ʻO ka acidosis tubular proximal

ʻO ka Proximal renal tubular acidosis kahi maʻi ia e hiki ke lawe ʻole nā ​​puʻupaʻa i nā waikawa mai ke koko i ka mimi. A ʻo kahi hopena, nui nā waikawa i koe i ke koko (i kapa ʻia ʻo acidosis).

Ke hana nei ke kino i kāna mau hana maʻamau, hana ia i ka waikawa. Inā ʻaʻole lawe ʻia a hoʻokaʻawale ʻia kēia waikawa, e lilo ke koko i acidic. Hiki i kēia ke alakaʻi i nā kaulike electrolyte i ke koko. Hiki iā ia ke kumu i nā pilikia me ka hana maʻamau o kekahi mau hunaola.

Kōkua nā puʻupaʻa i ka mālama ʻana i ka pae o ke kino ma ka hemo ʻana i ka waikawa mai ke koko a hoʻokuʻu aku iā ia i ka mimi. Hoʻopau ʻia nā mea ʻakika i ke kino e nā mea alkaline, ka bicarbonate nui.

Hana ʻia ka Proximal renal tubular acidosis (ʻano II RTA) ke ʻaʻole i hoʻopili pono ʻia ka bicarbonate e ka ʻōnaehana kānana o ka hakuʻala.

ʻAno II RTA ʻoi aku ka liʻiliʻi ma mua o ka ʻano I RTA. Kāhea ʻia ʻo ʻAno I ka distal renal tubular acidosis. Kū pinepine ka ʻano II i ka wā o ke pēpē a hele wale aku paha.

Nā kumu o ka ʻano II RTA e:

• Cystinosis (ʻaʻole hiki i ke kino ke wāwahi i ka lāʻau cysteine)
• Nā lāʻau e like me ifosfamide (kahi lāʻau chemotherapy), kekahi mau antibiotic i hoʻohana nui ʻole ʻia (tetracycline), a i ʻole acetazolamide
• ʻO Fanconi Syndrome, kahi maʻi o nā puʻupaʻa puʻuwai kahi i lawe mau ʻia ai kekahi mau mea i loko o ke kahe e nā puʻupaʻa i loko o ka mimi ma kahi o
• ʻImi ʻia i ka hoʻomanawanui fructose, kahi maʻi kahi hemahema o ka protein e pono ai e wāwahi i ka hua kō kō.
• Myeloma maha, kahi ʻano maʻi ʻaʻai koko
• ʻO ka hyperparathyroidism kumu, kahi maʻi kahi e hana ai nā gland parathyroid i ka ʻāʻī i ka nui o ka hormone parathyroid
• ʻO Sjögren Syndrome, kahi maʻi autoimmune kahi e luku ʻia ai nā glands e hana ai i ka waimaka a me ka luha
• ʻO ka maʻi ʻo Wilson, kahi maʻi hoʻoilina i nui ai ke keleawe i loko o nā kino o ke kino
• Ka nele o ka wikamina D

Nā ʻōuli o ka proximal renal tubular acidosis komo pū kekahi o kēia mau mea:

• Huikau a hoʻoliʻiliʻi paha ka makaʻala
• Make wai
• Ka luhi
• Hoʻonui ka nui o ka hanu ʻana
• Osteomalacia (palupalu o nā iwi)
• ʻEha ʻeha
• Nawaliwali

Hiki i nā ʻōuli ʻē aʻe ke hoʻopili pū me:

• Hoʻoemi i ka puka mimi
• Hoʻonui i ka helu o ka puʻuwai a i ʻole ka puʻuwai kūlike ʻole
• Pākuʻi kaʻiʻo
• ʻEha ma nā iwi, hoʻi, ʻaoʻao, a i ʻole ʻōpū
• Nā hemahema iwi

E hana ka mea mālama ola i kahi hoʻokolohua kino a nīnau e pili ana i nā ʻōuli.

ʻO nā hoʻokolohua i kauoha ʻia e komo pū:

• Ke kinoea koko arterial
• Ke kemika koko
• Ka pae pH o ke koko
• ʻO ka mimi pH a me ka hoʻāʻo hoʻouka wai
• Urinalysis

ʻO ka pahuhopu e hoʻihoʻi i ke kiʻekiʻe o ka waikawa maʻamau a me ke kaulike electrolyte i ke kino. E kōkua kēia i ka hoʻoponopono ʻana i nā maʻi iwi a hoʻēmi i ka maka o ka osteomalacia a me ka osteopenia i ka poʻe mākua.

ʻAʻole pono kekahi mau mākua i kahi lāʻau. Pono nā keiki āpau i ka lāʻau alkaline e like me ka potassium citrate a me ka sodium bicarbonate. ʻO kēia ka lāʻau e kōkua i ka hoʻoponopono i ke kūlana acidic o ke kino. Kōkua ka lāʻau i ka pale ʻana i ka maʻi iwi i hoʻokumu ʻia e ka nui o ka waikawa, e like me nā rikeke, a e ʻae ai i ka ulu maʻamau.

Hoʻohana pinepine ʻia nā diuretics Thiazide e mālama i ka bicarbonate i ke kino.

Pono e hoʻoponopono ʻia ke kumu paʻa o ka nerosis tubular proximal renal tubros inā hiki ke loaʻa.

Pono ʻia nā huamona Vitamin D a me ka calcium e kōkua i ka hōʻemi ʻana i nā kino iwi i loaʻa mai ka osteomalacia.

ʻOiai ke kumu kumu o ka proximal renal tubular acidosis e hele wale aku, ʻo nā hopena a me nā pilikia hiki ke mau a i ʻole ke hoʻoweliweli i ke ola. Hoʻomaʻamaʻa maʻamau ka hoʻomaʻamaʻa.

Kāhea i kāu mea hāʻawi inā loaʻa iā ʻoe nā ʻōuli o ka proximal renal tubular acidosis.

E kiʻi koke i ke kōkua lapaʻau inā loaʻa kekahi o nā ʻōkuhi pilikia e hiki mai ana.

• Hoemi i ka makaʻala a i ʻole disorientation
• Hoemi i ka ʻike
• Ka hopu ʻana i nā maʻi

ʻAʻole hiki ke pale ʻia ka hapa nui o nā maʻi e kumu i ka acidosis tubular proximal tubular acidosis.

Renal tubular acidosis - pili; ʻAno II RTA; RTA - pili kokoke; ʻO Renal tubular acidosis ʻano II

• Anatomia hakuʻala
• ʻO Kidney - ke kahe o ke koko a me ka mimi

Bushinsky DA. Pohaku hakuʻala. I: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. ʻO Williams Textbook of Endocrinology. 14th ed. Piladelapia, PA: Elsevier; 2020: chap 32.

ʻO Dixon BP. Acidosis tubular hōʻino. I: Kliegman RM, St Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. ʻO Puka Textbook of Pediatrics ʻo Nelson. 21st ed. Piladelapia, PA: Elsevier; 2020: chap 547.

Seifter JL. Nā maʻi kūmole. I: Goldman L, Schafer AI, eds. ʻO ka lāʻau lapaʻau Goldman-Cecil. 26th ed. Piladelapia, PA: Elsevier; 2020: chap 110.