Thandizo la odwala matenda ashuga a shuga

Matenda a shuga amatha nthawi yayitali, mpaka zaka 20, amakhala ndi vuto lowononga impso, pomwe sizipangitsa wodwalayo kumva zosasangalatsa. Zizindikiro za matenda a shuga a nephropathy amapezeka pamene kulephera kwa impso kwayamba kale. Ngati wodwala ali ndi zizindikiro za kulephera kwa impso. izi zikutanthauza kuti zinthu zosafunikira za metabolic zimadziunjikira m'magazi. Chifukwa impso zomwe zakhudzidwa sizingakwanitse kusefukira.

Magawo a matenda ashuga nephropathy. Kuyesa ndi kufufuza matenda

Pafupifupi onse odwala matenda ashuga ayenera kuyesedwa pachaka kuwunikira ntchito ya impso. Ngati matenda a diabetes a nephropathy atakula, ndikofunikira kuti muzitha kudziwa koyambirira, pomwe wodwalayo samadzimva. Chithandizo choyambirira cha matenda a shuga a nephropathy amayamba, amakhala ndi mwayi wopambana, ndiko kuti, wodwalayo amatha kukhala ndi moyo wopanda chimbudzi kapena kumuwonjezera impso.

Mu 2000, Unduna wa Zaumoyo ku Russia unavomereza gulu la anthu odwala matenda ashuga ndi magulu. Mulinso mitundu iyi:

Pambuyo pake, akatswiri adayamba kugwiritsa ntchito njira yodziwika bwino yokhudzana ndi matenda a impso a shuga. Mmenemo, osati 3, koma magawo 5 a shuga a nephropathy amadziwika. Onani magawo a matenda a impso osafunikira kuti mumve zambiri. Gawo liti la matenda ashuga okodzetsa wodwala ena limadalira kuchuluka kwake kwa kusefedwa (amafotokozedwa mwatsatanetsatane momwe amatsimikizidwira). Ichi ndiye chizindikiro chofunikira kwambiri chomwe chikuwonetsa momwe impso zimasungidwira bwino.

Pa nthawi yodziwitsa anthu odwala matenda ashuga, ndi bwino kuti dokotala adziwe ngati impsoyo yakhudzidwa ndi matenda ashuga kapena zina. Kupezeka kosiyanitsa kwa matenda ashuga nephropathy ndi matenda ena a impso kuyenera kupangidwa:

Zizindikiro za matenda a pyelonephritis:

Zakudya za matenda a impso a shuga

Nthawi zambiri omwe ali ndi vuto la impso odwala matenda ashuga, kuchepetsa magazi kumathandiza kuchepetsa kuthamanga kwa magazi, kuchepetsa kutupa, komanso kuchepetsa kufalikira kwa matenda ashuga. Ngati magazi anu atakhala abwinobwino, ndiye kuti musadye mopitilira mchere wa 5-6 wa mchere patsiku. Ngati muli kale ndi matenda oopsa, ndiye kuti kuchepetsa mchere wanu ndi magalamu awiri atatu patsiku.

Tsopano chinthu chofunikira kwambiri.Chithandizo cha boma chimalimbikitsa kudya “moyenera” anthu odwala matenda ashuga, komanso ngakhale ochepa mapuloteni a shuga a nephropathy. Tikukulimbikitsani kuti muganiza zogwiritsa ntchito zakudya zamafuta ochepa kuti muchepetse magazi anu kukhala abwinobwino. Izi zitha kuchitika pa kusefedwa kwa glomerular pamtunda wa 40-60 ml / mphindi / 1.73 m2. Mu nkhani "Zakudya za impso ndi matenda a shuga," mutu wofunikirawu wafotokozedwa mwatsatanetsatane.

Njira yayikulu yopetsera komanso kuchiza matenda a diabetes a nephropathy ndikuchepetsa shuga m'magazi ndikuwonetsetsa kuti ali ndi moyo wathanzi. Pamwambapa, mwaphunzira momwe mungachitire izi ndi zakudya zamafuta ochepa. Ngati kuchuluka kwa shuga m'magazi kumakwezedwa kwambiri kapena nthawi zonse kumasinthasintha kuchokera kumtunda kupita pa hypoglycemia, ndiye kuti magawo ena onse sangakhale othandiza.

Mankhwala ochizira matenda ashuga nephropathy

Pakuwongolera matenda oopsa, komanso matenda oopsa a impso, matenda a shuga nthawi zambiri amapatsidwa mankhwala - ACE inhibitors. Mankhwalawa samangochepetsa kuthamanga kwa magazi, komanso amateteza impso ndi mtima. Kugwiritsa ntchito kwawo kumachepetsa chiopsezo cha kulephera kwa impso. Mwinanso, zoletsa zazitali za ACE za nthawi yayitali ndizabwinoko kuposa captopril. omwe ayenera kumwedwa katatu patsiku.

Wodwala akayamba kukhosomola chifukwa chotenga mankhwala kuchokera ku gulu la zoletsa zoletsa za ACE, ndiye kuti mankhwalawo amasinthidwa ndi angiotensin-II receptor blocker. Mankhwala omwe ali mgululi ali okwera mtengo kwambiri kuposa ACE inhibitors, koma ocheperako amayambitsa zovuta. Amateteza impso ndi mtima ndi ntchito yofananira.

Kuthamanga kwa magazi kwa odwala matenda ashuga ndi 130/80 ndipo pansipa. Nthawi zambiri, odwala omwe ali ndi matenda a shuga a 2, amatha kuchitika pogwiritsa ntchito mankhwala osakanikirana. Imatha kukhala ndi ACE inhibitor ndi mankhwala osokoneza bongo “kuchokera kuzokakamiza” zamagulu ena: okodzetsa, ophera beta, othandizira calcium. ACE inhibitors ndi angiotensin receptor blockers palimodzi osavomerezeka. Mutha kuwerengera za mankhwala ophatikiza matenda oopsa, omwe akulimbikitsidwa kugwiritsa ntchito shuga, apa. Lingaliro lomaliza, lomwe mapiritsi okuthandizira, amapangidwa ndi adokotala okha.

Momwe mavuto a impso amakhudzira chisamaliro cha matenda a shuga

Ngati wodwala wapezeka ndi matenda a shuga, ndiye njira zochizira matenda osiyanasiyana zimasiyana kwambiri. Chifukwa chakuti mankhwala ambiri amafunika kuti athetsedwe kapena kuti mulingo wawo ukhale wochepa. Ngati kuchuluka kwa kusefera kwafupika kumacheperachepera, ndiye kuti mlingo wa insulini uyenera kuchepetsedwa, chifukwa impso zofowoka zimapangitsa pang'onopang'ono.

Chonde dziwani kuti mankhwala otchuka a mtundu wa 2 metformin (siofor, glucophage) angagwiritsidwe ntchito pokhapokha poyerekeza 60 ml / min / 1.73 m2. Ngati ntchito ya impso ya wodwalayo itafooka, ndiye kuti chiwopsezo cha lactic acidosis, chowopsa chowonjezera, chikuwonjezeka. Zikatero, metformin imathetsedwa.

Ngati wodwalayo akuwonetsa magazi m'thupi, ndiye kuti ayenera kuthandizidwa, ndipo izi zikuchepetsa kukula kwa matenda ashuga. Wodwala amatchulidwa mankhwala omwe amalimbikitsa erythropoiesis, i.e., kupanga maselo ofiira am'magazi. Izi zimangochepetsa chiopsezo cha kulephera kwa impso, komanso zimasintha bwino kwambiri moyo. Ngati odwala matenda ashuga sanakhalebe dialysis, zowonjezera zachitsulo zitha kupangidwanso.

Ngati prophylactic chithandizo cha matenda ashuga nephropathy sichithandiza, ndiye kuti kulephera kwa impso kumayamba. Zikakhala choncho, wodwalayo amayenera kuyesedwa, ndipo ngati ndi kotheka, ndikulanditsa impso. Pankhani yokhudza kupatsirana kwa impso, tili ndi nkhani ina. ndi hemodialysis ndi peritoneal dialysis tikambirana pansipa.

Hemodialysis ndi peritoneal dialysis

Panthawi ya hemodialysis, catheter imayikidwa mu mtsempha wamagazi.Amalumikizidwa ndi chida chakunja cha mbewa chomwe chimatsuka magazi m'malo mwa impso. Pambuyo poyeretsa, magaziwo amawabwezera kumagazi a wodwalayo. Hemodialysis imatha kuchitika kuchipatala. Zitha kuyambitsa kutsika kwa magazi kapena matenda.

Peritoneal dialysis ndi pamene chubu sichinayikidwe mu mtsempha, koma m'mimba. Kenako madzi ambiri amamwetsedwamo ndi dontho. Uwu ndi madzi apadera omwe amakoka zinyalala. Amachotsedwa ngati madzimadzi amachokera m'timabowo. Peritoneal dialysis iyenera kuchitidwa tsiku lililonse. Imakhala ndi chiopsezo cha matenda kumadera omwe chubu imalowa m'mimba.

Mu shuga mellitus, kusungirako kwamadzi, kusokonezeka kwa kuchuluka kwa nayitrogeni ndi ma elekitirodi a electrolyte kumayamba pamlingo wapamwamba kwambiri wamasefera. Izi zikutanthauza kuti odwala matenda ashuga ayenera kusinthidwa kuti ayimbe kale kuposa odwala omwe ali ndi matenda a impso. Kusankhidwa kwa dialysis njira kumadalira zomwe dokotala amakonda, koma kwa odwala palibe kusiyana kwakukulu.

Poyamba kuyamba aimpso m'malo mankhwala (dialysis kapena impso kupatsidwa zina) odwala matenda ashuga:

Zizindikiro zamagetsi oyesa magazi mwa odwala omwe ali ndi matenda a shuga omwe amathandizidwa ndi dialysis:

Ngati matenda a impso amapezeka mwa odwala matenda ashuga okhudzana ndi dialysis, zotupa za erythropoiesis zimalembedwa (epoetin-alpha, epoetin-beta, methoxypolyethylene glycol epoetin-beta, epoetin-omega, darbepoetin-alpha), komanso mapiritsi a jekeseni kapena jakisoni. Amayesa kukhalabe ndi kuthamanga kwa magazi pansi pa 140/90 mm Hg. Art. ACE inhibitors ndi angiotensin-II receptor blockers amakhalabe mankhwala osankhidwa pochiza matenda oopsa. Werengani nkhani yakuti “Hypertension in Type 1 and Type 2 Diabetes” mwatsatanetsatane.

Hemodialysis kapena peritoneal dialysis iyenera kungotengedwa ngati gawo lokhazikika pokonzekera kupatsirana kwa impso. Pambuyo kumuyika kwa impso kwa nthawi yothandizidwa, wodwalayo amachiritsidwa kwathunthu chifukwa cha kulephera kwa impso. Matenda a diabetes a nephropathy akhazikika, kupulumuka kwa odwala kukuchulukirachulukira.

Pokonzekera kufalitsa kwa impso chifukwa cha matenda ashuga, madokotala akuyesayesa kuwona kuti zingatheke bwanji kuti wodwalayo azikhala ndi vuto la mtima (matenda a mtima kapena sitiroko) panthawi kapena pambuyo pa opaleshoni. Kuti izi zitheke, wodwalayo amapimidwa mayeso osiyanasiyana, kuphatikizapo ECG yokhala ndi katundu.

Nthawi zambiri zotsatira za mayesowa zimawonetsa kuti ziwiya zomwe zimadyetsa mtima ndi / kapena ubongo zimakhudzidwanso kwambiri ndi atherosulinosis. Onani nkhani "Renal Artery Stenosis" kuti mumve zambiri. Pankhaniyi, kupatsirana kwa impso, tikulimbikitsidwa kupangitsanso mwamphamvu kuchuluka kwa ziwiya izi.

Kodi ndingathetse matenda ashuga osatha?

Ziwerengero zamanyumba zikuchepa kwambiri chaka chilichonse! Russian Diabetes Association imati munthu m'modzi mwa anthu 10 m'dziko lathu ali ndi matenda a shuga. Koma chowonadi ndichakuti si matenda omwewo omwe amawopsa, koma zovuta zake ndi moyo womwe umawatsogolera. Momwe mungathane ndi matendawa akufotokozedwa poyankhulana. Phunzirani zambiri. "

Diabetes nephropathy: ndi chiyani?

Diabetesic nephropathy (DN) ndi njira yothandizira matenda a impso yomwe yayamba chifukwa cha zovuta za matenda ashuga.Chifukwa cha DN, kuthekera kwa impso kumachepetsa, komwe kumayambitsa nephrotic syndrome, ndipo pambuyo pake kutha kulephera.

Wathanzi impso ndi matenda ashuga nephropathy

Kuphatikiza apo, amuna komanso odwala matenda ashuga omwe amadalira insulin ndi omwe ali ndi vuto kwambiri kuposa omwe ali ndi matenda osokoneza bongo omwe amadalira insulin. Pachimake pa chitukuko cha matendawa ndikusintha kwake mpaka pakufika poti matenda a impso alephera (CRF), omwe nthawi zambiri amapezeka zaka 15 mpaka 15 za matenda a shuga.

Potchula zomwe zimayambitsa kukula kwa matenda ashuga nephropathy, matenda a hyperglycemia nthawi zambiri amatchulidwa. kuphatikiza ochepa matenda oopsa. M'malo mwake, matendawa sikuti nthawi zonse amakhala chifukwa cha matenda ashuga.

Matenda a diabetes nephropathy ndi chotupa cha impso zomwe zimasokoneza njira ya matenda ashuga. Zofanana ndi matenda amtundu woyamba wa shuga, pomwe matenda akayamba kutha ndi omwe amawonera chiopsezo chakukula msanga kwa zovuta. Kutalika kwa matendawa kumakhudzanso kuwonongeka kwa minyewa.

Kukhazikika kwa kulephera kwa aimpso kwakanthawi kumasintha kwambiri kuwonetsa kwa matenda ashuga. Zimayipa kwambiri m'thupi la wodwalayo, zitha kukhala chifukwa chachindunji cha imfa.

Kungowunikira mosalekeza, kulandira chithandizo kwakanthawi, ndikuwunika momwe umagwirira ntchito kumachepetsa kuyenda kwa njirayi.

Njira za chiyambi ndi chitukuko

Pathogenesis ya nephropathy imachitika chifukwa cha kuwonongeka kwa mitsempha yaying'ono ya impso. Pali kuwonjezeka kwa epithelium yophimba ziwiya kuchokera mkati mwamkati (endothelium), kukula kwa nembanemba yamitsempha yamagalasi (basement membrane). Kukula kwa capillaries (micaneurysms) kumachitika. Malo okhala mkati mwathupi amadzaza ndi mamolekyulu a mapuloteni ndi dzuwa (glycoproteins), minofu yolumikizana imakula. Izi zimabweretsa kukula kwa glomerulossteosis.

Nthawi zambiri, mawonekedwe osokoneza amayamba. Amadziwika ndi kuyanjana kwamtundu wamtundu wapansi. Matenda a psychology amapita kwa nthawi yayitali, nthawi zambiri samabweretsa mapangidwe owoneka aimpso. Chowoneka mosiyana ndi njirayi ndikutukuka kwake osati mu shuga mellitus, komanso matenda ena, omwe amadziwika ndi kuwonongeka kwa mitsempha ya impso (matenda oopsa).

Mawonekedwe a nodular sakhala wamba, amakhala ndi mtundu woyamba wa matenda ashuga, amapezeka ngakhale atakhala ndi kanthawi kochepa, ndipo amakula msanga. Ma lesion (ochepa mawonekedwe a ma capillaries) amawonedwa, mawonekedwe a chotengera amatsika, ndipo kamangidwe kake ka aneurysms kamayamba. Izi zimapangitsa kusokonezeka kwa kayendedwe ka magazi.

International Classization of matenda a Revised 10 ili ndi ma code osiyana a ICD 10 osinthira, mapangidwe amisala a minyewa ya impso, komanso chosinthika chamutu chotchedwa Kimmelstil-Wilson syndrome. Komabe, chikhalidwe cha nephrology chachikhalidwe pansi pa matendawa chimanena zowonongeka zonse za impso mu shuga.

Ndi matenda a shuga, zida zonse za glomeruli zimakhudzidwa, zomwe zimayambitsa pang'onopang'ono kuphwanya kwakukulu kwa impso - kusefera kwamkodzo

Nephropathy mu shuga imadziwikanso ndi kuwonongeka kwa ziwiya zazing'onoting'ono zamagetsi zomwe zimanyamula magazi kupita ku glomeruli, kukula kwa machitidwe a sclerotic m'malo omwe amapezeka. Tubules a impso, ngati glomeruli, amasiya kugwira ntchito. Mokulira, kuphwanya kusokonezeka kwa madzi a m'magazi kumayamba ndipo kutuluka kwa mkodzo mkati mwa impso kumakulirakulira.

Mtundu wa zochitika

Palibe zenizeni zenizeni pazomwe zimayambitsa matenda a diabetesic nephropathy pakadali pano pakupanga mankhwala. Ngakhale kuti zovuta za impso sizikugwirizana mwachindunji ndi kuchuluka kwa shuga m'magazi, odwala ambiri omwe ali ndi matenda ashuga omwe ali pamndandanda woyembekezera kupatsirana kwa impso. Nthawi zina, matenda ashuga satenga mikhalidwe yotere, kotero pali malingaliro angapo opezeka ndi matenda a shuga.

Ziphunzitso zasayansi zakukula kwamatenda:

• Chiphunzitso cha chibadwa.Anthu omwe ali ndi vuto lobadwa nalo lotengeka ndi vuto la hemodynamic ndi metabolic matenda a shuga mellitus amakhala ndi impso.
• Chiphunzitso cha Metabolic. Kusakhazikika kwakanthawi kapena kuwonjezereka kwa shuga wabwinobwino wamagazi (hyperglycemia), kumayambitsa zosokoneza zam'magazi. Izi zimabweretsa njira zosasintha mu thupi, makamaka, kuwononga minofu ya impso.
• Chiphunzitso cha Hemodynamic. Mu shuga mellitus, kuthamanga kwa magazi mu impso kumayipa, zomwe zimapangitsa kuti pakhale matenda oopsa. M'magawo oyambilira, hyperfiltration imapangidwa (kupangika kwamikodzo), koma izi zimasinthidwa mwachangu chifukwa chokhala ndi gawo chifukwa magawo ake ndi otsekeka.

Kukula kwa matenda am'mimba kumalimbikitsidwa kwambiri ndi hyperglycemia wa nthawi yayitali, mankhwala osasinthika, kusuta fodya ndi zizolowezi zina zoyipa, komanso zolakwika zakudya zamagulu, kunenepa kwambiri komanso njira zotupa m'magulu apafupi (mwachitsanzo, matenda a genitourinary system).

Amadziwikanso kuti abambo nthawi zambiri amapanga zamtundu wamtunduwu kuposa azimayi. Izi zitha kufotokozedwa ndi kapangidwe kake ka genitourinary system, komanso kuperewera kopatsa chidwi kochokera kwa dokotala pachipatala.

Zowopsa Zokhudza Matenda A shuga Aakulu

Ngakhale kuti zifukwa zazikulu zowonetsera matendawa ziyenera kufunidwa pantchito zamkati zamkati, zinthu zina zitha kukulitsa chiopsezo chotenga matenda oterewa. Poyang'anira odwala matenda ashuga, madokotala ambiri mosakayikira amalimbikitsa kuti aziwunikira momwe matenda amtunduwu amathandizira ndikupanga mayeso pafupipafupi ndi akatswiri owerengeka (nephrologist, urologist, ndi ena).

Zomwe zimathandizira pakukula kwa matendawa:

• Shuga wokhazikika komanso wosasamala,
• Matenda a m'mimba omwe samatsogolera ngakhale pamavuto owonjezera (hemoglobin ochepera 130 mwa odwala achikulire),
• Kuthamanga kwa magazi, matenda oopsa,
• Kuchuluka kwa cholesterol ndi triglycerides m'magazi,
• Kusuta fodya komanso kumwa mowa mwauchidakwa.

Zizindikiro za matendawa

Tanthauzo la kudwala matenda kumayambiriro koyambirira lithandizira kuthandizira mosamala mankhwala, koma vutoli ndilo kuyamba kwa matendawa. Kuphatikiza apo, zizindikiro zina zitha kuwonetsa mavuto ena azaumoyo. Makamaka, zizindikiro za matenda a shuga a nephropathy ndi ofanana kwambiri ndi matenda monga matenda a pyelonephritis, glomerulonephritis kapena chifuwa chachikulu cha impso. Matenda onsewa amatha kuikidwa mu matenda a impso, chifukwa chake, kuti mupeze matenda olondola, kuyezetsa kokwanira ndikofunikira.

• Kuwonjezeka kwa kuthamanga kwa magazi - matenda oopsa,
• Zovuta ndi kupweteka kumbuyo
• Matenda a mitundu yosiyanasiyana, nthawi zina,
• Matenda am'mimba, mseru komanso kuwonda,
• Kutopa, kugona ndi kufooka wamba,
• Kutupa kwa miyendo ndi nkhope, makamaka kumapeto kwa tsiku,
• Odwala ambiri amadandaula za khungu louma, kuyimitsidwa ndi zotupa pa nkhope ndi thupi.

Nthawi zina, zizindikirazi zimatha kukhala zofanana ndi za matenda ashuga, choncho odwala samachita nawo chidwi. Tiyenera kudziwa kuti onse odwala matenda ashuga ayenera kukhala ndi mawonekedwe apadera omwe amawonetsa kupezeka kwa mapuloteni ndi magazi mumkodzo wawo. Zizindikirozi ndizizindikiro zakukula kwa vuto laimpso, lomwe lithandiza kudziwa matendawa posachedwa.

Matenda a matenda ashuga nephropathy

Dziwani matendawa kumayambiriro kumathandizira kulumikizana ndi katswiri - nephrologist. Kuphatikiza pa maphunziro a labotale omwe amathandizira kudziwa magawo a mkodzo ndi magazi mwa odwala, maphunziro apadera othandizira ndi ma microscopic a minofu ya gawo lomwe lakhudzidwa amagwiritsidwa ntchito kwambiri.Kuti muwonetsetse ngati muli ndi vuto loyenera, muyenera kuchita zingapo, zosiyanasiyana komanso zoyenera zomwe adokotala amatsimikiza.

Zomwe zingathandize kudziwa matendawa:

• Kupenda kwa impso. Mtundu wopweteketsa mtima komanso wopindulitsa kwambiri. Ultrasound ikuwonetsa ma pathologies a kukula kwa chiwalo, kusintha kukula kwake, mawonekedwe ndi mawonekedwe a aimpso a ducts.
• Kutulutsa ziwiya za impso. Zimachitika kuti kudziwa patency ndi kudziwa zotheka pathologies ndi kutupa njira.
• Biopsy ya minofu ya impso. Imachitika pansi pa opaleshoni yakumaloko, zomwe zimasantidwa ndi ma microscope kuti mupeze ma pathologies otheka.

Chithandizo cha odwala matenda ashuga a Nephropathy

Ntchito zikuluzikulu zimapangidwa kuti matenda a shuga akhale magazi komanso kukonza kwathunthu kwa thupi. Ma metabolic ambiri mu shuga mellitus amapezeka mosiyanasiyana, zomwe zimabweretsa kuwonongeka kwa mawonekedwe, kuwonongeka kwa mtima ndi mavuto ena. Kumayambiriro kwa matendawo, pali mwayi weniweni wowongolera vutoli ndi zakudya komanso chindapusa cha matenda ashuga.

Njira zopewera kukhazikitsa matenda a matenda ashuga:

• Kuthamanga kwa magazi,
• Kuwongolera shuga
• Zakudya Zamchere ndi Zakudya,
• Kutsitsa magazi m'thupi,
• Kusiya zizolowezi zoipa,
• Zochita zolimbitsa thupi
• Kukana kumwa mankhwala omwe amakhudza impso,
• Kuyendera pafupipafupi kwa nephrologist ndi kuyesa.

Zizindikiro zomwe zikuwoneka zokhazokha, njira zodzitetezera nokha sizikhala zokwanira, chifukwa chake muyenera kufunsa dokotala pazamankhwala oyenera. Kuphatikiza apo, ndikofunikira kuyang'anira kuwerengedwa kwamkodzo ndi magazi kuti zitsimikizire momwe mankhwalawo amathandizira.

Mankhwala akuphatikizapo:

• Kutenga angiotensin kutembenuza ma enzyme (ACE) zoletsa. Izi zimaphatikizapo mankhwala monga Enalapril, Ramipril, ndi Thrandolapril.
• Special angiotensin receptor antagonists (ARA). Mwa otchuka kwambiri ndi awa: Irbesartan, Valsartan, Losartan.
• Kukhalabe ndi mtima dongosolo, othandizira amagwiritsidwa ntchito omwe amatulutsa mawonekedwe a lipid mawonekedwe a magazi.
• Ndi kuwonongeka kwambiri kwa impso, tikulimbikitsidwa kumwa mankhwala osokoneza bongo, ma sorbets ndi odana ndi azotemic.
• Kuti muwonjezere hemoglobin, mankhwala apadera amagwiritsidwa ntchito, komanso njira zina. Kugwiritsa ntchito mankhwala kuyenera kuvomerezedwa ndi dokotala.
• Ma diuretics amathandiza polimbana ndi kutaya mtima, komanso kuchepetsa kuchuluka kwa madzi omwe amwedwa.

Ndalama zomwe zalembedwazo zimasinthasintha matenda oopsa komanso osakanikirana, kuchepetsa kuthamanga kwa magazi komanso kuchepetsa kuchepa kwa matendawa. Ngati chithandizo chamankhwala chokha sichokwanira, vuto la njira zambiri zakuthandizira impso likuyankhidwa.

Chithandizo Chakumapeto

Zizindikiro wamba za kulephera kwa impso sikuti zimangowonjezera mayeso a labotale, komanso mkhalidwe wa wodwalayo. Pakadutsa magawo a matenda a shuga a nephropathy, kutha kwa impso kumachepa kwambiri, motero njira zina pamavuto zimayenera kuganiziridwanso.

Njira zama Cardinal ndi:

• Hemodialysis kapena impso yochita kupanga. Zimathandizira kuchotsa zopangidwa zowola kuchokera mthupi. Njirayi imabwerezedwa pakatha pafupifupi tsiku limodzi, chithandizo chothandizira choterechi chimathandiza wodwalayo kukhala ndi vutoli kwa nthawi yayitali.
• Peritoneal dialysis. Mfundo yosiyana pang'ono kuposa hem hemalalysis. Njira zoterezi zimachitika pang'ono (pafupifupi kamodzi masiku atatu kapena asanu) ndipo sizimafunikira zida zamakono zamankhwala.
• Kupatsidwa impso. Kusamutsa chiwalo chopereka kwa wodwala. Opaleshoni yothandiza, mwatsoka, siofala kwambiri m'dziko lathu.

Mu magawo amtsogolo a matendawa, odwala ali ndi kuchepa kwa zofunika za insulin.Ichi ndi chizindikiro choopsa cha kupita patsogolo kwa matenda. Ichi ndichifukwa chake ndikofunikira kwambiri kuti pasakhale shuga wambiri. Pakadali pano, ngakhale odwala omwe samadalira insulin amasamutsidwa.

Kuzindikira kwa matenda ashuga nephropathy

Ngakhale atenga njira zopewera matenda a matenda ashuga, odwala matenda ashuga ambiri amakumana ndi zovuta izi. Nthawi zina, njira yokhayo yopulumutsira moyo wa wodwala ndikufalitsa impso. Ntchito ngati izi zimakhala ndi zinthu zingapo, nthawi yayitali yokonzanso komanso mtengo wokwera. Kuphatikiza apo, chiwopsezo cha kukonzanso kwa nephropathy ndichokwera kwambiri, chifukwa chake ndibwino kuti musalole kusintha kwa matendawa kupita patsogolo.

Momwe matendawa amathandizira odwala omwe ali ndi matenda ashuga nephropathy ndiabwino kwambiri. Matendawa amakula pang'onopang'ono, ndipo ngati mutsatira malangizo a dokotala ndikuwongolera shuga, odwala mwina sangadziwe zovuta ngati izi.

Nephropathy mu matenda a shuga amachitika pafupipafupi, pomwe palibe amene amadziwa kutsimikiza kwa zomwe zimayambitsa matenda. Amadziwika kuti ndi mokwera m'magazi a shuga, kulephera kwa impso kumakula nthawi zambiri, ndipo zinthu zina zowonjezera zimathandizira izi. Kupatula kukhazikika kwa kulephera kwambiri kwa impso ndi chiopsezo cha kufa, ndikofunikira kuyang'anira kuwerengera kwamkodzo ndikugwiritsa ntchito mankhwala othandizira kuti matenda asungidwe.

Zimayambitsa kuwonongeka kwa impso mu shuga

Chofunikira chomwe chimatsogolera ku matenda a impso a diabetes ndi nephropathy ndikusokonekera kwamtundu wa arterioles omwe akubwera komanso otuluka. Munthawi yachilendo, arteriole imachulukanso kawiri kuposa momwe imagwirira ntchito, zomwe zimapangitsa kupanikizika mkati mwa glomerulus, kulimbikitsa kusefera kwa magazi ndikupanga mkodzo woyamba.

Mavuto osinthika mu shuga mellitus (hyperglycemia) amachititsa kuti mitsempha ya magazi itheretu mphamvu ndi kunenepa. Komanso, shuga wambiri m'magazi amachititsa magazi kulowa m'magazi nthawi zonse, zomwe zimapangitsa kuti ziwonetserozo zikwaniritse, ndipo omwe akuchita izi samasunganso m'mimba mwake kapenanso kupyapyala.

Mkati mwa glomerulus, kupanikizika kumamangika, komwe kumapangitsa kuti kuwonongeka kwa kugwira ntchito kwa impso glomeruli ndi kulowa kwawo ndi minofu yolumikizana. Kupsinjika kwamphamvu kumalimbikitsa kudutsa mu ma glomeruli a mankhwala omwe nthawi zambiri samaloledwa: mapuloteni, lipids, maselo am magazi.

Diabetes nephropathy imathandizidwa ndi kuthamanga kwa magazi. Ndi kupanikizika kosalekeza, zizindikiro za proteinuria zimachulukana komanso kusefedwa mkati mwa impso kumachepa, zomwe zimatsogolera pakukula kwa impso.

Chimodzi mwazifukwa zomwe zimapangitsa nephropathy mu shuga ndi zakudya zomwe zimakhala ndi mapuloteni ambiri muzakudya. Poterepa, njira zotsatirazi za m'magazi zimayamba m'thupi:

1. Mu glomeruli, kupanikizika kumawonjezeka komanso kusefera kumawonjezeka.
2. Kuchulukitsa kwa mapuloteni a urinary ndi kuchuluka kwa mapuloteni mu minofu ya impso kukukulira.
3. Mawonekedwe a lipid pamagazi amasintha.
4. Acidosis imayamba chifukwa cha kuchuluka kwa mapangidwe a nayitrogeni.
5. Ntchito ya zinthu zomwe zikuchulukitsa glomerulossteosis imachulukirachulukira.

Matenda a shuga amayamba ndi shuga wambiri. Hyperglycemia sikuti imangowonjezera kuwonongeka kwakukulu kwa mitsempha yamagazi ndi ma free radicals, komanso imachepetsa chitetezo chifukwa cha glycation ya mapuloteni a antioxidant.

Poterepa, impso zimakhala ziwalo zomwe zimakhudzidwa kwambiri ndi oxidative nkhawa.

Zizindikiro za Nephropathy

Mawonetsedwe azachipatala a matenda ashuga nephropathy komanso gulu la magawo amawonetsa kupita patsogolo kwa chiwonongeko cha minofu ya impso ndi kuchepa kwa mphamvu yawo yochotsa zinthu zakupha m'magazi.

Gawo loyamba limadziwika ndi kuwonjezeka kwa impso - kuchuluka kwa kusefa kwamkodzo kumawonjezeka ndi 20-40% ndikuwonjezera magazi kwa impso. Palibe zizindikiro zaumoyo pakadali pano a matenda a shuga, ndipo kusintha kwa impso kumasinthanso ndi matenda a glycemia pafupi ndi abwinobwino.

Pachigawo chachiwiri, kusintha kwamapangidwe mu minyewa ya impso kumayamba: kupindika kwapansi pa glomerular kumakulitsidwa ndikumalowetsedwa ndi mamolekyulu ang'onoang'ono a protein. Palibe zizindikiro za matendawa, kuyesa kwa mkodzo ndikwabwinobwino, kuthamanga kwa magazi sikusintha.

Matenda a shuga a nephropathy a gawo la microalbuminuria amawonetsedwa ndi kutulutsidwa kwa albumin tsiku lililonse 30 mpaka 300 mg. Mtundu woyamba wa matenda ashuga, umachitika zaka 3-5 atatha matendawa, ndipo matenda a nephritis amtundu wa 2 amatha kutsatiridwa ndi kuwoneka kwa mapuloteni mkodzo kuyambira pachiyambi pomwe.

Kukula kwa kuchuluka kwa impso kwa mapuloteni kumayenderana ndi izi:

• Kulipira odwala matenda ashuga.
• Kuthamanga kwa magazi.
• Mafuta akulu kwambiri.
• Micro ndi macroangiopathies.

Ngati panthawiyi kukonzanso kwa zomwe zikutsimikizidwa kwa glycemia ndi kuthamanga kwa magazi kumakwaniritsidwa, ndiye kuti aimpso hemodynamics ndi kuvomerezeka kwamankhwala kumatha kubwezeretsedwanso.
Gawo lachinayi ndi proteinuria pamwamba pa 300 mg patsiku. Amapezeka mwa odwala matenda a shuga pambuyo zaka 15 zodwala. Kusefera kwa glomerular kumachepera mwezi uliwonse, komwe kumayambitsa kulephera kwa aimpso pambuyo pa zaka 5-7. Zizindikiro za matenda a shuga a nephropathy pakadali pano amaphatikizidwa ndi kuthamanga kwa magazi komanso kuwonongeka kwa mtima.

Kuzindikira kosiyanitsa kwa diabetesic nephropathy ndi nephritis, kochokera mu chitetezo chokwanira kapena mabakiteriya, zimatengera kuti nephritis imachitika ndikuwoneka kwa leukocytes ndi maselo ofiira amkodzo mkodzo, ndi nephropathy ya diabetes.

Kuzindikira nephrotic syndrome kumavumbulutsanso kuchepa kwa mapuloteni amwazi ndi cholesterol yayikulu, lipoproteins yotsika.

Edema mu matenda a shuga nephropathy amalimbana ndi okodzetsa. Amayamba kuwoneka pankhope ndi mwendo wotsika, kenako ndikufikira kumimba ndi chifuwa, komanso gawo la pericardial. Odwala amapita patsogolo kufooka, nseru, kupuma movutikira, kulephera kwa mtima kumalumikizana.

Monga lamulo, matenda a shuga a nephropathy amapezeka molumikizana ndi retinopathy, polyneuropathy ndi matenda a mtima. Autonomic neuropathy imatsogolera ku mawonekedwe osapweteka a myocardial infarction, atom ya chikhodzodzo, orthostatic hypotension ndi erectile dysfunction. Gawoli limawonedwa ngati losasinthika, popeza zoposa 50% ya glomeruli imawonongeka.

Gulu la odwala matenda ashuga nephropathy amasiyanitsa gawo lomaliza lachisanu ngati uremic. Kulephera kwa impso kumawonetsedwa ndi kuwonjezeka kwa magazi a mankhwala oopsa a nayitrogeni - creatinine ndi urea, kuchepa kwa potaziyamu komanso kuwonjezeka kwa serum phosphates, kuchepa kwa kuchuluka kwa kusefera kwa glomerular.

Zizindikiro zotsatirazi ndizomwe zimachitika ndi matenda a diabetesic nephropathy pakutha kwa impso:

1. Pang'onopang'ono matenda oopsa.
2. Zowopsa edematous syndrome.
3. Kupuma pang'ono, tachycardia.
4. Zizindikiro za pulmonary edema.
5. Kulimbana kwambiri magazi m'thupi matenda ashuga.
6. Matendawa

Ngati kusefera kwa glomerular kutsika mpaka kufika pa 7,5 ml / min, ndiye kuti zizindikiro za kuledzera zimatha kuyabwa pakhungu, kusanza, kupuma kwamiseche.

Kudziwitsa za phokoso lokhala ndi vuto la kubadwa kwa mafupa kumakhala kovuta kwa odwala kudwala ndipo amafunikira kulumikizidwa kwa wodwalayo ku zida za dialysis ndi chothandizira kupatsirana.

Njira zopezera nephropathy mu shuga

Kuzindikira nephropathy kumachitika pakusanthula kwamkodzo kuchuluka kwa kusefera, kupezeka kwa mapuloteni, maselo oyera am'magazi ndi maselo ofiira am'magazi, komanso zomwe zili mu syntinine ndi urea m'magazi.

Zizindikiro za matenda a shuga a nephropathy amatha kutsimikizika ndi kuwonongeka kwa Reberg-Tareev chifukwa cha zomwe zimapangidwa mu mkodzo wa tsiku ndi tsiku.Poyambirira, kusefedwa kumachulukitsa katatu mpaka 200-300 ml / min, kenako ndikugwetsa kakhumi matenda atayamba.

Kuti muzindikire diabetesic nephropathy omwe zizindikiro zake sizinawonekere, microalbuminuria amadziwika. Kusanthula kwa mkodzo kumachitika motsutsana ndi maziko a kulipidwa kwa hyperglycemia, mapuloteni amachepetsa mu chakudya, okodzetsa komanso zolimbitsa thupi samayikidwa.
Maonekedwe a proteinuria yosalekeza ndi umboni wa kufa kwa 50-70% ya glomeruli la impso. Chizindikiro chotere chimatha kuyambitsa osati neabetes ya nephropathy, komanso nephritis yotupa kapena autoimmune chiyambi. Muzochitika zokayikitsa, percutaneous biopsy imachitika.

Kuti mudziwe kuchuluka kwa kulephera kwa impso, urea wamagazi ndi creatinine amawunika. Kuchuluka kwawo kukuwonetsa kuyambika kwa matenda aimpso.

Njira zopewera komanso zochizira matenda a nephropathy

Kupewa kwa nephropathy ndi kwa odwala matenda ashuga omwe ali pachiwopsezo chachikulu cha kuwonongeka kwa impso. Izi zimaphatikizapo odwala omwe ali ndi vuto lochepa kwambiri la hyperglycemia, matenda opitilira zaka 5, kuwonongeka kwa retina, cholesterol yayikulu, ngati m'mbuyomu wodwalayo anali ndi nephritis kapena adapezeka kuti ali ndi vuto la impso.

Mtundu woyamba wa matenda a shuga, matenda a shuga amachepetsa matenda a shuga. Zimatsimikiziridwa kuti kukonzanso kwa hemoglobin ya glycated, monga m'munsi mwa 7%, kumachepetsa chiwonongeko cha ziwiya za impso ndi 27-34 peresenti. Mtundu wachiwiri wa matenda a shuga, ngati zotere sizingatheke ndi mapiritsi, ndiye kuti odwala amapatsidwira ku insulin.

Chithandizo cha matenda ashuga nephropathy pa gawo la microalbuminuria imachitikanso ndi kuvomerezedwa koyenera kwa carbohydrate metabolism. Gawo ili ndi lomaliza pamene mungachepetse komanso nthawi zina kusintha zina ndi zina ndipo chithandizo chimabweretsa zotsatira zabwino.

Njira zazikulu zamankhwala:

• Mankhwala a insulin kapena kuphatikiza mankhwala a insulin ndi mapiritsi. Chowerengera chake ndi glycated hemoglobin pansipa 7%.
• Zoletsa za angiotensin-kutembenuza enzyme: pa mavuto wamba - otsika Mlingo, ndi kuchuluka - sing'anga achire.
• Matenda a magazi mafuta m'thupi.
• Kuchepetsa mapuloteni azakudya 1G / kg.

Ngati matendawa adawonetsa gawo la proteinuria, ndiye kuti ndi matenda a shuga a m'mimba, chithandizo chikuyenera kukhazikika popewa kukula kwa impso. Mwa izi, kwa mtundu woyamba wa matenda ashuga, insulin mankhwala opitilira, ndipo kusankha mapiritsi ochepetsa shuga, mphamvu yawo ya nephrotoxic siyiyenera kuphatikizidwa. Mwa osankhidwa otetezeka kwambiri a Glurenorm ndi Diabeteson. Komanso, monga momwe zikuwonekera, ndi matenda a shuga 2, ma insulin amayikidwa kuphatikiza pa chithandizo kapena amasamutsidwa kwathunthu ku insulin.

Kupanikizika ndikulimbikitsidwa kuti isungidwe pa 130/85 mm Hg. Art. Popanda kufikira kuthamanga kwamagazi, kubwezeretsa kwa glycemia ndi lipids m'magazi sikubweretsa zotsatira zomwe mukufuna, ndipo ndizosatheka kuyimitsa kupitilira kwa nephropathy.

Pazipita achire ntchito ndi nephroprotective zotsatira anawona angiotensin-kutembenuza enzyme zoletsa. Amakhala ndi ma diuretics ndi beta-blockers.

Pa gawo pamene magazi a creatinine amakwezedwa mpaka 120 ndi kupitirira μmol / L, chithandizo cha kuledzera, matenda oopsa, ndikuphwanya zomwe zili mu electrolyte m'magazi. Pa mitengo yoposa 500 μmol / L, gawo la kusakwanira kosawonongeka limawonetsedwa kuti ndi malo ogwiritsira ntchito, omwe amafunikira kulumikizana kwa impso yochita kupanga.

Njira zatsopano zopewera kukula kwa matenda ashuga nephropathy zimaphatikizanso kugwiritsa ntchito mankhwala omwe amaletsa kuwonongeka kwa impso, zomwe zimakhudza kupezeka kwa nembanemba yapansi panthaka. Dzina la mankhwalawa ndi Wessel Douay F. Kugwiritsa ntchito kwake kuloledwa kuchepetsa kuchuluka kwa mapuloteni mumkodzo ndipo zotsatira zake zidapitilira miyezi itatu atachoka.

Kupezeka kwa kuthekera kwa aspirin kuti achepetse kupindika kwa mapuloteni kwadzetsa kufunafuna kwa mankhwala atsopano omwe ali ndi vuto lofananalo, koma osatchulanso zomwe zimakhumudwitsa mucous membrane. Izi zimaphatikizapo aminoguanidine komanso zotumphukira za vitamini B6. Zambiri pa matenda ashuga nephropathy zimaperekedwa mu kanema munkhaniyi.

Zoyambitsa Nephropathy

Impso zimasefa magazi athu kuzakumwa zozungulira nthawi yonseyi, ndipo zimatsuka nthawi zambiri masana. Kutulutsa konse komwe kumalowa impso ndi pafupifupi malita 2,000. Njirayi ndiyotheka chifukwa cha kapangidwe ka impso - zonse zimalowetsedwa ndi ma network a ma microcapillaries, tubules, mtsempha wamagazi.

Choyamba, kudzikundikira kwa ma capillaries omwe magazi amalowamo amayamba ndi shuga wambiri. Amatchedwa aimpso glomeruli. Mothandizidwa ndi shuga, ntchito zawo zimasintha, kukakamizidwa mkati mwa glomeruli kumakulanso. Impso zimayamba kugwira ntchito mopitilira muyeso, mapuloteni omwe alibe nthawi yosefera tsopano alowe mkodzo. Kenako ma capillaries awonongedwa, m'malo mwake minofu yolumikizana imamera, ma fibrosis amapezeka. Glomeruli mwina kusiya ntchito yawo, kapena kuchepetsa kwambiri zokolola zawo. Kulephera kwamkati kumachitika, kutuluka kwa mkodzo kumachepa, ndipo thupi limamwa.

Matenda a shuga ndi kupsinjika kudzakhala chinthu chakale

Matenda a shuga ndi omwe amayambitsa pafupifupi 80% yonse yamikwingwirima ndi kuduladula. Anthu 7 mwa anthu 10 amafa chifukwa cha mitsempha ya mtima kapena ubongo. Pafupifupi nthawi zonse, chifukwa chomaliza chomaliza ndi chimodzimodzi - shuga wamwazi.

Shuga akhoza ndipo amayenera kugwetsedwa, apo ayi. Koma izi sizichiritsa matendawa, koma zimangothandiza kulimbana ndi kufufuza, osati zomwe zimayambitsa matendawa.

Mankhwala okhawo omwe amalimbikitsidwa mwalamulo kwa odwala matenda ashuga komanso ogwiritsidwa ntchito ndi endocrinologists pantchito yawo ndi Ji Dao Diabetes Adhesive.

Kugwiritsa ntchito bwino kwa mankhwalawa, kuwerengera malinga ndi njira yokhazikika (kuchuluka kwa odwala omwe achiwonjezere kuchuluka kwa odwala omwe ali pagulu la anthu 100 omwe adachitiridwa chithandizo):

Opanga Ji Dao si bungwe lazamalonda ndipo amalipiridwa ndi boma. Chifukwa chake, tsopano wokhala aliyense ali ndi mwayi wopeza mankhwalawo kuchotsera 50%.

Kuphatikiza pa kuwonjezeka kwa kupsinjika ndi kuwonongeka kwa mtima chifukwa cha hyperglycemia, shuga imakhudzanso njira za metabolic, zomwe zimayambitsa zovuta zingapo zam'magazi. Mapuloteni ndi glycosylated (amachita ndi glucose, shuga), kuphatikiza mkati mwa impalism, ntchito ya michere yomwe imakulitsa kupezeka kwa makoma a mitsempha yamagazi, mapangidwe a ma free radicals. Izi zimathandizira kukhazikitsa matenda a shuga.

Kuphatikiza pa chachikulu chomwe chimayambitsa nephropathy - kuchuluka kwa shuga m'magazi, asayansi amatchulanso zinthu zina zomwe zimakhudza mwayi ndi kuthamanga kwa matendawa:

• chibadwa. Amakhulupirira kuti matenda a shuga a nephropathy amawonekera mwa anthu omwe ali ndi chibadwa. Odwala ena sasintha impso ngakhale atakhala nthawi yayitali kulipira chiphuphu cha matenda a shuga,
• kuthamanga kwa magazi
• matenda a kwamkodzo thirakiti
• kunenepa
• amuna
• kusuta

Zizindikiro za kupezeka kwa DN

Matenda a diabetes nephropathy amakula pang'onopang'ono, kwa nthawi yayitali matendawa samakhudza moyo wa wodwala yemwe ali ndi matenda ashuga. Zizindikiro palibe. Kusintha kwa glomeruli kwa impso kumayamba pokhapokha zaka zochepa moyo ndi matenda ashuga. Mawonetseredwe oyamba a nephropathy amagwirizanitsidwa ndi kuledzera kofatsa: ulesi, kukoma kosayenera mkamwa, kusowa kudya. Mlingo wa tsiku ndi tsiku wa mkodzo umachulukana, kukodza kumachitika pafupipafupi, makamaka usiku. Mphamvu ya mkodzo yocheperako imachepetsedwa, kuyezetsa magazi kumawonetsa hemoglobin yotsika, kuchuluka kwa creatinine ndi urea.

Zizindikiro za matenda ashuga nephropathy zimawonjezeka pamene gawo la matendawa limakulirakulira.Kuwonekera kokwanira, komwe kumatchulidwa kumachitika pokhapokha zaka 15 mpaka 20, pamene zosintha zosintha mu impso zikufika kwambiri. Amawonetsedwa ndikukakamizidwa kwambiri, edema yayikulu, kuledzera kwambiri kwa thupi.

Gulu la odwala matenda a shuga a Nephropathy

Matenda a diabetes nephropathy amatanthauza matenda a genitourinary system, code malinga ndi ICD-10 N08.3. Amadziwika ndi kulephera kwa impso, momwe kuchuluka kwa kusefedwa mu glomeruli impso (GFR) kumachepa.

GFR ndiye maziko a magawidwe a matenda ashuga nephropathy malinga ndi magawo akukulidwe:

1. Ndi hypertrophy yoyambirira, glomeruli imakulirakulira, kuchuluka kwa magazi osefedwa kumakula. Nthawi zina kuwonjezeka kwa kukula kwa impso kumawonedwa. Palibe mawonekedwe akunja pakadali pano. Ziyeso sizimawonetsa kuchuluka kwa mapuloteni mumkodzo. SCF>
2. Kupezeka kwa kusintha kwamapangidwe a glomeruli kumawonedwa patadutsa zaka zingapo chitadutsa matenda a shuga. Pakadali pano, nembanemba wa glomerular amadzala, ndipo mtunda pakati pa capillaries umakula. Pambuyo pochita masewera olimbitsa thupi komanso kuwonjezeka kwa shuga, mapuloteni amkodzo amatha kuwonekera. GFR imagwera pansi pa 90.
3. Kukhazikika kwa matenda a shuga a nephropathy amadziwika ndi kuwonongeka kwakukulu m'matumbo a impso, ndipo chifukwa chake, kuchuluka kwamapuloteni ambiri mu mkodzo. Odwala, kupanikizika kumayamba kuchuluka, poyamba pokhapokha atagwira ntchito zolimbitsa thupi kapena zolimbitsa thupi. GFR imatsika kwambiri, nthawi zina mpaka 30 ml / mphindi, zomwe zimawonetsa kuyambika kwa kulephera kwa impso. Asanakhale gawo ili, osachepera zaka 5. Nthawi yonseyi, kusintha kwa impso kumatha kusintha ndikusamalidwa bwino ndikutsatira kwambiri zakudya.
4. Matendawa otchulidwa MD amadziwika ngati kusintha kwa impso kusintha, mapuloteni amkodzo amapezeka> 300 mg patsiku, GFR 9030010-155Matenda a Nephropathy

Chinthu chachikulu pakupezeka kwa matenda ashuga nephropathy ndikuwazindikira matendawa panthawi yomwe vuto laimpso likadasinthidwanso. Chifukwa chake, odwala matenda ashuga omwe amalembetsedwa ndi endocrinologist amapatsidwa mayeso kamodzi pachaka kuti adziwe microalbuminuria. Mothandizidwa ndi kafukufukuyu, ndizotheka kudziwa mapuloteni mumkodzo ngati sanatsimikizidwe pakuwunika kofalikira. Kusanthula kumakonzedwa chaka chilichonse zaka 5 pambuyo poyambitsa matenda a shuga 1 ndipo pakatha miyezi 6 iliyonse atazindikira kuti ali ndi matenda a shuga a 2.

Ngati mulingo wa mapuloteni ndiwokwera kuposa wabwinobwino (30 mg / tsiku), kuyesedwa kwa Reberg kumachitika. Ndi chithandizo chake, chimawunikiridwa ngati mawonekedwe aimpso a glomeruli amagwira ntchito moyenera. Pakuyesa, kuchuluka konse kwamkodzo komwe kamatulutsa impso mu ola limodzi (monga njira, buku la tsiku ndi tsiku) limasonkhanitsidwa, ndipo magazi amatengedwanso kuchokera mu mtsempha. Kutengera ndi kuchuluka kwa mkodzo, mulingo wa creatinine m'magazi ndi mkodzo, mulingo wa GFR amawerengedwa pogwiritsa ntchito njira yapadera.

Kusiyanitsa matenda a shuga a m'mbuyomu chifukwa cha matenda osokoneza bongo a pyelonephritis, kugwiritsa ntchito kwamkodzo ndi kuyesa magazi kumagwiritsidwa ntchito. Ndi matenda opatsirana a impso, kuchuluka kwama cell oyera ndi mabakiteriya amkati amkati. Chifuwa cham'mimba chimadziwika ndi kukhalapo kwa leukocyturia komanso kusowa kwa mabakiteriya. Glomerulonephritis imasiyanitsa pamaziko a kuyesa kwa X-ray - urology.

Kusintha kwa magawo otsatirawa a matenda a shuga a nephropathy amatsimikizika pamtundu wowonjezereka wa albumin, mawonekedwe a mapuloteni ku OAM. Kupititsa patsogolo kwa matendawa kumakhudza kuchuluka kwa kupanikizika, kusintha kwambiri magazi.

Ngati kusintha kwa impso kumachitika mofulumira kwambiri kuposa kuchuluka kwapafupipafupi, mapuloteni amakula mwamphamvu, magazi amawonekera mkodzo, biopsy ya impso imachitidwa - gawo la minyewa ya impso limatengedwa ndi singano yopyapyala, yomwe imathandizira kumveketsa momwe masinthidwe ake.

Kodi matendawa amathandizidwa bwanji?

Kuti muzindikire matendawa, kupita kwa madokotala a akatswiri sikofunikira; Amapereka mankhwala.Cholinga chake pakali pano ndikuchepetsa shuga, cholesterol, triglycerides m'mwazi kukhala yokhazikika, kuchepetsa kuthamanga kwa magazi.

Magawo a shuga a Cholinga:

• 4-7 mmol / l - pamimba yopanda kanthu
• 6-8 mmol / l - pogona.
• mpaka 10 mmol / l - ola limodzi mutatha kudya.

Kuyambira gawo 3, kufunsira ndi nephrologist ndikofunikira. Ndi chitukuko chowonjezera cha nephropathy, wodwala matenda a shuga amalembetsa ndi nephrologist ndipo amamuyendera pafupipafupi.

Kumwa mankhwala

M mayeso akangoyamba kudziwa mapuloteni mumkodzo wa matenda a shuga, mankhwalawa amachokera ku gulu la ACE inhibitors. Amatha kulimbikitsa vasodilation komanso kuletsa enzyme, yomwe imakhudza kuchepa kwawo. Chifukwa chake, kuchepa kwa kuthamanga kwa magazi ndi kuteteza impso kumatheka. ACE inhibitors amachepetsa kutulutsa kwa albin mkodzo, amachepetsa chiopsezo cha matenda a mtima ndi ziwiya zazikulu. Mankhwala osokoneza bongo monga enalapril, Captopril, lisinopril amatha kuyimitsa chitukuko cha kuwonongeka kwa impso ngakhale kwa odwala matenda a shuga omwe alibe kuthamanga kwa magazi. Pankhaniyi, milingo yawo imasinthidwa kotero kuti palibe kuchepa kwambiri kwa kukakamizidwa.

Gulu lachiwiri la mankhwala ochizira matenda a shuga ndi nephropathy ndi AT1 receptor blockers. Amatha kuchepetsa kamvekedwe ka misempha ndi kukakamizidwa mwa iwo. Ndikokwanira kumwa mankhwalawa kamodzi patsiku, amalekerera mosavuta ndipo amakhala ndi zotsutsana pang'ono. Ku Russia, losartan, eprosartan, valsartan, candesartan amalembetsedwa. Kuti muteteze bwino impso, chithandizo chovuta chimagwiritsidwa ntchito ndi mankhwala ochokera ku magulu onse awiri.

Ndizovuta kwambiri kwa odwala matenda oopsa omwe ali ndi matenda ashuga nephropathy kuti achepetse zovuta, motero amapatsidwa mankhwala ena. Kuphatikiza kulikonse kumasankhidwa payekhapayekha kotero kuti kwathunthu amachepetsa kupsinjika kwa 130/80 kapena kutsika, ndikuwonetsa izi chiwopsezo cha kuwonongeka kwa impso ndizochepa - About matenda oopsa komanso matenda ashuga.

Mankhwala ochepetsa magazi mu shuga

Gawo 3, othandizira a hypoglycemic amatha kuthandizidwa ndi omwe sangadzikundike impso. Pa gawo 4, matenda a shuga a 1 amafunika kusintha kwa insulin. Chifukwa cha kusachita bwino kwa impso, amamuthira nthawi yayitali kuchokera magazi, kotero amafunikira zochepa. Pomaliza, chithandizo cha matenda a shuga a nephropathy amakhala ndikuthandizira thupi, kukulitsa kuchuluka kwa hemoglobin, m'malo mwa impso zomwe sizikugwira ntchito ndi hemodialysis. Pambuyo pokhazikika pamkhalidwewo, funso loti mwina lingasinthidwe ndi chinthu chopereka limaganiziridwa.

Pali zodabwitsa pakugwiritsa ntchito maantibayotiki. Zochizira matenda opatsirana a bakiteriya mu impso ndi matenda a diabetes nephropathy, othandizira othandizira amagwiritsidwa ntchito, mankhwalawa ndiwotalikirapo, poyenera kuwongolera milingo ya creatinine.

Kufotokozera kwapfupi

Matenda a shuganephropathy (matenda a impso a matenda a shuga) - matenda othandizira omwe amakhala ndi albinuria (AU) wopitilira 30 mg / tsiku, wapezeka kawiri mkati mwa miyezi 3-6 ndi kuchepa kwapang'onopang'ono kwa GFR komanso kuwonjezeka kwa kuthamanga kwa magazi (BP).

NB! Pamaso pa DN, kupezeka kwa Matenda a Impso Impso kumapangidwa motsimikiza momwe gawo limayendera.

Chiwerengero cha ma ICD-10 ndi ICD-9:

Tsiku loyambira / protocol: Chaka cha 2016.

Ogwiritsa Ntchito Protocol: akatswiri azachipatala, othandizira, othandizira, ma endocrinologists, ma urologist, abettrician-gynecologists, resuscitators.

Gulu la Odwala: akuluakulu.

Kukula kwa Umboni

Diagnosis (chipatala chakunja)

Matenda Othandizira Kunja

Njira zoyenera

Madandaulo:
Anachepetsa chilako
W ludzu
Khungu
Kukoma kosasangalatsa mkamwa,
Kuchepetsa mseru
Zofooka
Kutopa
Kugona
Kukodza pafupipafupi.

Anamnesis:
· Matenda okhazikitsidwa ndi matenda a shuga.

Kuyeserera kwakuthupi:
Kutupa (kuchokera kutumphuka kochepa kwambiri mpaka pamimba ndi masisitere).

Kafukufuku wa Laborator:

Urinalysis:
· Albuminuria (kuyesa kwa Albinuria kuyenera kuchitidwa ndi matenda ashuga 1 pambuyo pa ≥ zaka 5, ndi matenda a shuga a mtundu 2 akangomupeza),
· Kuchulukitsa kwa Albumin / Creatinine (A: C) mu mkodzo,
· Proteinuria kuyambira ochepa mpaka nephrotic (oposa 3g / tsiku),
Glucosuria
Hypoalbuminemia,
Hypoproteinemia,

Kuyesa kwamwazi wamagazi:
Hyperglycemia
Hyperlipidemia,
Kuchuluka kwa urea ndi creatinine,
Kuchulukitsa uric acid
· Kuchuluka kwa potaziyamu, phosphorous,
Kuchuluka kwa mahomoni a parathyroid,
Kukula kwa GFR (Hyperfiltration), ndi kuchepa kwa GFR,
· Kuchulukitsa kwa glycosylated hemoglobin,
Kuphwanya mbiri ya glycemic.

Kafukufuku wothandiza:
Ultrasound yamimba yam'mimba - kupezeka kwa madzimadzi aulere (ascites) kumatha kupezeka,
· Ultrasound a impso - kuchuluka kukula kwa impso, kukulitsa ndi kusayenda kwamkodzo mu CSF.

Diagnostic Algorithm:

Chithunzi 1 Diagnostic algorithm yokhudza matenda ashuga nephropathy

NB! Kuyesa kwa albuminuria kuyenera kuchitidwa ndi matenda ashuga amtundu woyamba pambuyo pa zaka 5, ndi matenda a shuga a 2 atangodziwikiratu.

Dokotala (chipatala)

DIAGNOSTICS PA STATIONARY LEVEL

Njira zoyenera kuzitsatira pamalo opumira:

Madandaulo ndi anamnesis:
· Mbiri ya kupezeka kozindikira matenda a shuga,
Zosintha mu urinalysis mwanjira ya proteinuria kapena kuchuluka kwake,
· Kuchuluka kwa kuthamanga kwa magazi, kutsika kwa magazi,
Maonekedwe a edema,
· Zosintha pakuyezetsa magazi monga kuchuluka kwa creatinine, urea.

Kuyeserera kwakuthupi:
Kuyesedwa kwa kupezeka ndi kuopsa kwa edema (kuchokera ku zotumphukira zochepa mpaka patsekeke ndi ma cellarca), kuyeza tsiku lililonse kulemera, kuchuluka kwa madzimadzi amalandila (mkati ndi mwaubwino) komanso mkodzo wothira. Kuzindikira kwa foci a matenda. Kuyeza kwa kuthamanga kwa magazi kukhala / kuyimirira kapena kunama / kuyimirira.

Kafukufuku wa Laborator:
OAM - albinuria, proteinuria. Leukocyturia, cylindruria, erythrocyturia, (tsiku ndi tsiku albuminuria / proteinuria),
Kuwerengera magazi - leukocytosis, kuchuluka kwa ESR, kuchepa magazi,
· Kusanthula kwa biochemical kwa magazi: kuchepa kwa albumin ndi mapuloteni athunthu, hyperglycemia (kuchuluka kwa mafuta m'thupi), kuchuluka kwa mafuta m'thupi ndi magawo ake, kuchuluka kwa urea, creatinine, uric acid, kuchuluka kwa potaziyamu, kuchepa kwa calcium, kuchuluka kwa phosphorous,
Kuchuluka kwa mahomoni a parathyroid,
Kuchepa kwa GFR,
Mbiri yapa glycemic,
· Pamaso pa kukana kwa NS, nthawi ya shuga yochepera zaka 5 ndi GFR> 60 ml / mphindi - kulowererapo kwa impso ya biopsy yotsatiridwa ndi mayeso a morphological (kuwala, immunofluorescence ndi ma elekitirodi elekitirodi

Kafukufuku wothandiza:
Ultrasound a impso - impso zazing'ono kukula kukula ndi kukulitsa ndi kusayenda kwamkodzo mu CSF.
Ultrasound yamimba yam'mimba - kupezeka kwa madzimadzi aulere (ascites) kumatha kupezeka,

Diagnostic Algorithm:
· Ngati pali mbiri yokhazikika ya albuminuria nthawi zopitilira 2 m'miyezi 3-6, kupezeka kwa DN kwakhazikitsidwa,
· Pamaso pa kukana kwa NS, nthawi ya shuga yochepera zaka 5 ndi GFR> 60 ml / mphindi - kupindika kozungulira kwa impso kutsatiridwa ndikuwunika kwa morphological (kuwala, immunofluorescence ndi ma elekitirofoni a elekitiroma) okhala ndi matenda a morphological.

Mndandanda wa njira zazikulu zodziwira matenda:
OAM
Kuwerengetsa magazi,
· Kuyesa kwamwazi wamagazi,
Ultrasound a impso.

Mndandanda wazinthu zowonjezera kuzindikira:
Ultrasound yam'mimba, yam'mimba,
Echocardiography,
· Ultrasound ya ziwiya impso
· Kuyendera impso ndi kusanthula kwa matenda a impso pamaso pa NS yolephera, nthawi ya shuga osakwana zaka 5 ndi GFR> 60ml / min

Kusiyanitsa mitundu

Mankhwala (zinthu zogwira ntchito) zomwe zimagwiritsidwa ntchito pochiza

Chithandizo (chipatala chakunja)

KUTENGA KWAULERE

Njira zamankhwala othandizira

NB! Kuchiza kwa DN kuyenera kutengera kuwunika kwakanthawi ndikuwongolera zomwe zili pachiwopsezo chachikulu pakukula kwa DN - hyperglycemia and hypertension (UD - 1A).

NB! Odwala ndi DN ayenera lingalirani chandamale HbA1C mulingo 6.5-7.0% zosinthika kwa wodwala payekha (UD - 2B)

NB! Cholinga chachikulu cha chithandizo cha DN chapamwamba ndikulepheretsa kukula kwa ESRD ndikuchepetsa chiopsezo cha mtima.

NB! Njira zochiritsira ziyenera kukhudza njira zazikulu za pathogenetic komanso zinthu zowopsa zomwe zimakhudza chitukuko ndi kupita patsogolo kwa DN; kuthekera kwakukulu pakuchepetsa kupita patsogolo kwa DN kungatheke ndi njira ya multifactorial (UD - 2C).

Mankhwala osagwiritsa ntchito mankhwala

· Kusintha kwa moyo. Odwala omwe ali ndi NAM ayenera kulangizidwa za kusintha kwamakhalidwe azithandizo zomwe zimaphatikizapo kuchepetsa kudya kwawo kwa sodium chloride ndi mapuloteni ndi chakudya, kusiya kusuta, ndikuwongolera thupi.
· Zosintha Zakudya: zoletsa kudya kwa NaCl ndi mapuloteni. Kusungidwa kwam'manja komanso kuwonjezeka kwa dziwe la sodium yosinthanitsidwa ndikudziwika kwa matenda ashuga, omwe ndi omwe amachititsa kuti magazi asokonezeke komanso kuchepa kwa magwiridwe antchito angapo a antihypertensive mankhwala (ACE inhibitors, ARBs, BCC).
· Zakudya za tsiku ndi tsiku za NaCl ziyenera kuchepetsedwa mpaka 3-5 g / tsiku.
· Muchepetse mapuloteni okwanira 0,8 g / kg / tsiku atha kuchepetsa kupitilira kwa DN (Pedrini MT et al., 1996, Andersen S etal., 2000). Ndikofunika kuti pang'ono pang'ono mapuloteni azinyama ndi ndiwo zamasamba. Kuletsedwa kwazakudya zamagulu ndikuwonjezereka kwa mafuta a polyunsaturated ndikofunikanso (Gross JL et al., 2002, Ros E et al., 2004). Zakudya za calorie ziyenera kukhala 30-35 kcal / kg / tsiku.
· Kusuta kufafaniza ndi chimodzi mwazofunikira pakusintha moyo wa wodwala yemwe ali ndi matenda ashuga, popeza zawonetsedweratu kuti chizolowezi ichi choyipa chimalumikizidwa ndi ziwopsezo zomwe zimapangitsa kuti akhale ndi DN komanso kupita patsogolo kwapang'onopang'ono (Orth S.R., 2002).
· Kuchepetsa thupi zofunika BMI> 27 kg / m 2.

Mankhwala

Kuwongolera glycemic.
Nthawi iliyonse ya DN, kufunitsitsa kuchepetsa hemoglobin ya glycated kuti ikhale pacholinga chake (6.5-7.0%) ndikofunikira. Mukakonzekera metabolic control, mulingo wa GFR (UD-1A) uyenera kukumbukiridwa.
Odwala omwe ali ndi matenda a shuga a 2: ndi GFR 30% ya magawo anayi oyambira milungu 4, komanso / kapena kuchuluka kwa hyperkalemia> 5.5 mmol / L.

NB! Mankhwala ochepetsa shuga omwe amavomerezeka kuti agwiritsidwe ntchito pamagawo osiyanasiyana a CKD onani CP CKD.

Malangizo a dyslipidemia:
Odwala omwe ali ndi DN, cholinga cha lipid-kutsitsa mankhwala ndi mulingo wa LDL Gulu la gulu Mayina a mankhwala osokoneza bongo Angiotensin Inhibitors
kutembenuza enzymePerindopril 5 mg, 10 mg,
Lisinopril 10 mg, 20 mg
Ramipril 2,5 mg, 5 mg 10 mg,
Fosinopril 10 mg, 20 mg, Angiotensin II receptor blockersLosartan 50 mg, 100 mg,
Valsartan 80 mg, 160 mg,
Candesartan 8 mg, 16 mg Zotsatira:
• Thuazide-ngati
• Kutuluka
• Potaziyamu-wosasamala (wotsutsa a al-
dosterone)
Indapamide 2,5 mg, 5 mg,
Furosemide 40 mg, Torasemide 5 mg, 10 mg
Spironolactone 25 mg, 50 mg
Ma calcium calcium blockers:
• Dihydropyridine,
• wopanda dihydropyridine,

Nifedipine 10 mg, 20 mg, 40 mg
Amlodipine 2.5 mg, 5 mg, 10 mg
Verapamil, Verapamil SR, Diltiazem
Zoyimitsa:
• Zosasankha (β1, β2),
• Mtima (β1)

• Zophatikizika (β1, β2 ndi α1)Propranolol, nadolol, pindolol, timolol, sotalol
metoprololatartrate 50 mg, 100 mg,
bisoprolol 2.5 mg, 5 mg, 10 mg,
nebivolol 5 mg
esmolol, talinolol, carvedilol.

Mankhwala a antihypertensive: gwiritsani ntchito ngati mankhwala osakanikirana

Moxonidine Direct Renin InhibitorsAliskiren

Kufunsira kwa Optometrist - kuti mutsimikizire matenda ashuga a retinopathy,
· Kufunsira kwa endocrinologist - pakuwongolera matenda ashuga,
- Kulumikizana ndi mtima - pamaso pa zisonyezo za kulephera kwa mtima ndi kusokonekera kwa mitsempha,
· Kufunsidwa kwa opaleshoni ya mtima - kukhazikitsa mtima wa hemodialysis.

Njira zopewera:

Kuwaphunzitsa wodwala kudya, kuwongolera ndikukwaniritsa kuchuluka kwa kuthamanga kwa magazi ndi hemoglobin ya glycated,
· Kuphunzitsa popewa matenda opatsirana a peritoneal dialysis.

Kuyang'anira Odwala

Zisonyezero zamankhwala othandizira:
· Matenda a electrolyte bwino, nthawi 1 pa sabata,
Kuchepetsa ndi / kapena kuphatikizika kwathunthu kwa edema, kuwongolera - masekeli tsiku ndi tsiku,
Chizolowezi chotsika komanso / kapena chizolowezi chamoto, kuwongolera kawiri pa tsiku,
· Malangizo a acidosis, nthawi 1 pa sabata,
· Chizolowezi chowonjezeka komanso / kapena kuphatikiza kuchuluka kwa hemoglobin ndi magazi m'thupi, kuwongolera 2 pamwezi,
· Kuchepetsa ndi / kapena kusintha mtundu wa phosphorous, ptg, kuwongolera nthawi imodzi m'miyezi itatu,
Kupititsa patsogolo thanzi labwino, kulakalaka kudya, IMT,
Kuchepetsa kukula kwa aimpso kulephera, mphamvu - pachaka cha GFR.

Chithandizo (ambulansi)

ZINSINSI NDI KUTHENGA KWA DZIKO LA EMERGENCY EMERGENCY

Njira zozindikiritsa: ayi.

Chithandizo cha mankhwala:
Chithandizo chamankhwala choperekedwa pa gawo la ambulansi yadzidzidzi (onani CP ya ma nosologies oyenerera):
- Chithandizo cha matenda a mtima pachimake (m'mapapo mwanga edema),
- Chithandizo cha mavuto oopsa,
· AH kukonza kwa CKD.

Chithandizo (kuchipatala)

KUGWIRITSITSA NTCHITO CHEMA

Chithandizo cha mavuto a pang'onopang'ono aimpso kukanika zimaphatikizapo kuzindikira ndi kukonza magazi m'thupi, metabolic acidosis, kusokonezeka kwa phosphate-calcium metabolism, dyselectrolytemia, onani KP "CKD mwa akulu."

Njira zamankhwala: onani malo apamwamba.
Chithandizo chosamwa: onani malo apamwamba.
Chithandizo cha mankhwala: onani malo apamwamba.

Opaleshoni

Mtundu wa ntchito:
Kupereka kwa impso,
Opaleshoni ya Bariatric
· Mapangidwe a aristiovenous fistula ndi catheter kuphatikizika (kwa mbali ya dialysis),
Kukhazikitsa kwa dialysis catheter kwakanthawi (mwadzidzidzi zikuwonetsa),
· Kupangidwe kwa AVF (pulogalamu hemodialysis),
Kuyika kwa kupanga ma prosthesis
· Kukhazikitsa catheter wokhazikika (zikuwonetsa),
Kuyika kwa peratheone catheter (kwa ma peritoneal dialysis),
Balloon angioplasty / kulimbitsa ziwiya za impso (ndi stenosis).

Mitundu ina ya chithandizo:
· Mathandizo obwezeretsa m'mimba (hemodialysis, hemodifiltration, peritoneal dialysis, onani CP CKD),
Katemera wa chiwindi "B",
· Maphunziro azamisala,
· Maphunziro odwala.

Zisonyezero zosamutsa kumadipatimenti osamalira ndi kusamalira anthu:
Kukula kwa vuto (oliguria, azotemia, edema),
Kupanikizika kwa matenda a extrarenal pathology (vuto lalikulu la matenda oopsa, ngozi ya pachimake yamatenda, mtima komanso / kapena kulephera kwa chiwindi, sepsis, etc.).

Zizindikiro zamankhwala ochiritsira
· Matenda a electrolyte bwino, nthawi 1 pa sabata,
Kuchepetsa ndi / kapena kuphatikizika kwathunthu kwa edema, kuwongolera - masekeli tsiku ndi tsiku,
· Chizolowezi kuchepa komanso / kapena kufalikira kwa magazi, kuwongolera kawiri pa tsiku,
· Malangizo a acidosis, nthawi 1 pa sabata,
· Chizolowezi chowonjezeka komanso / kapena kuphatikiza kuchuluka kwa hemoglobin ndi magazi m'thupi, kuwongolera 2 pamwezi,
· Kuchepetsa ndi / kapena kusintha mtundu wa phosphorous, PTH, kuwongolera nthawi imodzi m'miyezi itatu,
Kupititsa patsogolo thanzi labwino, kukulitsa chidwi cha chakudya, BMI,
Kuchepetsa kukula kwa aimpso kulephera, mphamvu - pachaka cha GFR.

Zambiri

Mndandanda wazopanga protocol:
1) Sultanova Bagdat Gazizovna - Doctor of Medical Science, Pulofesa, Mutu wa Dipatimenti ya Nephrology, Cardiology, KazMUNO.
2) Tuganbekova Saltanat Kenesovna - MD, wamkulu wazachipatala wa Unduna wa Zaumoyo wa Kazakhstan.
3) Kabulbaev Kairat Abdullaevich - dokotala wa sayansi yamankhwala, pulofesa wa gawo la "Nephrology" KazNMU dzina lake S.D. Asfendiyarova.
4) Taubaldieva Zhannat Satybaevna - woimira masayansi azachipatala, wamkulu wa dipatimenti ya endocrinology, JSC "National Science Science Medical Center".
5) Dyusenbaeva Nazigul Kuandykovna - woyimira masukulu azachipatala, othandizira anzawo ku dipatimenti ya General and Clinical Pharmacology ya JSC "MIA".

Mikangano yachidwi: ayi.

Mndandanda wazowunika:
1) Nurbekova Akmaral Asylovna - Doctor of Medical Science, Pulofesa wa Department of Endocrinology, KazNMU adatchulidwa pambuyo S.D. Asfendiyarova,
2) Duren Kazhebaevich Turebekov - Doctor of Medical Science, Mutu wa Dipatimenti ya Nephrology ya Astana City Hospital No. 1.

Migwirizano Yotsatira: Kukonzanso kwa protocol zaka 3 kuchokera pomwe idasindikizidwa komanso kuyambira tsiku lomwe idalowa mphamvu kapena pamaso pa njira zatsopano ndi umboni.

Zolemba zaukadaulo wazachipatala

Kuzindikira ndi kutsimikiza kwa gawo la matenda a matenda ashuga nephropathy kumadalira anamnesis (nthawi ndi mtundu wa matenda osokoneza bongo), zotsatira zasayansi (kuzindikira kwa microalbuminuria, proteinuria, azotemia ndi uremia).

Njira yoyambira yoyambira yodziwira matenda ashuga ndi kupezeka kwa microalbuminuria. Chotsatira cha microalbuminuria chimasankha bwino kwambiri kwamkodzo albumin mu 30 mpaka 300 mg / tsiku kapena 20 mpaka 200 μg / mphindi mu gawo limodzi la mkodzo. Microalbuminuria imadziwikanso ndi kuchuluka kwa albumin / creatinine mumkodzo wam'mawa, zomwe zimapatula zolakwika pakutha kwamkodzo tsiku lililonse.

Zolemba za "preclinical" kuwonongeka kwa impso mu diabetesic nephropathy ndi kuchepa kwamphamvu kwa minyewa kapena kuwonjezeka kwa gawo losaposa 22%, kuchuluka kwa GFR kopitilira 140-160 ml / min.

Microalbuminuria imadziwika kuti ndiyo njira yabwino kwambiri yotsimikizirira kuwonongeka kwa impso. Mawuwa amatanthauza kutuluka kwa albumin ndi mkodzo wambiri (kuyambira 30 mpaka 300 mg / tsiku), komwe sikumadziwika ndi mayeso amkodzo amkodzo.

Gawo la mycoralbuminuria ndi gawo lomaliza kusintha kwa matenda ashuga nephropathy ndi chithandizo cha panthawi yake. Kupanda kutero, mu 80% ya odwala omwe ali ndi matenda ashuga 1 ndi 40% ya odwala matenda ashuga a 2 omwe ali ndi microalbuminuria, gawo la matenda a matenda ashuga limayamba.

Microalbuminuria ndi harbinger wa osati gawo lapamwamba la matenda ashuga, komanso matenda a mtima. Chifukwa chake, kukhalapo kwa microalbuminuria mwa odwala kumakhala chisonyezo chowunikira kuti mudziwe zamomwe mtima, komanso chithandizo chogwira ntchito chomwe chimayang'ana pachiwopsezo cha matenda amtima.

Pakuyenera kutsimikiza kwa microalbuminuria, zingwe zoyesera zimagwiritsidwa ntchito, kudziwa komwe kumafika 95%, kutsimikizika kwake ndi 93%. Kuyesedwa koyenera kuyenera kutsimikiziridwa ndi njira yolondola kwambiri ya chitetezo cha mthupi. Popeza kusinthasintha kwa tsiku ndi tsiku mu albumin excretion, kuti mutsimikizire microalbuminuria, muyenera kukhala ndi zotsatirapo ziwiri zabwino ndiuchimo kwa miyezi 3-6.

, , , , , , , , , , , , , , ,

Gulu la Albuminuria

Urinary Albumin Excretion

Urinary Albumin Concentration

Chiwerengero cha albumin / creatine mkodzo

m'mawa

1 - mwa amuna. 2 - mwa akazi.

Malinga ndi malingaliro a American Diabetes Association (1997) ndi European Group for the Study of Diabetes (1999), kafukufuku wa microalbuminuria akuphatikizidwa pamndandanda wazomwe zimayenerezedwa kuti aziwunika odwala omwe ali ndi mtundu woyamba wa 2 ndi matenda a shuga.

Kutsimikiza kwachitetezo cha impso ndi njira imodzi yosadziwika yopezera matenda oopsa a matenda a shuga, omwe amawonedwa ngati njira yayikulu yopangira matenda ashuga a nephropathy. Ntchito yothandizira impso imamveka ngati kuthekera kwa impso kuyankha ndikuwonjezera GFR ku zolimbikitsira (kutsitsa mapuloteni apakamwa, makonzedwe apamwamba a dopamine, makonzedwe a gulu la amino acid). Kuchulukitsa kwa GFR pambuyo poyambitsa kukondoweza ndi 10% poyerekeza ndi oyambira kumawonetsa kusungirako kwampweya wolumikizika komanso kusowa kwa matenda oopsa mu impso glomeruli.

Zomwezi zimaperekedwa ndi chisonyezo cha kachigawo kena kosefera - kuchuluka kwa GFR pakuyenda kwa aimpso. Nthawi zambiri, kukula kwa kachulukidwe kake kamakhala pafupifupi 20%, kufunika kwake kupitirira 22% kukuwonetsa kuwonjezeka kwa GFR chifukwa cha kupsinjika kwakukulu mkati mwa impso glomerulus.

Miyezo yeniyeni ya GFR, yopitilira kuchuluka kwa 140-160 ml / min, imatumikiranso monga chizindikiro chosagwirizana ndi kukula kwa matenda oopsa a intracranial.

Mu gawo 1 ndi II la chitukuko cha matenda a shuga, kuphatikizidwa kwa impso mu njira yodziwika bwino sikunasonyezedwe ndi ziwonetsero zomwe zikuwonetsa mkhalidwe wa matenda oopsa mu impso glomerulus - mitengo yayikulu ya GFR yoposa 140-160 ml / min, kusapezeka kapena kuchepa kwa magwiridwe antchito a impso komanso / kapena kukhathamiritsa kwakukulu. tizigawo. Kuzindikira kwa microalbuminuria kumapangitsa kuzindikira matenda a shuga ndi nephropathy mu gawo la III la chitukuko.

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Magawo a chitukuko cha pathological process

Kugawidwa kwa nephropathy mu matenda a shuga kumakhazikitsidwa pakuwonekera pang'onopang'ono komanso kuwonongeka kwa impso, kuwonekera kwamankhwala, komanso kusintha kwa magawo a labotale.

Gawo la matenda ashuga nephropathy:

Mu gawo loyamba, pali kuchuluka kwa magazi, mkodzo kusefedwa mu impso nephrons motsutsana kumbuyo kwa kukula kwa glomerular kukula. Pankhaniyi, kupukusa kwa mapuloteni ochepa amalemu (makamaka albin) ndi mkodzo kumakhala mkati mwa chizolowezi cha tsiku ndi tsiku (zosaposa 30 mg).

Mu gawo lachiwiri, kukulira kwa mchipinda chapansi, kuchuluka kwa minyewa yolumikizana m'malo mwa ziwiya zama calibers osiyanasiyana kumawonjezeredwa. Kutupa kwa albumin mu mkodzo kumatha kupitirira kuchuluka kwa shuga m'magazi, kuwonongeka kwa matenda osokoneza bongo, komanso kuchita masewera olimbitsa thupi.

Mu gawo lachitatu, pali kuwonjezereka kosalekeza kutulutsidwa kwa albumin tsiku lililonse (mpaka 300 mg).

Gawo lachinayi, zizindikiro za matenda zimayamba kuonekera. Kuchuluka kwa kusefa kwa mkodzo mu glomeruli kumayamba kuchepa, proteinuria imatsimikiza, ndiye kuti, kumasulidwa kwa mapuloteni opitilira 500 mg masana.

Gawo lachisanu ndi lomaliza, kuchuluka kwa kusefedwa kwa glomerular kumachepetsa kwambiri (zosakwana 10 ml pa mphindi imodzi), kupukusa kapena nodular sclerosis kuli ponseponse.

Kulephera kwamankhwala kumakhala chifukwa chachikulu cha imfa kwa odwala omwe ali ndi matenda ashuga

Kuzindikira matenda gawo la matenda ashuga nephropathy

Gawo lazachipatala la matenda ashuga nephropathy limayamba ndi gawo IV malinga ndi Mogensen. Amayamba, monga lamulo, zaka 10-15 kuyambira chiyambi cha matenda a shuga ndipo amawonetsedwa:

• proteinuria (mu 1/3 mwazomwe zimachitika ndi nephrotic syndrome),
• ochepa matenda oopsa
• kukula kwa retinopathy,
• kuchepa kwa GFR munjira yachilengedwe matendawa pafupifupi 1 ml / mwezi.

Nephrotic syndrome, yomwe imapanganiza njira ya matenda ashuga okodzetsa mu 10% ya milandu, imawerengedwa ngati chidziwitso chazovuta za matenda a matenda ashuga nephropathy.Nthawi zambiri amakula pang'onopang'ono; mwa odwala ena, kupezeka kwa kukokana kwa edema kupita ku diuretic mankhwala kwadziwika kale. Nephrotic syndrome motsutsana ndi maziko a matenda a shuga a nephropathy amadziwika ndi kuchepa kwa GFR, kulimbikira kwa edema syndrome ndi proteinuria yayikulu, ngakhale atayamba kulephera kwa aimpso.

Gawo lachisanu la matenda ashuga nephropathy limafanana ndi gawo la matenda a impso.

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Mawonekedwe a kachipatala

Magawo atatu oyamba okukula kwa nephropathy amadziwika kokha pakusintha kwa mawonekedwe a impso ndipo alibe zizindikiro zowoneka, ndiye kuti, ndi magawo oyambira. M'magawo awiri oyamba, palibe zodandaula zomwe zimawonedwa. Mu gawo lachitatu, pakumuunika wodwalayo, kuwonjezereka kwa magazi kumapezeka nthawi zina.

Gawo lachinayi ndi Symbomatology yatsatanetsatane.

Nthawi zambiri zimadziwika:

Ndi mtundu uwu wa matenda oopsa, odwala sangawonjezere kuwonjezeka. Monga lamulo, motsutsana ndi kumbuyo kwa kuchuluka kwambiri (mpaka 180-200 / 110-120 mm Hg), mutu, chizungulire, kufooka kwathunthu sikuwoneka.

Njira yokhayo yodziwira kupezeka kwa matenda oopsa, kuchuluka kwa kusinthasintha masana ndikuwunika kapena kuwunikira.

Mu gawo lomaliza, la uremic, kusintha kumachitika osati mu chithunzi cha kuwonongeka kwa impso, komanso nthawi ya matenda a shuga. Kulephera kwamkati kumawonetsedwa ndi kufooka kwambiri, kusowa chidwi cha chakudya, kuledzera, khungu lotheka limatheka. Osangogwira impso zomwe zimakhudzidwa, komanso ziwalo zopumira komanso zodyera.

Khama limapitirira kuthamanga kwa magazi, amatchula edema, mosalekeza. Kufunika kwa insulin kumachepa, shuga m'magazi ndi mkodzo umagwa. Zizindikirozi sizikuwonetsa kusintha kwa wodwalayo, koma amalankhula za kuphwanya kwamisempha kwamanjenje, chodabwitsa kwambiri.

Ngati wodwala yemwe ali ndi matenda ashuga ayamba kuchuluka kwambiri, amafunika kuyang'ana impso

Matenda a matenda ashuga nephropathy

Njira zotsatirazi zopezeka ndi matenda ashuga a nephropathy amavomerezedwa:

• matenda ashuga nephropathy, gawo la microalbuminuria,
• diabetesic nephropathy, siteji ya proteinuria, yokhala ndi nitrogen-excreting ntchito impso,
• matenda ashuga nephropathy, gawo la matenda aimpso kulephera.

Kusanthula kwa Matenda a shuga

Kwa matenda oyamba a matenda ashuga a nephropathy komanso kupewa kwa zovuta zam'matenda a shuga, pulogalamu yotsimikizira odwala matenda ashuga odwala matenda a shuga idapangidwa ndikuti ndi gawo la chigwirizano cha St. Vincent. Malinga ndi pulogalamuyi, kupezeka kwa matenda a shuga ndi nephropathy kumayamba ndi kuwunika mkodzo pafupipafupi. Ngati proteinuria yapezeka, yotsimikiziridwa ndi maphunziro obwereza, ndiye kuti amapezeka ndi matenda a shuga, nephropathy, gawo la proteinuria ndi chithandizo choyenera chimayikidwa.

Popanda proteinuria, kuyesa kwamikodzo kumachitika kuti pakhale microalbuminuria. Ngati kwamikodzo albumin excretion ndi 20 μg / mphindi kapena mkodzo wa albumin / creatinine wocheperako 2,5 mg / mmol mwa amuna ndi ochepera 3.5 mg / mmol mwa akazi, ndiye kuti zotsatira zake zimawoneka ngati zoipa komanso yachiwiri ya urinalysis ya microalbuminuria imayikidwa mchaka chimodzi. Ngati kutulutsa kwa albumin ndi mkodzo kupitirira zomwe zaperekedwa, ndiye kuti popewa cholakwika, phunziroli liyenera kubwerezedwa katatu pasanathe milungu 6 mpaka 12. Atalandira zotsatira ziwiri zabwino, amapezeka ndi matenda a shuga, nephropathy, gawo la microalbuminuria, ndipo amathandizidwa ndi mankhwala.

Kukula kwa matenda ashuga nephropathy nthawi zonse kumalumikizidwa ndi kuwonongeka mkati mwa zovuta zina zamatenda a shuga ndipo amachita ngati chiwopsezo cha kukula kwa IHD. Chifukwa chake, kuwonjezera pa kafukufuku wokhazikika wa albuminuria, odwala omwe ali ndi vuto la mtundu 1 komanso 2 amafunikira kuwunikira pafupipafupi ndi ophthalmologist, cardiologist, ndi neuropathologist.

Kafukufuku wofunikira kwa odwala omwe ali ndi matenda osokoneza bongo kutengera gawo la diabetesic nephropathy

Zomwe zimayambitsa matenda ashuga nephropathy

● Chochititsa chidwi chachikulu pakupanga matenda a shuga ndi nephropathy ndi kuwonjezeka kwa shuga m'magazi, omwe amachititsa kuti mitsempha ya magazi ilowe m'malo mwake ndi minyewa yolumikizana yotsatira.

Pomaliza matendawa, kulephera kwa impso kumayamba. Ndikofunikira kwambiri kupeza nthawi ndi wodwala kuti mupewe zovuta.

● Chinyengo cha nephropathy chimakhala chakuti sichimakula mwachangu, koma pakupita zaka khumi ndi ziwiri, popanda kudziwonetsa mwa chilichonse. Ndipo izi zikuchitika!

Timapita kwa dokotala pokhapokha bingu litagunda komanso chithandizo chake chimafuna kuyesetsa kwakukulu osati kokha kwa wodwala, komanso kwa adokotala. Ichi ndichifukwa chake muyenera kudziwa zamankhwala matenda.

Zizindikiro za matenda a shuga a Nephropathy

● Pali magawo asanu omwe matendawa amakula:

— Gawo loyamba amapezeka koyambirira kwa matenda a shuga ndipo amasonyezedwa ndi kupsinjika kwa impso, maselo amitsempha yamagazi amawonjezeka kukula kwake, kusefedwa ndi kutuluka kwa mkodzo.

Potere, mapuloteni mumkodzo sanatsimikizidwe, ndipo palibe mawonekedwe akunja (madandaulo a odwala),

— Gawo lachiwiri limapezeka pafupifupi zaka ziwiri atapezeka kuti wapezeka. Mitsempha yama impso ikupitilira kukula, koma, monga gawo loyamba, matendawa samadziwonetsa.

— Gawo lachitatu nthawi zambiri amakula zaka zisanu atazindikira kuti ali ndi matenda ashuga. Monga lamulo, pakadali pano, pokonzekera matenda ena kapena mukamawunika pafupipafupi, mapuloteni ochepa amapezeka mumkodzo - kuyambira 30 mpaka 300 mg / tsiku.

Ndipo ichi ndi chozizwitsa kuchita, chifukwa kunja nephropathy sikumadzipatsanso. Pokhudzana ndi zomwe tafotokozazi, magawo onse atatuwa amayitanidwa preclinical . Ndi nthawi imeneyi pamene wodwala amafunikira chithandizo chamanthawi yomweyo,

— Gawo 4 mtima zaka 10-15 atatha matenda ashuga. Pakadali pano pali zizindikiro zowoneka bwino zakuchipatala: Mapuloteni ambiri amapezeka mumkodzo, kutupira kumawoneka kuti sangathe kuchotsedwa mothandizidwa ndi mankhwala okodzetsa.

Wodwalayo amachepetsa thupi, amakhala ndi tulo, amafooka, akumamva mseru, ludzu, chilakolako cha thupi chimachepa ndipo magazi amayamba kukwera pafupipafupi.

- Gawo 5, kapena uremic. M'malo mwake, awa ndi mathero a diabetesic nephropathy kapena gawo logona kwambiri la kulephera kwa impso: ziwiyazo zimayatsidwa mokwanira mu impso, sizingagwire ntchito yopanda kanthu, kuchuluka kwa kusefera kwa glomeruli ndi kosakwana 10 ml / min.

Zizindikiro za gawo lachiwiri la 4 zikupitilira, koma amatenga moyo wowopsa. Njira yokhayo yopulumutsira wodwalayo ndikubwezeretsanso mankhwala aimpso (hemodialysis, peritoneal dialysis), komanso kupatsirana kwa impso (kumuika) kapena kuwirikiza kawiri: impso + kapamba.

Matenda a shuga - nephropathy

● Kuti muchepetse ntchito ya impso, tengani zosonkhanitsira, zomwe zimaphatikizapo maluwa m'malo ofanana ndi kulemera kwake, ndikugulitsa mahatchi kumunda ,. Pogaya zonse ndikusakaniza bwino:

- supuni imodzi ya osakaniza kutsanulira 200 ml ya madzi otentha, kusiya kumwa kwa ola limodzi ndi kumwa chikho ⅓ katatu kapena kanayi pa tsiku kwa milungu itatu, mutatha kupuma kochepa, bwerezani njira ya mankhwalawa.

● Mutha kugwiritsa ntchito njira inanso yosakanikirana ndi mankhwala: kutsanulira 300 ml ya madzi awiri supuni, kubweretsa kwa chithupsa, kuchotsa mu chitofu, kutsanulira mu thermos ndikusiya kwa theka la ola.

Imwani mu ofunda mawonekedwe 3-4 pa tsiku, 50 ml musanadye milungu iwiri.

● Izi zikuthandizira ntchito osati impso zokha, komanso chiwindi, zimachepetsa shuga m'magazi:

- Thirani nyemba 50 za nyemba zouma ndi lita imodzi ya madzi otentha, ziperekeni kwa maola atatu ndi kumwa theka kapu 6 kapena 7 pa tsiku kwa masabata a 2-4.

● Pali njira inanso:

- kutsanulira supuni imodzi ya udzu 200 ml ya madzi otentha, kunena kwa ola limodzi, kusefa ndi kumwa chikho cha еды kwa milungu iwiri musanadye katatu patsiku.

Tiyeni tiziyesetsa kuchita izi kuti tidzakhale mosangalala kuyambira kale. Khalani athanzi, Mulungu akudalitseni!

Nkhaniyi idagwiritsa ntchito zida za dotolo-endocrinologist wa apamwamba kwambiri O. V. Mashkova.

Matenda a shuga ndi nephropathy ndimatchulidwe odziwika bwino a matenda a impso a shuga. Mawuwa amafotokoza zotupa za matenda a impso (glomeruli ndi tubules), komanso zombo zomwe zimawadyetsa.

Matenda a diabetes nephropathy ndi owopsa chifukwa amatha kutha kufikira gawo lomaliza (losautsa) la kulephera kwa impso. Poterepa, wodwalayo adzafunika kuyimba kapena.

Matenda a diabetes nephropathy ndi chimodzi mwazomwe zimayambitsa kufa koyambirira komanso kulemala kwa odwala. Matenda a shuga sikuti ndi okhawo omwe amachititsa vuto la impso. Koma pakati pa omwe akudwala dialysis ndikuyimirira pamzere wa impso wothandizira, ndiye wodwala kwambiri. Chimodzi mwazifukwa izi ndi kuchuluka kwakukulu kwa matenda ashuga a 2.

Zifukwa zoyambitsa matenda a shuga:

• shuga wambiri wodwala,
• cholesterol yoyipa komanso triglycerides m'magazi,
• kuthamanga kwa magazi (werengani tsamba lathu la "mlongo" wa matenda oopsa),
• kuchepa kwa magazi, ngakhale “kofatsa” kwambiri (hemoglobin m'magazi a odwala matenda a shuga kuyenera kusamutsidwira ku dialysis koyambirira kwa odwala omwe ali ndi matenda amtundu wina. Kusankha kwa dialysis kumatengera zomwe dokotala amakonda, koma kwa odwala palibe kusiyana kwakukulu.

Poyamba kuyamba aimpso m'malo mankhwala (dialysis kapena impso kupatsidwa zina) odwala matenda ashuga:

• Kuchulukitsa kwa impso ndi 6.5 mmol / l), komwe sikungathe kuchepetsedwa ndi njira zochizira.
• Kusungika kwamadzimadzi m'thupi ndi chiopsezo chokhala ndi edema ya m'mapapo,
• Zizindikiro zodziwika za kuperewera kwa mphamvu m'thupi.

Zizindikiro zamagetsi oyesa magazi mwa odwala omwe ali ndi matenda a shuga omwe amathandizidwa ndi dialysis:

• Glycated hemoglobin - ochepera 8%,
• Magazi a hemoglobin - 110-120 g / l,
• Matenda a parathyroid - 150-300 pg / ml,
• Phosphorous - 1.13-11.78 mmol / L,
• Calcium yonse - 2.10-22,7 mmol / l,
• Zogulitsa Ca × P = Zochepera 4.44 mmol2 / l2.

Hemodialysis kapena peritoneal dialysis iyenera kungotengedwa ngati gawo lokhalitsa pokonzekera. Pambuyo kumuyika kwa impso kwa nthawi yothandizidwa, wodwalayo amachiritsidwa kwathunthu chifukwa cha kulephera kwa impso. Matenda a diabetes a nephropathy akhazikika, kupulumuka kwa odwala kukuchulukirachulukira.

Pokonzekera kufalitsa kwa impso chifukwa cha matenda ashuga, madokotala akuyesayesa kuwona kuti zingatheke bwanji kuti wodwalayo azikhala ndi vuto la mtima (matenda a mtima kapena sitiroko) panthawi kapena pambuyo pa opaleshoni. Kuti izi zitheke, wodwalayo amapimidwa mayeso osiyanasiyana, kuphatikizapo ECG yokhala ndi katundu.

Nthawi zambiri zotsatira za mayesowa zimawonetsa kuti ziwiya zomwe zimadyetsa mtima ndi / kapena ubongo zimakhudzidwanso kwambiri ndi atherosulinosis. Onani nkhani "" "kuti mumve zambiri. Pankhaniyi, kupatsirana kwa impso, tikulimbikitsidwa kupangitsanso mwamphamvu kuchuluka kwa ziwiya izi.

Pakati pazovuta zonse zomwe matenda a shuga amawopseza munthu, matenda a shuga amachokera patsogolo. Kusintha koyamba kwa impso kumawoneka kale zaka zoyambirira pambuyo pa matenda ashuga, ndipo gawo lomaliza ndi kulephera kwa impso (CRF). Koma kutsatira mosamala njira zopewera matenda, kuzindikira kwa nthawi yake komanso chithandizo chokwanira kumathandizira kuchedwa kukula kwa matendawa momwe mungathere.

Zomwe zimayambitsa matendawa

Kuchepa kwa impso ndi chimodzi mwazomwe zimayambitsa matenda ashuga.Kupatula apo, ndi impso zomwe zimakhala ndi ntchito yayikulu yoyeretsa magazi kuti asamayeretsedwe ndi sumu.

Mwazi wamagazi ukangodumphadwala modwala matenda ashuga, zimakhala ngati ziwalo zamkati ngati choopsa. Impso zikuwona kuti zikuvutikira kupirira ntchito yake yosefera. Zotsatira zake, kuthamanga kwa magazi kumafooketsedwa, ma ayoni a sodium amadzisonkhanitsa mmenemo, zomwe zimayambitsa kuchepa kwa mipata ya mitsempha ya impso. Kupsinjika mwa iwo kumawonjezera (matenda oopsa), impso zimayamba kusweka, zomwe zimayambitsa kuchuluka kwakuchulukirachulukira.

Koma, ngakhale ali ndi bwalo loipa, kuwonongeka kwa impso sikumapezeka mwa odwala onse omwe ali ndi matenda ashuga.

Chifukwa chake, madokotala amasiyanitsa mfundo zitatu zitatu zomwe zimayambitsa zomwe zimapangitsa kuti matenda a impso asinthe.

1. Mitundu. Chimodzi mwa zifukwa zoyambira zomwe zimapangitsa munthu kukhala ndi matenda a shuga masiku ano amatchedwa kuti chibadwidwe chamtsogolo. Makina omwewo amadziwika kuti ndi nephropathy. Munthu akangokhala ndi matenda ashuga, njira zachilendo zachilengedwe zimathandizira kukulitsa kuwonongeka kwa mtima mu impso.
2. Hemodynamic. Mu shuga, nthawi zonse pamakhala kuphwanya kayendedwe ka impso (matenda oopsa omwewo). Zotsatira zake, mapuloteni ambiri a albin amapezeka mumkodzo, zotengera zomwe zimaponderezedwa zimawonongeka, ndipo malo owonongeka amakokedwa ndi minofu yochepa (sclerosis).
3. Sinthana. Chiphunzitsochi chimapereka gawo lalikulu lowononga la shuga m'magazi. Zida zonse mthupi (kuphatikiza impso) zimakhudzidwa ndi poizoni "wokoma". Mitsempha yamagazi yotumphukira imasokonekera, njira zachikhalidwe za metabolic zimasinthika, mafuta amaikidwa m'matumbo, omwe amatsogolera ku nephropathy.

Kupewa

Kwa odwala matenda ashuga, kupewa nephropathy kuyenera kukhala ndi mfundo zingapo:

• kuthandizira m'magazi a shuga otetezeka (onjezani zolimbitsa thupi, pewani kupsinjika ndikuwonetsetsa kuchuluka kwa shuga),
• Zakudya zoyenera (zakudya zopezeka ndi mapuloteni ochepa komanso chakudya, kukana ndudu ndi mowa),
• kuwunika kuchuluka kwa lipids m'magazi,
• kuwunika kuthamanga kwa magazi (ngati kudumpha pamwamba pa 140/90 mm Hg, kufunika kofunikira kuchitapo kanthu).

Njira zonse zodzitetezera ziyenera kuvomerezedwa ndi adokotala. Zakudya zochiritsika ziyeneranso kuchitika moyang'aniridwa ndi endocrinologist ndi nephrologist.

Matenda a shuga a shuga komanso matenda ashuga

Chithandizo cha matenda ashuga nephropathy sichingalekanitsidwe ndi mankhwalawa omwe amachititsa - matenda a shuga. Njira ziwiri izi ziyenera kupita limodzi komanso kusinthidwa malinga ndi zotsatira za kusanthula wodwala-matenda ashuga komanso gawo la matendawa.

Ntchito zikuluzikulu za kuwonongeka kwa shuga ndi impso ndizofanana - kuwunika kozungulira kwa magazi ndi kuthamanga kwa magazi. Othandizira omwe samakhala a pharmacological ali ofanana pamagawo onse a shuga. Izi ndikuwongolera mulingo wazakudya, zochizira, kuchepetsa nkhawa, kukana zizolowezi zolakwika, kuchita masewera olimbitsa thupi nthawi zonse.

Zomwe zimachitika pakumwa mankhwala ndizovuta. Mu magawo oyamba a shuga ndi nephropathy, gulu lalikulu la mankhwalawa ndi la kukakamiza. Apa mukuyenera kusankha mankhwalawa omwe ali otetezeka impso zodwala, atatsimikizika pamavuto ena a shuga, omwe ali ndi zinthu zamtima komanso zamkati. Izi ndi zoletsa kwambiri za ACE.

Pankhani ya shuga wodalira insulin, zoletsa za ACE zimaloledwa m'malo mwake ndi angiotensin II receptor antagonists ngati pali zovuta kuchokera ku gulu loyamba la mankhwala.

Ngati mayeso akuwonetsa kale proteinuria, kuchepa kwa ntchito ya impso ndi matenda oopsa ayenera kuganiziridwa pochiza matenda ashuga. Zoletsa mwapadera zimagwira ntchito kwa odwala matenda ashuga omwe ali ndi mtundu wa 2 matenda: kwa iwo, mndandanda wa othandizira otsogolera pakamwa (hypSS) omwe amafunikira kutengedwa nthawi zonse umachepa. Mankhwala otetezeka kwambiri ndi Glycvidon, Gliclazide, Repaglinide.Ngati GFR nthawi ya nephropathy ikutsikira mpaka 30 ml / mphindi kapena kuchepera, kusamutsa odwala kuti ayendetsedwe ka insulin ndikofunikira.

Odwala a shuga omwe ali ndi zovuta mwanjira ya matenda ashuga nephropathy, zikuchulukirachulukira. Nthawi zambiri, vutoli limakhala ndi odwala matenda a shuga 1, ndipo nthawi zambiri amakhala ndi matenda a shuga a 2. Matendawa "Nephropathy" ndikuphwanya magwiridwe antchito a impso.

Vuto la impso lomwe limayamba ndi matenda a shuga limatchedwa Matenda a shuga . Impso zimataya magwiridwe awo chifukwa cha khungu la impso. Kukula kwa matendawa kumachitika pang'onopang'ono komanso pafupifupi asymptomatic. Kumayambiriro kwa matendawo, odwala samva kupweteka kulikonse, chifukwa chake, mwatsoka, amatembenukira kwa nephrologist pamapeto omaliza. Awiri mwa magawo atatu mwa odwala omwe ali ndi matenda ashuga amazindikira izi.

Mpaka pano, palibe lingaliro lamitundu yonse yokhudzana ndi momwe makina akukulira matendawa, komabe malingaliro angapo a chitukuko cha DN :

• Mitundu : potengera kukhalapo kwa majini omwe amadziwonetsa okha mothandizidwa ndi hemodynamic ndi metabolic metabolites omwe amapanga shuga,
• Hemodynamic: kukula kwa DN chifukwa cha kuwonongeka kwa magazi mkati mwa impso. Poyamba, mawonekedwe a Hyperfiltration, ntchito yochepetsedwa ya impso ndi kuwonjezeka kwa minofu yolumikizana,
• Zamatsenga : kusokonezeka kwamankhwala am'mimba chifukwa cha hyperglycemia yayitali.

Zikuoneka kuti malingaliro onse atatuwa amalumikizana pakupanga matenda a matenda ashuga nephropathy.

Kuchulukitsa kwothina m'matumbo a impso ndikofunikanso kwambiri pakupanga kwa DN, ndi chifukwa cha neuropathy. Chifukwa cha zotupa zam'mimba, ntchito yaimpso imalephera.

Kuneneratu komanso kupewa matenda ashuga a nephropathy

Microalbuminuria yovomerezeka panthawi yokhayo ndiye gawo lokhalo lomwe lingayambitse matenda a shuga. Pa nthawi ya proteinuria, n`zotheka kupewa kupitirira kwa matenda mpaka matenda aimpso, pomwe mukufika kumapeto kwa matenda a shuga.

Pakadali pano, matenda a shuga a nephropathy ndi CRF omwe akupanga chifukwa cha izi ndi omwe akuwonetsa kusintha kwa mankhwala - hemodialysis kapena kupatsirana kwa impso. CRF chifukwa cha matenda ashuga nephropathy amachititsa 15% ya imfa zonse pakati pa odwala omwe ali ndi matenda a 1 a shuga osakwana zaka 50.

Kupewa kwa matenda ashuga nephropathy imakhala mu kupenyetsetsa kwa odwala omwe ali ndi matenda osokoneza bongo a endocrinologist-diabetesologist, kuwongolera kwakanthawi kwamankhwala, kuyang'anira kuwunika kwamankhwala a glycemia, kutsatira malangizo a dokotala.

Njira Zosavomerezeka

Kuzindikira kuwonongeka kwa impso kwa odwala omwe ali ndi matenda osokoneza bongo kumachitika ndi endocrinologist pogwiritsa ntchito njira zamankhwala, zamankhwala, zothandizira. Mphamvu yazodandaula za wodwalayo imatsimikiziridwa, mawonetsedwe atsopano amatenda amawululidwa, mkhalidwe wa wodwalayo umayesedwa. Kuzindikira kumatsimikiziridwa ndi maphunziro a Hardware. Ngati ndi kotheka, kuonana ndi nephrologist.

Njira zoyambira matenda:

• kusanthula kwa magazi ndi mkodzo,
• magazi ndi mkodzo mayeso a shuga, lipid metabolism product (ma ketones), mapuloteni, mkodzo,
• impso ultrasound
• impso.

Biopsy ndi njira yowonjezera. Amakulolani kuti mupeze mtundu wa kuwonongeka kwa impso, kuchuluka kwa kuchuluka kwa minofu yolumikizana, kusintha kwa kama.

Phunziro la ultrasound limakhala lothandiza pazochitika zonse za kuwonongeka kwa impso mu matenda a shuga, limazindikira kuchuluka kwa kuwonongeka ndi kuchuluka kwa kusintha kwa matenda

Ndikosatheka kuzindikira matenda a impso mu gawo loyamba la zovuta pogwiritsa ntchito njira zasayansi, mulingo wa kwamkodzo ndi wabwinobwino.Kachiwiri - ndikupsinjika kwamphamvu kwa minyewa ya impso (zolimbitsa thupi, kutentha thupi, mavuto azakudya ndi kuchuluka kwambiri kwa shuga m'magazi), albumin yocheperako imatha kupezeka. Mu gawo lachitatu, microalbuminuria wolimba akupezeka (mpaka 300 mg patsiku).

Mukamayang'ana wodwala ndi gawo lina lachinayi la nephropathy, kupenda mkodzo kumawonetsa kuchuluka kwa mapuloteni (mpaka 300 mg patsiku), micromaturia yosagwirizana (mawonekedwe a maselo ofiira amkodzo mkodzo). Anemia imayamba pang'onopang'ono (kuchepa kwa maselo ofiira am'magazi ndi hemoglobin), ndipo ESR (erythrocyte sedimentation rate) imakulanso malinga ndi zotsatira za kuyezetsa magazi kofala. Komanso kuwonjezeka kwa kuchuluka kwa magazi a metabolinine kumapezeka nthawi ndi nthawi (ndi kafukufuku wamankhwala osokoneza bongo).

Gawo lomaliza, lachisanu limadziwika ndi kuwonjezeka kwa creatinine komanso kuchepa kwa kusefukira kwa glomerular. Izi ndi zinthu ziwiri zomwe zimawonetsa kuwuma kwa matenda aimpso. Proteinuria imafanana ndi nephrotic syndrome, yomwe imadziwika ndi kutulutsidwa kwa tsiku ndi tsiku kwa oposa 3 g. Anemia imakulitsidwa m'magazi, ndipo kuchuluka kwa mapuloteni (mapuloteni onse, a albumin) amachepa.

Njira zochizira

Chithandizo cha matenda ashuga nephropathy amayamba ndi isanayambike microalbuminuria. Ndikofunikira kupereka mankhwala omwe amachepetsa kuthamanga kwa magazi, mosasamala kuchuluka kwake. Munthawi imeneyi, ndikofunikira kufotokozera wodwala chifukwa chake chithandizo choterocho chiri chofunikira.

Zotsatira za antihypertensive chithandizo koyambirira kwa nephropathy:

Chifukwa chake, kuyambika kwa antihypertensive chithandizo pamlingo wambiri wa matenda oopsa, proteinuria yoposa 3 g patsiku siyokonzedwa komanso yovunda, sizingasinthe kwambiri matendawa.

Ndikofunika kwambiri kupereka mankhwala omwe ali ndi mphamvu yoteteza minofu ya impso. Zoletsa za angiotensin-converting enzyme (ACE) zimakwaniritsa zofunikira izi, zomwe zimachepetsa kusefukira kwa albumin kukhala mkodzo woyamba ndikuchepetsa kuthinikizidwa kwa ziwiya zama glomerular. Katundu pa impso amakhala wamtundu, zomwe zimapangitsa kuteteza (nephroprotective). Amagwiritsa ntchito kwambiri Captopril, enalapril, perindopril.

Mu gawo la kukomoka kwa nephropathy, mankhwalawa amatsutsana. Ndi kuchuluka kwa creatinine m'magazi (pamwambapa 300 μmol / L), komanso kuwonjezeka kwapang'onopang'ono pazinthu za potaziyamu (pamwambapa 5.0-6.0 mmol / L), zomwe zimadziwika kuti kulephera kwa impso, kugwiritsa ntchito mankhwalawa kumatha kukulitsa vuto la wodwala .

Komanso mu zida za adotolo ndi angiotensin II receptor blockers (losartan, candesartan). Popeza dongosolo limodzi, lomwe limakhudzidwa mosiyanasiyana ndi magulu awa a mankhwalawa, dokotala payekhapayekha amasankha njira yomwe angakonde.

Ndi osakwanira kwenikweni, ntchito:

Maupangiri angapo azachipatala amafotokoza kuti mankhwala omwe amasankha beta-receptors ali otetezeka kwa odwala matenda ashuga. Amaloŵa m'malo mwa osankha beta-blockers (propranolol), omwe ntchito yawo imayambitsa matenda ashuga.

Ndi zochitika za kulephera kwa impso, proteinuria, zakudya zimakhala gawo la mankhwalawa.

Ndi matenda a shuga, nephropathy, ndiwo zamasamba ndi zipatso zosakhudzika kwambiri m'zakudya, kuchuluka kwa chakudya kumakhala kambiri mpaka 6 pa tsiku

Zofunika Pulogalamu Yopatsa Thanzi:

Ndikofunikira kuwongolera kuchuluka kwa mchere wambiri m'zakudya, osati kungolamulira kusinthanitsa kwamadzimadzi, koma chifukwa chotsatira mphamvu ya othandizira. Ngati mchere wambiri ndi wokwera, ndiye kuti ma antihypertensive othandizira amachepetsa mphamvu yake. Kuwonjezeka kwa mlingo pamenepa sikubala zipatso.

Ndi chitukuko cha edematous syndrome, kuwonjezeranso kuyika kwa loop diuretics (furosemide, torasemide, indapamide) kukuwonetsedwa.

Madokotala amawona kuchepa kwakukulu kwa kusefukira kwa glomerular (zosakwana 10 ml / min) ngati ntchito yolumikizika yaimpso, ndikusankha njira yothandizira. Kukonzekera hemodialysis, peritoneal dialysis thandizo mothandizidwa ndi zida zapadera kutiyeretsa magazi a zinthu za metabolic, kupewa kuledzera. Komabe, kungoyika impso kokha ndi komwe kungathetse vutoli poletsa matenda a impso.

Ndi hemodialysis, mankhwalawa amachitika m'magawo owonongeka a impso mu shuga, pomwe njira zina zamankhwala zimatha.

Kuwopsa kwa nephropathy ndi njira zopewera

Ngati matenda a shuga ndi matenda omwe ali ndi syndromes yachipatala, ndiye kuti kuvuta kwa impso kumakhala kovuta kudziwa. Kwa nthawi yayitali (ndi matenda a shuga a 2, amatha kukhala mpaka zaka makumi awiri), palibe zizindikiro zakuwonongeka kwa impso. Pokhapokha podzipatula kwambiri, mapuloteni ena amapezeka pazochitika za proteinuria, ndipo kuthamanga kwa magazi nthawi ndi nthawi kumakwera. Hypertensive syndrome, monga lamulo, sizimayambitsa madandaulo kapena kusintha kwa mkhalidwe wa wodwalayo. Izi ndizowopsa chifukwa, chifukwa cha kuthamanga kwa magazi, mitsempha ya mitsempha imatha kukhazikika: kulowerera kwamitsempha, ngozi ya mtima, mpaka kugunda.

Choopsa ndichakuti ngati wodwalayo samva kapena akumva kuwonongeka pang'ono, samapempha thandizo kwa dokotala. Mu shuga mellitus, odwala amayamba kumva kudwala, akufotokozera mwa kusinthasintha kwa shuga m'magazi ndi zinthu za metabolic (matupi a ketone, acetone).

Ndi chitukuko cha magawo oyamba a kulephera kwa impso, mawonetsedwe ake sakutanthauza. Kufooka wamba, kumva kusasangalala komanso kuledzera kosadziwika kungatchulidwenso chifukwa cha zovuta za metabolic matenda a shuga. Munthawi yamatenda operewera, zizindikiro za kuledzera ndi mankhwala a nayitrogeni zimawonekera, ndipo uremia amakula. Komabe, gawo ili ndilosasintha komanso lovuta kuyankha ngakhale pazovuta zazing'ono zamankhwala.

Chifukwa chake, kuyang'anitsitsa wodwalayo ndikuwunika komwe wodwalayo ndikofunikira, chifukwa chitha kuzindikira zovuta mu nthawi.

Zimalepheretsa kukula ndi kudwala kwa matenda ashuga nephropathy:

Zomwe zimayambitsa matenda a shuga a Nephropathy

Matenda a shuga ndi gulu lamatenda omwe amayamba chifukwa cha kulumala pakapangidwe ka insulin, komanso limodzi ndi kuwonjezereka kwa shuga m'magazi. Pankhaniyi, mtundu I wa shuga mellitus (wodalira insulin) ndi mtundu II matenda a shuga (osagwirizana ndi insulin) ndi omwe amadziwika. Kudziwikitsa kwa nthawi yayitali kuchuluka kwa glucose pamitsempha yamagazi ndi minyewa yamitsempha, kusintha kwamachitidwe mu ziwalo kumachitika komwe kumayambitsa kukula kwa zovuta za shuga. Matenda a shuga ndi nephropathy ndi amodzi mwa mavuto otere.

Mtundu woyamba wa matenda a shuga a mellitus, kufa chifukwa cha kufooka kwa impso ndi malo oyamba; matenda a shuga II, ndi wachiwiri pambuyo pamatenda amtima.

Kuwonjezeka kwa shuga m'magazi ndikomwe kumayambitsa kukula kwa nephropathy. Glucose samangokhala ndi poizoni m'mitsempha yamagazi ya impso, komanso imagwiritsa ntchito njira zina zomwe zimapangitsa kuwonongeka kwamitsempha yamagazi, kuwonjezereka kwa kuchuluka kwake.

Kuwonongeka kwa ziwiya za impso mu shuga.

Kuphatikiza apo, kuwonjezeka kwa kukakamizidwa m'matumbo a impso ndikofunikira kwambiri kuti pakhale matenda a shuga. Izi ndizotsatira za kusakwanira kwa malamulo a matenda ashuga a m'mimba (kuwonongeka kwa dongosolo lamanjenje mu matenda a shuga). Pomaliza, ziwiya zowonongeka zimasinthidwa ndi minyewa yochepa, ndipo ntchito ya impso imalephera kwambiri.

Pakupanga kwa matenda a shuga a nephropathy, magawo angapo amadziwika:

Gawo I - kukhathamiritsa kwa impso. Amapezeka mu matenda a shuga. Maselo amitsempha yamagazi a impso amawonjezeka pang'ono kukula, kutulutsa ndi kusefa kwa mkodzo kumawonjezeka. Mapuloteni mumkodzo sapezeka. Mawonekedwe akunja kulibe.

Gawo II - kusintha koyambirira kwamapangidwe. Amachitika pafupifupi 2 patatha zaka matenda atapezeka ndi matenda ashuga. Amadziwika ndi kukula kwa makulidwe a zotengera za impso. Mapuloteni mumkodzo samadziwikanso, ndiye kuti impso imagwira ntchito. Zizindikiro za matendawa kulibe.

Pakapita nthawi, nthawi zambiri zimakhala zaka zisanu Matendawa III matenda - oyambira matenda a shuga. Monga lamulo, pakamayesedwa pafupipafupi kapena pokonzekera matenda ena mkodzo, mapuloteni ochepa amatsimikizika (kuyambira 30 mpaka 300 mg / tsiku). Vutoli limatchedwa microalbuminuria. Maonekedwe a mapuloteni mumkodzo akuwonetsa kuwonongeka kwakukulu kwa ziwiya za impso.

Limagwirira mawonekedwe a mapuloteni mumkodzo.

Pakadali pano, kusintha kwa kusefukira kwamadzi kumachitika. Chizindikirochi chimadziwika ndi kusefedwa kwa madzi ndi zinthu zochepa zamahetsi pazinthu zovulaza. Kumayambiriro kwa matenda a shuga, nephropathy, kufera kwa glomerular imatha kukhala yabwinobwino kapena kukweza pang'ono chifukwa chakuwonjezeka kwa chotengera cha impso. Mawonetseredwe akunja a matendawo kulibe.

Magawo atatu awa amatchedwa preclinical, chifukwa palibe zodandaula, ndipo kuwonongeka kwa impso kumatsimikiziridwa pokhapokha njira zapadera zasayansi kapena mwa ma microscopy a minofu ya impso panthawi ya biopsy (sampling ya chiwalo chazomwe chikuwunikira). Koma kuzindikiritsa matendawa pamagawo awa ndikofunikira kwambiri, chifukwa nthawi imeneyi matendawa ndi omwe amasinthika.

IV siteji - matenda ashuga kwambiri nephropathy amapezeka zaka 10 mpaka 10 kuyambira pa chiyambi cha matenda ashuga ndipo amadziwika ndi mawonekedwe owoneka bwino azachipatala. Puloteni yambiri imachotsedwamo mkodzo. Matendawa amatchedwa proteinuria. Mapuloteni a protein amachepa kwambiri m'magazi, edema yayikulu imayamba. Ndi proteinuria yaying'ono, edema imapezeka m'madera am'munsi komanso kumaso, kenako ndi kupita patsogolo kwa matendawa, edema imakulirakulira, madzimadzi amadzaza m'matumba a m'mimba (m'mimba, pachifuwa pachifuwa, m'mitsempha ya pericardial). Pamaso pakuwonongeka kwambiri kwa impso, okodzetsa zochizira edema amakhala osathandiza. Pankhaniyi, amayamba kugwiritsa ntchito opaleshoni yochotsa madzimadzi (kuchotsera). Kuti thupi likhale ndi mapuloteni oyenera, thupi limayamba kuphwanya mapuloteni ake omwe. Odwala amachepetsa thupi kwambiri. Komanso, odwala amadandaula za kufooka, kugona, nseru, kulephera kudya, ludzu. Pakadali pano, pafupifupi odwala onse amafotokoza kuwonjezeka kwa kuthamanga kwa magazi, nthawi zina mpaka kuchuluka kwambiri, komwe kumayendetsedwa ndi mutu, kufupika, kupweteka mumtima.

Gawo V - uremic - omaliza a matenda ashuga nephropathy. kulephera kwa aimpso kulephera. Zida za impso zimayamwa kwathunthu. Impso sichita ntchito yake yobisalira. Kuchuluka kwa kusefera kwa glomerular kumakhala kochepera 10 ml / min.Zizindikiro za gawo lapita zimapitilira ndipo zikuwononga moyo. Njira yokhayo yotulukira ndi chithandizo cha impso (peritoneal dialysis, hemodialysis) ndi kumuika (Persad) wa zovuta za impso kapena impso.

Mitundu ya nephropathy ya impso

Siyani ndemanga 3,747

Vuto la matenda a impso, monga nephropathy ya impso, ndi owopsa ku moyo wa munthu. Zomwe zimayambitsa matendawa ndizosiyana. Nthawi zambiri matenda a ziwalo zamkati amabweretsa izi. Poyamba, matendawa amakula modabwitsa ndipo amawonekera pokhapokha kuwonongeka kwakukulu kwa zida zamagetsi komanso a impso parenchyma.

Zoyambira ndi zachiwiri

Kumene matendawa amachokera komanso koyambirira. Nthawi zina, cholowa cholowa m'malo. Zachiwiri zimaphatikizanso kukanika kwaimpso. Nphropathies yachiwiri imayambitsidwa ndi nephrosis, vasculitis ya mankhwala osokoneza bongo ndi zotupa mu impso ndipo pamapeto pake zimayambitsa vuto lalikulu la impso glomeruli. Fomu yoyamba imakwiyitsa kukula kwa ziwalo zilizonse kapena impso zokha mu nthawi yobereka:

Bweretsani ku zomwe zalembedwa

Mitundu ndi zizindikiro

Pathologies ndi chitukuko cha chiwalo kuyambitsa matenda.

M'malo mwake, nephropathy ndimawu ophatikizika amomwe amapangira njira zomwe zimadziwika ndi kuwonongeka kwa impso zonse. Makamaka, minofu ya impso, ma tubules ndi mitsempha yamagazi imakhudzidwa. Magwiridwe antchito amthupi lino amakhala ndi vuto lalikulu. Ngati chithandizo cha nephropathy cha impso sichinayambike, zotsatira zoyipa ndizotheka.

Kukula pang'onopang'ono kwa matendawo kumatanthauza zizindikiro zazikulu zobisika. Magawo oyamba nthawi zambiri sadzipangitsa kuti amve.

Pakapita kanthawi, wodwalayo amayamba kudandaula za zina mwazizindikiro: kutopa, kupweteka m'dera lumbar, ludzu losalekeza. Kulakalaka kumachulukirachulukira, njira zokuchiritsa zimachulukirachulukira. Popita nthawi, kuchulukana kumawonekera, kuthamanga kwa magazi kumakwera. Kutengera zomwe zimayambitsa ndi kuwonongeka kwa impso. nephropathy imagawidwa m'mitundu ingapo. Tiyeni tikambirane chilichonse mwatsatanetsatane.

Zamatsenga

Metabolic nephropathy ndiyoyambira komanso yachiwiri. Ndi matenda awa, ntchito zama metabolic zimasokonekera. Mitundu yoyamba imatengedwa ngati cholowa, mavuto amakula msanga: kulephera kwa impso ndi urolithiasis. Fomu yachiwiri imachitika chifukwa cha zoyambitsa ndi poizoni ndi matenda ena.

Dysmetabolic

Matendawa amayamba chifukwa cha matenda a metabolic.

Amadziwikanso kuti urate nephropathy, omwe amayamba chifukwa cha vuto la metabolism. Kuphatikiza apo ndikuphatikizidwa ndi kuwonongeka kwa impso chifukwa cha mchere wamchere. Oxalic acid, oxalates ndi urate zimayikidwa makamaka mu impso. Dysmetabolic nephropathy imagawidwa m'mitundu iwiri kutengera luso lamchere: oxalate ndi urate.

Pa nthawi yoyembekezera

Zizindikiro zazikuluzikulu za matenda amtunduwu, zomwe zimakhala zowopsa pa nthawi yomwe ali ndi pakati, zimakhala zowopsa zowopsa komanso kutupa kwambiri kwa thupi. Nephropathy ya digiri yoyamba imatsala pang'ono kunyalanyazidwa nthawi yapakati. Nthawi zambiri, odwala amapita kwa dotolo ndi madandaulo ngati patachitika degree 2 kapena 3, yomwe imadziwika ndi zizindikiro zowopsa komanso chiwopsezo chotayika cha fetal.

Preeclampsia (nephropathy), yosadziwika

Imachitika nthawi ya mochedwa toxicosis pa nthawi yapakati. Nephropathy yosadziwika imachitika motsutsana ndi maziko a matenda amkati, mutadwala matenda oopsa kapena nephritis. Amadziwika ndi proteinuria, matenda oopsa komanso kutupa. Potengera maziko a chizindikiro ichi, migraine yamphamvu imawonekera, masomphenya amachepa.Chithandizo chimatenga nthawi yayitali.

Zoopsa

Poizoni nephropathy ndimagwira ntchito kwa impso chifukwa cha mphamvu zamankhwala. Imadziwulula yokha motsogozedwa ndi poizoni wa hemolytic zinthu - acetic acid kapena sulfate yamkuwa. Zomwe zimawonekera kwambiri ndizowonongeka kwa impso zosadziwika mwatsatanetsatane chifukwa cha ziphe ndi vuto la hemodynamic. Zinthu zotsatirazi za nephrotoxic zimayambitsa izi:

Mankhwala

Mankhwala osalamulirika kapena kugwiritsa ntchito nthawi yayitali kumayambitsa matenda a thupi (kuwonongeka kapena kupweteka kwa impso). Kugonjetsedwa kumatha kukhala pachimake (kuyamwa kwa mankhwala waukulu) ndi mankhwala osatha (mankhwala osakhalitsa). Zizindikiro zotsatirazi za nephropathy ya impso zimachitika:

Kupangitsa kusiyanitsa

Kuphatikizika kochititsa chidwi ndi nephropathy ndi vuto lalikulu la impso. Imayamba tsiku pambuyo poti mtsempha wa X-ray wapangidwe. Mothandizidwa ndi iye, mulingo wa creatinine umakwera kwambiri. Poganizira kuti posachedwapa radiopaque madzimadzi imagwiritsidwa ntchito nthawi zambiri, kuchuluka kwa zolemba zamakono zikuwonjezeka chimodzimodzi.

Analgesic

Kugwiritsa ntchito mankhwala molakwika kwa gululi kumayambitsa chitukuko cha impso.

Analgesic nephropathy imachitika mwa odwala omwe amakonda kuzunza ma analgesics okhala ndi phenacetin ndi aspirin, paracetamol ndi caffeine. Njira iyi ya nephropathy imadziwika ndi kukula kwa necrosis ya papillae impso, kutupa njira mu aimpso tubules ndi minofu. Amayi amatha kukhala ndi analgesic nephropathy kuposa amuna.

Paraneoplastic

Paraneoplastic nephropathy imayamba pansi pa zochita zoyambitsa ma neoplasms osiyanasiyana. Ma tumor a ziwalo zopumira, minyewa yam'mimba, komanso chithokomiro cha chithokomiro chimathandiza kwambiri kugwira ntchito kwa impso. Nthawi zina chomwe chimayambitsa ndi magazi myeloma. Sichinthu chotsimikizika cha impso monga gawo la zomwe thupi limachita pakhungu. M'nthawi yochepa, matenda a nephrotic amakhala.

Ischemic

Ischemic nephropathy ndi chotsatira cha zotupa za atherosulinotic zamatumbo a impso. Pangozi yakugonjetsedwa ndi matendawa ndi anthu okalamba. Fomuyi imadziwika ndi kuchepa kwa impso. Kukula msanga kwa matendawa kumabweretsa kupendekera, kenako kufalikira kwathunthu kwa lumen m'mitsempha yamafungo. Zimayambitsa kuwonongeka kwa impso.

Hypertgency (hypertonic)

Kuwonongeka kwa ziwiya za ziwalo kumayamba kukhala kulephera kwa impso.

Njira ya pathological imayamba m'mitsempha yaying'ono yaimpso. Matenda oopsa a minyewa yomwe imakwiyitsa matenda a impso. Mitsempha yamkati imakhudzidwa ngati matenda oopsa kwambiri ali ndi vuto lalikulu kapena ngati sakuwachira. Ntchito yosefera ya glomeruli imasokonekera, ma nitrogenous slags samachotsedwa. Hypertensive nephropathy imapangitsa kulephera kwaimpso.

Mowa

Mowa nephropathy amayamba chifukwa cha nthawi yayitali ya zakumwa zoledzeretsa zimafanana ndi zomwe zimachitika m'thupi. Fomuyi imadziwika ndi zizindikiro za nephritis - kukodza pafupipafupi, kuwona kwamkaka ndi mkodzo. Nthawi zambiri limodzi ndi matenda a chiwindi ndi matenda enaake. Mankhwalawa panthawi ya mankhwala ayenera kukhala ndi vuto lothana ndi vuto.

Gouty

Mwambiri, zamatsenga zimakhudza amuna.

Zimayambitsidwa chifukwa cha kusagwira bwino ntchito kwa purine metabolism komanso kusintha kwa ma pathological m'matumbo. Matendawa amakhudza amuna nthawi zambiri kuposa azimayi. Ndi matenda awa, kaphatikizidwe ka uric acid amakula ndipo kusakhazikika kumayamba pakati pa katulutsidwe ndi kubwezeretsa kwamkodzo. Odwala ambiri motsogozedwa ndi gout yoyamba ali ndi vuto lochita kupunduka kwa impso.

Mtima

Ma nephropathies am'mimba amawonongera ziwiya za impso. Ischemia yocheperako kapena yamphamvu imayamba. Vascular ischemic ndi hypertonic nephropathies, zokhudza zonse zotupa za zotumphukira zimakhala. Chithunzi cha Clinical: Matenda amitsempha am'mimba amatsogolera ku sclerosis komanso kuvuta kwa minofu ya impso. Pali kuthamanga kwa magazi, kukodza mwachangu komanso kulephera kwaimpso.

Impso epithelium imakhudzidwa ndi mankhwala osakanikirana a protein.

Nephrons amakhudzidwa ndi paraproteins - mankhwala osokoneza bongo a protein. Myeloma nephropathy imakhala ya kusintha kwa ma pathological a distal aimpu. Mu mipata ya ma tubules, ma CD ambiri amayamba, zomwe zimabweretsa kusintha kwakukulu mu epithelium (myeloma impso). Zizindikiro zamtunduwu wa nephropathy ndizosiyanasiyana.

Membranous

Ndi matenda awa, kuphwanya kwakukulu ndikutulutsa kwa makoma a zombo zazing'ono zomwe zili mu glomeruli. Chizindikiro chachikulu ndikupezeka kwa mapuloteni mumkodzo kapena kutupa kwambiri kwa thupi lonse. Nthawi zambiri, nembanemba nephropathy ndimavuto kapena zotupa, chifuwa chachikulu, ndipo pafupifupi sipakhala matenda odziyimira pawokha.

Iga (immune) nephropathy

Amadziwika mu zamankhwala ngati matenda a Berger. Matenda a nephropathies ndi omwe amapezeka kwambiri a impso. Nthawi zambiri immune iga nephropathy imayamba unyamata. Imagawidwa kukhala matenda oyamba (odziimira) komanso yachiwiri (yomwe imabuka motsutsana ndi maziko a zovuta zina). Nthawi zambiri amapezeka pambuyo pachimake kupatsira ma virus matenda, kulimbitsa thupi kwambiri, matumbo matenda. Immunoglobulin A amayamba kudzikundikira mthupi.

Boma

Khungu lakhungu ndiye chizindikiro chachikulu cha mtundu wamatenda.

Mtundu wamtundu wamatenda amadziwika ndi njira ya asymptomatic. Chizindikiro chachikulu chidzakhala kutsika kwa khungu ndi tint yamkuwa. Pathology imayamba pang'onopang'ono. Zotsatira zakupha ndizotheka, zomwe zimachitika pambuyo pa zaka 5 kapena kupitilira apo, ngati matendawa sanalandiridwe. Nthawi zambiri amapezeka pa njira zopewera mankhwala.

Potaziyamu

Imachitika chifukwa cha chotupa cha adrenal chotupa, chamkati matenda oopsa kapena carcinoma ya adrenal cortex. Imadziwonetsa yokha mu matenda oopsa, kufooka kwa minofu ndi kukokana kwakanthawi. Pali chinthu china monga impso ya kalyopenic - pamene calcium imachotsedwa kwambiri kuchokera mthupi motsogozedwa ndi methaneamu ya aldosterone.

Kodi Reflux ndi chiyani?

Fomu ya Reflux imadziwika ndi kusintha kwamkodzo kwamkodzo. Matenda a ziphuphu ali ponseponse. Nthawi zambiri zimayambitsa pyelonephritis (pachimake komanso chovuta), kukula kwa ureter ndi kuwonjezeka kwa impso. Nthawi zambiri matenda amtunduwu amathandizidwa mwa ana. Reflux nephropathy nthawi zambiri imayamba chifukwa cha kusintha kwamtundu wamkodzo kapena njira yotupa mwa iwo.

Kuzindikira aimpso nephropathy

Kuyesedwa kwa magazi ndi zamankhwala ambiri ndi mbali imodzi ya mayeso a labotale.

Gawo lofunikira pakuwonetsa matenda a impso limawerengedwa kuti ndiosiyanitsa ndi mitundu ina ya aimpso. Kuphatikiza pa maphunziro ovomerezeka, dokotala atha kukuwuzani zowonjezera matenda. Njira zodziwika bwino zodziwikirazi ndi monga:

Chithandizo ndi kupewa

Chithandizo chimatengera chitukuko cha matenda ndi kutulutsa kwatsopano. Mukamasankha njira yochiritsira komanso mankhwala, dokotala amatengera deta ya labotale yomwe imakhala payokha kwa wodwala aliyense. Ngati nephropathy ndi yachiwiri, njira zochizira zimatsika pochiza matenda oyambira. Zoyesedwa zikutenga kuti abwezeretsanso diureis ndi kuchepetsa magazi.

Njira zopewera komanso kuchiza matenda a nephropathy zimangotsatira kutsatira zakudya zosavuta komanso kumwa.

Zakudya zoyenera

Zakudya ziyenera kukambirana ndi adokotala.

Chithandizo chimaphatikizapo mtundu wina wa zakudya womwe dokotala adzakulemberani potengera chithunzi cha anthu. Pankhani ya poizoni nephropathy, kulumikizana ndi chinthu choyipa kapena kukonzekera sikuyenera kuyikidwa pambali. Sitikulimbikitsidwa kudya zakudya zamchere, zonunkhira komanso zosuta. Thanzi liyenera kuphatikizapo kuchuluka kwa mavitamini ndi michere yonse yofunikira m'thupi.

Zithandizo za anthu

Pambuyo pozindikira zoyamba za matenda, muyenera kufunsa dokotala, kutsatira zomwe akutsimikiza osati kudzisamalira. Chithandizo cha nephropathy ndi wowerengeka azitsamba chingakhale chothandizira kuchipatala ndipo chitha kugwiritsidwa ntchito mutafunsa dokotala. Amachita bwino decoction wazitsamba zamankhwala okhala ndi okodzetsa komanso odana ndi kutupa.

Mavuto ndi udzu

Ma pathologies apakati nthawi zambiri amalowa. Mwachitsanzo, cystitis kapena pyelonephritis. Nthawi zina, matenda a impso a nephropathy amakula, kulephera kwa impso kapena mawonekedwe amiyala. Momwe matendawo amathandizira panthawi yake. Kungonyalanyaza zizindikiritso ndi mawonekedwe owoneka kwa nthawi yayitali kungayambitse imfa.