Lefu la tsoekere la bana ho bana: lisosa le matšoao

Lefu la Tsoekere - tlolo ea tlhaho e bakileng tlolo ea liminerale tsa liminerale, tseo ho monya le ho ts'oaroa ha metsoako ea phosphorus 'meleng ho nang le bothata, e lebisang ho tsamaiso ea methapo ea methapo. Ho latela data ea morao-rao, ke sehlopha sohle sa maloetse a lefutso. E bonahatsoa ke khatello ea mesifa, li-rickets tsa skeleton (li-varus deformities tsa masapo a likarolo tse tlase, li-rickets le tse ling), kholo ea ho khutlela morao. Tlhahlobo ea lefu la tsoekere la phosphate e ipapisitse le liphetho tsa liteko tsa laboratori tsa mali le urine (boemo ba alkaline phosphatase, calcium ions, mofuta o sebetsang oa vithamine D) le tlhahlobo ea liphatsa tsa lefutso. Phekolo ea lefu lena e etsoa ka ho fana ka litekanyetso tse phahameng tsa vithamine D, phosphorous le calcium complete, orthopedic kapa upasuaji oa ho lokisa liphofu tsa masapo.

Tlhahisoleseling ka kakaretso

Lefu la tsoekere la phosphate (vithamine D e hanyetsang) ke lebitso le kopantsoeng la lipulopathie tse 'maloa tsa lefutso (mafu a methapo ea methapo ea ho tsamaisa lintho ka har'a lipompo tsa liphio), moo ho ts'oaroa hoa ion ea phosphate ho sitisang kholo ea' mele oa tsona. E 'ngoe ea mefuta e atileng haholo ea lefu lena, e fetisitsoeng ke mochine o moholo o hokahaneng le X chromosome, e hlalositsoe khale ka 1937. Lilemong tse latelang, litsebi tsa liphatsa tsa lefutso li senotse mefuta e meng e mengata ea lefu la tsoekere la phosphate ka etiology e fapaneng, phetiso ea lefutso le setšoantšo sa bongaka. Leha ho le joalo, kaofela li na le litšobotsi tse tloaelehileng - li bakoa ke ho kenngoa ha phosphorous ka lipelong, li tšoauoa ka matšoao a tšoanang le a bang mme li hanana le tšebeliso ea litekanyetso tse tloaelehileng tsa vithamine D. Kajeno, ho fumanoe mefuta ea malapa ea lefu la tsoekere la phosphate, phetiso ea eona e hokahaneng le X chromosome ( ka bobeli e matla le e recessive), Autosomal e busang le e autosomal recessive. Ho ata ha mefuta e atileng haholo ea maemo ana ke mofuta oa "000 000" (mofuta oa X o hokahaneng), mefuta e meng ha e sa tloaeleha.

Lisosa le sehlopha sa lefu la tsoekere la phosphate

Ho sa tsotelehe lefutso la lefu la tsoekere la phosphate le boletsoeng esale pele, lisosa tsa kapele tsa hypophosphatemia ka mefuta e fapaneng ea lefu le tsona li ntse li le teng - tlolo ea mofuta o mong oa thipa (reabsorption) ea phosphates litubuaneng tsa liphio tse boletsoeng. Sena se o lumella ho bolela boemo bona ka li-tubulopathies kapa li-pathologies tsa tsamaiso ea moroto, leha ho le joalo, ha e etsahala, 'mele oohle mme haholo-holo tsamaiso ea masculoskeletal e na le bothata. Ntle le moo, mefuta e meng ea lefu la tsoekere ea phosphate e tsamaisana le ho monya calcium e ngata ka mpeng le liphio, nts'etsopele ea urolithiasis, ts'ebetso e sa tloaelehang ea litšoelesa tsa parathyroid. Ho na le khokahano e hlakileng pakeng tsa lefutso le mofuta oa kliniki ea lefu lena, e re lumellang ho theha sehlopha se hlakileng, se amoheloang ka kakaretso se kenyelletsang mefuta e 5 ea pathology.

Lefu la tsoekere le amanang haholo le phofo ea X - ke mofuta oa mofuta o atileng haholo oa lefu lena, ka lebaka la phetoho ea mofuta oa PHEX. E kenya enzyme e bitsoang endopeptidase, e laolang tšebetso ea methapo ea ion ea liphio le mala a manyane. Ka lebaka la bofokoli ba liphatsa tsa lefutso, enzyme e fumanoeng e sitoa ho etsa mesebetsi ea eona, ka hona, lipalangoang tse sebetsang tsa phosphate ions ka membrane ea sele ea litho tse kaholimo li fokotseha haholo. Sena se lebisa keketseho ea tahlehelo ea ion ea phosphate ka moriring le bothata ba ho monya ha bona ka mpeng ea mpa, ka lebaka leo hypophosphatemia e hlahang maling, 'me liphetoho tse kang lithong tsa masapo li bakoa ke khaello ea likarolo tsa liminerale.

Lefu la tsoekere le amanang le X le amanang le X - ho fapana le mofuta oa pejana, e ama banna feela, athe basali bona ba khona ho nka lintho tse tsoaloang ke lefutso. Sesosa sa mofuta ona oa lefu lena ke phetoho ea mofuta oa CLCN5, e kopantseng tatellano ea protheine ea chlorine ion. Ka lebaka la bofokoli ba liphatsa tsa lefutso, ho tsamaisoa ha li-ion tsohle (ho kenyelletsa le phosphates) ho ea lisele tsa nephron epithelial ho tsoha, ka lebaka leo lefu la tsoekere le phosphate le hlahang.

Lefu la Tsoekere la Autosomal Dominant Phosphate - mofuta oa lefu le bakoang ke liphetoho liphatseng tsa lefutso tsa FGF23 tse fumanehang ho chromosome ea 12. Se hlahisoang ke polelo ea sona ke protheine eo ka phoso e bitsang kholo ea kholo ea "fibroblast-23", leha e patiloe haholo ke li-osteoblasts mme e potlakisa tlhahiso ea li-ion tsa phosphate ka har'a moroto. Lefu la tsoekere la phosphate le fetoha le phetoho ea FGF23, ka lebaka leo protheine eo e e hlahisang e hanyetsana le ts'ebetso ea liprotheine tsa mali, ka lebaka leo e bokellanang, ka hona, phello e matlafatsoa ke kholo ea hypophosphatemia. Mofuta ona oa lefu o nkuoa e le mofuta o bonolo oa lefu la tsoekere.

Lefu la tsoekere la phososite le fetolang lefu la tsoekere Na ke mofuta o sa tloaelehang oa methapo ea mafu e hlahisoang ke liphetoho liphatseng tsa lefutso tsa DMP1 tse fumanehang ho 4th ea chromosome. Mofuta o kopanya acidic matrix dentine phosphoprotein, haholo-holo e thehiloeng dentin le lithong tsa masapo, moo e laolang kholo ea bona. Pathogenesis ea lefu la tsoekere ea phosphate ho mofuta ona oa liphatsa tsa lefutso ha e e-so ithutoe ka botlalo.

Autosomal recessive phosphate lefu la tsoekere le hypercalciuria - hape mofuta o sa tloaelehang oa lefu lena, o hlahisoang ke liphetoho tsa mofuta oa SLC34A3 tse fumanehang ho chromosome ea 9. E kenyelletsa tatellano ea mocha o itšetlehileng ka sodium ea phosphate ion lipelong, 'me e nang le sekoli sebopeho, e lebisa keketsong ea calcium le phosphorous ka har'a moroto ka phokotso e tšoanang ea plasma.

Ho boetse ho na le mefuta ea lefu la tsoekere la phosphate, le tsamaeang le hyperparathyroidism, urolithiasis le mathata a mang. Mefuta e meng ea lefu lena e amana le mefuta e kang ENPP1, SLC34A1 le tse ling. Boithuto ba lisosa tsohle tsa lefu la tsoekere la phosphate bo ntse bo tsoela pele.

Matšoao a lefu la tsoekere la Phosphate

Liponahatso tsa lefu la tsoekere la phosphate ka lebaka la lefutso la lefu lena le tšoauoa ka mefuta e fapaneng ea ho tsieleha - ho tloha thutong e batlang e atile ea ho batla ho hlaka. Maemo a mang a thuto ea methapo ea mafu (ka mohlala, ka lebaka la liphetoho tsa mofuta oa FGF23) a ka bonahatsoa feela ke hypophosphatemia le keketseho ea boemo ba phosphorine ka moroto, ha ho se na matšoao a kliniki. Leha ho le joalo, khafetsa, lefu la tsoekere la phosphate le lebisa setšoantšong sa li-rickets tse tloaelehileng mme li hlaha bongoaneng - lilemo tse 1-2, hang hoba ngoana a qale ho tsamaea.

Ho fokola mesifa ho tloha boseeng e ka ba e 'ngoe ea lipontšo tsa pele tsa lefu la tsoekere, empa ha le bonoe maemong ohle. Hangata, kholo ea lefu lena e qala ka ho fetoha ha maoto a O - a ka lebisang ho lemeng hampe. Ha nako e ntse e ea lefu la tsoekere la phosphate, ho ka ba le lipontšo tse ling tsa ramatiki - kholo ea ho khutla le ho holofala, ho holofala ha meno (haholo-holo ka lefu la lefutso). Pathological fractures, ponahalo ea "ricos" ea "rosary", ho totobala ha litšoantšo tsa masapo a maoto le matsoho ke tšobotsi. Hape, ka lefu la tsoekere la phosphate, bohloko bo ka morao (hangata ba sebopeho sa methapo) le masapo li ka bonoa, maemong a sa tloaelehang, ka lebaka la bohloko maotong, ngoana o amohuoa monyetla oa ho tsamaea. Mathata a nts'etsopele ea kelello a lefu lena, joalo ka molao, ha a hlokomeloe.

Tlhahlobo ea lefu la tsoekere

E 'ngoe ea mekhoa ea pele ea ho sibolla lefu la tsoekere la phosphate ke tlhahlobo e akaretsang ea ngoana ea kulang le tlhahlobo ea karabelo ea lefu lena ho ts'ebeliso ea litekanyetso tse tloaelehileng tsa vithamine D. Ha e le molao, ka lefu lena la litekanyetso ho na le setšoantšo sa litlolo tse hanang tšebeliso ea lithethefatsi tsa setso tsa vithamine ena (oli ea oli, tharollo ea oli) . Bakeng sa boikemisetso bo nepahetseng haholoanyane ba lefu la tsoekere la phosphate o sebelisa mekhoa ea lithuto tsa biochemical tsa mali le moroto, lithuto tsa x-ray, tlhahlobo ea limolek'hule. Pontšo ea kamehla ea lefu lena ke hypophosphatemia kapa ho fokotseha hoa maemo a phosphate ions maling a mali, a ikemiselitseng e le karolo ea tlhahlobo ea biochemical. Ka nako e ts'oanang, boemo ba khalsiamo bo ka ba bo tloaelehileng kapa bo eketsoa, leha ho le joalo, mefuta e meng ea lefu la tsoekere la phosphate (ka lebaka la liphetoho liphatseng tsa SLC34A3) le tsona li tšoauoa ka hypocalcemia. Hape, ka lefu la tsoekere la phosphate, keketseho ea phofo ea alkaline 'me ka linako tse ling ho eketsoa ha lihormone tsa parathyroid. Teko ea moroto oa biochemical e senola tlhahiso e phahameng ea phosphorus (hyperphosphaturia), 'me maemong a mang, hypercalciuria.

Boithuto ba Radiological ba lefu la tsoekere ba phosphate bo khetholla matšoao a li-rickets - ho fokola ha masapo a maoto, mangole le letheka, boteng ba masapo a manonyeletso (maemong a mang, ho fokola hoa masapo ho ka etsahala) le osteomalacia. Sebopeho sa masapo se fetotsoe - sebopeho sa cortical thickens, sebopeho sa trabecular se fetoha coarser, diaphysis e atolosoa. Khafetsa, lilemo tsa x-ray tsa masapo a nang le lefu la tsoekere la phosphate li ka morao haholo ho se hlileng se bonts'ang ho lieha ho nts'etsopele ea skeleton. Liphatsa tsa lefutso tsa morao-rao li u lumella ho fumana mofuta o mong le o mong oa lefu lena, e le molao, mokhoa oa tatellano e tobileng ea liphatsa tsa lefutso tse amanang le pathology o sebelisoa. Maemong a mang, nalane ea lefutso ea mokuli e ka bontša mofuta oa lefu la tsoekere la phosphate.

Phekolo ea lefu la tsoekere la Phosphate

Phosphate lefu la tsoekere le phekoloa ka mefuta e meng ea phekolo ea vithamine, methapo ea kutlo kapa ka linako tse ling mekhoa ea ho buuoa. Leha ho na le lebitso le leng la pathology ena (vithamine D e hanyetsanang le vithamine), vithamine ena e sebelisoa ka mafolofolo kalafo ea boemo bona, empa litekanyetso li lokela ho eketseha haholo. Ntle le moo, bakuli ba nang le lefu la tsoekere ba phosphate ba khethoa ka litokisetso tsa khalsiamo le phosphorus, livithamini A, E le sehlopha B. Ho bohlokoa hore kalafo e nang le livithamini tse qhibilihang habonolo (haholoholo D le A) e lokela ho etsoa ka tlasa taolo ea ngaka le ka ho shebisisa ka hloko litekanyetso ho thibela litla-morao tse sa batleheng le mathata. Ho shebella katleho ea kalafo le ho nepahala ha tekanyetso e boletsoeng ea moriana, ho etsoa tekanyo e tloaelehileng ea boemo ba phosphate le calcium moriring. Ka mefuta e matla ea lefu la tsoekere phosphate, tšebeliso ea vithamine D e kanna ea bontšoa bophelo bohle.

Boemong ba pelehi ba ho tseba lefu lena, kalafo ea lona e kenyelletsa thibelo ea mathata a marapo ke mekhoa ea litlama e amoheloang ka kotloloho - e roetse bandage bakeng sa lesapo la mokokotlo. Ka ho lemosoa hamorao ha lefu la tsoekere la phosphate le khaello e matla ea marapo, ho ka bontšoa khalemelo ea ho buoa. Mefuta ea asymptomatic ea lefu lena, e bonahatsoang feela ke hypophosphatemia le hyperphosphaturia, ho latela litsebi tse ngata, ha e hloke kalafo e matla. Leha ho le joalo, ho hlahlojoa ka hloko boemo ba masapo, tsamaiso ea mesifa, le liphio (thibelo ea urolithiasis) hoa hlokahala, e etsoang ka liteko tse tloaelehileng tsa bongaka ke endocrinologist.

Phatlalatso le thibelo ea lefu la tsoekere

Tsoelo-pele ea lefu la tsoekere ea phosphate e ka fapana mme ea itšetleha ka lintlha tse ngata - mofuta oa lefu lena, ho teba ha matšoao, lilemo tsa ho khetholla lefu la methapo le tšimoloho ea kalafo e nepahetseng. Khafetsa, lefu lena le letle, empa tlhoko ea bophelo bohle ea tšebeliso ea vithamine D, calcium le phosphorous e ka tsoela pele. Ho haelloa ke lesapo la marapo ho bakoang ke ho tsebahala ha lefu la tsoekere kapa kalafo e sa lokelang ea lefu la tsoekere ho ka senya bophelo ba mokuli. Ho thibela lefu lena la lefutso ho ka khoneha feela ka tlhabollo ea bongaka le ea tlhaho ea batsoali pele ba ima, hobane mekhoa e meng ea tlhahlobo ea bokhachane e se e hlahisitsoe.

Lisosa le mefuta e fapaneng ea lefu la tsoekere

Litlhaloso tsa pele tsa lefu lena li hlahile lekholong la bo20 la lilemo. Mokuli o ne a ngolisitsoe ka mofuta o atileng haholo oa li-hypophosphatemic rickets mme karolo ea lefutso ho hlaha hoa eona e netefalitsoe. Hamorao, mefuta e meng ea lefu la tsoekere la phosphate le eona e ile ea tsebahala, e na le likarolo tse tloaelehileng le lisosa tsa eona, mofuta oa lefa le likarolo tsa thupelo. Ka tlase re lula ho tse kholo.

Li-hypophosphatemic tse amanang le X li hokahane. Ena ke e 'ngoe ea maloetse a kang seratsoana, khafetsa ke 1: 20,000 ea bana. Sesosa sa lefu lena ho nkoa e le phetoho ea mofuta oa PHEX e kenyetsang ts'ebetso ea enzyme ea endopeptidase e amehang ts'ebetsong le ho nyenyefatseng ha li-hormone tse fapaneng tsa peptide. Maemong ana, ho haella ha liprotheine ho etsahala, ho tsamaisa metsoako ea phosphorus ka har'a litubu tsa nephron (karolo ea sebopeho sa leino) le mala, e lebisang tahlehelo ea ion ea phosphorous ka moriring le ho kenngoa ka mokhoa o sa sebetseng hantle kahara tšilo ea lijo. Kahoo, metabolism ea phosphorus-calcium e senyeha 'meleng,' me matšoao a fapaneng a amanang le sena a hlaha. Nako ea lefu lena e eketsoa ke metabolism e sa sebetseng ea vithamine D ho hepatocytes (lisele tsa sebete) le secretion e feteletseng ke litšoelesa tsa parathyroid tsa hormone ea parathyroid.
Autosomal e atileng ea hypophosphatemic rickets. Mofuta ona oa lefu o fokola ho feta oa pele mme o na le 'nete e sa tsitsang. E amana le phetoho ea mofuta oa FGF-23, e leng karyotyped ho chromosome 12. Mofuta ona ke ntho e potolohang e hlophisitsoeng ke osteocytes (lisele tsa masapo) e le hore e thibele phokotso ea renalorp (ho khutlisoa hape ka moroto) ea phosphates. Ka keketseho ea ts'ebetso ea eona maling, hypophosphatemia e bonoa.
Autosomal recessive hypophosphatemic rickets. Phapang ena ea lefu la tsoekere la phosphate e bakiloe ke phetoho ea mofuta oa DMP1, e ikarabellang ka ho hlophisoa ha protheine e itseng e amanang le taolo ea keketseho ea li-osteoblasts tse se nang masapo (masapo a masapo a masapo). E boetse e eketsa tahlehelo ea phosphorus ka har'a moroto ka mokokotlong o tloaelehileng oa hormone ea parathyroid le calcitriol.
Herederal hypophosphatemic rickets le hypercalciuria. Ena ke mokhoa o sa fumaneheng habonolo ka lebaka la phetoho ea mofuta oa SLC34A3, e kenyeletsang ts'ebetso ea sodium phosphate cotransporters, e fanang ka phetisetso ea lintho tsa transmembrane linthong tse renal tubules le phosphate homeostasis. E tšoauoa ka tahlehelo ea phosphorus le calcium ka hara moroto, keketseho ea ts'ebetso ea calcitriol le nts'etsopele ea li-rickets.

Thupelo ea bongaka ea lefu la tsoekere ea phosphate ke polymorphic. Hangata lefu lena le qala ho hlaha bongoaneng, empa le ka iponahatsa hamorao - ka lilemo tse 7-9. Ntle le moo, ho teba ha matšoao a hore na ho kula ho ka ba ho fapaneng le eng. Maemong a mang, lefu lena le na le mofuta oa lona 'me le bonahala ka liphetoho tse bonolo ho metabolite ea phosphorus. Leha ho le joalo, li-rickets tsa hypophosphatemic khafetsa li na le setšoantšo se pepesitsoeng sa kliniki:

ho khutla ha kholo ea 'mele le sekhahla sa kholo,
lesapo le senyehileng (lesapo la mokokotlo la likarolo tse ka tlase, "li-rickets" likhopo, letheka la masapo a sephara a sephakeng, ho senyeha ha lehata),
Phetoho ka sejoana sa masea (se tšoana le letata)
tlolo ea sebopeho sa meno,
ologicalological
bohloko ba masapo, jj.

Ho fokolisa mesifa, tšobotsi ea li-rickets tsa 'nete, hangata ha ho na lefu la tsoekere.

Nts'etsopele ea kelello boteng bona ha e utloe bohloko.

Ts'oaetso

Ho khetholla lefu la tsoekere la phosphate ho bana ho ipapisitse le setšoantšo se tloaelehileng sa kliniki, data e tsoang tlhahlobong le tlhahlobo ea 'mele. Tlhahlobo eo e netefalitsoe ke liphetho tsa lithuto tsa mahlale le tsa bongaka:

liphetoho litekong tsa mali (hypophosphatemia, phosphatase e eketsehileng ea alkaline, maemo a tloaelehileng kapa a phahametseng a hormone ea parathyroid le calcitonin) le moroto (hyperphosphaturia, ho fokotsa phosphate reabsorption ka li-renal tubules, ho eketsa khalsiamo ea calcium feela ka li-hypophosphatemic rickets tse nang le calcuria),
Lintlha tsa X-ray (matšoao a icoporosis ea methapo, bofokoli ba masapo, liphetoho sebopeho sa masapo, osteomalacia).

Ka linako tse ling qalong ea lefu lena, bakuli ba joalo ba fumanoa ba na le li-rats mme kalafo e beoa le vithamine D, kalafo e joalo ha e fane ka litholoana mme e fana ka lebaka la ho belaela lefu la tsoekere la phosphate ho ngoana. Haeba ho hlokahala, maemong a joalo, thuto ea liphatsa tsa lefutso e ka abeloa ho khetholla bofokoli ba liphatsa tsa lefutso.

Ho kopantsoe ha hypophosphatemia le li-rickets tsa maoto le matsoho ho boetse ho bonoa maemong a mang a pathological ao ho a khetholloang khethollo e lokelang ho etsoa:

lefu la liphio (renal tubular acidosis, lefu le sa foleng la liphio) le sebete (cirrhosis),
endocrine patology (hyperfunction ea parathyroid gust),
malabsorption ho ulcerative colitis, celiac Enteropathy,
alimentary (lijo) khaello ea vithamine D le phosphorous,
ho nwa meriana e itseng.

Phekolo e phethahetseng ea li-hypophosphatemic rickets e lokela ho qala methating ea pele ea lefu lena. Pele ho tsohle, e etselitsoe ho lokisoa ha mathata a metabolic le thibelo ea bofokoli ba masapo. Ha e laetsoe, ts'ebetso ea ts'ebetso le mamello ea motho ka mong ea meriana e nkoa e le eona.

Motheo oa phello ea kalafo ke kalafo ea nako e telele e nang le litekanyetso tse phahameng tsa vithamine D. E ngotsoe:

ka litlolo tse mafolofolo liseleng tsa masapo,
tahlehelo ea methapo ea phosphorus ka har'a moroto,
litekanyetso tse eketsehileng tsa alkaline phosphatase maling,
sethaleng sa ho itukisetsa ho buuoa ho lokisa bofokoli ba marapo.

Litekanyetso tsa pele tsa vithamini D ke 10,000-20000 IU ka letsatsi. Keketseho ea bona e eketsehileng e etsoa tlasa taolo ea matšoao a metabolism ea phosphorus-calcium maling. Litekanyetso tse phahameng tsa letsatsi le letsatsi li ka ba ngata haholo 'me ka linako tse ling li fihla ho 250,000-300,000 IU.

Ha ho e-na le mamello ea motho ka mong ea vithamine D, hammoho le hypercalciuria e matla, ho khethoa ha kalafo e joalo ho nkuoa ho sa lokelang.

Ntle le vithamine D, bakuli ba joalo ba khothalletsoa ho nka:

phosphorus le calcium litokisetso,
motsoako oa citrate (nakong ea likhoeli tse 6 ho ntlafatsa ho monya lintho tsena tsa ho batla),
kholo ea lihormone.

Nakong ea ts'ebetso e phahameng ea ts'ebetso, bakuli ba eletsoa hore ba phomole betheng, kamora ho fihlela phallo - ho silila ka kalafo, ho ikoetlisa ka ho ikoetlisa le ho phekola spa.

Litekanyetso tsa katleho ea kalafo e bolokehileng ke:

bophelo bo botle,
ho potlakisa kholo,
normalization of phosphorus metabolism 'meleng,
matla a radiology (ho khutlisetsoa sebopeho se tloaelehileng sa masapo).

Boteng ba bofokoli bo phatlalalitsoeng ba masapo khahlanong le semelo sa phetoho ea tleliniki le ea laboratori, khalemelo ea bona ea ts'ebetso e etsoa. Mekhoa e latelang e ka sebelisoa bakeng sa sena:

osteotomy (masapo) a masapo a malelele a tubular ka tokiso ea lengole la maoto le matsoho.
litho tsa maoto le matsoho ke ho sitisoa ke lisebelisoa tsa Ilizarov le compression.

Ts'ebetso e joalo e lokela ho etsoa feela kamora kalafo ea nako e telele ea ho boloka matla le ho hlahloba hantle.

Ke ngaka efe eo u lokelang ho ikopanya le eona?

Haeba lefu la tsoekere la phosphate le belaelloa, ho hlokahala hore u ee ngakeng ea bana eo ka mor'a tlhahlobo ea pele, e tla fetisetsa ngoana ho ea buisana le ngaka ea methapo ea kutlo, orthopedist, le nephrologist. Phekolo e kenyelletsa masseur, physiotherapist, setsebi ho tsa kalafo ea boikoetliso le phepo e nepahetseng. Haeba ho hlokahala, kalafo e etsoa ke ngaka e buoang ea methapo.