ostraya i xronicheskaya pochechnaya nedostatochnost.

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ostraya pochechnaya nedostatochnost - vnezapnoe naushenie sekretonoy i ekskretornoy funktsii obeix pochek v rezultate vremennogo umensheniya ili prekrasheniya funktsii nefronov, svyazannoe s ix povrejdeniem (chashe obratimim) ostraya i xronicheskaya pochechnaya nedostatochnost tsel lektsii: nauchit studentov viyavlyat osnovnie klinicheskie poyavleniya ostroy i xronicheskoy pochechnoy nedostatochnosti «bolezn – konflikt cheloveka s okrujayushey sredoy i (ili) samim soboy» (v.v. serov) ostraya pochechnaya nedostatochnost (opn) – vnezapnoe narushenie sekretornoy i ekskretornoy funktsii obeix pochek v rezultate vremennogo umensheniya ili prekrasheniya funktsii nefronov, svyazannoe s ix povrejdeniem (chashe obratimim) * v rezultate razvitiya opn narushaetsya: vivedenie produktov azotistogo obmena vodniy balans elektrolitniy balans kislotno-shelochnoe ravnovesie etiologiya: 4 gruppi faktorov, sposobnix privesti k razvitiyu opn 1. prerenalnie – funktsiya pochek soxranena, no snijaetsya pochechniy krovotok, umenshaetsya otsk padaet uroven arterialnogo davleniya snijaetsya uroven klubochkovoy filtratsii (kf) velichina klubochkovoy filtratsii zavisit ot: velichini pochechnogo krovotoka gradient gidrostaticheskogo davleniya tonusa pochechnix arteriol norma - kf (80 -120 ml/min.) …

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abdomioliz – ( ne travmaticheskiy pri teplovom udare, tyajeloy fizicheskoy rabote, gipokaliemiya, ishemiya mishts) 3. postrenalnie okklyuziya verxnix mochevix putey mochekamennaya bolezn, opuxol, travmi, strikturi, perevyazka mochetochnika zaderjka mocheispuskaniya (neyrogennogo xaraktera, priema lekarstvennix sredstv – xolinoblokatori, ganglioblokatori) 4. arenalnie travmaticheskoe porajenie obeix pochek, libo edinstvennoy pochki. udalenie edinstvennoy pochki patogenez v rezultate deystviya etiologicheskogo faktora snijaetsya pochechniy krovotok, osobenno v korkovom sloe, narushaetsya neobxodimiy uroven klubochkovoy filtratsiya stoykiy spazm kapillyarov pochechnogo klubochka ishemiya kori pochek oligo-, anuriya v rezultate narusheniya mikrotsirkulyatsii razvivaetsya stoykiy spazm v prinosyashey arterii pochechnogo klubochka, v rezultate etogo sbros krovi po arteriovenoznim shuntam, krov ne filtruetsya, a sbrasivaetsya v sosudi mozgovogo sloya, deponiruetsya. v rezultate zastoya krovi i uvelicheniya davleniya v mozgovom sloe gipoksiya i nekroz epiteliya kanaltsev. pri gibeli bolee 50% kanaltsev - neobratimie posledstviya. patogenez snijenie skorosti klubochkovoy filtratsii obstruktsiya kanaltsev kletochnimi tsilindrami obratniy tok klubochkovogo filtrata cherez povrejdenniy kanaltseviy epiteliy klinika delitsya na …

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ni v krovi narastaet giperazotemiya, mochevina krovi, 32 -50 mmol/l, kreatin 500-900 mkmol/l; giperkaliemiya 6 - mmol/l, narastaet uroven fosfora, magniya, (toksicheskoe deystvie na miokard, narushenie serdechnogo ritma, ostanovka serdtsa) gipergidratatsiya, atsidoz (dixanie kussmaulya, za schet snijeniya urovnya bikarbonatov) nevrologicheskie rasstroystva (nabuxanie stvolov nervnix kletok), arterialnaya gipertoniya bolnie vyali, sonlivi, gipergidratatsiya privodit k nevrologicheskim rasstroystvam. organi dixaniya: odishka, dixanie kussmaulya, m.b. otek legkix. s.s.s. ag, narushenie serdechnogo ritma jkt - uremicheskiy gastrit, enterokolit ( rvota, suxost vo rtu, otvrashenie k pishe, neredko nablyudaetsya parez kishechnika, zapori, ponosi. 3. diureticheskaya stadiya stadiya vosstanovleniya funktsii pochek, videlitelnoy kontsentratsionnoy diureticheskaya stadiya delitsya na 2 perioda, rannyaya - postepennoe vosstanovlenie diureza i pozdnyaya. poliuriya - do 4-5l mochi, nizkogo udelnogo vesa, nablyudayutsya narusheniya elektrolitnogo balansa, snijaetsya uroven kaliya, fosfora, magniya. kontsentratsionnaya funktsiya vosstanavlivaetsya cherez 2 -3 nedeli. ischezaet giperazotemiya, normalizuetsya uroven mochevini, kreatinina. medlennee vosstanavlivaetsya eritropoez lechenie likvidatsiya etiologicheskogo faktora normalizatsiya tsifr ad vozmeshenie …

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vaniya s pervichnim porajeniem klubochkov i kanaltsev, interstitsii -xgn, glomeruloskleroz, - pielonefrit, xron. interst. nefrit, - tuberkulez 2. obstruktivnie zabolevaniya pochek : - gidronefroz - moche-kamennaya bolezn - opuxoli, strikturi uretri adenoma predstatelnoy jelezi 3. pervichnie porajeniya sosudov pochek - stenoz pochechnix arteriy - zlokachestvennie gipertonii - nefroskleroz 4 sistemnie zabolevaniya soedinitelnoy tkani - kollagenozi - skv, ssu, up, - gemorragicheskiy vaskulit 5. zabolevaniya pochek obmennogo geneza - amiloidoz - podagra - saxarniy diabet - oksaloz 6. vrojdennie zabolevaniya pochek - gipoplaziya - polikistoz - udvoennaya pochka - anomalii pochechnoy nojki patogenez xpn morfologicheskoy osnovoy xpn yavlyaetsya umensheniya chisla funktsioniruyushix nefronov (kf) narushenie obratnogo vsasivaniya (belkov ak, elektrolitov, saxara) narushenie videlitelnoy funktsii giperazotemiya klassifikatsiya xpn (s.i.ryabov,1976 g.) 1. latentnaya (otsutstvie priznakov) 2. intermitiruyushaya 3. azotemicheskaya ( a, b) 4. uremicheskaya (a,b) klasssifikatsiya xpn (lopatkina n.a. -kuchinskogo i.n. 1. latentnaya kf do 50-60 ml/min 2. konservativnaya kf - 30-40 (nizkiy ud. …

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sudorojniy sindrom, retinopatiya) anemicheskiy sindrom (normoxromnaya, normotsitarnaya anemiya). prichini: snijenie virabotki eritropoetina uremicheskaya intoksikatsiya, ugnetenie kostnogo mozga snijenie prodoljitelnosti jizni eritrotsitov klinicheskie proyavleniya xpn narushenie svertivaemosti krovi ( gipokoagulyatsiya, povishennaya krovotochivost, v rezultate snijeniya aktivnosti trombotsitarnogo faktora) polineyropatii (sonlivost,bessonnitsa, tremor, sudorogi, xoreya, stupor, progressiruyushaya neyropatiya) klinicheskie proyavleniya xpn izmeneniya jkt ( s virajennimi proyavleniyami jeludochno-kishechnoy dispepsii) erozivnie i yazvennie porajeniya jkt uremicheskiy gastrit uremicheskiy kolit infektsionnie oslojneniya klinicheskie proyavleniya xpn endokrinnie rasstroystva: u podrostkov zaderjka polovogo sozrevaniya amenoreya, dismenoreya uremicheskiy psevdodiabet izmeneniya kostnoy sistemi pochechniy raxit rezorbtsiya kostnoy tkani osteoskleroz patologicheskie perelomi kostey diagnostika xpn jalobi, anamnez ob'ektivnie dannie diurez, ad, laboratornie dannie - proba po zimnitskomu - klubochkovaya filtratsiya (opredelenie v moche i krovi uroven kreatinina) b/x issledovanie krovi ost. azot, mochevina, kreatinin, lechenie xpn ustranenie elektrolitnix narusheniy korrektsiya metabolicheskogo atsidoza ustranenie sindroma gipergidratatsii korrektsiya kaltsievo-fosfornogo obmena antigipertenzivnaya terapiya simptomaticheskaya terapiya lechenie xpn dieta stol №7, №10 - (ogranicheskie …

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ostraya pochechnaya nedostatochnost - vnezapnoe naushenie sekretonoy i ekskretornoy funktsii obeix pochek v rezultate vremennogo umensheniya ili prekrasheniya funktsii nefronov, svyazannoe s ix povrejdeniem (chashe obratimim) ostraya i xronicheskaya pochechnaya nedostatochnost tsel lektsii: nauchit studentov viyavlyat osnovnie klinicheskie poyavleniya ostroy i xronicheskoy pochechnoy nedostatochnosti «bolezn – konflikt cheloveka s okrujayushey sredoy i (ili) samim soboy» (v.v. serov) ostraya pochechnaya nedostatochnost (opn) – vnezapnoe narushenie sekretornoy i ekskretornoy funktsii obeix pochek v rezultate vremennogo umensheniya ili prekrasheniya funktsii nefronov, svyazannoe s ix povrejdeniem (chashe obratimim) * v rezultate razvitiya opn narushaetsya: vivedenie produktov azotistogo obme...

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