ÍÄ×ÒÏËÏÂÉÀ - DNT Union
ÍÄ×ÒÏËÏÂÉÀ - DNT Union ÍÄ×ÒÏËÏÂÉÀ - DNT Union
eriTropoezis mastimulebeli agentebis meore Taobaa darbopoetini α (Aranesp®). es nivTiereba Seicavs or damatebiT aminomJavas, romlebic misi metaboluri stabilurobis gazrdas da naxevardaSlis periodis gaxangrZlivebas uzrunvelyofen. pirveli Taobis eriTropoetinisagan gansxvavebiT, darbopoetini kviraSi an or kviraSi erTxel keTdeba. amasTan, am preparatisaTvis damtkicebulia kanqveSa da intravenuri gamoyenebis Tanabari efeqturoba. mimdinareobs eriTropoezis mastimulebeli agentebis axali formebis SemuSaveba. mesame Taobis preparatad iTvleba e.w. eriTropoetinis receptorebis mudmivi aqtivatori - CERA (Mircera®). am preparatis molekulaSi damatebulia polimeruli jaWvi, romelic naxevardaSlis periods 130 saaTamde zrdis. klinikur praqtikaSi misi danergva uaxloes momavalSia mosalodneli. monitoringi eriTropoezis mastimulebeli agentebiT Terapiisas anemiis koreqciis fazaSi unda moxdes hemoglobinis maCveneblis Semowmeba 2-4 kviraSi erTxel. hemoglobinis maCveneblis sawyisi mateba unda Seadgendes 1-2 g/dl-s TveSi. Tu aRniSnuli maCveneblis miRweva ar xerxdeba, eriTropoezis mastimulebeli agentis doza unda gaizardos 25%-iT etapobrivad. Tu hemoglobinis maCveneblis aweva zedmetad swrafi tempiT xdeba, sasurvelia eriTropoetinis dozis 25-50%-iT Semcireba. SemanarCunebel fazaSi, roca hemoglobinis maCvenebeli stabiluria, misi gansazRvra aucilebelia 1-2 TveSi erTxel, xolo im pacientebSi, romlebic jer dializze ar imyofebian - SesaZloa ufro iSviaTadac. hemoglobinis maCveneblis fluqtuacia > 1 g/dl eriTropoetinis dozis koreqcias moiTxovs. im SemTxvevaSi, Tu eriTropoezis mastimulebeli agentis adekvaturi dozis gamoyenebis miuxedavad ver xdeba anemiis koreqcia, saqme gvaqvs eriTropoetinrezistentul anemiasTan. is SeiZleba sxvadasxva mizeziT iyos ganpirobebuli: 26 • rkinis deficiti (feritini < 200 mkg/l, transferinis gajerebis indeqsi < 20%). imis gamo, rom eriTropoetini mkveTrad zrdis organimzis moTxovnilebas rkinaze, misi daniSvna naCvenebia praqtikulad yvela pacientSi, razec qvemoT gveqneba saubari; • faruli an manifestirebuli gastrointestinuri sisxldena; • foliumis mJavis an vitamin B 12 -is deficiti; • infeqciebi, onkologiuri daavadebebi; • aluminiT qronikuli intoqsikacia dabali xarisxis sadializo wylis an aluminis Semcveli fosforSemboWvelebis gamoyenebis Sedegad; • hematologiuri daavadeba (mag. mielodisplaziuri sindromi, Talasemia da a.S.) • mZime meoradi hiperparaTireozis Sedegad ganviTarebuli Zvlis tvinis fibrozi; • malnutricia; • hemolizi; • Terapia agf inhibitorebiT an ar blokerebiT (garda kandesarTanisa); • dializis araadekvaturoba.
mogvyavs eriTropoetin-rezistentuli renuli anemiis SesaZlo sadiagnostiko-samkurnalo algoriTmi: rkinis deficiti rkinis gaZlierebuli substitucia MCV < 102 feritini, TSAT araadekvaturi pasuxi eriTropoetinze adekvaturi maCveneblebi dializis efeqturoba MCV gansazRvra Kt/V > 1.4 Kt/V < 1.4 paraThormonis gansazRvra optimaluri maRali ki ara mkurnalobis SeCereba eriTropoetinis antisxeulebi? agf inhibitoriT an ar blokeriT Terapia medikamenturi an qirurgiuli Terapia alumini? (desferalis testi) normaluri maRali Zvlis tvinis histologia desferaliT Terapia MCV > 102 vitamini B 12 , foliumis mJava? normaluri dabali dializis intensiurobis gazrda substitucia sur.1 eriTropoetin-rezistentuli anemiis sadiagnostiko-samkurnalo algoriTmi 27
- Page 1 and 2: ÓÀØÀÒÈÅÄËÏÓ ÃÉÀËÉÆ
- Page 3 and 4: membranul-proliferaciuli glomerulon
- Page 5 and 6: cxr.2 C3 nefrituli faqtoris maxasia
- Page 7 and 8: imunofluorescencia: mkveTrad dadebi
- Page 9 and 10: imunofluorescencia: xasiaTdeba C3-i
- Page 11 and 12: klinikuri mimdinareoba da laborator
- Page 13 and 14: membranul-proliferaciuli glomerulon
- Page 15 and 16: amiloiduri depozitebis warmoqmna Se
- Page 17 and 18: preglomeruluri sisxlZarRvebi Tirkml
- Page 19 and 20: amiloidozis Tanamedrove mkurnaloba
- Page 21 and 22: amiloidis daSla rogorc zemoT iyo aR
- Page 23 and 24: diagnostika Tirkmlebis qronikuli da
- Page 25: mkurnalobis ZiriTad meTods hemotran
- Page 29 and 30: eriTropoetinis sawinaaRmdego antisx
- Page 31: hemotransfuzia renuli anemiis mqone
mogvyavs eriTropoetin-rezistentuli renuli anemiis SesaZlo<br />
sadiagnostiko-samkurnalo algoriTmi:<br />
rkinis<br />
deficiti<br />
rkinis<br />
gaZlierebuli<br />
substitucia<br />
MCV < 102<br />
feritini,<br />
TSAT<br />
araadekvaturi pasuxi eriTropoetinze<br />
adekvaturi<br />
maCveneblebi<br />
dializis<br />
efeqturoba<br />
MCV gansazRvra<br />
Kt/V > 1.4 Kt/V < 1.4<br />
paraThormonis<br />
gansazRvra<br />
optimaluri maRali<br />
ki ara<br />
mkurnalobis<br />
SeCereba<br />
eriTropoetinis<br />
antisxeulebi?<br />
agf inhibitoriT<br />
an ar blokeriT<br />
Terapia<br />
medikamenturi<br />
an qirurgiuli<br />
Terapia<br />
alumini?<br />
(desferalis testi)<br />
normaluri maRali<br />
Zvlis tvinis<br />
histologia<br />
desferaliT<br />
Terapia<br />
MCV > 102<br />
vitamini B 12 ,<br />
foliumis mJava?<br />
normaluri dabali<br />
dializis<br />
intensiurobis<br />
gazrda<br />
substitucia<br />
sur.1 eriTropoetin-rezistentuli anemiis sadiagnostiko-samkurnalo algoriTmi<br />
27
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