Tunda tun zamanin tsufa, mun yi amfani da diuretics su bi mafi. Wasu daruttuka irin su maganin kafeyin suna da kyau (tunanin shayi ko abin sha). Duk da haka, ba har zuwa karni na ashirin ba cewa 'yan adam sun gane kwarewar kwayoyin diuretics. A 1937, masu bincike sun gano carbonic anhydrase diuretics. A shekara ta 1957, masu binciken sun gano yawancin tsire-tsire na chlorothiazide diuretics.
Diuretics aiki ta ƙaru ƙarar da fitsari da kuke samarwa da canza jikin ku na electrolyte ko gishiri da jiki. Kyawawan sauki ra'ayoyi, huh? Duk da haka, abubuwa daban-daban na biochemical wanda aikin aikin diuretics suke da wuyar fahimta. Alal misali, ƙaddamar da fitsari ya ƙunshi masu hankali, masu kwanto, masu fashi da sauransu.
A cikin mahimmanci, aikin diuretics ta hanyar kawar da jikinmu na yawan ruwa ko "ruwa." Akwai yalwacin cututtuka da aka zubar ta hanyar sakin ruwa ciki harda hauhawar jini, ƙin zuciya, ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwa (edema), ƙuƙwalwar ido (ƙirar ido) da busawa na biyu zuwa hanta ko koda.
Kafin muyi nazarin yadda ake yin nazarin diuretics, bari mu ɗanɗana ƙananan nephron da ƙwayar jikin gobara. Bayan haka, diuretics na aiki ta hanyar aiki akan sassa daban-daban na nephron, ɗayan ɗigon tsari na koda wanda ke da alhakin tsaftace fitsari.
A Dubi Nafron
A nan ne runduncen jiki nephron:
- Ana fitar da jini daga jiki zuwa cikin ruɗar daji wanda ya hada da glomerulus, wani nau'i na capillaries, da kuma kawunan Bowman. Cikin ginin ta tsakiya shine mataki na farko a cikin tarihin furotin.
- Glomerulus ya shiga cikin ƙananan ƙwayoyin halitta, tsarin kwayoyin microscopic da ke da alhakin yin fitsari. Sashi na farko na ƙwanan raƙuman ita ce ƙuƙwalwar ƙwaƙƙwaraccen ƙwararra.
- Kwangocin da aka yi amfani da shi ya zama abin hawa a cikin madaurin Henle. Sashi na farko na madauki shi ne ƙananan raƙuman ruwa kuma na biyu shi ne ɓangaren haɗuwa.
- Ƙungiyar haɓakawa suna ciyarwa cikin ƙwaƙwalwar ƙafa.
- Ƙungiyar da aka ƙwaƙƙwarar da ƙwaƙwalwar ƙuƙwalwa ta ƙuƙasa har zuwa ɗakin tattara.
Kamar yadda aka ambata a baya, daban-daban diuretics suna aiki a sassa daban-daban na ƙananan rufin. Gaba ɗaya, nephron yana da alhakin ɓoye sharar gida a cikin ultrafiltrate wanda ya zama asali da kuma mayar da kayan abinci da sauran kyawawan abubuwan da jikinmu ke bukata kamar ions sodium (Na + ), sodium bicarbonate (NaHCO 3 ), potassium ions (K + ), ruwa kuma kusan dukkanin glucose da amino acid. (Aikin haɓaka, mafi yawancin abin da ke cikin wannan zane-zane na gina jiki yana faruwa ne a cikin ƙwanƙwarar ƙwaƙwalwar ƙafa.)
Carbonic Anhydrase Masu hana
Carbonic anhydrase masu hanawa kamar aikin acetazolamide ta hana da enzyme carbonic anhydrase da ke cikin ƙananan ƙwaƙwalwar tubule. Yawanci, carbonhy anhydrase ne ke da alhakin shan sodium (NHE3 antiporter), potassium, ruwa, amino acid da kuma sugars koma cikin jini. Ta hanyar hana wannan enzyme, kwayoyi kamar acetazolamide ƙara yawan adadin ruwa a cikin tsarin ƙwallon ƙafa. Ana amfani da magunguna masu yawa na carbon Carbonic don magance glaucoma .
Sodium-Glucose Cotransporter 2 (SGLT2) Masu hanawa
Masu sintiri na Sodium-glucose 2 (SGLT2) masu hanawa sune ribonucleotides phosphorylated wadanda suke daukar mataki a kan mai kwakwalwa na sodium glucose wanda ke cikin ƙananan ƙwararru. Suna hana aikin wannan kayan motsa jiki kuma sun rage karfin glucose da ions sodium cikin jininka. Tare da ƙananan ions sodium rassan ruwa marasa ruwa su biyo baya (osmosis), kuma sakamakon m diuresis. Ko da yake SGLT2 magungunan kamar canagliflozin da dapagliflozin su ne m diuretics na fasaha, saboda ayyukan sukari, sun fi amfani dasu don magance ciwon sukari.acetazolimide
Madauki Diuretics
Jigilar tsabtace jiki kamar furosemide ta hana Na / K / 2Cl ɗauka a cikin motsin Henle; Ta haka, rage yawan sodium da ruwa a cikin jininka. Saboda magungunan rubutun mahimmanci kuma rikici tare da potassium reabsorption, mai ɓoyewar potassium zai iya faruwa. Idan mai cin gashin potassium yana da nauyi sosai, hypokalemia zai iya haifar. Yawanci, hypokalemia na iya yada hankalin da ake amfani da zuciyarka a Furosemide don magance hauhawar jini (cutar hawan jini), ruwa a cikin huhu (rubutun jini), ƙwanƙwasawa na kowa, hyperkalemia (matsanancin matakan potassium) da hypercalcemia ko ƙananan ƙwayoyin calcium ( amfani da alamar amfani).
Thiazides
Thiazides yayi aiki tare da yin tafiya tare da Na / Cl da ke motsawa a cikin ɗakin da aka kwantar da shi. Bugu da ƙari, don hana hana reuptake na ions sodium da ruwa, thiazides kuma ya haifar da wani fashewa na potassium. Ana amfani da thiazides a matsayin maganin hauhawar jini na farko; a gaskiya ma, wani shahararren bincike ya gano cewa thiazides sun fi tasiri kamar yadda na farko na daukar nauyin hawan jini fiye da masu kwance na ACE.
Yayin da ake yin amfani da koda (ma'auni na aikin koda) yana da ragu, thiazides ba sa aiki da kyau. Daga bayanin kula, thiazides sukan haɗa tare da diuretics na madaidaici don sakamako na synergistic.
Bugu da ƙari da hauhawar jini, ana amfani da thiazides don kula da ƙwayoyin koda da ciwon sukari insipidus (bambam da yawanci na 1 da na 2 masu ciwon sukari).
Maganin Noma-Musayar Diuretics
Kamar yadda sunayensu suka bada shawara, aikin farfadowa na potassium ya rage ta hanyar kara yawan ƙwayar fitsari ba tare da bata potassium ba. Maganin potassium-watsi da spironolactone ko amiloride suna aiki a kan tattara tubules amma sunyi amfani da hanyoyin daban-daban na aiki.
Spironolactone antagonizes aldosterone a cikin rashin fahimta fashion. Aldosterone shi ne hormone steroid wanda ya samo asali. Ta hanyar magance sakamakon aldosterone, potassium, sodium da riƙewar ruwa an rage. An yi amfani da Spironolactone sau da yawa don magance rikitarwa na potassium da thiazide da madauriyar diuretics. Wannan magani ne kuma ana gudanar da shi bayan ciwon zuciya ko kuma ana amfani da shi daga aldosteronism daga kowane dalili.
Amiloride ya kaddamar da tashoshi na sodium a cikin ɗakin tattarawa kuma ta haka ne ke raguwa da ruwa a jikinka. Kamar spironolactone, ana amfani da amaridide a yau da kullum don yada rikici na potassium wanda wasu diuretics ke haifarwa.
Diurtics na Osmotic
Labaran osmotic suna wucewa cikin jiki. A lokacin da mai tsauraran kwayoyin halitta kamar mannitol ya shiga cikin ƙananan ku, sai suka zana cikin ruwa ta hanyar osmosis. (Ka tuna da tsabtace ruwa, ruwa yana biyo bayan ƙaddarar tsararraki.) Bugu da ƙari kuma, diuretics na osmotic a rarraba da ƙwayar koda (tunanin kwakwalwa ko ido) zai iya zubar da ruwa kuma rage ƙumburi.
Bugu da ƙari ga zalunta da kullun ido (glaucoma) da ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwa (ƙarar ƙwayar intracranial), ana amfani da diuretics na osmotic zuwa ƙananan rashi na biyu don ƙara yawan nauyin sulhu da aka haifar daga chemotherapy ko rhabdomyolysis (raunin tsoka). A wasu kalmomi, ta hanyar maganin magungunan ƙwayoyi da raguwa na tsoka a cikin nephron, ƙananan ƙarfin da aka sanya akan kodan.
Vaptans
Magungunan ketare ko magunguna (conivaptan da tolvaptan) su ne sababbin magunguna. Suna aiki ne ta hanyar maganin wariyar launin fata ko hormone antidiuretic kuma zai ba da jikinka ya ɓoye ruwa marar iyaka. Saboda haka, taimakon gaggawa tare da yanayin hyponatremic da aka ƙayyade ta hanyar ƙaramin sodium a cikin jini kamar SIADH.
Mafi yawan darussan da aka tattauna akan wannan labarin suna samuwa ta takardar sayan magani. Duk da haka, za ka iya saya diuretics ba tare da takardar sayan magani ba. Ko da yake kawai ƙarar ƙarar kazarin ka da tsaura tare da matakan lantarki za su iya ji dadi, lokacin da aka dauka rashin dacewa, diuretics zai iya haifar da ciwon ruwa da yiwuwar rashin daidaituwa ta hanyar electrolyte (rikici tare da salts jikinka). Diuretics na iya kara ƙaruwa daga cirrhosis, rashin cin nasara zuciya, ko kuma gazawar sakewa. Don Allah a ɗauki diuretics kawai bayan yin shawarwari tare da likitanka musamman idan kuna daidaita al'amura.
A bayanin karshe, idan kuna yin tunani game da maganin kafeyin, bincike ya nuna cewa idan mutum mai lafiya yana shan giya na caffeinated, asarar ruwa ba ƙari ba ne ƙananan abin sha da ake cinyewa da kuma tsabtace yanayin ba a daidaita ba. A wasu kalmomi, idan kun kasance lafiya sai maganin kafeyin yana da lafiya.
Sources:
Eaton DC, Pooler JP. Babi na 8. Dokar Rarraba Ƙasa. A: Eaton DC, Pooler JP. eds. Vander's Renal Physiology, 8th . New York, NY: McGraw-Hill; 2013.
Sam R, Pearce D, Ives HE. Diuretic Agents. A cikin: Katzung BG, Trevor AJ. eds. Basic & Clinical Pharmacology, 13th . New York, NY: McGraw-Hill; 2015.