Kusukela kusukela esikhathini esidala, sisebenzise izidakamizwa ukuze sibone ngaphezulu. Amanye ama-diuretics afana ne-caffeine ayenawo wonke umuntu (cabanga itiye noma iziphuzo ezithambile). Kodwa-ke, kwakungakaze kube yikhulu leminyaka lama-20 ukuthi isintu saqaphela ukuthi kungenzeka ukuthi izidakamizwa zezidakamizwa zikwazi ukuthatha imithi. Ngo-1937, abacwaningi bathola izidakamizwa ze-carbonic anhydrase. Ngo-1957, abacwaningi babethole ama-diuretics amaningi kakhulu e-chlorothiazide.
I-Diuretics isebenza ngokwandisa umthamo womchamo owenzayo futhi uguqule izingqikithi zomzimba womzimba wakho we-electrolyte noma womzimba. Imiqondo elula emihle, huh? Noma kunjalo, izinqubo ezihlukahlukene zezinto eziphilayo ezisebenza ngazo izidakamizwa zinzima ukuqonda. Isibonelo, ukwakheka komchamo kuhilela ama-gradients, ama-osmosis, abathungisi kanye nokunye okunye.
Ngomqondo ovamile, izidakamizwa zisebenza ngokuqeda umzimba wethu ngokweqile ngokweqile noma "amanzi." Kukhona izifo eziningi ezikhishwa ukukhululwa komthamo okubandakanya ukushisa komfutho, ukwehluleka kwenhliziyo, ukuvuvukala kwengqondo (i-edema), ukuvuvukala kweso (ukuvuvukala kweso) nokuvuvukala kwesibindi noma isifo sezinso.
Ngaphambi kokufunda indlela ukusebenza ngayo izidakamizwa, ake sihambe kancane kwi- nephron kanye nesimo samathambo we-renal. Phela, izidakamizwa zisebenza ngezenzo ezingxenyeni ezihlukahlukene ze-nephron, iyunithi eyisisekelo yezinso eziphethwe ukuhlunga umchamo.
Ukubuka iNafron
Nansi i-rundown ye-nephron anatomy:
- Igazi likhishwa emzimbeni libe yi-corpuscle ye-renal ehlanganiswe ne-glomerulus, i-tuft yamapillazi, kanye ne-capmanle ka-Bowman. I-corpuscle yama-renal yisinyathelo sokuqala sokuhlunga umchamo.
- I-glomerulus igxila ema-tubulus e-renal, isistimu yamatayipi amancane anesibopho sokwenza umchamo. Ingxenye yokuqala ye-tuble ye-renal yi-tubula e-convoluted proximal.
- I-tubuloni ehamba phambili edlalwa yi-Henle. Ingxenye yokuqala ye-loop yehla isilungu futhi okwesibili yiyilungu elikhuphukayo elikhuphukayo.
- Isidumbu esenyukayo sondla endaweni ye-tubal evulekile.
- I-tuble ephazamisekile ekhonjisiwe iyaqhubekela phambili kumgwaqo wokuqoqa.
Njengoba kukhonjisiwe ngaphambili, izidakamizwa ezihlukahlukene zisebenza ezingxenyeni ezihlukene ze-tubal renal. Ngokuvamile, i-nephron inesibopho sokufihla imfucuza ibe yi-ultrafiltrate egcina ekugcineni iba umchamo nokuvuselela izakhi kanye nezinye izinto ezinhle umzimba wethu udinga njenge-sodium ions (Na + ), i-sodium bicarbonate (NaHCO 3 ), i-i-potassium ions (K + ), amanzi futhi cishe yonke i-glucose ehlungiwe nama-amino acids. (Ngokuyisisekelo, iningi lalezi zikhathi zokuvuselela izakhi zenzeka emgqonyeni we-convoluted.)
I-Carbonic Anhydrase Inhibitors
I-carbonic anhydrase inhibitors enjengomsebenzi we-acetazolamide ngokuvimbela i-enzyme i-carbonic anhydrase esesigxini esiphezulu se-tubuloni. Ngokuvamile, i-anhydrase ye-carbonic inesibopho sokuncelisa i-sodium (i-NHE3 antiporter), i-potassium, amanzi, ama-amino acids kanye noshukela emuva egazini lakho. Ngokuvimbela le enzyme, izidakamizwa ezifana ne-acetazolamide zandisa inani lamanzi ohlelweni lwe-tubula le-renal. Ama-inhibitors e-carbonic anhydrase asetshenziselwa ukuphatha i- glaucoma .
I-Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitors
I-sodium-glucose cotransporter 2 (SGLT2) inhibitors yi-ribonucleotide e-phosphorylated ethatha isinyathelo kwi-sodium glucose cotransporter esesigxini esiphezulu se-tubuloni. Zivimbela izenzo ze-transporter futhi zinciphise ukubuyisela kabusha kwe-glucose nama-sodium ions emuva egazini lakho. Ngama-ioni ambalwa kakhulu aphinde avuselele amanzi amancane alandela (osmosis), kanye nemiphumela emihle ye-diuresis. Nakuba izidakamizwa ze-SGLT2 ezinjenge-canagliflozin ne-dapagliflozin ziyi-diuretics ezinomsoco, ngenxa yezenzo zabo zoshukela, zisetshenziselwa ukuphatha isifo sikashukela.acetazolimide
Loop Diuretics
I-Loop diuretics efana ne-furosemide inqanda i-Na / K / 2Cl transporter emgqeni okhuphuka we-Henle; ngaleyo ndlela, ukunciphisa ukubuyisela kabusha kwe-sodium namanzi egazini lakho. Ngenxa yokuthi i-loop diuretics iphinda ihlaziye ngokubuyisela kabusha i-potassium, ukuchithwa kwe-potassium kungenzeka. Uma i-potassium ishaya kakhulu, i-hypokalemia ingabangela. Okubaluleke kakhulu, i-hypokalemia ingakwazi ukugxilisa indlela inhliziyo yakho isebenza ngayo i-Furosemide isetshenziselwa ukwelapha umfutho wegazi ophezulu (umfutho wegazi ophezulu), uketshezi emaphashini (i-pulmonary edema), ukuvuvukala okujwayelekile, i-hyperkalemia (amazinga aphezulu we-potassium) kanye ne-hypercalcemia noma amazinga aphezulu e-calcium ( ukusetshenziswa kwelebula).
Thiazides
I-Thiazides isebenza ngokugxilisa ne-Na / Cl transporter endaweni ye-distal ye-distoluted. Ngaphezu kokuvimbela ukuphindwa kabusha kwama-sodium ions namanzi, i-thiazide nayo iholela ekubhujisweni kwe-potassium. I-Thiazides isetshenziselwa ukwelashwa kokuqala komfutho wegazi ophezulu; Eqinisweni, isifundo esidumile sathola ukuthi ama-thiazide asebenza kangcono njengokwelashwa kokuqala kwe-hypertension kune-ACE inhibitors.
Uma izinga lokuhlunga kwe-glomerular (umsebenzi wezinso wezinso) liphansi kakhulu, ama-thiazide awasebenzi kahle lokho. Ngokuvamile, ama-thiazide avame ukuhlanganiswa ne-loop diuretics ngomphumela we-synergistic.
Ngaphezu kokushisa komfutho wegazi, ama-thiazide asetshenziselwa ukwelapha izinso ze-calcium ezinama-diabetes nesifo sikashukela i-insipidus (ehlukile kohlobo olujwayelekile kakhulu 1 nohlobo lwesibili lwesifo sikashukela).
I-Potassium-Sparing Diuretics
Njengoba amagama abo asikisela, i-potassium-sparing diuretics isebenza ngokwandisa ivolumu yomchamo ngaphandle kokuchitha i-potassium. I-potassium-ukuphazamisa njenge-spironolactone noma i-amiloride kokubili yenza isithwathwa sokuqoqa kodwa isebenzisa izindlela ezahlukene zesenzo.
I-spironolactone iphikisa i-aldosterone ngendlela engafanelekile. I-Aldosterone iyi-hormone ye-steroid ekhishwe yi-correx e-adrenal. Ngokuphikisa imiphumela ye-aldosterone, i-potassium, ukugcinwa kwe-sodium namanzi kuncishisiwe. I-spironolactone ivame ukusetshenziselwa ukulwa nokuchitheka kwe-potassium okubangelwa yi-thiazide ne-loop diuretics. Lesi sidakamizwa siphathwa ngemuva kokuhlaselwa kwenhliziyo noma esetshenziselwa ukuphatha i-aldosteronism kunoma yisiphi isizathu.
U-Amiloride uvimbela imigudu ye-sodium ebuthini lokuqoqa futhi ngaleyo ndlela ivimba ukubuyiswa kabusha kwamanzi emzimbeni wakho. Njenga-spironolactone, i-amiloride ivame ukusetshenziselwa ukulwa nokubhujiswa kwe-potassium okubangelwa ezinye izidakamizwa.
I-Osmotic Diuretics
I-osmotic diuretics idlula emzimbeni wakho. Uma i-osmotic diuretic efana ne-mannitol ingena emathinini akho e-renal, ayidonsela emanzini nge-osmosis. (Khumbula nge-osmosis, amanzi alandela ukuxilongwa okuphezulu kwezingxubevange. Ngaphezu kwalokho, izidakamizwa ze-osmotic ezitsheni ezingaphandle kwezinso (cabanga ubuchopho noma iso) nazo zingakhipha amanzi futhi zinciphise ukuvuvukala.
Ngaphandle kokwelashwa kokubili ukuvuvukala kwamehlo (glaucoma) nokuvuvukala kobuchopho (ukunyuka kwengcindezi yokunyuka kwengqondo), ama-osmotic diuretics asetshenziselwa ukwehlisa ukuhluleka okungekho emkhakheni we-solute obangelwa yi-chemotherapy noma i-rhabdomyolysis (ukuphazamiseka kwemisipha). Ngamanye amazwi, ngokuxubha izidakamizwa nezinsimbi zomsizi e-nephron, ukucindezeleka okuncane kufakwa ezintsheni.
Ama-Vaptans
Abaphikisi be-Vasoreceptor noma ama-vaptans (conivaptan ne-tolvaptan) yiqembu elisha lezidakamizwa. Zisebenza nge-antagonism ye-vasopressin noma i-hormone ye-antidiuretic futhi inika amandla umzimba wakho ukuvikela amanzi angenawo amandla e-electrolyte. Ngenxa yalokho, ama-vaptans asiza ngezimo ze-hyponatremic ezichazwe ukuhlushwa okuphansi kwe-sodium egazini njenge-SIADH.
Iningi lama-diuretics elikhulunywe ngakho kulesi sihloko liyatholakala ngemithi yesiguli. Noma kunjalo, ungathenga ezinye izidakamizwa ngaphandle kwemithi. Ngisho noma nje ukwandisa ivolumu yakho yomchamo futhi uhambelana namazinga akho e-electrolyte kungase kuzwakale inobungozi, uma kuthathwa ngokungalungile, izidakamizwa zingabangela ukuphelelwa amandla kwamanzi kanye nokungalingani kwe-electrolyte okungase kubulawe (ukungcola nge-body salts). I-Diuretics ingaphinde ikhulise i-cirrhosis, ukwehluleka kwenhliziyo, noma ukwehluleka kwenqunu. Sicela uthathe izidakamizwa kuphela emva kokubonisana nodokotela wakho ikakhulukazi uma udaba lwe-balance balance.
Encwadini yokugcina, uma ucabanga nge-caffeine, ucwaningo lubonisa ukuthi uma umuntu onempilo ephuza uphuzo oludakayo, ukulahlekelwa uketshezi akukona ukwedlula umthamo wesiphuzo esetshenziswayo futhi isimo se-hydration asizange sithinteke. Ngamanye amazwi, uma uphile kahle i-caffeine iphephile.
Imithombo:
I-Eaton DC, i-Pooler JP. Isahluko 8. Isimiso sokulinganisa kwePotassium. Ku: Eaton DC, Pooler JP. ama-eds. I-Vander's Physiology Renal, 8e . ENew York, NY: McGraw-Hill; 2013.
Sam R, Pearce D, Ives HE. Ama-Diuretic Agents. Ku: Katzung BG, Trevor AJ. ama-eds. I-Basic & Clinical Pharmacology, 13e . ENew York, NY: McGraw-Hill; 2015.