ʻO ka hemahema o ka renal i nā ʻīlio

Nā hōʻailona o ka maʻi

He ʻokoʻa nā hana o nā puʻupaʻa i loko o ke kino - ʻaʻole lākou e komo wale i ka excretory role, akā ke komo pū kekahi i ka metabolism o nā protein, carbohydrates a me nā lipids, ka hoʻoponopono ʻana i ka pale o ka acid-base, ka osmotic pressure, ke kaulike wai, ke koko, etc. No laila, me ka hoʻomohala ʻana o ka maʻi i loko Ua hoʻopilikia ʻia ke kino e ka nui o nā kaʻina hana, a ʻo nā hōʻailona o nā pilikia kīkī i nā ʻīlio hiki ke ʻokoʻa loa. No ka laʻana, hiki i kēia mau hōʻailona o ka maʻi ʻōpū, ka maʻi diabetes, urolithiasis, maʻi gum, i kekahi mau hihia, hiki iā ʻoe ke kānalua i ka hele ʻana o kahi kino ʻē i loko o ka ʻōpū a i ʻole ka ʻōpū.

ʻO nā hōʻailona nui o ka hāʻule ʻana o ka kidney i nā ʻīlio penei:

• hōʻole i ka ʻai ʻana a i ʻole ka nele o ka ʻai;

• ka luaʻi;

• lethargy, kaumaha;

• ʻala maikaʻi ʻole mai ka waha;

• hoʻonui i ka make wai;

• urination pinepine;

• Kaumaha emi.

E like me kā mākou e ʻike ai, ʻo nā hōʻailona o ka maʻi ke ʻano o ka nui o nā pathologies, no laila e hōʻoia ʻia ka maʻi ma nā hoʻokolohua. I loko o ke keʻena, pono ʻoe e hana i nā diagnostics penei:

• e lawe i ka ho'āʻo koko maʻamau a me ka biochemical;

• e hana i ka mimi maʻamau;

• hana i kahi ultrasound o ka ʻōpū o ka ʻōpū;

• ana i ke koko (tonometry);

• e haʻalele i nā maʻi ʻē aʻe me nā hōʻailona like, makemake ʻia e hana i kahi x-ray o ka ʻōpū o ka ʻōpū.

Ma muli o nā hopena o ka hoʻokolokolo ʻana, hiki ke ʻike ʻia nā hōʻailona kikoʻī o ka hāʻule ʻana o ke kīkī i nā ʻīlio:

• hoʻonui i ka urea, creatinine, phosphorus i ka biochemistry;

• anemia e like me ka ho'āʻo koko maʻamau;

• proteinuria, hematuria, emi iho ka mimi;

• hoʻonui i ke koko ma ka tonometry.

Hāʻawi ʻia i ka nui o nā puʻupaʻa, ʻoi aku ka liʻiliʻi o 60-70% o ka ʻiʻo puʻupaʻa e make no ka ulu ʻana o nā hōʻailona o ka maʻi, a hiki i ia manawa ʻaʻole loaʻa i ka ʻīlio nā hōʻailona o ke alo o ka maʻi. I ka wā mua o ka maʻi kīkī, hiki i ka nui o nā nephrons make ke piʻi i ka 75%! ʻO ka hōʻailona maikaʻiʻole o ka maʻi e pili ana i kēia hiʻohiʻona - i ka manawa e loaʻa ai i ka pipi nā hōʻailona o ka maʻi a hiki ke hana i kahi hōʻailona, ​​ma keʻano he kānāwai,ʻaʻohe mea e hiki ke kōkua. ʻO kekahi kumu i ka hopena maikaʻi ʻole ʻo ia ka ʻike pinepine ʻole o nā mea nona ka pilikia o ka ʻīlio, e kākau i nā hōʻailona āpau no ka ʻelemakule a ʻaʻole hele i ke keʻena lāʻau lapaʻau.

Acute renal failure (ARF)

ʻO ka hōʻino ʻole o ka renal i nā ʻīlio he maʻi maʻi e ulu ana ma muli o ka hōʻino ʻana o ka hana kīkī a hele pū me ka azotemia (ʻo ia hoʻi, ka piʻi ʻana o ka urea a me ka creatinine i nā hoʻāʻo koko), nā maʻi o ka wai a me ke kaulike electrolyte a me ke kaulike acid-base.

ʻO nā kumu o ka hoʻomohala ʻana o OPN penei:

• ka uhaki ʻana i ka ʻōnaehana circulatory ma muli o ka haʻalulu, ke kahe o ke koko, ka pathology cardiac, renal vascular thrombosis a me nā kūlana koʻikoʻi ʻē aʻe;

• ka hoʻohana ʻana i nā lāʻau nephrotoxic, e like me kekahi mau lāʻau antibiotic, nā lāʻau anti-inflammatory non-steroidal, immunosuppressive a me nā lāʻau lapaʻau chemotherapy, a i ʻole ka make ʻana me nā mea nephrotoxic, e like me ka ethylene glycol;

• ka hele ʻana o nā pathologies systemic koʻikoʻi, nā maʻi autoimmune, nā maʻi infectious (no ka laʻana, leptospirosis), etc.

He paʻakikī ka diagnostic ma muli o:

1. He moʻolelo kūikawā (lawe i ka lāʻau lapaʻau a i ʻole nā ​​​​mea nephrotoxic ʻē aʻe, ʻokiʻoki, trauma, etc.);

2. ʻO nā hōʻailona kikoʻī (hōʻole koke i ka ʻai, manaʻo ʻole, luaʻi, ka maʻi maʻi, ka hanu ʻino, ka convulsions, incoordination i ka lewa a me ka emi ʻana o ka nui o ka hoʻokumu ʻana o ka mimi a hiki i ka pau ʻole o ka urination);

3. Ma nā diagnostics laboratory:

   • hiki i kahi ho'āʻo koko ke ʻike i ka piʻi ʻana o ka hematocrit, ka piʻi ʻana o ka helu o nā leukocytes me lymphopenia;

   • e like me ka biochemistry koko, ʻike ʻia kahi piʻi holomua o ka ʻike o ka urea, creatinine, phosphorus, potassium a me ka glucose;

   • hoʻoholo ka urinalysis i ka emi ʻana o ka nui o ka mimi, proteinuria, glucosuria;

   • nā hopena o ka X-ray a me ka ultrasound i ka hoʻomohala ʻana o ke kaʻina hana, ma ke ʻano he kānāwai, ʻaʻole i loli. 

ʻO ka lōʻihi o ka haʻalele ʻana o ka ʻīlio e ola inā hāʻule kona mau puʻupaʻa e pili ana i ke kiʻekiʻe o ko lākou pōʻino, ka wikiwiki o ke kelepona ʻana i ke keʻena olakino a me ka pololei o ka lāʻau i kuhikuhi ʻia.

ʻO ka hōʻino ʻole o ka renal (CRF) i nā ʻīlio

ʻO ka pau ʻole o ka renal he ʻano pathological o ke kino i hōʻike ʻia e ka pōʻino hiki ʻole ke hoʻololi ʻia i nā puʻupaʻa, kahi hōʻino i ka excretion o nā huahana metabolism nitrogen mai ke kino a me kahi maʻi o nā ʻano homeostasis he nui (ʻo ia hoʻi, ke kūpaʻa mau o ka kaiapuni o loko. ke kino).

Hiki ke noʻonoʻo ʻia kēia maʻi ma ke ʻano he pae hope loa o ka piʻi ʻana o nā ʻano maʻi ʻano like ʻole: congenital malformations, glomerulonephritis, amyloidosis, pyelonephritis, nephrolithiasis, polycystic maʻi a me nā mea he nui. ʻO ka hapa nui o kēia mau hōʻailona hiki ke hana wale ʻia e ka biopsy (lawe i kahi ʻāpana o ke kino no ka histology), no laila, i ka hapa nui o nā hihia, ʻōlelo lākou i ka nephropathy bilateral mau loa ma ke ʻano he hopena.

E like me ka mea i ʻōlelo ʻia ma luna nei, ʻoi aku ka pōʻino o ka ʻoi aku ma mua o 75% o ka nui o ka ʻiʻo o ka puʻupaʻa e alakaʻi i ka hoʻopau ʻana i nā puʻupaʻa: ke emi nei ka hana ʻana (e alakaʻi ana i ka emi ʻana o ka nui o ka mimi), aia kahi lohi i ka excretion o ka nitrogen. nā huahana metabolism (ʻo ia ka pae hope loa o ka metabolism protein i loko o ke kino), a i ka wā hope loa, hoʻomohala ʻo CRF i nā ʻīlio i ka uremia - ka make ʻana o ke kino me nā huahana palaho. Eia kekahi, hana nā puʻupaʻa i ka hormone erythropoietin, ʻo ia ke kuleana no ka synthesis o nā ʻulaʻula ʻulaʻula - no laila, i ka pau ʻana o nā puʻupaʻa, e emi ana ka synthesis o ka hormone a ulu mālie ka anemia.

E like me ke ʻano o ka pathology acute, ʻike ʻia ka maʻi o ka hiki ʻole o ka renal ma ke kumu o ka anamnesis a me nā hopena hōʻike hōʻike: hypoplastic anemia, hoʻonui creatinine a me ke koko urea nitrogen, hyperphosphatemia, acidosis, hyperkalemia. Hoʻemi ʻia ka nui o ka mimi (i nā ʻīlio ma lalo o 1,025 hl), hiki nō hoʻi ka proteinuria haʻahaʻa (piʻi ka protein i loko o ka mimi).

Ma ka radiograph i ka hihia o ka renal i loko o nā ʻīlio, hiki ke ʻike ʻia kahi ʻano like ʻole o nā puʻupaʻa a me ka emi ʻana o ko lākou nui, e like me ka ultrasound - kahi ʻano heterogeneous, sclerosis o ka parenchyma, pau ʻole o nā papa (impaired cortico-medullary differentiation). ), ka emi ʻana o ka nui o ke kino.

Ma muli o ka waiwai o ka neʻe ʻana o ka creatinine i ka serum koko, ʻike ʻia nā pae 4 o CRF i nā ʻīlio:

1. kahua nonazotemic - hiki i kēia ke hoʻokomo i kekahi hana ʻino o nā puʻupaʻa me ka ʻole o kahi kumu i ʻike maopopo ʻia e pili ana i ka nephropathy. Hiki ke ʻike ʻia nā hoʻololi mua i nā puʻupaʻa e ka ultrasound, i ka mimi - ka piʻi ʻana o ka nui o ka protein a me ka emi ʻana o ka density. Wahi a ka biochemistry koko, ʻike ʻia ka piʻi mau ʻana o ka ʻike creatinine (akā i loko o ka pae maʻamau).

2. ʻO ka azotemia renal haʻahaʻa - He 125-180 µmol ka nui o ka creatinine serum. ʻO ka paepae haʻahaʻa o nā waiwai creatinine ​​uXNUMXbuXNUMXbhe ʻano ʻokoʻa paha ia o ka maʻamau, akā i kēia manawa, ʻike ʻia nā pilikia i ka hana o ka ʻōnaehana urinary i nā holoholona. ʻO nā hōʻailona o ka hāʻule ʻana o ke kīkī i nā ʻīlio he maʻalahi a ʻaʻole paha.

3. ʻO ka azotemia renal haʻahaʻa - He 181-440 µmol ka nui o ka creatinine serum. I kēia pae, ma ke ʻano he kānāwai, aia nā hōʻailona like ʻole o ka maʻi.

4. ʻO ka azotemia renal koʻikoʻi - ʻoi aku ka nui o ka creatinine ma luna o 441 µmol. I kēia wā, ʻike ʻia nā hōʻike ʻōnaehana koʻikoʻi o ka maʻi a me nā hōʻailona o ka ʻona.

Ka lapaʻau ʻana i ka hōʻino ʻole ʻana o nā ʻīlio

No laila, inā loaʻa i ka ʻīlio ka maʻi kīkī, hiki ke hoʻōla ʻia? ʻOkoʻa loa nā ʻano hana lapaʻau a me nā manawa o ka hoʻopau ʻana i ka hōʻino ʻana i nā ʻīlio ma muli o kona ʻano.

Hoʻokō ʻia ka mālama ʻana i ka hemahema renal acute i loko o kahi haukapila ma lalo o ka nānā mau ʻana o ke kauka. Hoʻonohonoho ʻia ka lāʻau lapaʻau kūikawā (pathogenetic), e kuhikuhi ana i ka hoʻopau ʻana i ke kumu o ka maʻi. Hoʻomaʻamaʻa mau ʻia ka maʻi intravenous symptomatic e hoʻomaʻamaʻa i ke koena wai-electrolyte a me ke koena acid-base, a e wehe i nā toxins. ʻO nā hoʻāʻo koko, ke kūlana maʻamau o ka mea maʻi, ka nui o ka mimi i hoʻokaʻawale ʻia e nānā ʻia i kēlā me kēia lā - no kēia, pono ka catheterization o ka ʻōpū a me ka hoʻokomo ʻana i kahi urinal.

I ka mālama ʻana i ka ʻai, ua kuhikuhi ʻia nā meaʻai kūikawā no ka hōʻole ʻana o ka kidney i nā ʻīlio, me ka luaʻi a me ka nele o ka ʻai - pono e hoʻolako ʻia nā meaʻai nui i loko o ka intravenously a i ʻole ma o nā paipu kūikawā (nasoesophageal probe, etc.).

I ka hihia o ka ʻona nui, ʻaʻole a kokoke pau i ka pau ʻana o ka hana ʻana o ka mimi a me ka maikaʻi ʻole o ka mālama conservative i nā lā 1-3 mua o ka hale maʻi, ua ʻōlelo ʻia ka dialysis (ʻo ia ke kaʻina hana o ka wehe ʻana i nā huahana a me ka wai nui mai ka wai. kino).

Me ka hoʻomohala ʻana o ka hemahema renal acute o kekahi etiology, pono e hoʻomaopopo ka mea nona ka holoholona e makaʻala ka prognosis o ka maʻi a hiki i ka maikaʻi ʻole, hiki i nā hoʻopiʻi like ʻole i ka wā o ka mālama ʻana. Pono ʻoe e hoʻomākaukau no ka hale maʻi pipiʻi no ka wā lōʻihi - i ka wā e hoʻāʻo ai e mālama i kahi puaʻa i ke kūlana koʻikoʻi ma ka home, hiki iā ʻoe ke nalowale i ka manawa, a laila hoʻemi nui ʻia ka manawa o ka hoʻōla. Akā me ka mālama pono a me ka manawa kūpono, loaʻa i ka ʻīlio nā manawa āpau no ka hoʻōla piha a me ka hoʻōla.

ʻO ka hoʻomaʻamaʻa ʻana i ka hōʻino ʻole o ka renal i nā ʻīlio hiki ke hōʻailona wale ʻia. I kēia hihia, he mea nui e hoʻomaopopo i ka ʻoiaʻiʻo ʻo CRF kahi maʻi holomua, hiki ʻole ke hoʻololi ʻia me kahi hopena make: inā hāʻawi ʻia ka holoholona i ka pae 4 (terminal), a laila ʻaʻole paha ʻo ia e ola no hoʻokahi mahina.

ʻOiai ka mālama ʻana i ka ʻai i loko o kahi holoholona me CRF, ʻo ka mea nui e hahai i kahi meaʻai kūikawā (nā kumu a mākou e kūkākūkā ai ma lalo) a loiloi i nā hoʻāʻo koko i ka manawa.

Ma ke alo o ka luaʻi a me ka hōʻole ʻana i ka hānai, hoʻohana ʻia nā lāʻau antiemetic (e like me maropitant, metoclopramide), a me nā lāʻau gastroprotective (sucralfate) a me H2 receptor antagonists (ranitidine).

Me ka hoʻonui ʻana i ka nui o ka phosphorus i loko o ke koko biochemistry, nā lāʻau lapaʻau e hoʻopaʻa i ka phosphorus i loko o ka ʻōpū, nā mea i kapa ʻia ʻo phosphate binders (no ka laʻana, ipakitine).

Me ka hoʻomau mau ʻana i ka ʻai, ka luaʻi ʻole ʻole, a me nā hōʻailona ʻē aʻe o ka inu ʻana o ka uremic, pono ka mālama ʻana i ka inpatient me ka intravenous therapy a me ka nānā ʻana i nā hoʻāʻo koko e hoʻopaʻa i ka holoholona.

Eia kekahi, me ka hoʻomohala ʻana o ka CRF i nā holoholona, ​​​​ʻike pinepine ʻia ka piʻi ʻana o ke koko, no ka mea, ʻo ka mālama ʻana i ka angiotensin-converting enzyme inhibitors (ACE inhibitors) i kuhikuhi ʻia me ka mana o ka proteinuria a me ka azotemia (no ka mea hiki i kēia mau lāʻau ke hoʻonui i ka maʻi. ka paʻakikī o CRF).

Ke kūpaʻa ke kūlana o ka holoholona, ​​​​e nānā ʻia ke ʻano o ka maʻi a me ka maikaʻi o ka mālama ʻana. Me ka papa haʻahaʻa o ka maʻi, pono e nānā i ka ʻīlio i hoʻokahi manawa i kēlā me kēia 1 mahina.

Pehea ka lōʻihi o ka noho ʻana o nā ʻīlio me CRF ma muli o ke ʻano a me ke ʻano o ka piʻi ʻana o ka maʻi. ʻAʻole maikaʻi ka prognosis lōʻihi, hele ka maʻi i ka pae hope i kekahi mau mahina a i ʻole mau makahiki.

ʻai

E kamaʻilio kākou e pili ana i ka meaʻai ma ka hōʻino ʻole o ka puʻupaʻa. ʻO ka meaʻai kekahi o nā ʻano koʻikoʻi o ka mālama ʻana i ke kino a me ka hoʻolohi ʻana i ka ulu ʻana o nā hōʻailona o ka maʻi maʻi maʻi maʻi maʻi, a ma ka hōʻino ʻana i ke kīkī koʻikoʻi kekahi o nā mea nui o ka mālama ʻana. Eia kekahi, ʻo ka pane i ka nīnau no ka lōʻihi o ke ola ʻana o kahi ʻīlio me ka hemahema o ka ʻōpū ma muli o ka meaʻai i haku pono ʻia.

ʻO nā pahuhopu o ka hoʻomaʻamaʻa meaʻai no ka hemahema o ka renal i nā ʻīlio, penei:

• hāʻawi i ke kino me ka ikaika piha;

• hoʻomaha i nā hōʻailona o ka maʻi kīkī a me ka ʻona uremic;

• ka hōʻemi kiʻekiʻe loa o nā hewa o ka wai, electrolyte, vitamina, mineral a me ka acid-base balance;

• hoʻolohi i ka holomua o ka hana ʻole o ka renal.

A laila, e noʻonoʻo mākou i nā hiʻohiʻona nui o ka meaʻai no ka hemahema renal.

No ka hōʻemi ʻana i ka hopena o ka haki ʻana o ka protein i ke kino, e alakaʻi ana i ka pohō kaumaha a hoʻonui i ka ʻona, pono ia e hāʻawi i ka holoholona me ka nui o ka ikehu maʻalahi. Pono e hoʻomanaʻo ʻia ʻo nā ʻāpana ikehu non-protein e loaʻa nā carbohydrates a me nā momona. I ka hoʻokumu ʻana i nā meaʻai no nā ʻīlio me ka maʻi kīkī, hoʻohui pinepine ʻia nā mea momona, e hoʻonui ai i ka ikehu o ka meaʻai, e hoʻomaikaʻi i kona palatability a me ka palatability.

No ka mea ʻoi aku ka nui o nā meaʻai protein kiʻekiʻe i ke koʻikoʻi o ka nephropathy, pono e hoʻohana ʻia nā protein kiʻekiʻe i ka haʻahaʻa i ka wā e hoʻomohala ai i nā meaʻai. Ua hōʻike ʻia ʻo ka emi ʻana o ka nui o ka protein ma ka kaupalena ʻana i ka lawe ʻana i nā waikawa amino pono ʻole hiki ke hōʻemi i ka hōʻiliʻili ʻana o nā huahana metabolism nitrogen a ma muli o ka hopena, e hōʻoluʻolu i nā hōʻike lapaʻau o ka maʻi.

ʻAʻole i emi iki ka mea nui o ka emi ʻana o ka nui o ka phosphorus i nā meaʻai, ka mea (hōʻoia) e hoʻonui i ke ola o nā ʻīlio, pale i ka emi ʻana o ka nui o ka calcium i loko o ke kino (ma muli o ka ulu ʻana o ka hyperparathyroidism lua) a, ma muli o ka hopena. , ho'ēmi i ka uluʻana o ka osteodystrophy a me ka calcification o nāʻiʻo palupalu.

He mea nui nō hoʻi e kaupalena ʻia ka sodium (ʻo ia kahi ʻāpana o ka paʻakai papa) i nā meaʻai e hōʻemi i ke kiʻekiʻe kiʻekiʻe (ʻo ia ka hopena o nā puʻupaʻa maʻi).

Pono e hoʻomanaʻo ʻia e hoʻokuʻu ʻia nā huaora wai-soluble i ka mimi, no laila, me ka polyuria e kūʻē i ke ʻano o ka maʻi kīkī, hiki ke hemahema. Hiki i kēia nalowale o nā huaora ke kōkua i ka anorexia, no laila pono e hoʻonui ʻia nā meaʻai me nā huaora hiki ke hoʻoheheʻe ʻia i ka wai.

Hōʻike ʻia ka hoʻohui ʻana o ka nui o ka meaʻai meaʻai no nā maʻi kīkī, no ka mea, ua hele pū ʻia lākou me ka lohi ʻana i ka neʻe ʻana o ka ʻōpū, a hiki i ka fiber meaʻai ke hoʻomaikaʻi i ke kūlana a me ka motility o ka ʻōpū o ka ʻōpū.

No laila, inā hānai maikaʻi ʻia ka ʻīlio i mua o ka hiki ʻole o ka renal, ʻo ka meaʻai ka meaʻai ke ala nui e hoʻomaha ai i nā hōʻailona o ka uremia i nā holoholona. A hiki i ka meaʻai meaʻai holoholona ke koho i ka meaʻai kūpono no ka hōʻino ʻole ʻana: ʻoi aku, hiki ke lilo i meaʻai ʻenehana i mākaukau (e like me Royal Canin Renal, Hill's K / d, Purina NF), a i ʻole kahi meaʻai home i hoʻokumu ʻia i kēlā me kēia. ma ka pipi, ka uala a me ka aila mea kanu).

ʻAʻole ka ʻatikala he kāhea e hana!

No ka ʻike kikoʻī hou aku o ka pilikia, manaʻo mākou e hoʻopili i kahi loea.

E nīnau i ke kauka

October 8 2020

Hana hou ʻia: Pepeluali 13, 2021