Ho tloha mehleng ea boholo-holo, re sebelisitse diuretiki ho hlahloba ho feta. Li-diuretics tse kang caffeine li fumaneha hangata (nahana ka tee kapa lino tse bonolo). Leha ho le joalo, e ne e se ho fihlela lekholong la mashome a mabeli la lilemo moo moloko oa batho o neng o lemoha bokhoni ba meriana ea li-diuretics. Ka 1937, bafuputsi ba ile ba fumana li-dihythese tsa carbonic anhydrase. Ka 1957, bafuputsi ba ne ba fumane li-diuretic tse matla haholo tsa chlorothiazide.
Li-diuretiki li sebetsa ka ho eketsa molumo oa moroto oo u o hlahisang le o fetola lihlopha tsa 'mele oa hau oa motlakase kapa oa' mele. Likhopolo tse bonolo, ha ho joalo? Leha ho le joalo, mekhoa e fapa-fapaneng ea lik'hemik'hale ea likokoana-hloko eo ho eona ho sebetsang ka thata ho etsa hore li-diuretics li sebetse ka thata ha li utloisise. Ka mohlala, sebopeho sa moroto se akarelletsa mahlaseli a mahloriso, li-osmosis, li-transporter le tse ling tse joalo.
Ka kakaretso, diuretiki li sebetsa ka ho tlosa 'mele ea rona ea metsi a feteletseng kapa "metsi." Ho na le maloetse a mangata a ts'oanetsoeng ke ho lokolloa ha metsi a nang le khatello ea kelello, ho hloleha ha pelo, ho ruruha ha boko (edema), ho ruruha ha mahlo (ho ruruha ha leihlo) le ho ruruha ho ea ho sebete kapa lefu la liphio.
Pele re ithuta hore na li-diuretics li sebetsa joang, a re ke re tsamaee ka bokhutšoanyane ka nephron le sebōpeho sa li-tubules tsa renal. Ha e le hantle, diuretiki li sebetsa ka liketso likarolong tse sa tšoaneng tsa nephron, e leng motheo oa motheo oa liphio tse ikarabellang bakeng sa ho hloekisa moroto.
Sheba Nephrone
Mona ho na le mesifa ea nephron e nyenyane:
- Mali a tlisoa ke 'mele ho ea ho corpuscle ea renal e entsoeng ka glomerulus, tft ea capillaries, le capsule ea Bowman. The coral corpuscle ke mohato oa pele oa ho hloekisa moroto.
- Glomerulus e kenella ka har'a li-tubules tsa renal, e leng tsamaiso ea li-tubes tse nyenyane tse ikarabellang bakeng sa ho etsa motsoako. Karolo ea pele ea tubule ea renal ke khubu e khotsofatsang e khotsofatsang.
- Tula e khotsofatsang e fepa kahare ho Henle. Karolo ea pele ea mokotla o theoha leoto mme la bobeli ke leoto le leholo le nyolohang.
- Leoto le ntseng le nyoloha le fepa ka har'a tile ea conal.
- Taba ea distal convaluted e hula ho fihlela mokotong o bokellang.
Joalokaha ho boletsoe pejana, diuretiki tse fapaneng li sebetsa likarolong tse fapaneng tsa toro ea renal. Ka kakaretso, nephron e ikarabella bakeng sa ho pata litšila ka ultrafiltrate e qetellang e fetoha motsoako le ho nchafatsa limatlafatsi le lintho tse ling tse ntle tseo 'mele oa rona o li hlokang joaloka li-ion sodium (Na + ), sodium bicarbonate (NaHCO 3 ), ione ea potassium (K + ), metsi 'me hoo e ka bang li-glucose le li-amino acid tse tlhotliloeng. (Ha e le hantle, boholo ba ts'ebetso ena ea phepo ea phepo e etsahalang ka tulong e tsitsitseng ea khomo.)
Carbonic Anhydrase Inhibitors
Carbonic anhydrase inhibitors joaloka acetazolamide mosebetsing ka ho thibela enzyme carbonic anhydrase e fumanehang ka har'a tbule e khotsofatsang. Ka tloaelo, anhydrase ea carbonic e ikarabella bakeng sa ho anya sodium (NHE3 antiporter), potasiamo, metsi, amino acid le tsoekere tse khutlelang mali a hao. Ka ho thibela enzyme ena, lithethefatsi tse kang acetazolamide li eketsa metsi a mangata tsamaisong ea tubule. Li-carbonic anhydrase inhibitors li sebelisoa haholo ho tšoara glaucoma .
Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitor
Sodium-glucose cotransporter 2 (SGLT2) inhibitors ke li-ribonucleotides tsa phosphorylated tse nkang khato ho sodium ea glucose cotransporter e fumanehang ka har'a lefuba le khotsofatsang. Li thibela liketso tsa mohoebi ena 'me li fokotsa ho khutlisetsoa ha glucose le li-ion tse khutlelang mali a hao. Ka li-ion tse fokolang tsa sodium tse khutlisang metsi a seng makae li latela (osmosis), le liphello tse bonolo tsa diuresis. Le hoja lithethefatsi tsa SGLT2 tse kang canagliflozin le dapagliflozin ke tsebo e bonolo ea diuretics, ka lebaka la liketso tsa tsoekere, li sebelisoa haholo ho phekola lefu la tsoekere.acetazolimide
Loop Diuretics
Li-loop diuretics tse kang furosemide li thibela motho ea nang le Na / K / 2Cl mohareng o nyolohang oa Henle; ka hona, ho fokotsa ho beboa ha sodium le metsi ka mali a hau. Hobane li-diuretic tsa loop li boetse li ja ka potlako ea potassium, ho senya potasiamo ho ka etsahala. Haeba potassium e senya e le matla haholo, hypokalemia e ka fella. Ka ho khetheha, hypokalemia e ka senya tsela eo pelo ea hau e sebetsang ka eona Furosemide e sebelisetsoa ho tšoara khatello ea mali (khatello e phahameng ea mali), metsi a matšoafong (pulmonary edema), ho ruruha ka ho feletseng, hyperkalemia (maemo a kotsi a potassium) le hypercalcemia kapa phahameng calcium levels ( tlosa-lebokose tšebeliso).
Thiazides
Thiazides e sebetsa ka ho phunya le Na / Cl e tsamaisa tululeng e khutsitseng. Ntle le ho thibela ho tsosolosoa ha li-ion sodium le metsi, thiazides e boetse e etsa hore potassium e senyehe. Thiazides e sebelisoa e le phekolo ea pele ea khatello ea meriana; Ha e le hantle, phuputso e tummeng e fumanehile hore thiazides e sebetsa hantle joaloka phekolo ea pele ea khatello ea meriana ho feta ACE inhibitors.
Ha palo ea li-glomerular filtration rate (mosebetsi o itseng oa liphio) o le tlase haholo, thiazides ha e sebetse hantle. Ka tloaelo, li-thiazide li atisa ho kopantsoe le li-diuretics tse holimo bakeng sa phello ea synergistic.
Ho phaella khatellong ea mokuli, thiazides e boetse e sebelisoa ho phekola li-kidney tse nang le liphio le lefu la tsoekere insipidus (e fapaneng le mofuta o tloaelehileng haholo oa mofuta oa 1 le mofuta oa 2 oa lefu la tsoekere mellitus).
Potassium-Sparing Diuretics
Joalokaha mabitso a bona a bontša, potasiamo-sparing diuretics e sebetsa ka ho eketsa molumo oa metsi oa motsu ntle le ho senya potasiamo. Potassium-sparing joaloka spironolactone kapa amiloride ka bobeli e sebetsana le li-tubules empa li sebelisa mekhoa e sa tšoaneng ea liketso.
Spironolactone e hanyetsa aldosterone ka mokhoa o sa utloisisoeng hantle. Aldosterone ke hormone ea steroid e hlahisoang ke adrenal cortex. Ka ho hanyetsa liphello tsa aldosterone, potasiamo, ts'ireletso ea sodium le metsi e fokotsehile. Hangata moea o sebelisoang ho loantša tšenyo ea potassium e bakoang ke li-diuretics tsa thiazide le loop. Meriana ena e boetse e tsamaisoa ka mor'a lefu la pelo kapa e sebelisetsoang ho phekola aldosteronism ho tloha molemong ofe kapa ofe.
Amiloride e thibela mechine ea sodium ka har'a maqhubu a bokellang 'me kahoo e thibela ho tsosolosoa ha metsi ka' mele oa hau. Joaloka spironolactone, amiloride e atisa ho sebelisoa ho loantša tšenyo ea potassium e bakoang ke li-diuretiki tse ling.
Osmotic Diuretics
Li-osmotic diuretics li feta 'meleng oa hao li tiile. Ha lefu la dirotic la osmotic le kang mannitol le kenella li-tubules tsa hau tse nang le mafura, li hula metsing ka mokhoa o fokolang. (Hopola ka se-osmosis, metsi a latela litlhoko tsa mahloriso a phahameng. Ho feta moo, li-osmotic diuretics ka ntle ho liphio (nahana ka boko kapa leihlo) li ka boela tsa tlohela metsi le ho fokotsa ho ruruha.
Ho phaella tabeng ea ho phekola ho ruruha ha mahlo (glaucoma) le ho ruruha ha boko (khatello e eketsehileng ea khatello ea kelello), li-osmotic diuretics li boetse li sebelisetsoa ho fokotsa ho hlōleha ho eketsehileng ho eketsa moroalo oa solute o bakoang ke chemotherapy kapa rhabdomyolysis (ho senyeha ha mesifa). Ka mantsoe a mang, ka ho hlatsoa lithethefatsi le likarolo tsa mesifa le nephron, khatello ea kelello e behoa liphio.
Lifapane
Bahanyetsi ba Vasoreceptor kapa li-vaptans (conivaptan le tolvaptan) ke sehlopha se secha sa lithethefatsi. Li sebetsa ka mokhoa o khahlanong le vasopressin kapa anti-hormone le ho etsa hore 'mele oa hau o boloke metsi a se nang metsi a electrolyte. Ka lebaka leo, li-vaptane li thusa maemo a hyponatremic a hlalosoang ke maqhubu a tlaase a sodium maling joaloka SIADH.
Tse ngata tsa diuretics tse tšohloang sehloohong sena li fumaneha ka lengolo la ngaka. Leha ho le joalo, o ka reka diuretics ntle le lengolo la ngaka. Le hoja ho eketsa molumo oa hau oa motsoako le ho fokotsa litekanyetso tsa hau tsa electrolyte ho ka utloahala ho le monate, ha ho nkoa ka tsela e sa lokang, diuretics e ka baka tšelo ea metsi le ho se leka-lekane ha motlakase (electrolyte). Diuretics e ka boetse ea eketsa lefu la cirrhosis, ho hloleha ha pelo, kapa ho hlōleha ha renal. Ka kopo, nka li-diuretics feela ka mor'a ho buisana le ngaka ea hau haholo-holo haeba u na le litaba tse leka-lekaneng tsa tekanyo ea metsi.
Tlhahisoleseding ea ho qetela, haeba u ntse u ipotsa ka caffeine, lipatlisiso li bontša hore ha motho ea phetseng hantle a noa lino tse tahang ka cafeine, ho lahleheloa ke mokelikeli ha ho felle feela ka tekanyo ea seno se sebelisoang 'me boemo ba motlakase ha boa sekisetsa. Ka mantsoe a mang, haeba u phetse hantle, caffeine e sireletsehile.
Lisebelisoa:
Eaton DC, Pooler JP. Khaolo ea 8. Taolo ea Tekanyo ea Potassium. Ka: Eaton DC, Pooler JP. eds. Vander's Renal Physiology, 8e . New York, NY: Hill ea McGraw; 2013.
Sam R, Pearce D, Ives HE. Li-Diuretic Agents. Ka: Katzung BG, Trevor AJ. eds. Basic & Clinical Pharmacology, 13e . New York, NY: Hill ea McGraw; 2015.