Kubvira kare, tashandisa diuretics kuti tione zvakawanda. Mimwe diuretics yakafanana ne caffeine inowanzoitika (funga tea kana zvinonwiwa). Zvisinei, yakanga isiri kusvikira muzana remakore rechimakumi maviri revanhu kuti vanhu vazive kukwanisa kwemapurisa zvekurapa. Muna 1937, vatsvakurudzi vakawana carbonic anhydrase diuretics. Pakazosvika 1957, vatsvakurudzi vakanga vawana zvakawanda zvakanyanya zvechirori chlorothiazide diuretics.
Diuretics inoshanda kuburikidza nekuwedzera huwandu hwemuti iwe unobereka nekuchinja mararamiro emuviri wako we electrolyte kana muviri. Pretty simple concepts, huh? Kunyange zvakadaro, nzira dzakasiyana-siyana dzehupenyu hwehupenyu dzinoshandiswa nehutachiona hunooma zvakaoma kunzwisisa. Semuenzaniso, kuumbwa kwemuti kunosanganisira maitiro ekutengesa, kusisa, vatengesi uye zvimwewo.
Nenzira yakazara, diuretics inoshanda nekubvisa muviri wedu wehuwandu hwehuwandu hwemvura kana "mvura." Pane zvirwere zvakawanda zvinosungirwa nekubudiswa kwemvura kunosanganisira kuwedzera kwehutano, kusakadzwa kwemwoyo, kuputika kweuropi (edema), kuvhara kweziso (kuvhara kweziso) uye kuzvimba kwechipiri kune chiropa kana chirwere chepfungwa.
Tisati tadzidza maitiro ekushanda kwemauretics, ngatitangei muchidimbu nephron uye maitiro e renal tubules. Pashure pezvose, diuretics inoshanda nekuita pane zvikamu zvakasiyana-siyana zveNephron, nheyo yehutano yeimpimpiti iyo inokonzera kusvina urini.
A Tarisa paNefironi
Heino mhepo yakasara ye nephron anatomy:
- Ropa rinounzwa kubva mumuviri richienda kune real corpuscle iyo inoumbwa ne glomerulus, tuft ye capillaries, uye capmanle yaBowman. Iyo renal corpuscle ndiyo danho rokutanga mumuginini kucheneswa.
- Iyo glomerulus inokwidziridza kusvika mumapuranga emvura, chirongwa chemashirasiki michina inokonzera kukonzera urini. Chikamu chekutanga chemumvuri webhuruti ndiyo inonzi profuimal convoluted tubule.
- Iyo yakawanda yakawanda yekomboni inotyisa inopinda muchidzitiro chaHenle. Chikamu chekutanga chechivharo chiri kuburuka chikamu uye chechipiri ndiyo yakasimudza nhengo yechikwata.
- Icho chinokwira chikafu chinopa zvokudya mumarara ekutenda convoluted.
- Icho chinokonzerwa nechepaloluted tubule chinokwidza kusvika kune duct inounganidza.
Sezvambotaurwa, zvirwere zvakasiyana-siyana zvinoshandiswa pamativi akasiyana ezvinyorwa zvekubata. Pasi rose, nephron inosungirirwa kuchengetedza dhayi muyunyu ye ultrafiltrate iyo inowanzova mumvura uye kudzorerazve mishonga nezvimwe zvinhu zvakanaka izvo muviri wedu unoda se sodium ion (Na + ), sodium bicarbonate (NaHCO 3 ), ion potassium (K + ), mvura uye inenge yose yakasanganiswa glucose uye amino acids. (Zvechokwadi, zvizhinji zvekugadzirisa zvinokonzerwa nemuviri zvinowanzoitika mumugumo wekutulutsira.)
Carbonic Anhydrase Inhibitors
Carbonic anhydrase inhibitors sezvakaita acetazolamide kushanda nekudzivisa enzyme carbonic anhydrase iri munzvimbo yakawanda yekutombulisa tubula. Kazhinji, carbonic anhydrase inokonzera kunwisa sodium (NHE3 antiporter), potasium, mvura, amino acid uye shuga zvakare muropa rako. Nokudzivisa iyi enzyme, zvinodhaka zvakadai seacetazolamide zvinowedzera huwandu hwemvura mumutambo wehubhu. Carbonic anhydrase inhibitors inowanzoshandiswa kurapa glaucoma .
Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitor
Sodium-glucose cotransporter 2 (SGLT2) inhibitors inonzi phosphorylated ribonucleotides inotora matanho pane sodium glucose cotransporter iri mumugwagwa wakanyanyisa. Vanodzivisa zviito izvi zvekutakura uye kuderedza kushandiswa kweglucose uye ionic ions zvakare muropa rako. Zvishoma nezvishoma iononi ion inobata mvura shomanana inotevera (osmosis), uye zvinyorwa zvinyoro diuresis. Kunyange zvazvo mishonga yeSGLT2 yakaita canagliflozin uye dapagliflozin ndeyechokwadi diuretics, nokuda kwezviito zvavo zveshuga, iyo inowanzoshandiswa kurapa chirwere cheshuga.acetazolimide
Loop Diuretics
Loop diuretics sezvinoita furosemide inhibisa Na / K / 2Cl inotakura mumhepo yakakura yeHenle; nokudaro, kuderedza sodium uye mvura yekudzorerazve muropa rako. Nokuti loop diuretics inosvinawo ne potassium reabsorption, kuparara kwe potassium kunogona kuitika. Kana potassium kuparara kwakanyanya zvakakwana, hypokalemia inogona kuguma. Zvinonyanya kukosha, hypokalemia inogona kukanganisa nzira iyo mwoyo wako unoshanda Furosemide inoshandiswa kuporesa kuwedzera kwehutano (high blood pressure), mvura inopisa mumapapu (pulmonary edema), kuwedzera kwechiremera, hyperkalemia (zvinokuvadza kwazvo potassium mazinga) uye hypercalcemia kana high calcium levels ( off-label use).
Thiazides
Thiazides inoshanda nokuputika neNa / Cl inotakura mumugwagwa we distal convoluted. Mukuwedzera kuvhara reuptake yeonic ion nemvura, thiazides inokonzerawo kuparara kwe potassium. Thiazides inoshandiswa seyero yekutanga kurapwa kwehutachiona; Zvechokwadi, chidzidzo chakazivikanwa chakawana kuti thiazides inoshanda zvakanyanya sekutanga kwekodzero yekurapa kwehutano hwepamusoro kupfuura ACE inhibitors.
Apo glomerular filtration rate (chiyero chepfungwa inoshanda) yakanyanya kwazvo, thiazides haishandisi izvozvo zvakanaka. Nenzira, thiazides inowanzobatanidzwa ne loop diuretics nokuda kwehutano hwechirwere.
Pamusoro pehuwandu hwehutachiona, thiazides inoshandiswawo kurapa calcium-ine-kidney mawere uye chirwere cheshuga insipidus (yakasiyana kubva kune yakanyanya kunyanya aina 1 uye chirwere chechipiri chirwere cheshuga mellitus).
Potassium-Sparing Diuretics
Sezvo mazita avo anoratidza, potasium-sparing diuretics inoshandisa kuburikidza nekuwedzera urine volume pasina kuparadza potasium. Potassium-kupera se spironolactone kana amiloride zvose zvinoita pakuunganidza tubules asi kushandisa nzira dzakasiyana dzekuita.
Spironolactone inorwisa aldosterone nenzira isina kunzwisiswa. Aldosterone steroid hormone inogadzirwa ne adrenal cortex. Nokupikisa migumisiro yealdosterone, potassium, sodium uye kuchengetwa kwemvura kunoderedzwa. Spironolactone inowanzoshandiswa kurwisa potassium-kuparara kunokonzerwa ne thiazide uye loop diuretics. Ichi chirwere chinoshandiswa zvakare mushure mekurwadziwa kwemwoyo kana kushandiswa kurapa aldosteronism kubva kune chimwe chikonzero.
Amiloride inogadzirisa zvirongwa zve sodium mukutakura tubule uye nokudaro inodzivisa kugadziriswa kwemvura mumuviri wako. Kufanana ne spironolactone, amiloride inowanzoshandiswa kurwisa potassium-kuparadza kunokonzerwa nedzimwe diuretics.
Osmotic Diuretics
Osmotic diuretics inopinda mumuviri wako yakasimba. Apo sosmotic diuretic semannitol inopinda mumapapiro enyu emvura, inodha mumvura kuburikidza nechisimba. (Cherechedzai musmosis, mvura inotevera kukanganiswa kwepamusoro.) Zvakare, osmotic diuretics muvasculature kunze kweevo (funga uropi kana ziso) inogonawo kubvisa mvura uye kuderedza kuzvimba.
Mukuwedzera pakurapa maziso ose ekudzivirira (glaucoma) uye kuora kweuropi (kuwedzerwa kusagadzikana kwechisimba), osmotic diuretics inoshandiswawo kuderedza kusagadzikana kwechipiri kuwedzerwa mutoro usingagumi wakabva chemotherapy kana rhabdomyolysis (musimba kuputsika). Mune mamwe mazwi, kuburikidza nekuderedza mishonga nemakumbo emisungo muNephron, kunetseka kunowanikwa paitsvo.
Vaptans
Vasoreceptor vanopikisa kana vaptans (conivaptan uye tolvaptan) iboka idzva remishonga. Dzinoshanda kuburikidza nemakwikwi evasopressin kana antidiuretic hormone uye inoita kuti muviri wako uchengete mvura ye electrolyte-isina. Sezvo zvakadaro, vaptans vanobatsira ne hyponatremic mamiriro ezvinhu anotsanangurwa nechepasi yakanyanya mujasi muropa seSADH.
Mazhinji e diuretics anokurukurwa munyaya ino anowanikwa nemishonga. Kunyange zvakadaro, unogona kutenga zvimwe diuretics pasina mushonga. Kunyange zvazvo kungoita kuti urinhi yako iwedzere uye kuwirirana nemazinga ako e electrolyte kunogona kuonesa kushaya simba, kana kutorwa zvisina kukodzera, diuretics inogona kukonzera kupera simba uye kunogona kuuraya mararamiro emagetsi. Diuretics inogonawo kuparadzira chirwere chinonzi cirrhosis, kusagadzikana kwemoyo, kana kukanganisa kwechirwere. Ndapota tora diuretics mushure mekunge taurirana nachiremba wako kunyanya kana iwe shanduko yemari yakadzika.
Pamusoro pekupedzisira, kana iwe uri kunetseka nezve caffeine, tsvakurudzo inoratidza kuti kana munhu ane hutano anonwa doro rehafini, kurasikirwa kwemvura inenge isingasviki nehuwandu hwechinwa chinoshandiswa uye huwandu hwemhepo hahutombomiridzi. Mune mamwe mazwi, kana uine hutano ipapo caffeine yakachengeteka.
Sources:
Eaton DC, Pooler JP. Chitsauko 8. Mutemo wePotassium Kuenzanisa. Mu: Eaton DC, Pooler JP. eds. Vander's Renal Physiology, 8e . New York, NY: McGraw-Hill; 2013.
Sam R, Pearce D, Ives HE. Diuretic Agents. Mu: Katzung BG, Trevor AJ. eds. Basic & Clinical Pharmacology, 13e . New York, NY: McGraw-Hill; 2015.