Kronik Renal Yetmezlik - ForumCampus.com

8/14/2019 Kronik Renal Yetmezlik - ForumCampus.com

1/34

41#4?#=: ]rcf' Kr' Inain{ IDKNG 4

D_Zgjg gbnginuj vnE_Zbj Adu{dbdrg Kn`ci}ng|duzcg~ D_Zgjg gbnginujgkn ng {ninb inunbn adu{dgg k~r~i~g~g

knnrbngkjrjbinujkjr' Zdb" knajkrn vnzd genkng oorn` adu{db hnjrij adu{dbdrd

zd}bded` ~zh~bdidbdrkd kj``d{bj cb~gidbkr' O~ adu{dbdrkd gnfrc{cùj` n{`jbj jbdbdrkdg `dgbidbkr'

]c{dgujznb gnfrc{cùj` jbdbdr `~bbdgbdedùd !rdkzchrdfj` `cg{rdu{dldgbdr" dijgchbj`c|jkbnr* vn dgnu{n|j zd}bdedùd0 gen uvodbdgugg gcridb cbk~~gkdg nijg cb~gidbkr'

U~o`bjgj` knajkrduzcg }anuj vdrud !o~ cr{dbdid . 5)>k|nzjgknkjr* dgnu{n|j vnzd {nkdvj genuj j|c{cgj` uvbdr vnrjbnrn`"rnajkrduzcg udbdgidbkr'

rgn`< 4= `h `}n`

5. q 4= `h 9 ='5 `h q 4=== ib#`h 9 5== ib>. q 4= `h 9 ='> `h q 4=== ib#`h 9 >== ib

Dgnu{n|j urdugkd jkrdr ` `cg{rcb nkjbinbjkjr' krdr `74ib#`h#udd{ jun gcridbkjr' Kdad d| jun D_Zgjg odbdghkgnijkjr' O~ k~r~ikd uv vnrjbinuj" kjrn{j` vn kc}dijgknnrbngkjrjbinbjkjr'


2/34

41#4?#=: ]rcf' Kr' Inain{ IDKNG ?

Dijgchbj`c|jk {cùjuj{nuj Dijgchbj`c|jkbnr ejkkj hrdi !)* ngf'

{nkdvjujgkn adbng `~bbdgbid`{dkr' Dijgchbj`c|jkbnr }rcùjidb {~o~b

aernbnrjgkn ojrj`nrn` rngdb adudrd gnkngcb~r'

Ng {cùj` dijgchbj`c|jk Gncizejg" Ng d| {cùj` cbdg U{rn}{cizejg"

Hng{dijejg" Dij`dejg vn @dgdizejg cr{dknrnenbj gnfrc{cùj`{jr'

Hng{dijujg gnfrc{cùjuj{nuj }cbj~rj jbn unzrnknr"od|ng cbjh~rj` cbdojbjr'


3/34


Ujbjgkjr~rj Gd~g frdùjzcgnb nù`rnuzcg~gkd dr{ @~g frdùjzcgnb nù`rnuzcg~gkd dr{ Hbj`c|~g frdùjzcgnb nù`rnuzcg~gkd dr{ krdr kdguj{nujgjg kinuj ]rc{njg~rj Unr~i `rnd{jgjg dr{ O^G dr{ Hbj`c|~rj

Dijgchbj`c|jk {cùjuj{nujUni}{cibdr


4/34


5/34

41#4?#=: ]rcf' Kr' Inain{ IDKNG >

@rcgj` _ngdb Zn{in|bj`@rcgj` _ngdb Zn{in|bj`N{jzcbclj]d{chngn|@bjgj` o~bh~bdrBdocrd{~dr o~bh~bdr

[naju[nkdvj]rchgc|


6/34


@rcgj` _ngdb Zn{in|bj` !@_Z* @_Z }rjinr ojr oorn` adu{dbkr' Hnbjjij dzbdr)zbbdr urnojbjr'

@_Z }rchrnuujf gnfrcg zì jbn`drd`{nrj|nkjr' [i gnfrcgbdrg 4#5 fcgùjzcg k

`dbk |didg jkrdr `cgudg{rn vn

kjb~n n{in zn{ngnj oc|~b~r' [i gnfrcgbdrg 4#; fcgùjzcg k

`dbk |didg d|c{nij hnbjjr'


7/34


@rcgj` _ngdb Zn{in|bj` !@_Z*

Gnkngbnrj

Oorn`bnrjg `cglngj{db idbfcriduzcg~ @rcgj` }znbcgn}arj{ju _ngdb jnij

!UBN hjoj vdu`bj{ju cb~{~rdg vdu`bnradu{db`bdr*

ii~gcbclj` adudr !ii~g `ci}bn`u adu{db`bdr* D_Zgjg jbnrbninuj


8/34


@rcgj` _ngdb Zn{in|bj` !@_Z*

@bjgj` Kgnibnrj

Unr~i Ernd{jgjgn,

Gcg)d|c{nij` 24'6 ih#kb

Adfjf rngdb d|c{nij 4'6 ) ?'1 ih#kb

Cr{d knrnen rngdb d|c{nij ?': ) > ih#kbjkkn{bj rngdb d|c{nij 7> ih#

, Jg{nrgd{jcgdb _ngdb Jg{nrnu{ Ucejn{z


9/34

41#4?#=: ]rcf' Kr' Inain{ IDKNG :

]d{chngn|ju @_Zkn oorn` fcg`ujzcgbdr knjjr' rnijgjg `bjgj`

onbjr{jbnrj vn }cbjuju{nij` oc|~`b~`bdr hrbr' Oorn`bnr hbcinr~bdr fjb{rduzcg vn {~o~bnr un`rnuzcg

jbn {c`ujgbnrjg !rn" `rnd{jgjg vn kjnr gj{rclng

d{`bdr* d{bidugkd hrnv dbr' D|c{nij Oorn`bnr hbcinr~bdr fjb{rduzcg" {~o~bnr un`rnuzcg vn

{~o~bnr hnrjnijbji zcb~zbd ve~{ uvbdr" ijgnrdbbnrvn nbn`{rcbj{bnrj k|ngbnr'

Duj{)od| knghnuj oc|~b~r' Oorn`bnr bc`db vn uju{nij` n{`jbnrbn acricgbdr vn

od| `jizdudb idkknbnrj !nrz{arc}cjn{jg" d`{jf vj{dijgK* ung{n|bnr'

Dgnij" _ngdb cu{nckju{rcfj


10/34

41#4?#=: ]rcf' Kr' Inain{ IDKNG 4=

]d{chngn|ju

Duj{)od| knghnuj Ujgkjrji fddbjzn{bnrj

ucgrdugkd cb~dg duj{"gcridb duj{)od| knghnujgjgurkrbinuj jjg oorn`fcg`ujzcgbdr jbn d{br'

Hbcinr~b~ubdrkdg fjb{rn

nkjbng oj`drocgd{g hnrjnijbjij oorn` fcg`ujzcg~jbn udbdgr'

Oj`drocgd{g hnrj)nijbjijvn duj{ un`rnuzcgin`dgj|idbdrggoc|~bidu uju{nij`

dujkc|jun gnkng cb~r' Duj{bnxrjg nbjijgduzcg~

{di}cg in`dgj|idbdrknvrnzn uc`dr'


11/34


]d{chngn|ju

Duj{)od| knghnuj [di}cg in`dgj|idbdrg jb`j GA5

{di}cg uju{nijkjr' GA5 ojr A dbr vn GA; adbjgn

kgr' Gnfrcgbdr oc|~bk~~ |didg0

GA5 rn{jij dr{dr' GA5 vn GA; `cgudg{rduzcgbdrgg

dr{idu" uj{c`jg `ccrkjgduzcg~ jbnrngdb kc`~bdrkd zdghz odbd{r'

Dujkjg {di}cgbdgidugkd ?'in`dgj|id `nij` {di}cg~k~r' @nij` icojbj|duzcg~ rngdb

cu{nckzu{rcfj hnbjjijgn gnkng cb~r' @rcgj` dujkc|ju dzg |didgkd @

acincu{d|jujgj kn oc|dr vnaj}c`dbnij hnbjjr'


12/34

41#4?#=: ]rcf' Kr' Inain{ IDKNG 4?

]d{chngn|ju

U~ knghnuj @_Z{n adu{dbdr gnhd{jf uv

odbdgugkdkr' Knajkrduzcg vdrkr'

]cbj~rj" `~uid vn juadbucg~e~ cb~dg

hdu{rcjg{nu{jgdb `dz}bdrgnkngjzbn u~ jin ju{njgkndr{ hrbr !}cbjkj}uj"ajkrduzcg~ urkrin` jjg*'

@_Z jbnrbnkj`n" adu{dbdrkdkn}rnuzcg hnbjjr'

@~uid vn kjnr `dz}bdrcbidugd rding u~ jinju{nj d|dbr vnzd k~r~r'


13/34


]d{chngn|ju

U~ knghnuj Gnfrcgbdrd `dg dffnrng{ dr{nrjcb

jbn hnbjr' Gcridb k~r~ikd }bd|idgg

zd`bd` 4#;)4#5

hbcinr~b~ubdrd hjrnr" fjb{rnnkjbjr vn hbcinr~bdr fjb{rd{cbdrd` {~o~bdr b~ingnhgknrjbjr'

O~ k~r~i fjb{rduzcg frd`ujzcg~

cbdrd` dkbdgkrbr' fjb{rduzcg frd`ujzcg~ 9 rngdb `dg

d`# hbcinr~bdr fjb{rduzcg


14/34

41#4?#=: ]rcf' Kr' Inain{ IDKNG 4;

]d{chngn|ju

U~ knghnuj Hbcinr~bdr fjb{rduzcg cbidkdg `dg nffnrng{ dr{nrjcb

!nffnrng{ dr{nrjcb ink~bbdkd)gnfrcgbdrg {~o~bdr}crujzcgbdrd }drdbnb cbdrd` unzrnkng vd|d rn`{d`d}jbbdrbdrkr)o~b~g~r* jbn hbcinr~b~u~ {nr` nknr'

Udb`b oorn`{n" nrjzj`bnr !genbj`bn rn vnuckz~i* oorn` jg{nru{juz~i~gkd ojrj`jr' O~nrjzj`bnr jg{nru{juz~i~ aj}nr{cgj` adbn hn{jrjr' O~

u~z~g {~o~bnr b~ingkng jg{nru{juz~id hnbinuj jjgojr ~zdr dgbdigkdkr' Ozbnen u~ vd|d rn`{d`d}jbbdrbdrgd hjrnen` vn oorn`bnrj {nr` nknrn`"ujr`bduzcgd hnrj kgnen`{jr'

HF_gg d|dbk |didg0 oz` ij`{drkd `dg" vd|drn`{d `d}jbbdrbdrgkd `dg dìgkd dr{ ucg~e~nffnrng{ dr{nrjcb zcb~ jbn hbcinr~b~u~ {nr` nknr'

@dg dì dr{{ |didg0 nrjzj`bnr !rn vn uckz~i*jg{nruj{juz~i~g kgd d{br !xduac~{*' Ozbnen

aj}nr{cgjuj{n ~|~g urin| vn u~z~g {~o~b kgdìdu jjg kdad ~zdr cb~~r vn ucgrd`j nijbjijjg jg{nru{juz~id hjrnr' O~ ink~bbdr xduac~{cbdrd` dkbdgkrbr'


15/34

41#4?#=: ]rcf' Kr' Inain{ IDKNG 4>

]d{chngn|ju_ngdb un`cgknr aj}nr}drd{jrcjkj|i#rngdb cu{nckju{rcfj

In{docbj` dujkc|jujg nbjijgduzcg~ jjg" ojr {di}cg uju{nicbdrd`" ~|~g urnbj ][A dr{ `nij` bn|zcgbdrggcb~idugd gnkng cb~r'

][A }drd{jrcjk on|jgjg dgd aernbnrj {drdfgkdg un`rn{nnkjbjr'

][A `nij`bnrkng Ed vn ]~ icojbj|n nknr' ][Agg `nij`|nrjgkn n{`jbj cbdojbinuj jjg vj{dijg K hnrn`bjkjr' ][A hdu{rcjg{nu{jgdb uju{nikng Ed vn ] nijbjijgj dr{rr' O~

n{`j jjg kn Vj{dijg K hnrn`bjkjr' ][Agg oorn`bnr |nrjgkn`j n{`juj" Ed hnrj nijbjijgjg dr{

!n`u`rnuzcg~g d|dbidu* vn {~o~bdr ] hnrj nijbjijgjgd|dbidukr !n`u`rnuzcg~g dr{idu*'

][A dzg |didgkd oorn`bnrkn vj{dijg Kgjg d`{jf fcridkgig !4"?> kjazkrcqzeacbnedbejfnrcb* ~zdrr'

Un`cgknr aj}nr}drd{jrcjkj|i !][A dr{* ] vn Ed`cgudg{rduzcg~g~g `cr~gidukr'


16/34


17/34



][A dr{gg ucg~bdr vn `bjgj` onbjr{jbnrj< Z~i~d` kc`~ `dbujfj`duzcg~9]_^_[U In{docbj` nij` adu{db !rngdb cu{nckzu{rc}az* @nij` jbjj fjorc|juj9DGNI

Nrj{rcuj{ frdljbj{nujgjg dr{9B\U Grcg vn `dubdrkd nbn`{rj` d`{jvj{ngjg knjjij gnkngjzbn

Grciu`bnr oc|~`b~`bdr9ING[DB KN]_NUZCG" ADBU\B@ VN@DU \DZJFBJJ

Dijgc duj{bnrjg hnrj nijbjijgjg d|dbidu ][A `uij jgubjg rn|ju{dgugd gnkng cb~r' @dg n`nrj dr{dr' [c`b~`

ajuuj cb~~r9DGC_N@U ][A unbbnr vn a~icrdb jii~gj{nzj oc|dr9NGFN@UZCGBD_D

]_NKU]C\UZCG ][A rngdb fcg`ujzcg `dzogg dr{gd `d{`kd o~b~g~r'


18/34



_~oonr ldx

Fjor| kc`~ dr{ vn `nij`{n|dzfbdid


19/34

41#4?#=: ]rcf' Kr' Inain{ IDKNG 4:

]d{chngn|ju

Dgnij)@cdh~bduzcg oc|~`b~`bdr E_Zkn gcgrnlngnrd{jf" gcricuj{j` vn

gcric`rcij` dgnij hrbr' Nrz{arc}cjn{jg rnbndujgh fd`{crg nùj`bjj

gnkngjzbn" nrj{rcobdu{ jgajojuzcg~" _OE irgg d|dbidu" Fn nùj`bjj !`dg `dzo" nijbjijgjg d|dbidu* iznbcfjorcuju"

@rcgj` ngfnùjzcg @cdh~bduzcg oc|~`b~`bdr

{arciocuj{c}d{j


20/34

41#4?#=: ]rcf' Kr' Inain{ IDKNG ?=

]d{chngn|juGd knghnuj vn @dg odugegg `cg{rcb

Gd odbdgu

Oorn`bnr uckz~i odbdgug urkrin`bn hrnvbjkjr'

Fd|bd Gd~g n`u`rn{n nkjbjr" d|dbk |didg {~{~b~r'

@dg odugegg `cg{rcb

_ngdb zn{in|bj` cbh~bdr aj}nr{dgujzcg jbn unzrnknr'

Aj}nr{dgujzcg

uju{cbj` odug 7 41= iiAh !`}n`* 7 ?== iiAh !`nkj*

kjzdu{cbj` odug 7 :> iiAh !`}n`* 7 4;> iiAh !`nkj*'


21/34

41#4?#=: ]rcf' Kr' Inain{ IDKNG ?4

]d{chngn|juGd knghnuj vn @dg odugegg `cg{rcb

Aj}nr{dgujzcg~g gnkngbnrj [~| vn uv n`u`rnuzcg~ oc|~`b~`bdr

Kdidr unr{bjj

Dkrngnrlj` d`{jvj{ngjg knjinuj _ngjg)dghj{ngujg)dbkcu{nrcg uju{nijgjg d`{jvduzcg~

_ngdb }rcu{dhbdgkjgbnrjg kn}rnuzcg~

Kjnr jzcgj` oc|~`b~`bdr

Ih dr{9 ~z~~`b~` vn irciu`bnr aduudujzn{ @ gcridb vnzd k` cbdojbjr' K` cbk~~gkd

`nkjbnrkn drb izc}d{j zd}dojbjr'


22/34

41#4?#=: ]rcf' Kr' Inain{ IDKNG ??

@bjgj` o~bh~bdr @bjgj` o~bh~bdr gcgu}nujfj`{jr'

]cbj~rj & }cbjkj}uj" Gce{~rj#jgecg{jgngen" Hdu{rcjg{nu{jgdb onbjr{jbnr" dgcrnqj vnzd kn}rnuzcg'

Fj|j`unb i~dzngn o~bh~bdr Knajkrduzcg" Drb` `dzo" Ucbh~g i~`c| iniordgbdr" Crdb bunrbnr !Crdb od`{nrjbnr {drdfgkdg udbzdkd`j rngjg

dicgzdd z`i gnkngjzbn cb~~r*'

Oorn` }db}duzcg~gkd `bin" ]d{cbclj` `r`bdr vnzd kj `dz}bdr Aj}nr{dgujf adu{dbdrkd rn{jgdb dzrbid gnkngjzbn `rb`

cb~dojbjr'


23/34


Crdb bunr


24/34


25/34


26/34


[nkdvj

rnij` adu{dbdrkd uv {nkdvjuj ng gnibjujkjr'

Unonon zgnbj` u}nujfj` {nkdvjbnr }bdgbdgr'

]rjinr gnkngjg cr{dkdg `dbkrbidu" aj}nr`dbunij` gnfrc}d{j`

k~r~ibdrg k|nb{jbinuj" ngfnùjzcgbdrg hjknrjbinuj" ij`c{j`

ngfnùjzcgbdrg `cg{rcb" cou{rùjzcgbdrg hjknrjbinuj vn

jnijgjg gnkng cbk~~ dgcridb rngdb `dg d`gg

k|ngbnginuj o~ `d}udikdkr'

Kj~rn{j`bnr ngkj`n knjbkjr !cbjh~rj zcùd*'

@cgunrvd{jf inkj`db {nkdvj ~zh~bdidbdr zd}br'


27/34


[nkdvj

@cgunrvd{jf inkj`db {nkdvj Ugru| u~ vnrjbjr' U{rnu{ng !nvrn knjj`bj`bnrj* `dgbr' Oorn`

fddbjzn{bnrjgj |crbdzded` {nkdvjbnrkng !gnfrc{c`ujgbnrj`cr{j`cu{nrcjkbnr* `dgbr'

Knajkrduzcg vn }rnrngdb d|c{nij gnkngbnrj !enrrdajikdadbn" `~uid" kjzdrn* hjknrjbjr' Kjzn{ }rc{njgj k|ngbngjr' ] `u{bdgr' @dg oduge `cg{rcb nkjbjr' U~kd nrjzng vj{dijgbnr vnrjbjr' Duj{)od| knghnuj k|ngbngjr' Dgnij k|nb{jbjr'


28/34


[nkdvj

@cgunrvd{jf inkj`db {nkdvj

U~kd nrjzng vj{dijgbnr O vn E vj{dijgbnrj vnrjbjr'

Kjzn{ vn }rc{njg ]rc{njg crdg . 4>)?> drdugkdk|ngbnginbjkjr'

@nkj ?:)5= . @}n` 4>)46 .

Ajbbu }rnuerj}{jcg kjn{ @K


29/34

41#4?#=: ]rcf' Kr' Inain{ IDKNG ?:

[nkdvj


] ù{bdidu ] odbdzebdr vnrjbjr'

Dbijgz~i ajkrcùj{" `dbujz~i uj{rd{ vn `dbujz~i

`drocgd{ Hkdbdrbd ojrbj`{n vnrjbjr' Odbed zdg n{`jbnrj aj}cfcufd{nij"

`cgu{j}duzcg vn dbijgz~i {cùjuj{nujkjr' @dg Ed vn ] unvjznbnrj 4=)4; hg drdb`bdrbd

j|bnginbjkjr'


30/34

41#4?#=: ]rcf' Kr' Inain{ IDKNG 5=

[nkdvj

@cgunrvd{jf inkj`db {nkdvj Gd odbdgu vn `dg odugegg k|nb{jbinuj

Gd odbdgugg urkrbinuj jjg ='=5 {c ='4; h uckj~i#4== `edbjnrng kjzn{bnr hgkn ? `n| vnrjbjr'

Aj}nr{dgujzcg~g {nkdvjuj0 Gd dbigg d|db{bidu

Kjrn{j`bnr On{d)dkrngnrlj` dhcgju{bnr !}rc}dgcbcb* Dbfd)dkrngnrlj` obc`rbnr !}rd|cujg* DEN jgajoj{rbnrj !ed}{c}rjb" ngdbd}rjb" ongd|n}rjb* @dbujz~i `dgdb obc`rbnrj !vnrd}dijb" dibckj}jgn*

Dgdocbj` dldgbdr vnrjbnojbjr'

Nrj{rc}cjn{jg u{jibduzcg~ vn `nij` oc|~`b~`bdrgg k|nb{jbinujjjg [nu{cu{nrcgn" u{dgc|cbcb !Xjgu{rdb V*" cqzin{acbcgn vn

gdgkrcbcgn knedgcd{n `~bbdgbdojbjr' N{`juj {dr{idbkr'


31/34


[nkdvj


Dgnijgjg {nkdvjuj0 @dg {rdguf|zcg~ Nrj{rc}cjn{jg vnrjbnojbjr'

]EV rnu{crduzcg~gkd c` n{`jbjkjr' Dg{j`cr rn{jijgj u~}rnun nknr' Aj}nr{dgujzcg

vn gon{ zd}dojbjr' Kj``d{bj `~bbdgbidbkr' Nrz{arc}cjn{jg u~o`~{dg) >= {c 4>= ^#`h

kc|~gkd adf{dkd 5 `n| vnrjbnojbjr'


32/34

41#4?#=: ]rcf' Kr' Inain{ IDKNG 5?

[nkdvj


][A u~}rnuzcg~0 K` kc| 4" ?> kjazkrcqzeacbnedbejfnrcb

!edbej{rjcb* jbn zd}bdojbjr'

Edbej{rjcb ?'> ) 5'> gh#`h kc|~gkd vnrjbjr' ]rc{c`cb Aj}nrfcufd{nij `cg{rcb nkjbjr' Od|db ][A unvjznuj onbjrbngjr' ?'> {c 5'> gh#`h#hg kc| ~zh~bdgr'

Unr~i Ed 4 & ? adf{d j|bngjr' ][A 4" 5 vn 6' dzbdrkd `cg{rcb nkjbjr'


33/34


[nkdvj

@cgunrvd{jf inkj`db {nkdvj Kjzn{ bj}jkbnrjgjg `cg{rcb hnrn`bjkjr' Cinhd 5 vn cinhd 6 zd duj{bnrj

njecudgcjkbnrn kgnrn` bc`db rngdb n{`jbnrngnkng cb~r'

Cinhd 5 }cbz~gud{~rd{nk !]^* zd duj{bnrjrngdb fcg`ujzcg~ `cr~r' Cinhd 5 ]^FD vnrjbinuj aj}nr`cbnu{nrcbnijzj

d|db{r' Zdghz vn `cdh~bduzcg~ odu`bdr"`dg odugeg rnu{crn nknr vn rngdb

anickjgdij`bnrj hnbj{jrjr' 4)> h cinhd 5 ]^FD #hg


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41#4?#=: ]rcf' Kr' Inain{ IDKNG 5;

zj knrubnr

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Kronik Renal Yetmezlik - ForumCampus.com