ʻO nā puʻupaʻa (mai ka Lani lat, renis) nā lālā i ʻāpana o ka ʻōnaehana urinary. Mālama lākou i ka kānana ʻana o ke koko ma ka hoʻopau ʻana i nā ʻōpala o laila ma o ka hana ʻana o ka mimi. Mālama pū lākou i ka wai o ke kino a me ka ʻike mineral.

ʻO nā nothings, ʻelua i ka helu, aia ma ka ʻaoʻao hope o ka ʻōpū ma ka pae o nā iwi ʻaoʻao ʻelua i hala, ma kēlā me kēia ʻaoʻao o ka iwikuamoʻo. ʻO ka hakuʻala ʻākau, aia ma lalo o ke ake, ma lalo iki o ka hema, aia ma lalo o ka ʻāpala.

Kēlā me kēia hakuʻala, bean-hoʻokino, ana i ka awelika 12 knm ka loa, 6 knm ka laula a 3 knm ka mānoanoa. Kuhi ʻia lākou e kahi adrenal gland, kahi lālā no ka ʻōnaehana endocrine a pili ʻole i ka hana mimi. Hoʻopuni ʻia kēlā me kēia e ka pūpū pale i waho, ka capsule fibrous.

Māhele ʻia ka loko o nā puʻupaʻa i ʻekolu mau ʻāpana (mai waho a i loko).

• ʻO ka ʻōpū, ʻo ka ʻaoʻao i waho loa. ʻO Pale i ke kala a ma kahi o 1 cm ka mānoanoa, uhi ia i ka medulla.
• ʻO ka medulla, ma waenakonu, he ʻulaʻula ʻulaʻula i ke kala. Loaʻa iā ia he mau miliona o nā wae kānana, nā nephrons. He glomerulus ko kēia mau hale, kahi poepoe liʻiliʻi kahi e hana ai ke kānana koko a me ka mimi. Pili pū lākou i nā tubule i pili pono i ka hoʻololi ʻana i ka mimi.
• ʻO nā calyces a me nā pelvis he mimi e ʻohiʻohi ana i nā lua. Loaʻa i nā calyces i ka mimi mai nā nephrons a laila ninini ʻia i loko o ka pelvis. E kahe ana ka mimi ma waena o nā ureter i ka pūpū, kahi e mālama ʻia ai ma mua o ka hemo ʻana.

Kaha ʻia ka lihi o nā puʻupaʻa e kahi notch, ka hilum renal kahi e hoʻopau ai nā kīʻaha koko a me nā ʻalalā a me nā ureter. Hiki ke koko "hoʻohana" i nā puʻupaʻa ma o ke aʻa ākea, kahi lālā o ka aorta ʻōpū. Hoʻokaʻawale kēia aʻa aʻa i loko o ka puʻupaʻa. Hoʻouna ʻia ke koko e hoʻouna ʻia i ka vena cava inferior ma o ka aa koko. Loaʻa i nā puʻupaʻa 1,2 liters o ke koko i kēlā me kēia minuke, ʻo ia ka hapahā o ka nui o ke kahe o ke koko.

I ka hanana o nā pathologies, hoʻokahi wale nō hakuʻala hiki ke hana i nā hana renal.

ʻEhā mau hana nui a nā hakuʻala:

• Ka ulu ʻana o ka mimi mai ka kānana ʻana i ke koko. Ke hele ke koko i nā puʻupaʻa ma o ke aʻaʻa renal, hele ia ma nā nephrons kahi e hoʻomaʻemaʻe ʻia ai i kekahi mau mea. Hoʻokuʻu ʻia nā mea ʻōpala (urea, uric acid a i ʻole creatinine a me nā koena o ka lāʻau) a me nā mea keu aku i ka mimi. ʻO kēia kānana e hiki ai i ka manawa like ke hoʻomalu i ka wai a me ka ion content (sodium, potassium, calcium, etc.) i loko o ke koko a mālama i ke kaulike. I loko o 24 mau hola, kānana ʻia ka 150 a 180 lita o ka plasma koko e hana ai ma kahi o 1 lita a 1,8 lita o ka mimi. Hana ʻia ka mimi i ka wai a me nā solutes (sodium, potassium, urea, creatinine, etc.). ʻAʻole loaʻa kekahi mau mea i loko o ka mimi (glucose, proteins, red blood cell, white blood cell, bile).
• Secretion o renin, kahi enzyme e kōkua i ke kaohi i ke kahe o ke koko.
• ʻO ka huna o erythropoietin (EPO), kahi hormone e hoʻoulu ai i ke kūkulu ʻia ʻana o nā hunaola ʻulaʻula i ka iwi iwi.
• ʻO ka loli o ka wikamina D i kāna ʻano hana.

Nā pōhaku hakuʻala (pōhaku hakuʻala) : i kapa ʻia he "pōhaku hakuʻala", he mau aniani paʻakikī kēia e hana i nā puʻupaʻa a hiki ke hōʻeha i nā ʻehaʻeha. Ma aneane 90% o nā hihia, hana nā pōhaku urinary i loko o kahi puʻupaʻa. He loli loa ko lākou nui, mai kahi mau mile a i kekahi mau kenimika ke anawaena. ʻO kahi pōhaku i hana ʻia i loko o ka puʻupaʻa a i ke kaʻa ʻana i ka ʻōpū hiki ke ālai maʻalahi i kahi ureter a hōʻeha i ka ʻehaʻeha. Kapa ʻia kēia he colic renal.

Nā hana ʻino :

Mākala hōʻino : anomaly congenital i hiki ke hoʻopili i hoʻokahi kīʻaha a ʻelua paha. I ka ulu ʻana o ka embryonic, hoʻoneʻe ka hakuʻala i ke kolamu i kona wahi hope loa a kaʻapuni. I ka hihia o kēia pathology, ʻaʻole i hana pololei ʻia ka huli ʻana. ʻO ka hopena, ke pelvis, aia ma ke ʻaoʻao o loko o ka ʻole o ka mea, i loaʻa ma kona alo mua. ʻO ka anomaly he benign, paʻa pono ka hana renal.

Pālua kōpaʻa . Kūʻokoʻa kēia kīʻaha, me kāna vascularity ponoʻī a me kāna ureter ponoʻī e alakaʻi pololei i ka pūpū a hui pū paha i ka ureter o ka puʻupaʻa ma ka ʻaoʻao like.

Hydronéphrose : he mea ia o ka calyces a me ka pelvis. ʻO kēia hoʻonui ʻana i ka nui o kēia mau lua ma muli o ka hoʻopili ʻana a i ʻole ke ālai ʻana o ka ureter (malformation, lithiasis…) ka mea e pale i ke kahe o ka mimi.

Kahiko holo lio : malformation i hopena ʻia mai ka hui ʻana o nā puʻupaʻa ʻelua, ma o ka pou o lalo. Aia kēia puʻupaʻa ma lalo o nā puʻupaʻa maʻamau a ʻaʻole pili ka ureter. ʻAʻole hiki i kēia ʻano ke alakaʻi i kekahi hopena pathological, ʻike pinepine ʻia ia e ka manawa maʻamau i kahi X-ray ninaninau ʻia.

ʻO ke kino maʻamau :

Ka hōʻeha ākea a me ka hōʻino ʻole : ka emi ʻana o ka hiki ʻana o nā puʻupaʻa ke kānana i ke koko a hoʻokuʻu i kekahi mau hormones. ʻO nā huahana o ka metabolism a me ka wai nui e hele liʻiliʻi a emi i loko o ka mimi a hōʻiliʻili i loko o ke kino. ʻO ka maʻi maʻi maʻi maʻi ma muli o nā pilikia mai ka maʻi diabetes, ke koko kiʻekiʻe, a i ʻole nā ​​maʻi ʻē aʻe. Acute kidney failure, ma kekahi ʻaoʻao, hiki koke mai. Hiki pinepine ia ma muli o ka emi ʻana o ke kahe koko renal (dehydration, maʻi koʻikoʻi, etc.). Hiki i nā maʻi ke loaʻa ka pōmaikaʻi mai ka hemodialysis me ka hoʻohana ʻana i ke kīkī hana.

ʻO Glomerulonephritis : ka hoʻohauna a hoʻopōʻino paha i ka glomeruli o ka puʻupaʻa. ʻAʻole holo pono ke kānana o ke koko, loaʻa nā protein a me nā hunaola ʻulaʻula i ka mimi. Hoʻomaopopo mākou ma waena o ka glomerulonephritis mua (pili wale nā ​​nothings) mai ka glomerulonephritis lua (ka hopena o kahi maʻi ʻē aʻe). ʻO ke kumu maʻamau o ke kumu i ʻike ʻole ʻia, ua hōʻike ʻia hiki i ka glomerulonephritis ke laʻa, ke hele ma hope o kahi maʻi, ka lawe ʻana i kekahi lāʻau (eg: non-steroidal anti-inflammatory drug like ibuprofen) a i ʻole ka genetical predisposition.

Infections

Pyelonephritis : maʻi o nā puʻupaʻa me ka bacteria. I ka hapanui o nā hihia, ʻo kēiaEscherichia Coli, kuleana no 75 i ka 90% o cystitis (maʻi urinary tract maʻiʻaʻai), e hoʻonui i ka pākino a piʻi i nā puʻupaʻa ma o nā ureter (8). ʻO nā wahine, ʻoi loa i nā wahine hāpai, ʻo ia ka nui o ka makaʻu. ʻO nā ʻōuli e like me ka cystitis e pili ana i ke kuni a me ka ʻeha o ke kua i lalo. Hana ʻia ka lapaʻau ma ka lawe ʻana i nā lāʻau ʻaloʻalo.

ʻO nā kūpuna Benign

Cyst : ʻO kahi cyst kidney kahi ʻeke o ka wai e hana i nā puʻupaʻa. ʻO nā cista maʻalahi (a me kahi kaʻawale) ka mea maʻamau. ʻAʻole lākou e hoʻokumu i nā pilikia a i ʻole nā ​​hōʻailona. ʻAʻole ka maʻi nui ka hapa nui, akā hiki i kekahi ke hoʻohaunaele i ka hana o ka meaola a hana i ka ʻeha.

Maʻi Polycystic : ka maʻi hoʻoilina i hōʻike ʻia e ka hoʻomohala ʻana i kahi lehulehu o nā kōpū renal. Hiki i kēia ʻano ke alakaʻi i ke kiʻekiʻe o ke koko a me nā kōpaʻa ʻole.

Nā kūpale kūpale 

ʻŌpū o ka pūpū o ka lolo : hōʻike ia ma kahi o 3% o nā maʻi ʻaʻai a hoʻopili ʻelua mau manawa i ka nui o nā kāne ma mua o nā wahine (9). Hana ʻia ka maʻi ʻaʻai ke hoʻololi ʻia kekahi mau hunaola i loko o ka puʻupaʻa, e hoʻonui i ke ala exaggerated a uncontrolled, a hana i kahi tum tumo malignant. I ka hapanui o nā hihia, ʻike pinepine ʻia ka maʻi ʻaʻai kolo ma kahi nānā ʻana o ka ʻōpū.

Kāohi. Pono ka pale ʻana i kāu mau puʻupaʻa. ʻOiai ʻaʻole hiki ke pale ākea ʻia kekahi mau maʻi, hiki i nā ʻano nohona olakino ke hōʻemi i ka pilikia. Ma ka laulā, noho hydrated (ma ka liʻiliʻi 2 liters o kēlā me kēia lā) a me ke kaohi ʻana i kāu lawe paʻakai (ma o ka papaʻai a me nā haʻuki) he mea maikaʻi no ka hana puʻupaʻa.

Paipai ʻia nā hana kikoʻī ʻē aʻe e hōʻemi i ka makaʻu a pale paha i ka hoʻi hou ʻana o nā pōhaku kōkō.

I ke kumu o ka holo pono ʻole ʻana o ka puʻupaʻa, ʻo nā kumu nui ʻelua ka diabetes (ʻano 1 a me 2) a me ke kahe kiʻekiʻe. ʻO ka kaohi maikaʻi o kēia mau maʻi e hoʻoliʻiliʻi nui i ka makaʻu o ka holomua i kahi hihia o ka lawa ʻole. ʻO nā ʻano ʻē aʻe, e like me ka hōʻalo ʻana i ka ʻalekohola, lāʻau lāʻau a me ka hōʻino ʻana i ka lāʻau, hiki ke pale aku i ka maʻi.

ʻŌpū o ka pūpū o ka lolo. ʻO nā kumu pilikia nui ke puhipaka, ka nui o ke kino a me ka momona paha, a ʻaʻohe o ka dialysis i ʻoi aku ma mua o ʻekolu mau makahiki. Hiki i kēia mau kūlana ke hoʻoikaika i ka ulu ʻana o ka maʻi ʻaʻai (10).

Nā hoʻokolohua hoʻokolohua : Ka hoʻoholo ʻana i kekahi mau mea i loko o ke koko a me ka mimi e hiki ai ke loiloi i ka hana o ka hakuʻala. ʻO kēia ka hihia, no ka laʻana, no ka creatinine, urea a me nā protein. I ke kumu o ka pyelonephritis, kauoha ʻia kahi cytobacteriological examination o ka mimi (ECBU) e hoʻoholo i nā germs e pili ana i ka maʻi a pēlā e hoʻopili ai i ka lāʻau.

ʻO Biopsy: hoʻāʻo e pili ana i ka lawe ʻana i kahi laʻana o ka puʻupaʻa e hoʻohana ana i kahi nila. Hoʻokomo ʻia ka ʻāpana i hoʻoneʻe ʻia i ka hoʻokolohua microscopic a me / a i ʻole ka hoʻopili ʻana o ka biochemical e hoʻoholo ai inā he maʻi ʻaʻai ia.

NA POSA 

Ultrasound: ke kiʻina kiʻi e hilinaʻi nei i ka hoʻohana ʻana o ka ultrasound e ʻike pono ai i ka hanana kūloko o kahi meaola. ʻAe ʻo Ultrasound o ka ʻōnaehana urinary i ka ʻike ʻana i nā puʻupaʻa akā ʻo nā ureter a me ka pūpū. Hoʻohana ʻia ia e hoʻokalakupua, i waena o nā mea ʻē aʻe, malformation renal, lawa ʻole, pyelonephritis (pili me ECBU) a i ʻole pōhaku hakuʻala.

Uroscanner: ke kiʻi kiʻi ʻana i loko o ka "scanning" i kahi ʻāpana i hāʻawi ʻia o ke kino i mea e hana ai i nā kiʻi ʻāpana, mahalo i ka hoʻohana ʻana o kahi kukuna X-ray. Hiki iā ia ke nānā i ka mimi holoʻokoʻa holoʻokoʻa (nā puʻupaʻa, nā ʻōpū excretory, bladder, prostate) i ke ʻano o ka pathology renal (cancer, lithiasis, hydronephrosis, a pēlā aku.). Ke hoʻololi hou nei ia i ka urography intravenous.

MRI (kiʻi resonance ʻumeume) Hiki iā ia ke kiʻi i nā kiʻi kikoʻī loa i nā ana āpau o ke alapiʻi mimi i ka hihia o kahi MRI o ka wahi tiyan-pelvic. Hoʻohana ʻia ia e hoʻohālikelike i kahi tumo a i ʻole e hana i kahi kuhi o ka maʻi ʻaʻai.

Intravenous urography: X-ray nīnau e hiki ai ke ʻike i ka ʻōnaehana urinary holoʻokoʻa (nā puʻupaʻa, nā pūpū, nā ureter a me nā urethra) ma hope o ka hoʻopili ʻana o kahi huahana opaque i nā kukuna X e hoʻopili ana i ka mimi. Hiki ke hoʻohana i kēia ʻenehana kikoʻī i ka hanana o lithiasis a i ʻole e hoʻohālikelike i ka hana o nā puʻupaʻa.

ʻO ka scintigraphy kidney: he ʻenehana kiʻi kēia e pili ana i ka lawelawe ʻana i kahi tracer radioactive i ka mea maʻi, i pāhola ʻia ma nā puʻupaʻa. Hoʻohana ʻia kēia hoʻokolohua e ana i ka hana o nā puʻupaʻa, e nānā i ka morphology a i ʻole e loiloi i ka hopena o ka pyelonephritis.

I ka lāʻau lapaʻau Kina, hoʻopili ʻia kēlā me kēia ʻano manaʻo ʻelima i hoʻokahi a i ʻole nā ​​ʻokana. Pili pololei ka makaʻu me nā puʻupaʻa.