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"etiology": "<p>Наиболее часто причиной РВАГ являются атеросклероз (около 75%) и фибриозно-мышечная дисплазия (до 25%) среди всех больных с вазоренальной гипертензией. Значительно реже (менее 1%) развитие реноваскулярной гипертензии обусловлено иными причинами (системные васкулиты, тромбоэмболии, врожденные аневризмы почечных артерий, травмы, ангиомы и др.) или внепочечной патологией (опухоли со сдавлением, метастазы, гематомы).<br /> Атеросклероз почечных артерий, как правило, обнаруживается у лиц старшей возрастной группы, чаще – у мужчин, с признаками атеросклеротического поражения в других органах (сердце, мозг, периферические сосуды). В 30-50% имеется двустороннее поражение. Атеросклеротическая бляшка, как правило, локализуется в проксимальном сегменте, значительно реже (менее 25%) в процесс вовлекается весь сосуд. Атеросклеротический процесс в почечных артериях не всегда приводит к развитию вазоренальной гипертензии, и, как правило, это наблюдается при значительном сужении просвета артерии (более 75%) или в период дестабилизации атеросклеротической бляшки с формированием атеротромбоза. <br /> Фиброзно-мышечная дисплазия как причина развития вазоренальной гипертензии чаще встречается у молодых женщин до 30 лет. Мужчины болеют в 4-5 раз реже. Фиброзно-мышечная дисплазия поражает все слои артерий, преимущественно медию. При медиальной форме фиброплазии характерным является чередование участков сужения в местах фиброза медии с аневризматическим расширением сегментов, лишенных внутренней эластической мембраны и гладких мышц, в результате вид сосуда напоминает бусы. В 30% в процесс вовлекаются обе почечные артерии. Возможны очаги фиброзо-мышечной дисплазии в других сосудах.<br /> Врожденные аномалии почечных артерий встречаются редко, но манифестация заболевания чаще наблюдается в детском возрасте.</p>",
"pathogenesis": "<p>Патогенетические механизмы формирования вазоренальной артериальной гипертензии включают в себя каскад нейрогуморальных нарушений, обусловленных снижением кровообращения в одной или обеих почках. Вследствие ишемии почки, происходит стимуляция ренин-ангиотензиновой системы, гиперпродукция ренина, и связанная с ней активация синтеза ангиотензина и альдостерона. Если в патологический процесс вовлечена одна почка, то наблюдается повышение функции коллатеральной почки с увеличением диуреза и снижением артериального давления. При двустороннем поражении почечных артерий патогенез вазоренальной гипертензии несколько отличается, так как нет компенсаторных механизмов неповрежденной почки.</p>",
"diagnostics": "<p>Проводится на основании жалоб, данных анамнеза, объективного осмотра. Необходимо проведение расширенного биохимического анализа крови с определением холестерина, липопротеидов низкой плотности, триглицеридов, кальция, мочевой кислоты, гликозилированного гемоглобина. Показано определение клиренса креатинина, активности ренина плазмы крови, уровня альдостерона, ТТГ, эхокардиографии, эхографии артерий, УЗИ почек, проведение суточного мониторирования АД, ангиографии, компьютерной томографии, пункционной биопсии.</p>",
"treatment": "<p>Медикаментозное лечение следует проводить больным с атеросклеротическим стенозом почечных артерий при условии: <br /> - если <a href=\"/symptom/vysokoe_davlenie/\" title=\"Перейти на страницу симптома Высокое давление\">гипертензия</a> умеренная и хорошо контролируется препаратами; <br /> - если имеются сопутствующие заболевания, обусловливающие высокий риск операции (распространенный атеросклероз, застойная сердечная недостаточность и др.).<br /> В связи с малой эффективностью медикаментозного лечения, больным с вазоренальной гипертензией показана хирургическая реконструкция артерий или чрезкожная транслюминальная ангиопластика. Оперативное лечение преследует цель не только снизить АД, но и сохранить орган.<br /> 1. Показанием к реваскуляризации (ангиопластика, стентирование или хирургическое вмешательство) является ухудшение функции или уменьшение размеров почки на фоне медикаментозного лечения.<br /> 2. Чрезкожная транслюминальная ангиопластика показана больным с фиброзно-мышечной дисплазией и атеросклеротическим поражением с гипертензией, рефрактерной к терапии или с прогрессирующим ухудшением функции почек.<br /> 3. Баллонная ангиопластика без стентирования оправдана при наличии стеноза вне устья почечной артерии, при отсутствии окклюзии (более 90%) и при размерах стенозированного участка менее 7-10 мм.<br /> 4. Стентирование проводится при локализации стенотического участка в устье почечной артерии более 90%, при протяженности стеноза более 7-10 мм, при развитии рестеноза после ангиопластики.<br /> 5. Хирургическое лечение необходимо при технической невозможности проведения ангиопластики, а также при неэффективности последней.</p>",
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},
"code": "E60",
"name": "Алиментарная недостаточность цинка",
"icd_name": "Алиментарная недостаточность цинка",
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"age_min": 0,
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"cause": [
3
],
"periodicity": 1,
"slug": "e60_alimentarnaya_nedostatochnost_cinka",
"lead": "отсутствие или недостаток поступления в организм цинка ",
"description": "",
"etiology": "<p>Дефицит цинка может быть вызван нарушением деятельности щитовидной железы, болезнями печени, плохим усвоением, недостатком этого минерала в воде, пище, а также слишком большим количеством фитина в продуктах питания, так как фитин \"связывает\" цинк, затрудняет его усвоение (кстати, нельзя принимать цинк вместе с селеном, так как два этих элемента взаимоисключают друг друга.). Если в пище слишком много белка, это тоже может быть причиной недостатка цинка в организме. При болезнях: рак бронхов, воспалении или раке предстательной железы, других раковых опухолях, лейкозах также происходит перерасход цинка, который необходим для роста клеток.</p>\r\n<p>Добавки кальция и богатый кальцием рацион (молочные продукты) способны снижать усвоение цинка почти на 50%, а кофеин и алкоголь усиленно выводят его из организма.<br /> <br /> Содержание цинка снижается при приеме внутрь противозачаточных средств (пероральных контрацептивов). Кортикостероиды (кортизон, преднизолон), назначаемые при ряде заболеваний (артрит, бронхиальная астма и др.), также снижают уровень цинка.<br /> <br /> Цинк быстро выводится из организма при стрессах, а также под действием ядовитых металлов, пестицидов и др.<br /> <br /> Уровень цинка в организме значительно снижается с возрастом, следовательно, пожилые люди в той или иной мере испытывают дефицит цинка.</p>",
"pathogenesis": "<p>Незаменимость цинка для течения кардинальных процессов жизнедеятельности явно проявляется при возникновении его дефицита. Классическим примером дефицита цинка является энтеропатический акродерматит. Он относится к редким, наследуемым по аутосомно-рецессивному типу заболеваниям. Манифестирует в грудном возрасте и без лечения приводит к смертельному исходу. Полагают, что в результате генетического дефекта в клетках Панета нарушается всасывание цинка в кишечнике. Клинически акродерматит проявляется типичными признаками дефицита цинка. На первый план выступают поражения кожи в виде хронического эритематозно-буллезного дерматита на конечностях и вокруг естественных отверстий тела, частое присоединением вторичного инфицирования, патологией роста ногтей и волос, аллопецией. Характерны тяжелые желудочно-кишечные расстройства с синдромом нарушенного всасывания, глазные симптомы (блефарит, конъюнктивит, <a href=\"/symptom/svetoboyazn/\" title=\"Перейти на страницу симптома Светобоязнь\">фотофобия</a>, помутнение роговицы), нервно-психические нарушения, замедление роста, гипогонадизм, анемия, гепатоспленомегалия, снижение остроты вкуса и обоняния. Дефицит цинка, испытываемый женщиной во время беременности, приводит к широкому спектру врожденных уродств у плода - расщеплению верхней челюсти, верхнего неба, микроцефалии.</p>",
"diagnostics": "<p>Диагностика дефицита цинка основывается на определении уровня цинка в сыворотке крови, эритроцитах, моче, волосах. Наиболее информативным по мнению многих авторов является исследование цинка в сыворотке крови. По данным Карлинского М. В. концентрацию цинка в крови менее 13 мкмоль/л можно расценивать как цинк-дефицитное состояние, а содержание цинка менее 8,2 мкмоль/л является неблагоприятным прогностическим признаком. Однако необходимо учитывать, что не всегда уровень цинка в крови коррелирует с клиническими проявлениями. Так, концентрация цинка в крови может изменяться в течение дня в зависимости от приема пищи, стресса, перенесенной инфекции, при нарушениях забора и хранения крови. Поэтому при диагностике дефицита цинка необходимо учитывать не только концентрацию цинка в сыворотке крови, но и положительную динамику клинических симптомов, а также повышение концентрации цинка в ответ на терапию цинксодержащими препаратами.</p>",
"treatment": "<p>Восполнить дефицит можно с помощью продуктов питания, таких как морепродукты (устрицы, креветки), печень, нежирная говядина, твердые сыры, бобовые, орехи, грибы и ягоды (черника, малина). Кроме того, большинство пищевых добавок и витаминно-минеральных комплексов содержат цинк.</p>",
"prevention": "",
"clinical_picture": "<p>Симптоматика недостаточности цинка чрезвычайно вариабельна. Поражаются самые разные ткани, органы и системы. У таких пациентов могут постепенно возникать: изменения кожи (различные <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">высыпания</a> около естественных отверстий и на конечностях, ухудшение заживления царапин, ссадин и других кожных дефектов, <a href=\"/symptom/izmeneniya_struktury_kozhi/\" title=\"Перейти на страницу симптома Изменения структуры кожи\">сухость кожи</a>); изменения волос (их очаговая потеря, появление красноватого оттенка или уменьшение пигментации) и исчерченность ногтей (поперечные белые полосы); поражение глаз (отек роговицы, иногда ведущий к ее помутнению, <a href=\"/symptom/vospalenie/\" title=\"Перейти на страницу симптома воспаление\">воспаление</a> конъюнктивы, катаракта); изменение восприятия вкусов и запахов; утрата аппетита; неврологические расстройства (<a href=\"/symptom/drozhanie/\" title=\"Перейти на страницу симптома Дрожание \">дрожание </a>конечностей, изменение походки и речи, <a href=\"/symptom/demenciya/\" title=\"Перейти на страницу симптома Деменция\">слабоумие</a>, снижение внимания и обучаемости); нарушения поведения (необоснованная <a href=\"/symptom/razdrazhitelnost_i_ozloblenie/\" title=\"Перейти на страницу симптома Раздражительность и озлобление\">раздражительность</a>, пониженное настроение, <a href=\"/symptom/sonlivost/\" title=\"Перейти на страницу симптома Сонливость\">сонливость</a>); затяжные или преждевременные роды, атонические кровотечения в родах; прекращение или задержка роста и полового созревания детей; длительно заживающие язвы на слизистых; склонность к частым инфекционным болезням; <a href=\"/symptom/erektilnaya_disfunkciya/\" title=\"Перейти на страницу симптома Эректильная дисфункция\">импотенция</a>; <a href=\"/symptom/besplodie/\" title=\"Перейти на страницу симптома Бесплодие\">бесплодие</a>.</p>",
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