Tsarin filtration na Glomerular: lissafin lissafi

Kodan suna da muhimmiyar mahimmanci ga jikin mutum. Don tantance yanayin da aikin su akwai hanyoyi da samfurori da yawa. Ɗaya daga cikin irin wannan alamar shine jigon filtration na glomerular.

Mene ne?

Wannan alamar ita ce siffar mahimmanci na ainihin aikin kodan. Ya nuna yadda yawancin fitsari na farko ya kafa a cikin kodan a kan wani lokaci.

Hanyoyin filtration na duniya zasu iya bambanta a ƙarƙashin rinjayar abubuwan da ke shafi jikin.

Wannan nuna alama taka muhimmiyar rawa a cikin ganewar asali na koda gazawar da kuma sauran cututtuka. Don ƙayyade shi, kana buƙatar sanin wasu matsaloli, suna nuna a cikin lissafin lissafi, wanda akwai da yawa da bambancin da iri.

Yawancin lokaci, yawancin tsarin jiki na tsari ne (kamar kallikrein-kinin, renin-angiotensin-aldosterone, endocrin, da dai sauransu). A cikin labarun, yawancin lokaci lalacewar koda kanta ko kuma rushewa daga ɗaya daga cikin wadannan tsarin da aka gano.

Menene wannan alamar ta dogara ne kuma ta yaya za'a iya ƙaddara?

Abubuwan da ke shafi canji a cikin GFR

Kamar yadda aka fada a sama, nauyin zane-zane na duniya ya dogara ne da alamun da dama ko yanayi.

A gare su yana yiwuwa a ɗauka:

• Adadin ƙananan ƙwayoyin cuta ya gudana. Ana haifar da adadin jini da ke gudana ta hanyar arteriole kawo koda ga glomerulus. Yawanci wannan mai nuna alama a cikin mutum mai lafiya yana kimanin kusan 600 a minti daya (an yi lissafi don mutum mai matsakaicin kimanin kilo 70).
• Ƙarfin a cikin tasoshin. Yawanci, matsa lamba a cikin jirgin ruwa mai karɓa ya kamata ya fi girma a cikin jirgin mai fita. Sai kawai to tsari, wanda ke ƙarƙashin aikin kodan, za a gudanar da shi - filtration.
• Yawan adadin nephrons masu aiki. A sakamakon wasu cututtuka, yana yiwuwa a rage yawan yawan kwayoyin koda akan aiki, wanda a sakamakon haka zai haifar da raguwa a cikin yanayin da ake kira filtration surface, kuma, daidai da haka, za a gano adadin ƙwaƙwalwar ƙwararrun ƙwayoyin halitta.

Bayarwa don tabbatar da GFR

Wadanne lokuta wajibi ne a tantance wannan alamar?

Mafi sau da yawa yawan nau'in filtration na duniya (yawancin wannan alama alama ce ta 100-120 a minti daya) an ƙaddara ga cututtukan koda. Babban magunguna wanda ya wajaba a ayyana shi ne:

• Glomerulonephritis. Yana haifar da ƙãra a yawan adadin nephrons.

• Amyloidosis. Saboda samuwar wani fili mai gina jiki - amyloid - ƙarfin filtration na ƙwayar koda ya rage, wanda zai haifar da tarawa da guba mai guba da guba na jiki.
• Magunguna da kuma mahaukaci na Nephrotoxic. Dangane da liyafar liyafar su, za a iya shawo kan ƙananan parenchyma tare da rage yawan ayyukansa. Kamar yadda wadannan mahadi zasu iya aiki kamar sulham, wasu maganin rigakafi.
• Koda gazawar kamar yadda mai wahala na da yawa cututtuka.

Wadannan jihohin sune mahimmanci, a ƙarƙashin abin da ƙaƙaɗɗen jigilar ɗakunan ƙasƙanci zai iya zama ƙasa da al'ada.

Hanyar don ƙayyade filtration na glomerular

A halin yanzu, an yi amfani da hanyoyi masu yawa da gwaje-gwaje, wanda ya sa ya yiwu don ƙayyade matakin filtration na glomer. Dukansu suna da suna maras muhimmanci (don girmama masanin kimiyya wanda ya bude wannan ko wannan samfurin).

Hanyar manyan hanyoyin nazarin aikin glomeruli shine jarrabawar Reberga-Tareev, da ƙaddamar da tsararren ƙwallon ƙafa ta daidaitattun Cockcroft-Gold. Wadannan hanyoyi suna dogara ne akan canje-canje a cikin nau'in halittar halitta da kuma lissafi na yarda. Bisa ga canje-canjensa a plasma jini da fitsari, an yanke shawarar ƙarshe game da aikin kodan.

Zaka iya aiwatar da bayanai na samfurori ga dukan mutane, tun da waɗannan binciken ba su da wata takaddama.

Wadannan samfurori guda biyu da aka ambata sune daidaitattun a cikin nazarin zane na ainihi. Ana amfani da wasu hanyoyi fiye da sau da yawa kuma ana gudanar da su akan wasu alamomi.

Ta yaya ma'anar tsarin halittar creatinine da menene hanyoyin da aka nuna?

Jarabawar Reberga-Tareev

An yi amfani dashi a cikin aikin asibiti sau da yawa fiye da gwajin Cockcroft-Gold.

Don gudanar da bincike da yin amfani da jini magani da kuma fitsari. Wajibi ne muyi la'akari da lokacin tarin samfurori, saboda daidaito na bincike ya dogara ne akan wannan.

Akwai bambance-bambancen da yawa na gwajin. Hanyar da ta fi dacewa ita ce: furotin da aka tara don da yawa (yawanci lokuta biyu). A kowane daga cikinsu ne m da creatinine yarda da diuresis minti daya (da adadin fitsari samar da minti). Ƙididdigar yawan tsararren filtration na ƙa'idodin yana dogara ne akan waɗannan alamun biyu.

Matsayi mai mahimmanci na ƙin creatinine a cikin wani ɓangaren yau da kullum na fitsari ko bincike na samfurori guda shida-shida.

A a layi daya, da abin Hanyar ne da za'ayi samfurin, dauka da safe azumi jini daga jijiyar tantance creatinine taro.

Cockcroft-Gold gwajin

Wannan samfurin yana da kama da kama da samfurin Tareev. Da safe, a cikin komai a ciki, an ba marasa lafiya abin sha na wani nau'i na ruwa (kofuna na 1.5-2 na ruwa - shayi ko ruwa) don tayar da kayan aikin sassauci. Bayan minti 15, masu haƙuri suna zubar da ciki a cikin bayan gida (don cire daga cikin magungunan zafin jiki ya kasance da fitsari na dare). Ana nuna alamar haƙuri.

Sa'a daya daga baya an tattara ɓangaren farko na fitsari da kuma lokacin da aka nuna urination daidai. A lokacin sa'a na biyu, an tattara kashi na biyu. Tsakanin zubar da jinin marasa lafiya ya dauki ml 6 na jini don sanin matakin magani na creatinine.

Bayan kayyadadden tsararraki na minti daya da ƙaddarar creatinine, ƙayyade ƙwamarta. Yaya za a iya ƙayyade gudunmawar filtration glomerular?

Ƙididdigfin lissafi don bayaninsa kamar haka:

• F = (u: p) ˑ v, inda
  
  U - ƙaddamar da creatinine a cikin fitsari,
  P - Halitta a cikin jini jini,
  V - diuresis minti daya,
  F - izinin ƙasa.

Bisa ga mai gabatarwa F, an ƙaddamar da ƙaddamar game da ƙwarewar kodan.

Tabbatar da ƙaddamarwa ta hanyar ƙaddamarwa ta hanyar tsarin MDRD

Ya bambanta da ƙananan hanyoyin da za su ba mu damar ƙayyade yawan nauyin ƙwayar halitta, tsarin MDRD ya zama ɗan ƙarami. Ana amfani da su ne a ko'ina cikin kasashen Turai. A ra'ayinsu, gwajin Reberga-Tareev ba shi da kyau.

Dalilin wannan ƙwarewar shine don sanin GFR, bisa ga jima'i, shekarun da kuma kwayar halittar halitta. Ana amfani dashi a cikin ma'anar aikin koda a cikin mata masu ciki.

Yana kama da wannan:

• GFR = 11.33 x Crk - 1.154 x shekaru - 0.203 x K, inda
  
  Cutar shine ƙaddamar da creatinine a cikin jini (a cikin mmol / l),
  K shine jigilar jima'i (alal misali, ga mata yana da 0.742).

Wannan tsari ya tabbatar da kyau tare da ragewa a cikin nauyin gyare-gyare, amma babban haɓaka shi ne sakamakon da ba daidai ba idan an karu da ƙimar ƙwallon ƙafa. An tsara samfurin lissafin (sabili da wannan karamin) da kuma ƙarin (CKD-EPI).

Amfani da wannan tsari shi ne cewa yana yiwuwa a ƙayyade canje-canjen da suka shafi shekarun aikin koda da kuma kula da su a cikin hanzari.

Ragewa a cikin mai nuna alama

Bayan duk gwaje-gwaje da bincike da aka gudanar, ana fassara sakamakon.

Ragewa a cikin ƙwayar filtration na glomerular an lura a cikin wadannan lokuta:

• Da shan kashi na kayan aiki na kwayoyin koda. Ragewar GFR yana kusan mai nuna alama, yana nuna ƙaddamar da wannan yanki. A wannan yanayin, tare da ragewa a GFR, ƙila za a iya rage yawan ƙwarewar kodan (a farkon matakai).
• Renal rashin cikakken. Babban dalilin dashi na GFR da ragewa a cikin samfurin filtration. A cikin matakansa, akwai cigaba da karuwa a cikin haɓakar halittar halittar halitta, raguwar yawan tsaftacewa zuwa lambobi masu mahimmanci, da kuma ci gaba da maye gurbin jiki tare da samfurori na samfurori.
• Rage glomerular tacewa rate za a iya lura yayin da shan wasu nephrotoxic maganin rigakafi, wadda take kaiwa zuwa cin gaban m na koda gazawar. Za'a iya ƙididdige wasu nau'o'i da kuma cephalosporins a matsayin irin wannan.

Jirgin gwaji

Don ƙayyade iyawar filtration, yana yiwuwa a yi amfani da gwajin gwagwarmaya mai kira.

Yawanci amfani da guda amfani da dabba gina jiki ko amino acid da kaya (in babu contraindications) ko koma ga igiyar jini gwamnati na dopamine.

Lokacin da aka ɗora furotin cikin jiki, mai haƙuri yana karɓar nau'in gina jiki (100 grams) (adadin ya dogara da nauyin mai haƙuri).

A cikin rabin sa'a na gaba, mutanen kirki suna karuwa a GFR ta hanyar 30-50%.

Wannan abu ne ake kira wurin ajiyar kariya, ko PFR.

Idan da karuwa a GFR bai faru, ya kamata a da ake zargi sosai koda ko tace permeability wasu cigaban jijiyoyin bugun gini raunuka (kamar, misali, a cikin m nephropathy) , da kuma na koda gazawar.

Samfurin da dopamine yana nuna irin wannan sakamakon kuma an fassara shi a daidai lokacin gwajin loading gina jiki.

Muhimmancin gudanar da wannan binciken

Me yasa akwai hanyoyi da yawa don tantance tasirin filtration kuma me ya sa yake da muhimmanci don ƙayyadadden yawan ƙididdigar launi?

Hanyar wannan alamar, kamar yadda aka sani, ya bambanta da jihohin daban. Abin da ya sa a halin yanzu akwai hanyoyi da bincike da yawa da aka kirkiro wanda ya ba mu damar duba yanayin da ake sarrafawa ta jiki kuma ya hana ci gaba da cututtuka daban-daban.

Bugu da kari, wadannan cututtuka tsokane yawancin ma'amaloli a koda dasawa, wanda shi ne quite lokaci-cinyewa da kuma wahala, sau da yawa sakamakon da bukatar sake magani ko yin karin hadaddun ayyuka.

Wannan shine dalilin da ya sa ganewar asali na maganin wannan kwayar halitta yana da mahimmanci ga marasa lafiya da likitoci. Lokacin da aka gano cuta ya fi sauƙin magancewa kuma ya hana shi fiye da yadda aka yi watsi da shi.