BOLALARDA O’TKIR BUYRAK JAROHATI
Keywords:
O'tkir buyrak yetishmovchiligi, o'tkir buyrak zararlaishi, gipoksik/ischemik zararlaish, o'tkir tubulyar nekroz.Abstract
O'tkir buyrak jarohati (O’BJ) (avvalroq o'tkir buyrak yetishmovchiligi deb atalgan) qon tarkibida kreatinin va azotli hayotiy mahsulotlar konsentratsiyasining ortishi bilan , shuningdek, buyraklarning suv-elektrolit gomeostazini to'g'ri boshqarish qobiliyatsizligi bilan xarakterlanadi, O’BJ bolalar orasida ko'paymoqda va so'nggi o'n yilliklarda O’BJ etiologiyasi buyraklarning dastlabki kasalliklaridan ko'p faktorli sabablar tomon siljigan, ayniqsa, kasalxonaga yotqizilgan bolalar orasida. Genetik omillar ba'zi bolalarning O’BJga moyilligini oshirishi mumkinligi aniqlangan. Buyrak jarohatlari pre-renal yetishmovchilikka, buyraklarning ichki kasalliklariga, shu jumladan, vaskulyar insultlarga va obstruktiv uropatiyalarga bo'linadi. Gipoksiya/ishemiya tufayli yuzaga kelgan O’BJ ning patofiziologiyasi etarlicha o'rganilmagan, ammo so'nggi bir necha yil ichida hujayra, biokimyoviy va molekulyar jarayonlarni aniqlashda sezilarli yutuqlar erishilgan. Anamnez to'plash, jismoniy tekshiruv va laboratoriya tekshiruvlari, shu jumladan, siydik tahlili va rentgenografik tekshiruvlar O’BJ ning mumkin bo'lgan sabablarini aniqlashga yordam beradi. Ko'plab aralashuvlar, masalan, buyrak dozasidagi dofaminni kiritish va diuretiklar bilan davolash, O’BJ ning rivojlanishini o'zgartirmasligini ko'rsatdi. O’BJ ning prognozi asosan uning asosidagi etiologiyaga bog'liq. Har qanday sabablarga ko'ra O’BJni boshdan kechirgan bolalar, dastlabki jarohatidan so'ng bir necha yil o'tib, kechki buyrak kasalligi rivojlanishi xavfiga duchor bo'lishadi. O’BJ ni davolashdagi terapevtik aralashuvlar asosan qoniqarli bo'lmagan, ehtimol O’BJ ning patofiziologiyasining murakkab tabiatidan, shuningdek, serum kreatinini konsentratsiyasining buyrak funktsiyasining noaniq ko'rsatkichi ekanligidan va davolangan bemorlardagi hamroh omillardan kelib chiqqan. O’BJ ning patofiziologiyasini, O’BJ ning erta biomarkerlari va O’BJ ni yaxshiroq tasniflashni tushunishning yaxshilanishi O’BJ ni davolash uchun muvaffaqiyatli terapevtik strategiyalarni ishlab chiqish uchun zarur.
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