Hepatorenal chirwere

Hepatorenal syndrome mamiriro umo mune kufambira mberi kweitsvo kutadza kunoitika mumunhu ane cirrhosis yechiropa. Icho chinetso chakakomba chinogona kutungamira kurufu.

Hepatorenal syndrome inoitika apo itsvo dzinomira kushanda zvakanaka muvanhu vane matambudziko akakomba echiropa. Urine shoma inobviswa mumuviri, saka marara zvigadzirwa zvine nitrogen inovakwa muropa (azotemia).

Dambudziko racho rinoitika mukati memunhu mumwe chete pagumi vari muchipatara nekutadza kwechiropa. Inotungamira kukundikana kwetsvo muvanhu vane:

• Chiropa chakakundikana kutadza
• Doro hepatitis
• Cirrhosis
• Yakabatwa mudumbu fluid

Njodzi zvinhu zvinosanganisira:

• Ropa rinodonha kana munhu achisimuka kana kamwe kamwe achichinja chinzvimbo (orthostatic hypotension)
• Kushandiswa kwemishonga inonzi diuretics ("mapiritsi emvura")
• Kubuda ropa mudumbu
• Utachiona
• Chazvino dumbu remvura kubviswa (paracentesis)

Zviratidzo zvinosanganisira:

• Kuzvimba mudumbu nekuda kwemvura (inonzi ascites, chiratidzo chechirwere chechiropa)
• Kuvhiringidzika kwepfungwa
• Tsvina yemhasuru
• Rima-rakasviba weti (chiratidzo chechiropa chirwere)
• Yakaderera weti kubuda
• Kusvotwa uye kurutsa
• Kurera huremu
• Yero ganda (jaundice, chiratidzo chechiropa chirwere)

Aya mamiriro anoonekwa mushure mekuyedzwa kutonga zvimwe zvikonzero zveitsvo kutadza.

Kuongorora kwepanyama hakuwone kukundikana kweitsvo chaiko. Nekudaro, iyo bvunzo inowanzo kuratidza zviratidzo zvechirwere chisingaperi chechiropa, senge:

• Kuvhiringidzika (kazhinji nekuda kwehepatic encephalopathy)
• Kuwedzera kwemvura mudumbu (ascites)
• Jaundice
• Zvimwe zviratidzo zvechiropa kutadza

Zvimwe zviratidzo zvinosanganisira:

• Kusanzwisisika kusagadzikana
• Machende madiki
• Ruzha ruzha munzvimbo yedumbu kana uchinge waratidzwa nemazano eminwe
• Kuwedzera kwemazamu tishu (gynecomastia)
• Maronda (maronda) paganda

Izvi zvinotevera zviratidzo zveitsvo kutadza:

• Zvishoma kana zvisina kubuda weti
• Kuchengetwa kwemvura mukati medumbu kana kumagumo
• Yakawedzera BUN uye creatinine mazinga eropa
• Yakawedzera weti yakatarwa giravhiti uye osmolality
• Yakaderera ropa sodium
• Yakadzika kwazvo weti sodium kukosheswa

Izvi zvinotevera zviratidzo zvechiropa kutadza:

• Isina kujairika prothrombin nguva (PT)
• Kuwedzera kweropa ammonia level
• Yakaderera ropa albumin
• Paracentesis inoratidza ascites
• Zviratidzo zvehepatic encephalopathy (iyo EEG inogona kuitwa)

Chinangwa chekurapa ndechekubatsira chiropa kuti chishande zvirinani uye kuve nechokwadi chekuti moyo unokwanisa kupomba ropa rakakwana kumuviri.

Kurapa kwakada kufanana neitsvo kutadza kubva pane chero chikonzero. Inosanganisira:

• Kumisa mishonga yese isingakoshi, kunyanya ibuprofen nedzimwe NSAID, mamwe maantibayoti, uye diuretics ("mapiritsi emvura")
• Kuva ne dialysis yekuvandudza zviratidzo
• Kutora mishonga yekuvandudza BP uye kubatsira itsvo dzako kushanda zvirinani; kuiswa kwealbumin kunogona kubatsira
• Kuisa shunt (inozivikanwa se MAZANO) kubvisa zviratidzo zve ascites (izvi zvinogona zvakare kubatsira itsvo kushanda, asi maitiro acho anogona kuve nenjodzi)
• Kuvhiya kuisa shunt kubva mudumbu nzvimbo kuenda kune jugular vein kubvisa zvimwe zviratidzo zveitsvo kukundikana (maitiro aya ane njodzi uye haawanzo kuitwa)

Mhedzisiro yacho inowanzo kuve yakashata. Rufu runowanzoitika nekuda kwehutachiona kana kubuda kwakanyanya (kubuda ropa).

Zvinetso zvinogona kusanganisira:

• Kubuda ropa
• Kukuvadza, uye kutadza kwe, akawanda masisitimu ehurongwa
• End-danho chirwere cheitsvo
• Kuyerera kwemvura uye moyo kutadza
• Coma inokonzerwa nechiropa kutadza
• Zvirwere zvechipiri

Ichi chirwere chinowanzoonekwa muchipatara panguva yekurapwa kwechiropa kusagadzikana.

Cirrhosis - hepatorenal; Chiropa kutadza - hepatorenal

Fernandez J, Arroyo V. Hepatorenal syndrome. Muna: Feehally J, Floege J, Tonelli M, Johnson RJ, eds. Yakakwana Kliniki Nephrology. 6th ed. Philadelphia, PA: Elsevier; 2019: chits. 73.

Garcia-Tsao G. Cirrhosis uye sequelae yayo. Mune: Goldman L, Schafer AI, eds. Goldman-Cecil Mushonga. 26th ed. Philadelphia, PA: Elsevier; 2020: chits. 144.

Mehta SS, Kudonha MB. Hepatic encephalopathy, hepatorenal syndrome, hepatopulmonary syndrome, uye mamwe maratidziro echirwere chechiropa. Muna: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger uye Fordtran's Gastrointestinal uye Chirwere Chiropa. 11th ed. Philadelphia, PA: Elsevier; 2021: chits. 94.