hoouka kaua ana o ka maʻi. Ma ia he hihia, ke kahuna lapaau nui ma'ūhū immunoassay a me ka loaʻaʻana nā mea'aʻaʻa. Ināʻaʻole hookupaa iho la ia ma ka keʻena hoʻokolohuaʻikepili, ia mea pono e hoʻomau i ka PalekanaEND_LINK huli, o ka oi aku kane nā mea maʻi, no kā lākou nosology, keia mea pohihihi.

Differentiate lupus nephritis ma SLE nā mea maʻi me ka mea koʻohune endocarditis, huʻi exacerbations o rheumatoid arthritis, mau myeloma, maʻi hepatitis B, a me ka amyloidosis maʻi pale,ʻo Hanoka-Schonlein purpura.

Ka mua kahua o ka lapaau

Lapaʻau o lupus nephritis - he lōʻihi a me ka hooluhi kaʻina mea pinepine mau i ka wā e ola ana. Ua lawe wahi i loko o nā kahua o ka hoʻonaʻauao. Ma ke kahua mua docked exacerbation. Ka pahuhopu o ka lapaʻau - e hoʻokō i ka pilina paʻa ke kala, a ma ka liʻiliʻi loa emi i ka lapaʻau hoikeana.

Ka lapaʻauʻia e hoʻomaka me ka hikiwawe e loaa mai ka nui o kaʻike,. A pau ka hana ia oe ua hiki i ka elima a hiki i nā lāʻehiku o ka kali hiki ia i ka ona e kuhihewa. Inā ke kaʻina ha awina mea haʻahaʻa (ka mea, e hōʻike i ka lāʻau lapaʻau kino titers), ke kauka i ke kaupalena 'ia ka hoʻohana' ana o corticosteroids ma kiʻekiʻe nā māhele no ka manawa o elua mahina, i ukali ia e kekahi kali emi ma ka laʻau heluna (ho opa ao ana i ka lāʻau 'hiki ole e, ke hoole i ka adrenal glands).

Inā he oi kokololio papa o ka maʻi, i hou i ka steroid, intravenously lawelawe kiʻekiʻe nā māhele o nā cytostatics. Kēia lāʻau ikiʻai wale Inc ua lawe mai i loko o eono mahina. Wale ma hope o kēia wā e hoʻomaka e emi i ka mahele lāʻau o ka ai ', a ua hoolilo i ka hoʻomanawanui i ku una i ka lapaʻauʻia.

i Mai e hoopoina i loko o nā mea maʻi me SLE pinepine hoʻomōhala hoʻolaha intravascular coagulation, no laila ka mea, ua pono e lawe kāohi ana, oia hoi:

• transfusion o ke koko a me kona eiiiiiaiou;
• intravenous "Trental";
• subcutaneous aaieieno? o 2,5 huahelu o na tausani o ka "heparin".

Lua o ke kahua o ka lapaau

Lupus nephritis ma SLE i loko o ka lua o ke kahua ua no hoi ia me ka steroid a me cytotoxic ai '. mea nui uuku wale no ka mahele lāʻau lākou. Loa lohi, ma eha i ka eono mahina, i ka mahele lāʻau "Prednisolone" titrated i 10 milligrams no kilogram o ke kino ke kaumaha. Cytotoxic konohiki no hoi i kauoha mai ai bolus nā māhele hookahi o kela mea keia ekolu mahina, a ina i ka maikaʻiʻano o ka maʻi, laila, neʻe ma i ka hookahi ka pahu kui o kela mea keia eono mahina.

Oia malama Inc e mau no ka makahiki. Over manawa, ka mea, ua hoʻohuiʻia (inā pono) Kāohiʻana o kaʻaoʻao 'ole o ka ai' a me symptomatic lapaʻau.

Akā, e like me ka 'āwīwī hoomaka lapaʻau ma umikumamalima pakeneka o nā mea maʻi nō hoʻomōhala hakuʻala ole. Ma keia hihia, hiki wale kōkua hemodialysis a me nā konāhua transplantation. Eia naʻe, i kēia mau ohe. Mea i loaʻa i ka mea mau lehulehu.

ʻai no ka lupus nephritis

I mea e malama iʻaʻa puʻuwai hana me ka lupus nephritis hoʻomanawanui iki mai e hoopili aku i kekahi mau rula:

1. E inu nui o fluids i ka luawai wae i i ke koko a me ka malama i ka nui o ka pūnao.
2. Ka ai e komo nīnūnē dala o ka potasiuma, phosphorus a me ka kumuʻiʻo, mai kēia mau kumu mua i ka hopena maikaʻi ia ma poino puʻupaʻaʻelua.
3. E hāʻawi mai hoʻi i ka hewaʻano.
4. Komo i loko o ka malamalama hoounauna.
5. Mau ka huli i kou koko,.
6. Kali i kaʻai ana o ka momomaʻai.
7. Mai Mai lawe NSAIDs, no ka mea, i ka hopena maikaʻi ia ma luna o nā puʻupaʻa.

Inā ka hoʻomanawanui ma hope kēia mau koi, i ka mea e like ai o ke ola ua me ka nui loa holomua, a me ke ola prognosis mea hou i olelo mua iaʻi.

Outlook

Map of ana lupus nephritis membranous hilinaʻi nui ma luna pehea na'lii loli i nā puʻupaʻa, a me ka hoʻomaka 'ana o ka Inc. I ka mua o ka hoʻomanawanui hele i ke Kauka, ka mea i oi aku ka likelihood o ka maikaʻi hoʻokūkū.

Hoʻokahi kanahā makahiki aku nei, wale i ka piha ana o nā mea maʻi me ka lupus nephritis ua noho aku ma mua o ka makahiki mai kaʻike,. Mahalo i kēia ano o ka lapaau a me kaʻike,, nā mea maʻi ke manao i oi aku mamua o elima-makahiki lifespan.