Matenda a shuga a shuga: Kufotokozera, kuyambitsa, kupewa
Nephropathy ndimatenda omwe minyewa imagwira ntchito.
Matenda a shuga - Izi ndi zotupa za impso zomwe zimayamba chifukwa cha matenda ashuga. Zilonda zam'mimba zimakhala ndi sclerosis ya aimpso, zomwe zimabweretsa kuwonongeka kwa impso.
Ndi imodzi mwazovuta komanso zowopsa za matenda ashuga. Zimachitika ndimodalira insulin (mu 40% ya milandu) komanso osadalira insulini (20-25% ya milandu) mitundu ya matenda a shuga.
A mawonekedwe a matenda ashuga nephropathy ndi pang'onopang'ono ndipo pafupifupi asymptomatic chitukuko. Gawo loyamba lachitukuko cha matendawa silimabweretsa zosasangalatsa zilizonse, chifukwa chake, nthawi zambiri madokotala amafunsidwa kale kumapeto kwa matenda ashuga nephropathy, pomwe zimakhala zosatheka kuchiritsa zomwe zachitika.
Chifukwa chake, ntchito yofunika ndikudziwunika kwakanthawi ndi kuzindikira zizindikiro zoyambirira za matenda ashuga.
Zomwe zimayambitsa matenda ashuga nephropathy
Chifukwa chachikulu cha kukhazikitsidwa kwa matenda a shuga ndi nephropathy ndi kuwonongeka kwa matenda osokoneza bongo - nthawi yayitali hyperglycemia.
Zotsatira za hyperglycemia ndi kuthamanga kwa magazi, komwe kumakhudzanso ntchito ya impso.
Ndi shuga wambiri komanso kuthamanga kwa magazi, impso sizingagwire ntchito moyenera, ndipo zinthu zomwe zimayenera kuchotsedwa ndi impso zimadziunjikira m'thupi ndikupangitsa poyizoni.
Chobadwa chathu chimakulitsanso chiopsezo chokhala ndi matenda a shuga - ngati makolo atalephera kugwira ntchito yaimpso, ndiye kuti chiwopsezo chikuwonjezeka.
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.
Stage Diabetesic Nephropathy
Pali magawo asanu akuluakulu pakapangidwe ka matenda a shuga a nephropathy.
Gawo 1 - limayamba kumayambiriro kwa matenda ashuga.
Amadziwika ndi kuwonjezeka kwa glomerular filtration rate (GFR) yoposa 140 ml / min, kuchuluka kwa magazi aimpso (PC) ndi albuminuria yabwinobwino.
Gawo lachiwiri - limakula ndikulimbana ndi matenda ashuga (osaposa zaka zisanu). Pakadali pano, kusintha koyambirira kwa minyewa ya impso kumawonedwa.
Amadziwika ndi albuminuria yabwinobwino, kuchuluka kwa kusefedwa kwa glomerular, kukula kwa zigawo za pansi komanso glomerular mesangium.
Gawo lachitatu - amakula ndi matenda ashuga kuyambira azaka 5 mpaka 15.
Amadziwika ndi kuwonjezeka kwakanthaŵi kwa kuthamanga kwa magazi, kuchuluka kapena kufulumira kwa kusefukira kwa glomerular, ndi microalbuminuria.
Gawo 4 - gawo la nephropathy.
Amadziwika ndi mulingo wabwinobwino kapena wocheperako wa kusefera kwambiri, ochepa matenda oopsa ndi proteinuria.
Gawo 5 - uremia. Amakhala ndi mbiri yayitali ya matenda ashuga (woposa zaka 20).
Amadziwika ndi kuchepa kwa kusefukira kwa glomerular, magazi oopsa. Pakadali pano, munthuyu amakhala ndi vuto la kuledzera.
Ndikofunika kwambiri kuzindikira kukula kwa matenda ashuga mu magawo atatu oyambirira, pamene chithandizo cha kusintha chikuchitikirabe. Mtsogolomo, sizingatheke kuchiritsa kwathunthu kusintha kwa impso, ndizotheka kungopitilira kuwonongeka kwina.
Zizindikiro za matenda a shuga a Nephropathy
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.
Matenda a matenda ashuga nephropathy
Kuyesedwa kwa njira sikumakulolani kuti muzindikire matendawo omwe matendawa alibe. Chifukwa chake, odwala onse omwe ali ndi matenda ashuga amawonetsedwa kutsimikiza kwa mkodzo albumin mwa njira zapadera. Kupezeka kwa microalbuminuria (kuyambira 30 mpaka 300 mg / tsiku) kumawonetsa kukhalapo kwa matenda ashuga. Chofunikanso chimodzimodzi ndi kutsimikiza kwa kusefukira kwa glomerular. Kuwonjezeka kwa kusefedwa kwa glomerular kumawonetsa kuchuluka kwa kupsinjika mu ziwiya za impso, zomwe zimawonetsa mosadziwika kukhalapo kwa matenda ashuga a nephropathy.
Gawo lachipatala la matendawa limadziwika ndi ma protein ambiri mkodzo, matenda oopsa, kuwonongeka kwa ziwiya zam'maso ndi kuwonongeka kwa mawonekedwe amawonongeka komanso kuchepa kwapang'onopang'ono kwa kuchuluka kwa kusefera kwa glomerular, kuchuluka kwa kusefa kwa glomerular kumachepa pafupifupi 1 ml / mphindi mwezi uliwonse.
Gawo V la matendawa amapezeka ndi kuchepa kwa kusefera kwa mafuta osachepera 10 ml / min.
Chithandizo cha odwala matenda ashuga a Nephropathy
Zochita zonse zochizira matenda a shuga a nephropathy amagawika magawo atatu.
1. Kupewa matenda a impso mu shuga. Izi ndizotheka ndikusungabe kuchuluka kwa shuga m'magazi chifukwa chogwiritsira bwino mankhwala ochepetsa shuga.
2. Pamaso pa microalbuminuria, kukonza shuga wambiri wabwinobwino kulinso kofunikira, komanso chithandizo cha matenda oopsa, omwe nthawi zambiri amapezeka kale pamlingo uwu wamatenda. Zoletsa za angiotensin-akatembenuka enzyme (ACE), monga enalapril, mu milingo yaying'ono amaonedwa kuti ndi mankhwala oyenera pochiza kuthamanga kwa magazi. Kuphatikiza apo, zakudya zapadera zomwe zimakhala ndi mapuloteni osaposa 1 g pa 1 makilogalamu amalemu amthupi ndizofunikira kwambiri.
3. Pulogalamu ya proteinuria ikachitika, cholinga chachikulu chamankhwala ndicho kupewa kuchepa kwamphamvu kwa impso ndi kukula kwa matenda a impso. Chakudyacho chimabweretsa malamulo ochulukirapo ophatikiza mapuloteni omwe amapezeka muzakudya: 0,7-0.8 g pa 1 makilogalamu a thupi. Pokhala ndi mapuloteni otsika muzakudya, kuwonongeka kwa mapuloteni enieni amthupi kungachitike. Chifukwa chake, ndi cholinga cholowa m'malo, ndikotheka kupereka ma enzoni a ketone amino acid, mwachitsanzo, ketrateil. Kusunga kuchuluka kwa shuga wamagazi ndikuwongolera kuthamanga kwa magazi kumakhalabe kofunikira. Ma calcium blockers (amlodipine) kapena beta-blockers (bisoprolol) amawonjezeredwa ndi ma AC inhibitors. Ndi edema, diuretics imalembedwa (furosemide, indapamide) ndipo kuchuluka kwamadzi akumwa kumawongoleredwa, pafupifupi lita imodzi patsiku.
4. Ndi kuchepa kwa kusungunuka kwa glomerular osachepera 10 ml / min, aimpso kusintha kwachakudya kapena kufalikira kwa ziwalo. Pakadali pano, chithandizo cha mankhwala aimpso chikuyimiridwa ndi njira monga hemodialysis ndi peritoneal dialysis. Koma njira yabwino yochizira matenda a matenda a shuga ndi kufalikira ndikuwonjezera zovuta kupweteka kwa impso. Pakutha kwa 2000, zinthu zoposa 1,000 zofunika kuzigulitsa zinagwiridwa ku United States. M'dziko lathu, kufalikira kwa ziwalo zosiyanasiyana kukuchitika.
Dokotala wothandizira, nephrologist Sirotkina E.V.
# 4 Sayan 08/30/2016 05:02
Moni Wamkazi 62 g. Matenda a shuga a mtundu wachiwiri pa insulin; kumapeto kwa kumapeto kwa sitimayi tidazindikira kuti pali matenda ashuga a mtima.Rheumatism pamiyendo ndi mikono, imayenda kwambiri pamiyendo. Kutayamba kwa chilimwe, kusamba kwake kumayamba (samatha kugona, mantha, akunena kuti winawake akumugwiritsa ntchito, zina.) Misozi.
Zomwe zimachitika
Cholinga chachikulu cha glomerulosulinosis mwa anthu omwe ali ndi matenda ashuga ndi hyperglycemia. Kuchuluka kwa glucose m'magazi kumayambitsa poizoni m'maselo omwe amadyamo. Nthawi yomweyo, ntchito ya impso imasokonekera, popeza mawonekedwe amitsempha amawonongeka, matenda oopsa, zovuta pakubwera kwa magazi, zomwe zimalepheretsa kusefedwa kwathunthu.
Kukula kwa nephropathy ndi shuga kumadutsa magawo asanu. Ndi mwambo kugwiritsa ntchito magawo omwe amavomerezedwa kwambiri malinga ndi Mogensen. Kupenda kumeneku kumakupatsani mwayi wodziwa siteji, mawonetseredwe amachitidwe azachipatala komanso nthawi yomwe matendawo amakula.
Ndizotheka kupewa kupezeka kwa matenda amisempha mu impso pokhapokha mutazindikira ndikuyamba kulandira chithandizo pakukonzekera magawo atatu oyamba. Maonekedwe a proteinuria akuwonetsa kuwonongeka kwa mitsempha yamagazi, yomwe singathe kuchiritsidwa. Pambuyo pake, ndizotheka kuthandizira ntchito ya thupi pofuna kupewa kuwonongeka.
Kuzindikira koyambirira kwa matenda a shuga a nephropathy amapangidwa ndikutsatira albin mkodzo. Chovomerezeka ndizopezeka muzazochepa kwambiri, osakwana 30 mg patsiku. Ndi microalbuminuria, mlingo wake wa tsiku ndi tsiku umakwera mpaka 300 mg. Kuwerenga kukaposa 300 mg, chikhalidwe chotchedwa macroalbuminuria chimalimbikitsidwa. Zowonetsera zamatenda zimawonjezeredwa kwa izo: kuthamanga kwa magazi, edema, kuchepa magazi, kuchuluka kwa calcium, magazi, mkodzo, dyslipidemia.
Chithandizo cha nephropathy mu shuga chimayenda bwino pokhapokha magawo atatu a chitukuko cha matenda. Tidzaletsa kufalikira kwa kuwonongeka m'mitsempha ya impso, poteteza kapena kufulumira kuyambika kwa matendawa. Poterepa, mayendedwe azachipatala ndi awa:
Zakudya za matenda a impso a nephropathy zimasonyezedwanso ngakhale koyamba kuwonetsa kwa microalbuminuria. Mapuloteni amayenera kudyedwa pamiyeso yovomerezeka, popeza kugawanika kwake kumayambitsa kupanga poizoni, zomwe zimakhala zovuta kuchotsa impso ndi ziwiya zowonongeka.Komabe, ndizopangiranso zinthu zomanga thupi, chifukwa chake sizingafanane ndi zakudya.
Mu magawo oyamba, mapuloteni amayenera kudyedwa monga amawerengera: 1 g pa 1 makilogalamu a shuga. Pa magawo a matenda akuwonetsa nephropathy, izi zimachepetsedwa mpaka 0,8 g pa 1 kg yolemera. Kugwiritsa ntchito sodium chloride (mchere wa gome) mu chakudya kumatsitsidwanso mpaka magalamu 3-5 patsiku kwa microalbuminuria ndi mpaka 2 magalamu a proteinuria. Popeza mchere umathandiza kusunga madzi mthupi. Chifukwa chake, ndi nephropathy yowonetsedwa puffiness, ndikofunikira kuchepetsa kumwa - osaposa 1 lita imodzi patsiku.
Mndandanda wazinthu zomwe zikulimbikitsidwa kuti zithetse matenda a shuga ndi motere:
Kupewa
Chithandizo chokwanira cha hypoglycemia ku matenda osokoneza bongo kale amateteza monga matenda a shuga. Komabe, kuchuluka kwa glucose kochulukirapo m'magazi kumathito kumakhudzanso magwiridwe antchito kwa nthawi yayitali ndipo pamapeto pake kumawonekeranso pakuwoneka kwa microalbuminuria. Chachikulu pankhaniyi ndikuzindikira mwachangu zomwe zasintha ndikuchita zina.
Kupewa kwa nephropathy kwa anthu odwala matenda a shuga ndi motere:
Cholinga chachikulu cha kupewa chiwonetsero cha matenda ashuga nephropathy ndikuletsa kukula kwa aimpso kulephera, komwe kumabweretsa imfa. Pachifukwa ichi, anthu omwe ali ndi matenda ashuga amayenera kuwunikidwa pafupipafupi ndi madokotala, kutsatira malangizo awo onse, ndikuyang'anira kuwerengera kwawo shuga.
Komabe, mukamatenga njira zopewera komanso zochizira kuti mupewe matenda a nephropathy, munthu asayiwale za kukhalapo kwa chomwe chimayambitsa matendawa - komanso matenda oopsa a shuga. Kuwongolera zakudya komanso kusankhidwa kwa mankhwala sikuyenera kukulitsa vutoli.
Chifukwa cha mankhwalawa matenda oopsa, omwe amapezeka kale kumayambiriro kwa nephropathy, mankhwalawa amayenera kusankhidwa mwanjira kuti asayambitse matenda ena ovuta a shuga. Pa gawo la proteinuria, la mtundu II odwala matenda ashuga, si mankhwala onse ochepetsa shuga omwe amaloledwa, glyclazide, glycidone, repaglinide amaloledwa. Ndipo ochepetsedwa ndi GFR, amapatsidwa insulin. Chifukwa chake, ndikofunikira kukumbukira kuti chithandizo cha chiwonetsero cha matenda ashuga glomerulossteosis chikugwirizana ndi chithandizo cha matenda ashuga.
Zomwe zimayambitsa matenda ashuga nephropathy
Matenda a shuga ndi gulu lonse la matenda omwe amawoneka chifukwa chophwanya mapangidwe kapena zochita za insulin. Matenda onsewa amaphatikizidwa ndi kuwonjezereka kwamphamvu kwa glucose wamagazi. Pankhaniyi, mitundu iwiri ya shuga imadziwika:
Ngati ziwiya ndi minyewa yamitsempha zimadziwika kuti zimakhala ndi shuga kwa nthawi yayitali, kuchuluka kwa shuga m'magazi ndikofunikira. apo ayi, kusintha kwa ziwalo zomwe zimakhala zovuta za shuga kumachitika mthupi.
Chimodzi mwazovuta izi ndi matenda ashuga. Imfa ya odwala chifukwa cha kulephera kwa impso mu matenda monga mtundu I matenda a shuga amayamba. Ndi matenda amtundu wa II matenda a shuga, malo otsogolera omwe amafa amakhala ndi matenda ogwirizana ndi mtima, ndipo kulephera kwaimpso kumawatsatira.
Popanga nephropathy, gawo lofunikira limaseweredwa ndi kuwonjezeka kwa shuga m'magazi.Kuphatikiza apo glucose imagwira maselo am'mimba ngati poizoni, imathandizanso kupanga zinthu zomwe zimapangitsa kuwonongeka kwa makoma amitsempha yamagazi ndikuwapangitsa kuti akhale ovomerezeka.
Mimba matenda a shuga
Kukula kwa matenda a shuga a nephropathy kumathandizira kuwonjezeka kwa kupanikizika m'mitsempha ya impso. Itha kuchitika chifukwa cha kuwongolera kosayenera mu kuwononga kwamanjenje yomwe imayambitsa matenda a shuga mellitus (diabetesic neuropathy).
Mapeto ake, timisempha tomwe timapangika m'malo mwa ziwiya zowonongeka, zomwe zimayambitsa kusokoneza kwambiri impso.
Zizindikiro za matenda a shuga a Nephropathy
Matendawa amakula zingapo:
Ndayamba Amawonetsedwa pakuwonetsa impso, ndipo zimachitika kumayambiriro kwa matenda ashuga, wokhala ndi zofunikira zake. Maselo amitsempha yama impso amawonjezeka pang'ono, kuchuluka kwa mkodzo ndi kusefedwa kwake kumawonjezeka. Pakadali pano, mapuloteni mumkodzo sanadziwikebe. Palibe zizindikiro zakunja.
Gawo lachiwiri yodziwika ndi chiyambi cha kusintha kwamaumbidwe:
III gawo - Ichi ndi chiyambi cha matenda ashuga. Zimachitika, monga lamulo, zaka zisanu atazindikira wodwala yemwe ali ndi matenda ashuga. Nthawi zambiri, mukamazindikira matenda ena kapena mukamawunika pafupipafupi, mapuloteni ochepa (kuyambira 30 mpaka 300 mg / tsiku) amapezeka mumkodzo. Mkhalidwe wofananawo umatchedwa microalbuminuria. Zomwe mapuloteni amawonekera mumkodzo akuwonetsa kuwonongeka kwakukulu m'mitsempha ya impso.
Magawo atatu oyambayo amatchedwa preclinical, chifukwa palibe zodandaula za wodwala, ndipo kusintha kwa impso kumatsimikiziridwa pokhapokha njira zasayansi. Komabe, ndikofunikira kudziwa matendawa m'magawo atatu oyamba. Pakadali pano, ndikuthekanso kukonza zinthu ndikusintha matendawo.
Gawo la IV - amapezeka zaka 10-15 wodwala atapezeka ndi matenda a shuga.
Ngati proteinuria ndi yaying'ono, ndiye kuti miyendo ndi nkhope zimatupa. Matendawa akamakula, edema imafalikira thupi lonse. Kusintha kwa matenda a impso kukhala ndi mawonekedwe, kugwiritsa ntchito mankhwala okodzetsa kumakhala kosayenera, chifukwa sikothandiza. Momwemonso, opaleshoni yochotsa madzimadzi kuchokera kumiyendo ikusonyezedwa (kupyoza).
Pofuna kukhalabe ndi protein yamagazi m'magazi, thupi limaphwanya mapuloteni ake omwe. Odwala amayamba kuchepa thupi kwambiri. Zizindikiro zina zimaphatikizapo:
Pafupifupi nthawi zonse pamakhala kuwonjezeka kwa kuthamanga kwa magazi, nthawi zambiri manambala ake amakhala okwera kwambiri, motero kupuma movutikira, kupweteka mutu, kupweteka mumtima.
V siteji Imatchedwa gawo lothana ndi vuto la impso ndipo ndi mathero a matenda a shuga. Kuthwa kwathunthu kwamitsempha ya impso kumachitika, imatha kukwaniritsa ntchito ya mawonedwe.
Zizindikiro za gawo lathali zikupitilira, pokhapokha pokhapokha zikuwopseza moyo. Kupatula kwa hemodialysis, peritoneal dialysis, kapena kupatsirana kwa impso, kapena ngakhale kupangika kwathunthu, kupweteka kwa impso, ndi komwe kungathandize pakadali pano.
Njira zamakono zoperekera matenda a matenda ashuga
Kuyesedwa kwathunthu sikupereka chidziwitso cha magawo omwe matenda amayambitsidwa. Chifukwa chake, kwa odwala omwe ali ndi matenda ashuga pamakhala kupezeka kwamkodzo.
Ngati zizindikiro za Albin zili m'mitundu 30 mpaka 300 mg / tsiku, tikulankhula za microalbuminuria, ndipo izi zikuwonetsa kukula kwa matenda a shuga m'thupi. Kuchuluka kwa kusefedwa kwa glomerular kumasonyezanso matenda a shuga.
Kukula kwa matenda oopsa kwambiri, kuchuluka kwamapuloteni mu mkodzo, kuwonongeka kwamawonekedwe ndi kutsika kosasinthika kwa kusefukira kwa zinthu ndi zina mwa zinthu zomwe zimayambitsa matenda omwe matenda a shuga amadutsa. Mlingo wosefera wa glomerular umatsikira mpaka 10 ml / min ndikuchepera.
Matenda a shuga, nephropathy
Njira zonse zokhudzana ndi chithandizo cha matendawa zimagawika magawo atatu.
Kupewa kwa kusintha kwamatenda am'magazi mu shuga mellitus. Zimakhala ndikukhalabe ndi shuga m'magazi pamlingo woyenera. Kwa izi, mankhwala ochepetsa shuga amagwiritsidwa ntchito.
Ngati microalbuminuria alipo kale, ndiye kuwonjezera pa kukhala ndi shuga, wodwalayo amamulembera chithandizo cha matenda oopsa. Angiotensin-converting enzyme inhibitors akuwonetsedwa pano. Itha kukhala enalapril ang'onoang'ono Mlingo. Kuphatikiza apo, wodwalayo ayenera kutsatira zakudya zapadera zama protein.
Ndi proteinuria, choyambirira ndikupewa kuchepa kwambiri kwa machitidwe a impso ndi kupewa kulephera kwa impso. Chakudyacho chimakhala choletsa kwambiri pamapuloteni omwe amapezeka muzakudya: 0,7-0.8 g pa 1 kg ya kulemera kwa thupi. Ngati protein yachepa kwambiri, thupi limayamba kuphwanya mapuloteni ake omwe.
Pofuna kupewa izi, ma ketone analogi amino acid amapatsidwa kwa wodwala. Chofunikira kukhala ndikusungabe kuchuluka kwa glucose m'magazi ndikuchepetsa kuthamanga kwa magazi. Kuphatikiza pa ACE inhibitors, amlodipine amalembedwa, omwe amaletsa njira za calcium ndi bisoprolol, beta-blocker.
Diuretics (indapamide, furosemide) ndi mankhwala ngati wodwala ali ndi edema. Kuphatikiza apo, kuchepetsa kudya kwamadzimadzi (1000 ml patsiku), komabe, ngati pali matenda a shuga, kudya zamadzimadzi kuyenera kuganiziridwanso kudzera m'matenda a matenda.
Ngati kusefukira kwa glomerular kutsika mpaka 10 ml / mphindi kapena kutsika, wodwalayo amamuika kuti alandire chithandizo (peritoneal dialysis ndi hemodialysis) kapena kufalikira kwa ziwalo.
Moyenera, gawo lothana ndi matenda ashuga nephropathy amathandizidwa ndi kupatsirana kwa kupweteka kwaimpso. Ku United States, ndikudziwitsa za matenda a shuga a nephropathy, njirayi ndi yofala kwambiri, koma m'dziko lathu, zojambulira zotere zimapezekabe.
Mfundo zachithandizo
Chithandizo cha matenda ashuga nephropathy ali ndi njira zingapo:
Therapy ndizokhazikitsidwa:
Woopsa kuwonongeka impso, aimpso m'malo.
Komanso, wodwala ayenera:
Ndipo ngati magawo oyamba a mankhwala adapangidwira njira zodzitetezera, milandu yonyalanyazidwa imapereka njira yoopsa.
Zochizira matenda a shuga, nephropathy, njira zonse zochotsera matenda a mtima zimayikidwa ndi adokotala.
Sintha shuga
Matenda a shuga m'thupi amabwera pochizira nephropathyndi mndandanda wama shuga omwe amachititsa kuti matendawa azikula.
Kafukufuku wachipatala adakhazikitsa: ngati kwa nthawi yayitali index ya glycemic hemoglobin sapitirira 6.9%, ndizotheka kupewa chitukuko cha nephropathy.
Akatswiri amavomereza mfundo za glycated hemoglobin yopitilira 7% pachiwopsezo chachikulu cha dera la hypoglycemic, komanso mwa odwala omwe ali ndi matenda am'mtima.
Pochiza matenda a shuga, nephropathy, zizindikiro za shuga m'thupi ziyenera kubweretsedwa mwachizolowezi
Pofuna kukonza mankhwala a insulini ndikofunikira: kuwunikiranso mankhwala omwe agwiritsidwa ntchito, njira yawo komanso Mlingo.
Monga lamulo, dongosolo lotsatirali limagwiritsidwa ntchito: insulin yayitali imaperekedwa nthawi 1-2 patsiku, mankhwala osokoneza bongo - musanadye.
Kusankha kwa mankhwala ochepetsa shuga a matenda a impso ndi ochepa. Kugwiritsa ntchito mankhwala, kuchotseka komwe kumachitika kudzera mu impso, komanso kukhala ndi vuto losafunikira m'thupi, ndikosayenera.
Ndi matenda a impso, ntchito:
Kwa odwala matenda ashuga amtundu wa 2, kugwiritsa ntchito mankhwala otetezeka kwambiri pakamwa, omwe ali ndi zotsika kwambiri kudzera mu impso, akulimbikitsidwa:
Ngati sizotheka kupeza chindapusa chokwanira chifukwa chakumwa mapiritsi a mtundu wa 2 odwala ashuga, akatswiri amapanga chithandizo chophatikiza pogwiritsa ntchito insulin yayitali. Zinthu zitafika povuta kwambiri, wodwalayo amasamukira ku insulin.
Pa gawo la kulephera kwa impso, kugwiritsa ntchito mapiritsi kumatsutsana, insulin yokha imagwiritsidwa ntchito. Kupatula ndi glycidone, kugwiritsa ntchito komwe kumakhala kotheka ndi zizindikiro zina.
Matenda a kuthamanga kwa magazi
Kusintha kwamatenda a impso kumachitika, ndikofunikira kwambiri kusintha zizindikiro zamagazi ndikuchotsa ngakhale owonjezera omwe ali nawo.
Kumayambiriro kwa chitukuko, matendawa sayenera kupitilira 130/85 mm RT. Art. ndipo musakhale otsika kuposa 120/70 mm RT. Art.
Kupsinjika kwa magazi, chizolowezi choyenera kwambiri, chimakupatsani mwayi kuti muchepetse kukula kwa njira za impso.
Posankha mankhwala, ndikofunikira kulingalira momwe zimakhudzira gawo lomwe lakhudzidwa. Monga lamulo, akatswiri amatembenukira pamagulu otsatirawa a mankhwala:
Lipid kagayidwe kachakudya
Ndi kuwonongeka kwa impso, mafuta a cholesterol sayenera kupitirira 4.6 mmol / L, triglycerides - 2.6 mmol / L. Chosiyana ndi matenda a mtima, momwe mulingo wa triglycerides uyenera kukhala wochepera 1.7 mmol / L.
Kuwonongeka kwa lipid metabolism kumabweretsa kukula kwakukulu kwa kusintha kwa matenda a impso
Kuti tichotse izi, kugwiritsa ntchito magulu otsatirawa:
Solyanka yozizira m'mitsuko: chokhalira ndi kabichi ndi phala lamatenthe nthawi yachisanu
Autumn ndiyo nthawi yotentha kwambiri yokolola. Makamaka zosankha zosiyanasiyana zimapangidwa kuchokera ku kabichi. Sangophika, kuwotcha, msuzi wa kabichi wamatumbo momwemo, komanso ma saladi osiyanasiyana, vinaigrette, ndi solyanka. Ndimapereka Chinsinsi Chosavuta kuphika, koma chokoma cha masamba hodgepodge. Kukonzekera koteroko sikothandiza osati monga chakudya chokoma komanso cha vitamini, komanso kuvala kabichi msuzi ndi hodgepodge. Pakukonzekera kwake, amayi okhala kunyumba achuma nthawi zambiri amagwiritsa ntchito ndiwo zamasamba zonse zomwe sizimasungidwa nthawi yayitali: mwachitsanzo, zowonongeka. M'nyengo yozizira, ndi nthawi yocheperako, mumatha kuphika chakudya chokoma komanso chosangalatsa.
Kuthetsa Matenda a Renal
Anemal magazi amawonedwa mu 50% ya odwala omwe ali ndi vuto la impso ndipo amapezeka pa gawo la proteinuria. Mwanjira imeneyi, hemoglobin sapitirira 120 g / l mwa akazi ndi 130 g / l mwa oyimira theka lamphamvu la anthu.
Kupezeka kwa njirayi kumapangitsa kuti pakhale kusakwanira kwa mahomoni (erythropoietin), omwe amachititsa kuti hematopoiesis wamba. Kuchepa kwa magazi m'thupi kumachitika nthawi zambiri limodzi ndi kuperewera kwa chitsulo.
Matenda a mtima nthawi zambiri amayamba chifukwa cha kuchepa magazi m'thupi
Mphamvu ya wodwalayo yakuthupi ndi yam'maganizo imachepa, kugonana kumachepa mphamvu, chilakolako cha kugona ndikugona.
Kuphatikiza apo, kuchepa magazi kumapangitsa kuti nephropathy ipite patsogolo kwambiri.
Pofuna kuthetsa kuchepa kwa magazi m'thupi, jakisoni wothandizila wa Recormon, Eprex, Epomax, Epocrine, Eristrostim amapangidwa kamodzi masiku 7. Mankhwalawa ali ndi zotsatira zoyipa zingapo, zomwe zimapangitsa kuti azitha kuyang'anira thupi lawo nthawi zonse.
Kubwezeretsanso mulingo wa chitsulo, Venofer, Ferrumleck, etc. amathandizira kudzera m'mitsempha.
Nephropathy kwa matenda ashuga
Siyani ndemanga 1,673
Masiku ano, anthu odwala matenda ashuga nthawi zambiri amakumana ndi matenda monga matenda ashuga nephropathy. Uku ndi kusokonezeka komwe kumakhudza mitsempha ya magazi a impso, ndipo kungayambitse kulephera kwa impso. Matenda a shuga ndi impso zimayenderana kwambiri, monga momwe zikuwonera chifukwa chachikulu cha nephropathy mwa odwala matenda a shuga. Pali magawo angapo a chitukuko cha matendawa, omwe amadziwika ndi zizindikiro zosiyanasiyana. Mankhwalawa ndi ovuta, ndipo kudaliraku kumadalira khama la wodwalayo.
Anthu odwala matenda ashuga ali pachiwopsezo chotenga matenda "owonjezera" - kuwonongeka m'mitsempha ya impso.
Electrolyte bwino
Kuthekera kwa mankhwala a enterosorbent kuyamwa zinthu zovulaza kuchokera m'matumbo am'mimba kumathandizira kuchepetsa kwambiri kuledzera kwa thupi komwe kumayambitsa vuto laimpso ndi mankhwala omwe amagwiritsidwa ntchito.
Enterosorbents (makala ophatikizidwa, Enterodeum, ndi zina) amalembedwa ndi dokotala payekhapayekha ndipo amatengedwa ola limodzi ndi theka mpaka maola awiri asanadye ndi mankhwala.
Miyezi yambiri ya potaziyamu m'thupi (hyperkalemia) imachotsedwa mothandizidwa ndi oyambitsa potaziyamu, yankho la calcium gluconate, insulini yokhala ndi shuga. Ndi chithandizo cha mankhwala, hemodialysis ndiyotheka.
Chotsani Albuminuria
Kuwonongeka kwa impso glomeruli, ngakhale kwambiri ndi nephropathy, kumapangitsa kukhalapo kwa mapuloteni mu mkodzo.
Renal glomerular permeability imabwezeretsedwa mothandizidwa ndi nephroprotective Sulodexide.
Nthawi zina, akatswiri amapereka Pentoxifylline ndi Fenofibrate kuti athetse albinuria. Mankhwalawa ali ndi zotsatira zabwino, koma kuchuluka kwa chiwopsezo cha zotsatira zoyipa pazabwino zogwiritsidwa ntchito ndi akatswiri sizinadziwike bwino.
The terminal gawo la matenda ashuga nephropathy imakhudzanso zochita - aimpso m`malo mankhwala. Kusankha kwadongosolo kumakhudzidwa ndi zaka, momwe thupi la wodwalayo limadutsidwira komanso kuopsa kwa kusintha kwa matenda.
Dialysis - kuyeretsa magazi kudzera mu zida zapadera kapena kudzera mu peritoneum. Ndi njira iyi, ndizosatheka kuchiritsa impso. Cholinga chake ndikusintha chiwalo. Mchitidwewu suyambitsa kupweteka ndipo nthawi zambiri umaloledwa ndi odwala.
Kuthira kwina m'malo "kwapulumutsa moyo" wa odwala ambiri omwe ali ndi vuto la impso
Pa hemodialysis, chipangizo chapadera chimagwiritsidwa ntchito - dialyzer. Kulowa mu ziwiya, magazi amachotsa zinthu zapoizoni ndi madzimadzi ochulukirapo, omwe amathandizira kuti pakhale zamagetsi zamagetsi zamchere komanso zamchere.
Mchitidwewu umachitika katatu pa sabata ndipo umakhala pafupifupi maola 4-5 mumankhwala ndipo ungayambitse:
Nthawi zina, peritoneal dialysis imachitidwa, yomwe imawonetsedwa ndi kusatheka kwa hemodialysis:
Ndi peritoneal dialysis, kuyeretsa magazi kumachitika kudzera mwa peritoneum, pomwe pamenepa ndi dialyzer.
Ndondomeko zitha kuchitidwa onse kuchipatala komanso kunyumba kawiri kapena kupitilira tsiku.
Chifukwa cha peritoneal dialysis, zotsatirazi zingaoneke:
Kutsegula sikunachitike ndi:
Ngati njirayi yakanidwa, katswiriyo ayenera kulimbikitsa lingaliro lake.
Kupatsirana kwa impso
Njira yokhayo yophatikizira thupira ndi gawo la matenda a matenda ashuga nephropathy.
Kuchita opaleshoni yopambana kungathandize kwambiri wodwalayo kukhala wathanzi.
Opaleshoni sikuchitidwa ndi zotsatirazi zotsutsana:
Kuthekera kochita opaleshoni yamatenda a metabolic, komanso matenda osiyanasiyana a impso: membrous proliferative glomerulonephritis, hemolytic uremic syndrome ndi matenda ena, amasankhidwa payekhapayekha ndi katswiri aliyense.
Kuchuluka kwa shuga m'magazi, kupezeka kwakanthawi yayitali, kumakhudza mitsempha ya magazi ndipo pamapeto pake kumakhudza ziwalo. Chifukwa chake, ndi matenda ashuga, zovuta zovuta zimayamba zomwe zimatsogolera kuwonongeka kwa impso, mtima, ma eye eye, misempha. Impso nthawi zambiri zimadwala nthendayi, chifukwa zimachotsa poizoni wambiri m'thupi. Vuto lalikulu la matenda ashuga limawerengedwa kuti ndi matenda a shuga, chifukwa chake ndi momwe zimachitikira.
Kodi matenda a shuga ndi nephropathy ndi ati?
Matenda a diabetes a nephropathy amatanthauza kuwonongeka kwa ziwiya, tubules, ndi glomeruli impso. Nthawi zambiri zimachitika ngati zovuta mu shuga mellitus wa mtundu wodalira insulin, kawirikawiri - mtundu wachiwiri.Matenda akuwonetsedwa ndi kuchepa kwa ntchito yosefera mu impso, kuwonjezeka kwa kukakamizidwa mu ziwiya za chiwalo, zomwe zimapangitsa kuti pakhale kulephera kwa impso. Zizindikiro zoyambirira zomwe zikuwonetsa nephropathy ndikuwonekera mu mkodzo wa albumin (mapuloteni) komanso kusintha kwa kusefera kwa glomeruli.
Diabetesic nephropathy, nambala ya ICD-10: N08.3, ndi chimodzi mwazomwe zimayambitsa matenda a shuga mellitus. Pazifukwa zomwe zimawonekera kale m'malo osiyidwa, pomwe kugonjetsedwa sikungasinthe. Choopsa chachikulu ndikuti nephropathy imapangitsa kuwonongeka kwambiri kwa impso - kulephera kwa impso, komwe kumapangitsa kusefedwa kwa thupi (dialysis) kapena kufalikira kwa ziwalo. Pakapanda chithandizo chanthawi yake, zotsatira zakupha zimatsata.
Zimathandizanso kukulitsa nephropathy, komanso matenda ashuga, chibadwa champhamvu. Chifukwa chake, kupezeka kwa matendawa m'mabanja kumangoika anthu ake pachiwopsezo cha matenda a nephropathy.
Zomwe zimayambitsa zingakhalenso zopanda matenda ashuga poyamba, pomwe "matenda a shuga" sanadziwikebe. Vuto lofala la metabolism ndi kulemera kwambiri motsutsana ndi maziko awa kungayambitse matenda omwe amatchedwa prediabetes. Ngati kagayidwe kachakudya mu thupi sizachilendo, zinthu zimachulukirachulukira ndi kukula kwa matenda osokoneza bongo komanso matenda aimpso.
Pazonse, zifukwa zomwe zimayambitsa kupezeka kwa matenda ashuga nephropathy ndi awa:
Zizindikiro komanso matendawa
Zizindikiro za matenda a shuga a nephropathy m'magawo oyamba a chitukuko palibe. Uku ndiye kunyada kwamatenda. Chifukwa chake, anthu omwe ali ndi "matenda okoma" amalangizidwa kuti azichita mayeso a albin nthawi ndi nthawi. Matendawa amatha kudutsa zaka zingapo chitukuko, ndipo kungoyambira kulephera kwa impso kumawonetsa matchulidwe a nephropathy (kuchuluka kwa kuthamanga kwa magazi, kusungika kwamikodzo, kutupa ndi kusinthika kwa zomwe munthu ali nazo).
Kugawidwa kwa matenda a shuga a nephropathy m'magawo ndi motere:
- gawo la kusintha kwa impso - limayamba pambuyo pa zaka 2 mpaka 3 za matenda a shuga, makoma a zotengera komanso gawo lapansipansi limakhuthala, GFR imakulitsidwa, albumin siinapezeke,
- gawo la zizindikiro zazikulu za matenda ashuga glomerulosulinosis ndi proteinuria (macroalbuminuria). Imadziwonetsa mu shuga mellitus pachaka cha 10 ndi 15, mapuloteni mu mkodzo amatsimikiza kukhala opitilira 300 mg patsiku, zotupa zotupa za matumbu amadzaza oposa 50%. Chifukwa cha kuchepa kwakukulu kwa milingo ya albumin, thupi likuyesayesa kuloweza m'malo mwake, kwinaku likugawa masitolo ake omwe amapanga kutopa, kufooka, kuchepa thupi kwambiri, komanso thanzi labwino. Pa matenda a shuga, kutupa ndi miyendo ndi nkhope kuwonekera, pambuyo pake kudzikundikira kwamadzi m'thupi lonse, palinso kuwonjezeka kwakukulu kwa kuthamanga kwa magazi, limodzi ndi kupweteka kwa mutu, kupweteka kwa mtima ndi kupuma movutikira.
- gawo la kulephera kwambiri kwa impso (uremia) - limayamba pambuyo pa zaka 15 mpaka 20 za matenda osatha a shuga, ntchito ya impso imachepetsedwa, GFR imachepa, chifukwa zotengera zachiwalo zimatha kupezeka ndi matenda a sclerosis, zizindikiro za gawo lapitalo zimakulitsidwa. Pakufunika pakubwezeretsanso chithandizo, m'malo mwake impso zimaleka kusefa, zomwe zikusonyeza kuti ziphe.
Kuzindikira matendawa
Kuti muthane bwino ndi zizindikiro za matenda a shuga, kupezeka nthawi yake ndikofunikira. Ndi nthenda yotere, imachitika ndi njira yoyesera magazi, mkodzo (tsiku ndi tsiku ndi m'mawa), komanso Doppler ultrasound ya ziwiya za impso. GFR komanso mawonekedwe a albumin amatenga gawo lodziwika pofufuza nephropathy. Palinso mayeso ofulumira amwini odzipangira mapuloteni mu mkodzo.Koma chifukwa chodalirika pafupipafupi, simuyenera kudalira kuwunikaku.
Posankha nephropathy, kuwunika kosungirako kwaimpso ndikofunikira. Zimathandizira kudziwa kusinthasintha kwa kuchuluka kwa kusefedwa kwa ma protein omwe amapanga kapena ma amino acid. Pambuyo pakuputa, GFR imatha kuwonjezeka ndi 10 - 20%, izi sizitengedwa ngati zopatuka. Mtunduwu umawerengedwa ngati chizindikiro kuposa kapena 90 ml / mphindi / 1.73 m? Ndi diabetesic nephropathy, GFR ndiyosakwana 60, ndipo pamapeto pake imatsikira mpaka pansi pa 15 ml / min / 1.73 m?
Kodi matenda ashuga nephropathy?
Matenda a shuga a nephropathy amadziwika ndi kusintha kwa matenda am'mitsempha yama impso. Kusintha kumeneku kumachitika m'mitundu iwiri yonse ya matenda a shuga, motero, zimayambitsa ziwopsezo za ziwiya zazikulu komanso zazing'ono.
Chifukwa chachikulu chomwe chimapangitsa kukula kwa nephropathy imawerengedwa ngati kuchuluka kwa shuga. Izi, zomwe zimakhala ndizambiri mthupi, zimakhala ndi poizoni m'maselo a ziwiya zonse ndipo zimayambitsa njira zomwe zimapangitsa kuti mitsempha ndi mitsempha ipitirire. Nthawi yomweyo, ntchito yayikuluyo, kusefedwa kwake, imachepa pang'onopang'ono, ndipo chifukwa cha izi, kulephera kwa impso, kulephera.
Matenda a shuga ndi matenda ochedwa shuga.
Zosintha impso zimawonedwa pafupifupi 20% ya odwala omwe ali ndi matenda osokoneza bongo, nthawi zambiri ma nephropathies amakula ndi mawonekedwe akudwala a insulin. Mwa odwala omwe ali ndi vutoli palinso amuna ambiri, kuchuluka kwa matendawa kumatsika kuyambira zaka 15 mpaka 20 kuyambira chiyambi cha matenda ashuga.
Chithunzi cha kuchipatala
Matenda a diabetes nephropathy amadziwika kuti ndi matenda omwe amapezeka pang'onopang'ono ndipo ndiye chiopsezo chachikulu cha vutoli. Wodwala matenda a shuga kwa nthawi yayitali mwina sangathe kuzindikira kusintha komwe kumachitika ndipo chizindikiritso chakecho pambuyo pake sichilola kuti zitheke komanso kutsimikizika kwa matenda.
Zizindikiro zoyambirira za nephropathy mu matenda osokoneza bongo ndi kusintha kwa kusanthula - proteinuria ndi microalbuminuria. Kupatuka pamiyezo yazizindikiro izi, ngakhale pang'ono kwa odwala matenda ashuga, imawerengedwa ngati chizindikiro choyamba cha nephropathy.
Pali magawo a matenda a shuga a nephropathy, omwe aliwonse amadziwika ndi mawonetsedwe ake, m'tsogolo komanso magawo a mankhwalawa.
Ili ndiye gawo logonera thupi. Amayamba kumayambiriro kwa matenda ashuga, pomwe minyewa ya impso imangokulira pang'ono ndipo chifukwa cha izi, kusefedwa kwa mkodzo kumawonjezeka ndipo kutuluka kwake kumakulanso. Pakadali pano, palibe mawonekedwe akunja, monga momwe mulibe mapuloteni mumkodzo. Mukamayesa mayeso owonjezera, mutha kulabadira kuwonjezeka kwa kukula kwa chiwalocho molingana ndi ultrasound.
Kusintha koyambirira kwa chiwalo kumayamba. Odwala ambiri, gawoli limayamba kukula pafupifupi zaka ziwiri itatha matenda a shuga mellitus. Makoma a mitsempha ya magazi amapindika pang'onopang'ono, ndipo khungu lawo limayamba. Zosintha pakuwunika pafupipafupi sizikuwonekeranso.
Kuchuluka kwa kusefukira kwa madzi ndi kuchuluka kwakanenepa kwamankhwala kumasintha mosiyanasiyana kukuwonjezereka pang'ono, izi zimachitika chifukwa chakuchulukitsidwa kowonjezereka m'matumbo a chiwalo. Palibenso zisonyezo zachipatala za kupsinjika panthawiyi, odwala ena amangodandaula za kuwonjezeka kwapadera kwa kuthamanga kwa magazi (BP), makamaka m'mawa. Magawo atatu ali pamwambawa a nephropathy amaonedwa ngati apadera, ndiye kuti, zovuta zakunja komanso zowoneka bwino za zovuta sizikupezeka, ndipo kusintha komwe kumawunikiridwa kumapezeka pokhapokha pakuwunika kapena mwatsatanetsatane kwa ma pathologies ena.
Zaka 15 mpaka 20 kuyambira kumayambiriro kwa matenda ashuga, matenda a shuga oopsa amayamba.Pakayezetsa mkodzo, mutha kuzindikira kuchuluka kwamapulogalamu obisika, m'magazi mumakhala kuchepa kwa chinthuchi.
Nthawi zambiri, odwala okha amayang'anira chitukuko cha edema. Poyamba, kulumikizira kumatsimikiziridwa kumadera am'munsi komanso kumaso, ndikudwala kwamatenda, edema imakhala yayikulu, ndiye kuti imaphimba mbali zosiyanasiyana za thupi. Madzimadzi amadziunjikira pamimba ndi pachifuwa, mu pericardium.
Pofuna kupitiliza kuchuluka kwa mapuloteni m'magazi am'magazi, thupi la munthu limagwiritsa ntchito njira zowonjezera, ndikayatsidwa, limayamba kuphwanya mapuloteni ake omwe. Nthawi yomweyo, kuchepa kwamphamvu kwa wodwala kumawonedwa, odwala amadandaula chifukwa cha ludzu lalikulu, kutopa, kugona, komanso kusowa kudya kumachepa. Kupuma pang'ono, kupweteka mumtima kumalumikizana, pafupifupi kuthamanga kwa magazi kumafikira kwambiri. Pakufufuzidwa, khungu la thupi limakhala lofiirira, msuzi.
- uremic, amadziwikanso ngati gawo loyesa zovuta. Zombo zowonongeka pafupifupi zimazunzidwa kwathunthu ndipo sizimagwira ntchito yawo yayikulu. Zizindikiro zonse za gawo lapitalo zimangokulitsa, kuchuluka kwamapuloteni ambiri kumatulutsidwa, kupanikizika kumakhala pafupifupi nthawi zambiri, dyspepsia imayamba. Zizindikiro za poyizoni yemwe amayamba chifukwa cha kusweka kwa ziwalo zakepi lake zimatsimikizika. Pakadali pano, kupukusa ndi kusindikiza kwa impso zopanda pake zimapulumutsa wodwalayo.
Mfundo zoyambirira zamankhwala
Njira zochizira zochizira matenda onse a shuga ndi nephropathy zitha kugawidwa magawo angapo.
- Gawo loyamba likugwirizana ndi njira zopewera Cholinga chofuna kupewa chitukuko cha matenda ashuga. Izi zitha kuchitika ndikusungabe zofunikira, ndiye kuti, wodwalayo kuyambira pachiwopsezo cha matenda ashuga ayenera kumwa mankhwala omwe. Mukazindikira microalbuminuria, ndikofunikira kuyang'anitsitsa shuga m'magazi ndikwaniritsa kuchepetsedwa kwake kofunikira. Pakadali pano, kusokonezeka nthawi zambiri kumabweretsa kuchuluka kwa magazi, choncho wodwala amayankhidwa kuti alandire mankhwala. Nthawi zambiri, Enalapril amatchulidwa muyeso wochepa kuti muchepetse kuthamanga kwa magazi.
- Pa gawo la proteinuria Cholinga chachikulu cha chithandizo cha mankhwalawa ndikuti tiletse kuchepa msanga kwa ntchito ya impso. Ndikofunikira kuti muzikhala ndi chakudya chokhazikika komanso choletsa mapuloteni a 0,7 mpaka 0,8 pa kilogalamu yodwala. Ngati kudya mapuloteni kuli kochepa, ndiye kuti kuvunda kwa chinthu chake kudzayamba. Ndi cholowa m'malo, Ketosteril adalembedwa, ndikofunikira kupitiliza kumwa antihypertensive mankhwala. Komanso, calcium tubule blockers ndi beta-blockers - Amlodipine kapena Bisoprolol - amawonjezeredwa ku chithandizo chamankhwala. Ndi edema yayikulu, okodzetsa amalembedwa, voliyumu yamadzi onse omwe amagwiritsidwa ntchito amawunikidwa nthawi zonse.
- Pa siteji yothandizira M'malo mankhwala ntchito, i.e. dialysis ndi hemodialysis. Ngati ndi kotheka, kufalitsa chiwalo kumachitika. Kuphatikizika konse kwa chithandizo chamankhwala, detoxification ndi mankhwala.
Panthawi yamankhwala, ndikofunikira kukankha gawo lakusintha kosasintha kwa ziwiya za impso momwe zingathere. Ndipo izi zimadalira wodwala iyemwini, ndiye kuti, pakumvera kwake malangizo a dokotala, pakudya kosalekeza kwa mankhwala omwe amachepetsa shuga, potsatira zakudya zomwe wapatsidwa.
Amakhala ndi chidwi chachikulu. Diabetesic nephropathy (glomerular microangiopathy) imakhala yovuta kwambiri shuga, yomwe nthawi zambiri imapha ndipo imapezeka mu 75% ya odwala matenda ashuga.
Imfa ya matenda ashuga nephropathy ndiyo yoyamba pamtundu woyamba wa matenda ashuga ndipo wachiwiri mu mtundu 2 wa matenda ashuga, makamaka pamene kuvutikaku kukukhudza dongosolo la mtima.
Ndizosangalatsa kuti nephropathy imakonda kukhazikika mu mtundu wa 1 wa abambo a achinyamata ndi achinyamata kuposa ana ochepera zaka 10.
Mavuto
Mu matenda a shuga a nephropathy, ziwiya za impso, mitsempha, arterioles, glomeruli ndi tubules zimakhudzidwa. Pathology imayambitsa kusokoneza kwamoto ndi lipid bwino. Chochitika chodziwika kwambiri ndi:
- Arteriosulinosis ya mtsempha wama impso ndi nthambi zake.
- Arteriosulinosis (njira ya pathological mu arterioles).
- Matenda a shuga a shuga osawonedwa.
- Mafuta ndi glycogen amayika m'matumba.
- Pyelonephritis.
- Necrotic aimpso papillitis (aimpso papilla necrosis).
- Necrotic nephrosis (kusintha kwa necrotic mu epithelium ya renal tubules).
Matenda a diabetesic nephropathy m'mbiri ya nthendayi amapezeka kuti ndi matenda osokoneza bongo a impso (CKD) ndi mawonekedwe a gawo la zovuta.
Ma psychology a shuga mellitus ali ndi nambala yotsatira malinga ndi ICD-10 (International Classization of Diseases of the 10th revice):
- E 10,2 - ndi mtundu wodwala wa insulin, womwe umalemedwa ndi impso zodwala.
- E 11.2 - ndi osadalira insulini amadalira matenda ndi kulephera kwa aimpso.
- E 12.2 - wokhala ndi vuto la kuperewera kwa zakudya m'thupi ndi impso zomwe zakhudzidwa.
- E 13.2 - ndi mitundu yotchulidwa yamatenda ndi impso zopanda thanzi.
- E 14.2 - ndi mawonekedwe osadziwika ndi kuwonongeka kwa impso.
Njira yopititsira patsogolo
Diabetes nephropathy ali ndi malingaliro angapo a pathogenesis, omwe amagawidwa mu metabolic, hemodynamic ndi genetic.
Malinga ndi matumizidwe a hemodynamic ndi metabolic, chiyambi cholumikizira cha izi ndi hyperglycemia, chosakwanira kubwezera kwa pathological njira mu chakudya cha metabolism.
Hemodynamic. Hyperfiltration imachitika, pambuyo pake pamakhala kuchepa kwa ntchito yotseka impso komanso kuwonjezeka kwa minofu yolumikizira.
Zamatsenga. Hyperglycemia yomwe imakhalapo kwa nthawi yayitali imabweretsa vuto la impso.
Hyperglycemia imayendera limodzi ndi zotsatirazi:
- glycation yamapuloteni omwe amakhala ndi hemoglobin yokhala ndi glycated amapezeka,
- sorbitol (polyol) shunt imayendetsedwa - kumwa kwa shuga, ngakhale insulin. Njira yosinthira shuga kukhala sorbitol, kenako makutidwe ndi okosijeni kuti asungunuke, kumachitika. Sorbitol imadziunjikira mu minofu ndikuyambitsa microangiopathy ndi kusintha kwina kwa matenda.
- kusokoneza mayendedwe atatu.
Ndi hyperglycemia, puloteni ya kinase C imagwira, zomwe zimapangitsa kuti minofu iwonjezeke komanso kupanga ma cytokines. Pali kuphwanya kapangidwe ka mapuloteni ovuta - proteinoglycans ndi kuwonongeka kwa endothelium.
Ndi hyperglycemia, intodyrenal hemodynamics imasokonezeka, zomwe zimayambitsa kusintha kwa impso. Hyperglycemia ya nthawi yayitali imayendetsedwa ndi intracranial matenda oopsa ndi hyperfiltration.
Mkhalidwe wovuta wa arterioles umakhala chifukwa chogundira matenda oopsa: chotupa chokulira komanso chosakanikira. Kusintha kumakhala kachitidwe kamachitidwe ndipo kumachulukitsa kukomoka kwa impso.
Chifukwa cha kupanikizika kwanthawi yayitali m'matumba, ma mitsempha ndi mafupa am'mimba amawonongeka. The lipid ndi mapuloteni kupezeka kwa chapansi nembanemba kumakulanso. Mawonekedwe a mapuloteni ndi lipids mu malo osakanikirana amawonedwa, atrophy of a renal tubules and sclerosis of glomeruli is seen. Zotsatira zake, mkodzo suusefa bwino. Pali kusintha kwa hyperfiltration ndi hypofiltration, kupitirira kwa proteinuria. Mapeto ake ndikuphwanya dongosolo la impso ndi kukula kwa azothermia.
Hyperlicemia ikapezeka, lingaliro lopangidwa ndi akatswiri obadwa ndi majini limapereka chisonkhezero chapadera cha majini pamitsempha ya impso.
Glomerular microangiopathy ingayambenso chifukwa cha:
- matenda oopsa komanso matenda oopsa,
- hyperglycemia wosakhazikika,
- matenda a kwamkodzo thirakiti
- mafuta olakwika
- onenepa kwambiri
- zizolowezi zoipa (kusuta, kuledzera),
- kuchepa magazi (kuchepa kwa hemoglobin m'magazi),
- kugwiritsa ntchito mankhwala okhala ndi nephrotoxic.
Magawo a matenda
Kuyambira 1983, gawoli malinga ndi magawo a matenda a shuga a nephropathy adachitidwa molingana ndi Mogensen.
Kupsinjika kwa matenda a shuga 1 amakhala akuphunzira bwino, chifukwa nthawi yomwe zimapezeka kuti zamatenda zimatsimikizika molondola.
Chithunzi cha matenda pachipatalachi sichinatchulidwepo kalikonse ndipo wodwalayo samazindikira kuti zikuchitika kwazaka zambiri, kufikira atayamba kulephera.
Magawo otsatirawa a matenda.
1. Kuzindikira kwa impso
Poyamba anthu amakhulupirira kuti glomerular microangiopathy imayamba pambuyo pazaka 5 zodziwitsa matenda ashuga 1. Komabe, zamakono zamankhwala zimapangitsa kuti athe kuzindikira kukhalapo kwa kusintha kwa pathological komwe kumakhudza glomeruli kuyambira pomwe mawonetseredwe ake. Zizindikiro zakunja, komanso edematous syndrome, sizikupezeka. Pankhaniyi, mapuloteni mumkodzo amakhala amtundu wambiri ndipo kuthamanga kwa magazi sikupatuka kwakukulu.
- kutsegula kwa magazi mu impso,
- kuchuluka kwa maselo am'mimba mu impso (hypertrophy),
- GefRular filtration rate (GFR) ukufika pa 140 ml / min, yomwe ndi 20-40% kuposa zomwe zinali zabwinobwino. Izi ndizoyankha pakuwonjezeka kwa shuga mthupi ndipo zimadalira mwachindunji (kuwonjezeka kwa glucose kumapangitsa kusefedwa).
Ngati glycemia ikwera pamwamba pa 13-14 mmol / l, kutsika kwa mzere mu kusefedwa kumachitika.
Matenda a shuga akamalipiridwa bwino, GFR imasinthasintha.
Ngati mankhwalawa a mtundu woyamba a shuga apezeka, ngati mankhwala a insulin atayikidwa limodzi ndi kuchedwa, kusinthika kwa kusintha kwa impso komanso kuchuluka kosasefukira kumatha.
2. Zosintha pamangidwe
Nthawiyi sikuwonetsedwa ndi zizindikiro. Kuphatikiza pa kufalikira kwa zizindikiro za chibadwa cha gawo 1 la ndondomekoyi, kusintha koyambirira kwa minyewa ya impso kumawonedwa:
- nembanemba yapansi panthaka imayamba kuonda pambuyo pa zaka ziwiri kumayambiriro kwa matenda ashuga,
- pambuyo 2-5 zaka, kukula kwa mesangium kumawonedwa.
Amatembenukira gawo lomaliza la matenda ashuga. Palibe zizindikiro zapadera. Nthawi ya siteji imachitika ndi SCFE yabwinobwino kapena yokwezeka pang'ono ndikuwonjezera magazi aimpso. Kuphatikiza:
- kuthamanga kwa magazi (BP) kukwera pang'onopang'ono (mpaka 3% pachaka). Komabe, nthawi ndi nthawi amalumpha m'magazi. Komabe, chizindikirochi sichikupereka chidaliro zana kuti anthu asintha mu impso,
- mapuloteni amapezeka mumkodzo, kuwonetsa kuti chiwopsezo chomakula cha impso chikuwonjezeka ka 20. Ndi chithandizo chosayembekezereka, kuchuluka kwa albumin mu mkodzo kumawonjezeka mpaka 15% pachaka.
Gawo lachinayi kapena gawo la microalbuminuria (30-300 mg / tsiku) limawonedwa zaka 5 pambuyo poyambika kwa matenda ashuga.
Magawo atatu oyamba a matenda a shuga a nephropathy amathandizika ngati chithandizo chanthawi yake chaperekedwa ndipo shuga ya magazi ikonzedwa. Pambuyo pake, mapangidwe a impso samadzichiritsa okha kuti abwezeretse, ndipo cholinga chamankhwala ndicho kuteteza izi. Vutoli limakulirakulira chifukwa chosowa zizindikiro. Nthawi zambiri ndikofunikira kuti musinthe njira yogwiritsira ntchito labotale yopendekera.
4. Akuluakulu a shuga nephropathy
Gawolo limawonekera patatha zaka 10-15 atatha matenda ashuga. Amadziwika ndi kuchepa kwa kuchuluka kwa msuzi wa sitiroberi mpaka 10-15 ml / min.pachaka, chifukwa cha kuwonongeka kwakukulu m'mitsempha yamagazi. Kuwonetsedwa kwa proteinuria (oposa 300 mg / tsiku). Izi zikutanthauza kuti pafupifupi 50-70% ya glomeruli idakumana ndi ziwopsezo ndipo kusintha kwa impso kudasinthika. Pakadali pano, zizindikiro zowoneka za matenda ashuga nephropathy ayamba kuonekera:
- kuwongola miyendo, kenako nkhope, m'mimba ndi chifuwa,
- mutu
- kufooka, kugona, ulesi,
- ludzu ndi mseru
- kusowa kwa chakudya
- kuthamanga kwa magazi, komwe kumakhala ndi kuchuluka pafupifupi chaka chilichonse ndi 7%,
- zopweteka mtima
- kupuma movutikira.
Kuchuluka kwa mapuloteni a kwamikodzo komanso kuchepa kwa magazi ndi zizindikiro za matenda a shuga.
Kuperewera kwa mapuloteni m'mwazi kumalipiridwa ndi kukonza kwazinthu zake, kuphatikiza mapuloteni ena, omwe amathandizira kusintha mapangidwe a protein. Kudziwononga nokha kumachitika. Wodwala amachepetsa kwambiri, koma izi sizimadziwika kwambiri chifukwa cha edema yowonjezereka. Kuthandizira kwa okodzetsa kumakhala kopanda ntchito ndipo kuchoka kwa madzimadzi kumachitika ndi kuchotseredwa.
Pa gawo la proteinuria, pafupifupi pazochitika zonse, retinopathy imawonedwa - kusintha kwa m'mitsempha yamaso, chifukwa chomwe magazi omwe amapezeka ku retina amasokonezeka, dystrophy yake, kuwala kwa patsekeke ndipo, chifukwa chake, khungu limawonekera. Akatswiri amasiyanitsa kusintha kwa matenda, monga a impso retinal syndrome.
Ndi proteinuria, matenda amtima amayamba.
5. Uremia. Kulephera kwina
Gawo limadziwika ndi sclerosis yathunthu yam'madzi komanso bala. Danga lamkati mwa impso limakhazikika. Pali dontho mu GFR (ochepera 10 ml / min). Mafuta oyeretsa mkodzo ndi magazi amasiya, kuchuluka kwa ma nitrogenous slag m'magazi kumawonjezeka. Kuwonekera:
- hypoproteinemia (ochepa mapuloteni amchere m'magazi),
- hyperlipidemia (mwachilendo kwambiri lipids ndi / kapena lipoproteins m'magazi),
- kuchepa magazi (okhutira hemoglobin),
- leukocytosis (kuchuluka kwa khungu loyera)
- isohypostenuria (kutuluka kwa thupi la wodwalayo mosiyanasiyana magawo ofanana mkodzo, wokhala ndi kachulukidwe kochepa). Kenako pakubwera oliguria - kuchepa kwa mkodzo ndi anuria komwe kumachitika mkodzo sudzalowa mu chikhodzodzo konse.
Pambuyo 4-5 zaka, siteji kudutsa matenthedwe. Izi sizingasinthe.
Ngati kulephera kwa aimpso kumapitirira, chodabwitsa cha Dan-Zabrody ndicotheka, chodziwika ndi kusintha kwamphamvu kwa wodwala. Kuchepetsa ntchito ya insulinase enzyme ndi kuchepa kwa impso zotulutsira insulin kumachepetsa hyperglycemia ndi glucosuria.
Pambuyo pa 20-25 zaka kuchokera kumayambiriro kwa matenda ashuga, kulephera kwa impso kumadwaladwala. Kukula mwachangu ndikotheka:
- ndi zinthu za chibadwa chathu,
- ochepa matenda oopsa
- Hyperlipidemia,
- kutupa pafupipafupi
Njira zopewera
Malamulo otsatirawa athandiza kupewa matenda a shuga, omwe amayenera kusungidwa kuyambira nthawi ya matenda ashuga:
- Yang'anani kuchuluka kwa shuga m'thupi lanu.
- Sinthani kuthamanga kwa magazi, nthawi zina ndimankhwala.
- Pewani atherosulinosis.
- Tsatirani zakudya.
Tisaiwale kuti zizindikiritso za matenda a shuga sizimawonekera kwa nthawi yayitali komanso kungopita kwa dotolo mwatsatanetsatane ndikuthandizani kuti musapweteke.
Chiwopsezo cha kukhala ndi matenda ashuga a nephropathy ndi omwewo kwa matenda amtundu wa 1 shuga ndi matenda a 2. Matenda a matenda ashuga nephropathy amaphunziridwa bwino mu T1DM, popeza ali ndi chidziwitso cholondola cha kuyambika kwa matenda ashuga. Microalbuminuria imayamba 20-30% ya odwala pambuyo zaka 15 zokhala ndi matenda ashuga 1. Kukhazikika kwa zodziwikiratu za nephropathy kumadziwika kuti zaka 10-15 atayamba T1DM.Odwala omwe alibe proteinuria, nephropathy amatha kukhala ndi zaka 20-25, ngakhale kuti izi zimapangitsa kuti chiwopsezo chake chikhale chochepa ndipo chimakhala -1% pachaka.
Ndi T2DM, mafupipafupi a microalbuminuria (30-300 mg / tsiku) atadwala zaka 10 ali 25%, ndipo macroalbuminuria (> 300 mg / tsiku) ndi 5%.
Zizindikiro zake za matenda a shuga a nephropathy
Chizindikiro chazachipatala cha matenda a shuga ndi nephropathy ndi proteinuria / microalbuminuria wodwala matenda a shuga. Ndiye kuti, muzochita zamankhwala, kafukufuku wa albuminuria ndikokwanira kuzindikira matenda a matenda ashuga. Kuphatikiza pa proteinuria ndi microalbuminuria, muyeso wa mapuloteni amphongo amathandizidwanso:> 3500 mg / g creatinine, kapena> 3500 mg / tsiku, kapena> 2500 mg / min.
Chifukwa chake, potengera zomwe tafotokozazi, mfundo zomanga zamatenda azachipatala pankhaniyi ndizotsatirazi. Ngati wodwala yemwe ali ndi matenda ashuga amawonetsa zizindikiro zilizonse za matenda a impso, ndiye kuti ali ndi CKD, koma ngati wapezeka wa microalbuminuria / proteinuria, ndiye kuti matenda a CKD akuphatikizidwa ndi kupezeka kwa matenda ashuga a nephropathy. Ndipo motere: ngati wodwala wodwala matenda a shuga alibe microalbuminuria / proteinuria, ndiye kuti alibe matenda a shuga, koma CKD yokha, ngati pali zizindikiro za matenda a impso kupatula proteinuria.
Kupitilira apo, pamene ma lable kapena zida zodziwitsa za CKD zikupezeka mwa wodwala, kuchuluka kwa vuto laimpso kumafotokozedwa pogawana magawo a CKD malinga ndi kuchuluka kwa kusefedwa kwa gawo (GFR). Nthawi zina, kuphwanya GFR kukhoza kukhala koyamba, ndipo nthawi zina chizindikiritso chokhacho cha CKD, chifukwa chimawerengeredwa mosavuta malinga ndi kafukufuku wamapulogalamu ammagazi a creatinine, omwe wodwala matenda ashuga amawerengedwa monga momwe anakonzera, makamaka akavomerezedwa ku chipatala (onani mawerengedwa owerengera pansipa) .
Mlingo wa kusefera kwa glomerular (GFR) wotsika ndi kutukuka kwa CKD wagawidwa m'magawo asanu, kuyambira 90 ml / min / (1.73 sq. M. Thupi) kenako ndi gawo la 30 mpaka siteji III komanso ndi gawo la 15 - kuyambira III mpaka komaliza, gawo V.
GFR imatha kuwerengetsa m'njira zosiyanasiyana:
- Fomula ya Cockcroft-Gault (ndikofunikira kubweretsa pamalo oyenera a 1.73 m 2)
Mwachitsanzo (wamkazi wazaka 55, kulemera kwa makilogalamu 76, creatinine 90 μmol / l):
GFR = x 0.85 = 76 ml / mphindi
GFR (ml / mphindi / 1.73 m 2) = 186 x (serum creatinine mu mg%) 1L54x (zaka) -0.203 x 0.742 (kwa akazi).
Popeza matenda ashuga a nephropathy alibe magawo a vuto laimpso, kuzindikira kumeneku nthawi zonse kumayendera limodzi ndi kupezeka kwa magawo a CKD I-IV. Kutengera ndi zomwe tafotokozazi, komanso motsatira miyezo ya ku Russia, wodwala yemwe ali ndi matenda ashuga omwe amapezeka ndi microalbuminuria kapena proteinuria amapezeka ndi matenda a diabetes. Kuphatikiza apo, mwa wodwala yemwe ali ndi DN, gawo la CKD liyenera kufotokozedwa, pambuyo pake mawonekedwe onse a DN agawidwa m'magulu awiri:
- matenda ashuga nephropathy, gawo la microalbuminuria, CKD I (II, III kapena IV),
- matenda ashuga nephropathy, proteinuria ya gawo, CKD II (III kapena IV),
- matenda ashuga nephropathy, gawo la matenda aimpso kulephera (matenda a impso).
Wodwala akakhala kuti alibe microalbuminuria / proteinuria, ndiye kuti zitha kuwoneka kuti palibe matenda a diabetes a nephropathy. Komanso, malingaliro aposachedwa apadziko lonse lapansi akuwonetsa kuti kupezeka kwa matenda ashuga nephropathy kungachitike mwa odwala omwe ali ndi matenda ashuga, pomwe amachepetsa 30% mu GFR miyezi 3-4 atatha kuyamba chithandizo ndi ACE inhibitors.
Zowopsa zomwe zimachitika ndi matenda a shuga a nephropathy
Chiwopsezo chotenga DN sichingathe kufotokozedwa kwathunthu pokhapokha nthawi ya matenda ashuga, matenda oopsa komanso mtundu wa kayendetsedwe ka hyperglycemia, chifukwa chake, zonse zakunja ndi ma genetic mu pathogenesis ya DN ziyenera kukumbukiridwa. Makamaka, ngati mu banja la wodwala yemwe ali ndi matenda ashuga panali odwala omwe ali ndi matenda ashuga nephropathy (makolo, abale kapena mlongo), ndiye kuti chiwopsezo cha chitukuko chake mwa wodwala chimawonjezeka kwambiri ndi T1DM komanso T2DM. Zaka zaposachedwa, mitundu ya diabetes ya nephropathy yapezekanso, yomwe, makamaka, imadziwika pa chromosomes 7q21.3, Jupp 15.3, ndi ena.
Kafukufuku akuchitika awonetsa kuchuluka kwakukulu kwa DN mwa anthu omwe ali ndi matenda oopsa am'magazi, koma sizikudziwika ngati matenda oopsa amathamangitsa chitukuko cha DN kapena ngati chikhazikitso cha kutchulidwa kwambiri kwa impso.
Udindo wa kuyang'anira glycemic pakukonzekera kwa DN unawonetsedwa bwino mu DM1 - motsutsana ndi maziko a insulin Therapy, kusintha kosinthika kwa glomerular hypertrophy ndi hyperfiltration kunawonedwa, microalbuminuria idayambika pambuyo pake, proteinuria idakhazikika komanso ngakhale idachepa, makamaka pakulamulira bwino glycemic kwa zaka zopitilira 2. Chitsimikizo chowonjezera cha mphamvu ya kuwongolera glycemic chinapezeka mwa odwala omwe ali ndi matenda ashuga pambuyo pakuthana kwa maselo a pancreatic, omwe amalola kuti matenda a glycemia akhale ambiri. Adawona kusintha kwina kwa mbiri yakale (!) Kukula kwa zizindikiro za matenda ashuga nephropathy, pamene euglycemia adasungidwa zaka 10. Ndili nawo pazokambiranazi komwe zotsatira izi zidawonetsedwa, ndipo zikuwoneka kuti ndizofunika kwambiri kuti zowonetsa bwino zakusintha koonekera sizinayambike kuposa zaka 5 za kulipira bwino kwa matenda ashuga komanso, kuphatikizapo, matenda a shuga mellitus nodular glomerulossteosis . Chifukwa chake, chofunikira osati kupewa, komanso kutembenuka kwakutali kwa gawo lotsogola kwambiri la DN ndiko kukhazikika kwa kagayidwe kake ka nthawi yayitali. Popeza sichikupezeka paliponse odwala ambiri omwe ali ndi matenda osokoneza bongo, njira zina zopewera ndi kuchizira matenda a shuga zimaganiziridwa.
DN nthawi zambiri imayamba kutsutsana ndi kunenepa kwambiri, ndipo kuchepa kwamafuta kunenepa kwambiri kumachepetsa proteinuria ndikusintha ntchito ya impso. Koma sizikudziwikabe ngati zotsatira zake ndizodziyimira payekha pakukonza kagayidwe kazakudya komanso kuchepa kwa kuthamanga kwa magazi komwe kumakhudzana ndi kuchepa kwa kunenepa kwambiri.
Hypoglycemic mankhwala
Pa gawo la kwambiri matenda a shuga a nephropathy, ndizofunikira kwambiri kuti tikwaniritse chindapusa cha carbohydrate metabolism (HLA 1c
- Glycvidonum mkati 15-60 mg 1-2 kawiri pa tsiku kapena
- Glyclazide pakamwa 30-120 mg kamodzi patsiku kapena
- Repaglinide mkati mwa 0,5-3,5 mg katatu pa tsiku.
Kugwiritsa ntchito mankhwalawa ndizotheka ngakhale pa gawo loyambirira la kulephera kwa impso (serum creatinine mpaka 250 μmol / l), bola ngati glycemia imayendetsedwa mokwanira. Ndili ndi GFR
Antihypertensive mankhwala
Ndi osakwanira antihypertensive monotherapy, kuphatikiza mankhwala zotchulidwa:
- Perindopril pakamwa 2-8 mg 1 nthawi patsiku, mosalekeza kapena
- Ramipril pakamwa 1.25-5 mg 1 nthawi patsiku, mosalekeza kapena
- Trandolapril pakamwa 0,5 -4 mg 1 nthawi patsiku, mosalekeza kapena
- Fosinopril pakamwa 10-20 mg kamodzi patsiku, mosalekeza kapena
- Hinapril mkati 2,5 - 40 mg kamodzi patsiku, mosalekeza
- Enalapril vspr 2.5-10 mg kawiri pa tsiku, mosalekeza.
- Atenolol pakamwa 25-50 mg 2 kawiri pa tsiku, mosalekeza kapena
- Verapamil pakamwa 40-80 mg 3-4 pa tsiku, mosalekeza kapena
- Diltiazem mkati 60-180 mg 1-2 nthawi kugogoda, mosalekeza kapena
- Metoprolal mkati 50-100 mg 2 kawiri pa tsiku, mosalekeza kapena
- Moxonidine pakamwa 200 mcg kamodzi tsiku lililonse, mosalekeza kapena
- Nebivolol pakamwa 5 mg kamodzi tsiku lililonse, mosalekeza kapena
- Furosemide mkati 40-160 mg m'mawa pamimba yopanda kanthu katatu pa sabata, mosalekeza.
Kuphatikiza kwa mankhwala angapo ndikuthekanso, mwachitsanzo:
- Captopril pakamwa 12.5-25 mg katatu patsiku, mosalekeza kapena
- Perindopril pakamwa 2 -8 mg 1 nthawi patsiku, mosalekeza kapena
- Ramipril pakamwa 1.25-5 mg 1 nthawi patsiku, mosalekeza kapena
- Trandolapril pakamwa 0,5-4 mg 1 nthawi patsiku, mosalekeza kapena
- Fosinopril pakamwa 10-20 mg kamodzi patsiku, mosalekeza kapena
- Hinapril pakamwa 2.540 mg kamodzi patsiku, mosalekeza kapena
- Enalapril pakamwa 2.5-10 mg 2 kawiri pa tsiku, mosalekeza
- Amlodipine pakamwa 5-10 mg kamodzi patsiku, mosalekeza kapena
- Indapamide pakamwa 2.5 mg kamodzi tsiku lililonse (m'mawa pamimba yopanda kanthu), mosalekeza kapena
- Furosemide mkati 40-160 mg pamimba yopanda kanthu katatu pa sabata, mosalekeza
- Atenolol pakamwa 25-50 mg 2 kawiri pa tsiku, mosalekeza kapena
- Bisoprolol mkati 5-10 mg kamodzi patsiku, mosalekeza kapena
- Metoprolol mkati 50-100 mg 2 kawiri pa tsiku, mosalekeza kapena
- Moxonidine pakamwa 200 mcg kamodzi patsiku, mosalekeza kapena
- Nebivolol mkati 5 mg kamodzi patsiku, mosalekeza.
Pa serum creatinine pamlingo wa 300 μmol / L, zoletsa zoletsa za ACE zimaletsedwa kale dialysis.
Kuwongolera kwa kusokonezeka kwa metabolic ndi electrolyte mu kuperewera kwaimpso
Pomwe proteinuria imawonekera, zakudya zama protein ochepa ndi mchere wochepa zimayikidwa, kuletsa kudya mapuloteni a nyama mpaka 0,6-0.7 g / kg pa thupi (pafupifupi mpaka 40 g protein) ndimankhwala okwanira a caloric (35-50 kcal / kg / tsiku), kuchepetsa mchere mpaka 3-5 g / tsiku.
Pachipatala cha creatinine cha 120-500 μmol / L, chodabwitsa cha kulephera kwaimpso chimachitika, kuphatikizapo chithandizo cha kuchepa kwa impso, osteodystrophy, hyperkalemia, hyperphosphatemia, hypocalcemia, ndi zina zambiri. Ndi kukula kwa aimpso kulephera, pali zovuta zomwe zimadziwika pakuwongolera kagayidwe kazakudya komwe kamakhudzana ndi kusintha kwa insulin. Kuwongolera uku ndikovuta kwambiri ndipo kuyenera kuchitidwa payekhapayekha.
Ndi hyperkalemia (> 5.5 meq / l), odwala amalembedwa:
- Hydrochrothiazide pakamwa 25-50 mg m'mawa wopanda kanthu kapena
- Furosemide mkati 40-160 mg m'mawa pamimba yopanda kanthu katatu pa sabata.
- Sodium polystyrenesulfonate pakamwa 15 ga 4 pa tsiku mpaka kufikira ndikusunga mulingo wa potaziyamu m'magazi osaposa 5.3 meq / l.
Pambuyo pakufika pamlingo wa potaziyamu m'magazi a 14 meq / l, mankhwala amatha kuyimitsidwa.
Pankhani ya ndende ya potaziyamu m'magazi opitilira 14 meq / l ndi / kapena zizindikiro za Hyperkalemia yayitali pa ECG (kutalika kwa nthawi ya PQ, kukulira kwa zovuta za QRS, kusalala kwa mafunde a P), zotsatirazi zimaperekedwa mwachangu poyang'anira ECG:
- Calcium gluconate, 10% yankho, 10 ml yolowa mkati kwa mphindi 2-5 kamodzi, pakalibe kusintha mu ECG, kubwereza jakisoni ndikotheka.
- Soluble insulin (yaumunthu kapena nkhumba) yochepa yogwira 10-20 IU mu glucose solution (25-50 g glucose) kudzera mu mnofu wa celloglycemia, ndi hyperglycemia kokha insulin imayendetsedwa molingana ndi msinkhu wa glycemia.
- Sodium bicarbonate, 7.5% yankho, 50 ml kudzera m'mitsempha, kwa mphindi 5 (ngati concomitant acidosis), pakalibe zotsatira, bwerezaninso pambuyo pa mphindi 10-15.
Ngati izi sizothandiza, hemodialysis imachitidwa.
Odwala azotemia, enterosorbents amagwiritsidwa ntchito:
- Yoyendetsedwa kaboni mkati 1-2 g masiku 3-4, nthawi ya mankhwala imatsimikiziridwa payekha kapena
- Povidone, ufa, mkati mwa 5 g (kusungunuka mu 100 ml ya madzi) katatu patsiku, nthawi yamankhwala imatsimikiziridwa payekhapayekha.
Ngati kuphwanya phosphorous-calcium metabolism (nthawi zambiri hyperphosphatemia ndi hypocalcemia), zakudya zimayikidwa, kuletsedwa kwa phosphate mu chakudya mpaka 0.6-0.9 g / tsiku, ndi kusagwira kwake, kukonzekera kwa calcium kumagwiritsidwa ntchito. Mulingo woyenera wa phosphorous m'magazi ndi 4.5-6 mg%, calcium - 10,5-11 mg%. Pankhaniyi, chiwopsezo cha ectopic calcation ndi chochepa. Kugwiritsa ntchito ma aluminium phosphate omangira ma aluminium kuyenera kukhala ochepa chifukwa choopsa kwambiri cha kuledzera. Kuletsa kwa endo native synthesis wa 1,25-dihydroxyvitamin D ndi mafupa kukana parathyroid timadzi timatulutsa hypocalcemia, kuthana ndi omwe metabolites a vitamini D amauza.
Odwala ndi hyperphosphatemia ndi hypocalcemia ndi mankhwala:
- Calcium calcium, mu koyamba mlingo wa 0,5-1 g wa calcium yoyambira mkati katatu pa tsiku ndi chakudya, ngati kuli kotheka, onjezani mlingo uliwonse pakadutsa masabata 2 mpaka 3 mpaka 3 katatu pa tsiku mpaka phosphorous m'magazi 4, 5-6 mg%, calcium - 10,5-11 mg%.
- Calcitriol 0,25-2 mcg pakamwa 1 nthawi patsiku akuyang'aniridwa ndi seramu calcium kawiri pa sabata. Pamaso pa aimpso magazi ndi matenda mawonetseredwe kapena concomitant zamtima matenda.
- Epoetin-beta subcutaneously 100-150 U / kg kamodzi pa sabata mpaka hematocrit ifike 33-36%, hemoglobin level 110-120 g / l.
- Iron sulfate mkati mwa 100 mg (potengera chitsulo chosazidwa) 1-2 pa tsiku kwa ola limodzi la chakudya, kwa nthawi yayitali kapena
- Iron (III) hydroxide sucrose tata (yankho la 20 mg / ml) 50-200 mg (2,5-10 ml) isanadze kulowetsedwa, kuchepetsa 0,9% mu sodium mankhwala enaake (1 ml ya mankhwala 20 ml ya njira), kudzera m'mitsempha kutumikiridwa pa mlingo wa 100 ml kwa mphindi 15 katatu pa sabata, kutalika kwa mankhwala kumatsimikiziridwa payekha kapena
- Iron (III) hydroxide sucrose tata (yankho la 20 mg / ml) 50-200 mg (2.5-10 ml) kudzera mu liwiro la 1 ml / mphindi 2-3 kamodzi pa sabata, kutalika kwa mankhwala kumatsimikiziridwa payekhapayekha.
Zotsatira za extracorporeal chithandizo cha matenda aimpso kulephera mu shuga amatsimikiza kale kuposa odwala omwe ali ndi aimpso osiyanasiyana, popeza mu shuga amasungidwe amadzimadzi, utsi wamphamvu wa nayitrogeni komanso electrolyte umakhala ndi mfundo zapamwamba za GFR. Ndi kuchepa kwa GFR kosakwana 15 ml / mphindi ndikuwonjezereka kwa creatinine mpaka 600 μmol / l, ndikofunikira kuyesa zomwe zikuwonetsa ndi zotsutsana ndikugwiritsira ntchito njira zochiritsira zosowa m'malo: hemodialysis, peritoneal dialysis ndi kupatsirana kwa impso.
Chithandizo cha uremia
Kuwonjezeka kwa seramu creatinine pamtunda kuchokera pa 120 mpaka 500 μmol / L kumawonekera kwambiri pazomwe zimalepheretsa impso kulephera. Pakadali pano, chithandizo chamankhwala chimachitika ndikufuna kuthetsa kuledzera, kuimitsa matenda oopsa, ndikukonzanso zovuta zamagetsi am'madzi. Makhalidwe apamwamba a serum creatinine (500 μmol / L ndi apamwamba) ndi hyperkalemia (kupitirira 6.5-7.0 mmol / L) amawonetsa kuyambika kwa gawo lothana ndi kulephera kwa aimpso, komwe kumafunikira njira zakunja kwa dialysis.
Chithandizo cha odwala omwe ali ndi matenda osokoneza bongo nthawi ino amachitika palimodzi ndi ma endocrinologists ndi nephrologists. Odwala omwe akudwala matenda a impso amalephera kuchipatala m'madipatimenti apadera a nephrology omwe amakhala ndi makina a dialysis.
Chithandizo cha matenda a shuga ndi nephropathy mu mawonekedwe a mawonekedwe a aimpso kulephera
Odwala omwe ali ndi matenda amtundu wa 1 komanso mtundu wa 2 wodwala omwe ali pa insulin mankhwala, kupitilira kwa matenda aimpso kulephera nthawi zambiri kumadziwika ndi kukula kwa matenda a hypoglycemic omwe amafunikira kuchepetsa kuchuluka kwa insulin (Zabrody phenomenon). Kukula kwa matenda amtunduwu kumachitika chifukwa chakuti kuwonongeka kwambiri kwaimpso parenchyma, ntchito ya aimpso insulinase yomwe ikugwira nawo ntchito yoyipa ya insulin imachepa. Chifukwa chake, insulini yoyendetsedwa bwino imapangidwa pang'onopang'ono, imazungulira m'magazi kwa nthawi yayitali, ndikupangitsa hypoglycemia. Nthawi zina, kufunika kwa insulini kumachepetsedwa kwambiri kwakuti madokotala amakakamizidwa kuletsa jakisoni wa insulin kwakanthawi. Kusintha konse kwa insulin kuyenera kuchitidwa pokhapokha ngati chiwopsezo cha glycemia chikuyenera. Odwala omwe ali ndi matenda a shuga a mtundu wachiwiri omwe adalandira mankhwala a hypoglycemic, omwe ali ndi vuto lofooka la impso, ayenera kusinthidwa kupita ku insulin. Izi ndichifukwa choti ndi chitukuko cha matenda aimpso osalephera, chimbudzi cha kukonzekera konse kwa sulfonylurea (kupatula glyclazide ndi glycidone) ndi mankhwala ochokera ku gulu la Biguanide amatsika kwambiri, zomwe zimapangitsa kuti chiwopsezo chawo m'magazi chiwonjezeke.
Kukonzekera kuthamanga kwa magazi kukukhala njira yayikulu yochizira matenda a impso, omwe amachepetsa kuyambika kwa kulephera kwa impso.Cholinga cha antihypertensive tiba, komanso gawo la proteinuric la nephropathy, ndikukhala kuthamanga kwa magazi pamlingo wosaposa 130/85 mm Hg. ACE inhibitors amaonedwa ngati mankhwala osankha oyamba, monga mwa magawo ena a matenda ashuga a nephropathy. Nthawi yomweyo, munthu azikumbukira kufunika kogwiritsa ntchito mankhwalawa mosamala ndi kulephera kwa impso (serum creatinine level of more 300 μmol / L) chifukwa cha kufupika kwakanthawi kwa ntchito ya kusefukira kwa impso komanso kukula kwa vuto la Hyperkalemia. Mu gawo la kufooka kwa impso, monga lamulo, monotherapy sakhazikika pamlingo wamagazi, chifukwa chake, tikulimbikitsidwa kuchita mankhwala ophatikiza antihypertensive omwe ali m'magulu osiyanasiyana (ACE inhibitors + loop diuretics + calcium channel blockers + kusankha beta-blockers + pakati zochita mankhwala) . Nthawi zambiri, magawo anayi okha a mankhwalawa othandizira matenda oopsa mu matenda aimpso kulephera amatha kukwaniritsa kuchuluka kwa magazi.
Mfundo yofunika yochizira nephrotic syndrome ndikuchotsa hypoalbuminemia. Ndi kuchepa kwa serum albumin ndende ya osakwana 25 g / l, kulowetsedwa kwa njira za Albin ndikulimbikitsidwa. Nthawi yomweyo, ma loop diuretics amagwiritsidwa ntchito, ndipo mlingo wa furosemide womwe umayendetsedwa (mwachitsanzo, lasix) umatha kufika 600-800 ndipo ngakhale 1000 mg / tsiku. Potazium-spure diuretics (spironolactone, triamteren) mu gawo la kufooka kwa impso sikugwiritsidwa ntchito chifukwa chowopsa cha hyperkalemia. Liazide diuretics imaphatikizidwanso pakulephera kwa impso, chifukwa zimathandizira kuchepa kwa kusefedwa kwa impso. Ngakhale kutayika kwakukulu kwa mapuloteni mu mkodzo ndi nephrotic syndrome, ndikofunikira kupitilizabe kutsatira mfundo yotsika ya mapuloteni otsika, momwe mapuloteni omwe amapezeka ndi nyama sayenera kupitirira 0,8 g pa 1 kg ya thupi. Nephrotic syndrome imadziwika ndi hypercholesterolemia, chifukwa chake njira yothandizira mankhwalawa imaphatikizapo mankhwala ochepetsa lipid (mankhwala othandiza kwambiri ochokera ku gulu la statins). Kukula kwa odwala omwe ali ndi matenda osokoneza bongo omwe ali ndi matenda ashuga nephropathy mu gawo la matenda aimpso kulephera komanso nephrotic syndrome ndi osavomerezeka. Odwala otere ayenera kukhala okonzekera mwachangu chithandizo chowonjezera cha impso.
Odwala mu gawo la matenda aimpso kulephera, pamene serum creatinine imaposa 300 μmol / l, amafunikira pazomwe zimalepheretsa mapuloteni amtundu wa nyama (mpaka 0,6 g pa 1 kg ya kulemera kwa thupi). Pokhapokha ngati kuphatikizidwa kwa matenda aimpso kulephera komanso nephrotic syndrome ndikololedwa kudya mapuloteni ochuluka mwa 0,8 g pa kg iliyonse ya thupi.
Ngati mukufunikira kutsatira kwa moyo wanu wonse zakudya zama protein ochepa omwe ali ndi odwala omwe ali ndi chakudya chochepa, mavuto omwe amabwera chifukwa cha kupatsirana kwa mapuloteni awoawo kumatha. Pachifukwa ichi, tikulimbikitsidwa kugwiritsa ntchito ketone analogues ya amino acid (mwachitsanzo, ketrateil ya mankhwala). Mankhwalawa ndi mankhwalawa, ndikofunikira kuwongolera kuchuluka kwa calcium m'magazi, chifukwa nthawi zambiri hypercalcemia imayamba.
Matendawa, omwe nthawi zambiri amapezeka mwa odwala omwe amalephera kupweteka aimpso, nthawi zambiri amagwirizanitsidwa ndi kuphatikizika kwa aimpso erythropoietin - mahomoni omwe amapereka erythropoiesis. Pofuna kubwezeretsa mankhwala, ntchito erythropoietin (epoetin alpha, epoetin beta) imagwiritsidwa ntchito. Potengera momwe mankhwalawo amathandizira, kuperewera kwachuma cha seramu kumakulirakulira, motero, kuthandizira kwambiri, mankhwala a erythropoietin ayenera kuphatikizidwa ndi kugwiritsa ntchito mankhwala okhala ndi chitsulo.Pakati pa zovuta za erythropoietin mankhwala, kukula kwa ochepa ochepa matenda oopsa, hyperkalemia, ndi chiopsezo chachikulu cha thrombosis. Mavuto onsewa ndiosavuta kuwawongolera ngati wodwala ali ndi chithandizo cha hemodialysis. Chifukwa chake, ndi 7-10% yokha ya odwala omwe amalandira chithandizo cha erythropoietin mu pre-dialysis siteji ya aimpso kulephera, ndipo pafupifupi 80% amayamba mankhwalawa akaperekedwa ku dialysis. Ndi magazi osasinthika oopsa komanso matenda oopsa a mtima, chithandizo cha erythropoietin chimatsutsana.
Kukula kwa aimpso kulephera amadziwika ndi hyperkalemia (oposa 5.3 mmol / L) chifukwa kuchepa kwa aimpso excretion wa potaziyamu. Pachifukwa ichi, odwala amalangizidwa kuti asatenge zakudya zomwe zili ndi potaziyamu (nthochi, maapricots owuma, zipatso za zipatso, zipatso zouma, mbatata). Milandu pomwe hyperkalemia imafika pazomwe zimawopseza kumangidwa kwamtima (kupitirira 7.0 mmol / l), wogwirizira wa potaziyamu, 10% calcium gluconate solution, amathandizidwa kudzera m'mitsempha. Ma resin a Ion amagwiritsidwanso ntchito pochotsa potaziyamu m'thupi.
Mavuto a phosphorous-calcium metabolism osalephera aimpso amadziwika chifukwa cha hyperphosphatemia ndi hypocalcemia. Kuwongolera hyperphosphatemia, kuletsa kudya zakudya zomwe zimakhala ndi phosphorous (nsomba, zolimba komanso zosinthidwa tchizi, burwheat, etc.) ndikuyambitsa mankhwala omwe amamangira phosphorous m'matumbo (calcium carbonate kapena calcium acetate) amagwiritsidwa ntchito. Kuwongolera hypocalcemia, kukonzekera kwa calcium, colecalciferol, ndi mankhwala. Ngati ndi kotheka, opaleshoni yochotsa matenda a hyperplastic parathyroid gil.
Enterosorbents ndi zinthu zomwe zimatha kumangirira zinthu zopweteka m'matumbo ndikuzichotsa m'thupi. Kuchita kwa ma enterosorbents mu kuperewera kwa impso kumalingidwa, kumbali imodzi, kupangitsa kuti kulowererapo kwa poizoni wa uremic kuchokera m'magazi, ndi mbali inayo, kuchepetsa kuchepa kwa sumu zam'mimba kuchokera m'matumbo kulowa m'magazi. Monga enterosorbents, mutha kugwiritsa ntchito kaboni yokhazikitsidwa, povidone (mwachitsanzo, ma postodeis), minisorb, ma resin a ion-exchange. Enterosorbents iyenera kumwedwa pakati pa chakudya, maola 1.5-2 mutamwa mankhwalawa. Pochiza ma sorbents, ndikofunikira kuwunika pafupipafupi ntchito zamatumbo, ngati pakufunika kutero, mupeze mankhwala othandizira mankhwala othandizira kapena othandizira enemas.
Kuphatikizika kwa impso ndi kapamba
Lingaliro la kuphatikiza kotereku ndiloyenera chifukwa chokwanira kuti wodwalayo athe kukonzanso, popeza kufalikira kwa ziwalo zimaphatikizapo kuthetseratu mawonetseredwe a kulephera kwa impso ndi matenda a shuga mellitus omwe, omwe adayambitsa matenda a impso. Nthawi yomweyo, kuchuluka kwa odwala omwe ali ndi matenda a shuga komanso kumuika pambuyo pochita izi ndi kutsika poyerekeza ndi kumuyika kwina impso. Ichi ndichifukwa cha zovuta zambiri zaluso pochita opareshoni. Komabe, podzafika kumapeto kwa chaka cha 2000, zinthu zoposa 1,000 zophatikizidwa pamodzi za impso ndi kapamba zidachitidwa ku United States of America. Kupulumuka kwa zaka zitatu kwa odwala kunali 97%. Kusintha kwakukulu muumoyo wa odwala, kuyimitsidwa kwa kuwonjezereka kwa kuwonongeka kwa ziwalo zomwe zikuyang'aniridwa mu matenda a shuga, komanso kudziyimira pawokha kwa insulin kwapezeka mu 60-92% ya odwala. Ndi kusintha kwa matekinoloje atsopano mu zamankhwala, ndizotheka kuti m'zaka zikubwerazi mtundu wamtunduwu wogwirizira udzakhala patsogolo.
Kubwezeretsa kwa glomerular chapansi chapamwamba
Amadziwika kuti gawo lofunikira pakukweza kwa matenda ashuga nephropathy imaseweredwa ndi kuphatikizika kwa glycosaminoglycan heparan sulfate, yomwe ndi gawo la membrane wa glomerular basrane ndipo imapereka chida chosankha fungo.Kubwezeretsanso komwe kusungidwa kwa phula ili mu minyewa yam'mimba kumatha kubwezeretsanso kuperewera kwamitsempha komanso kuchepetsa kuchepa kwa mapuloteni mu mkodzo. Kuyesera koyamba kugwiritsa ntchito glycosaminoglycans pochiza matenda a shuga a nephropathy anapangidwa ndi G. Gambaro et al. (1992) mu makoswe omwe ali ndi matenda a shuga a streptozotocin. Zinakhazikitsidwa kuti kuikidwa kwake koyambirira - pakuwonekera kwa matenda a shuga - kumalepheretsa kusintha kwa kusintha kwa morphological mu minofu ya impso komanso mawonekedwe a albuminuria. Kuchita bwino kwa mayeso kwatilola kupitabe ku mayesero azachipatala a mankhwala omwe ali ndi glycosaminoglycans popewa komanso kuchiza matenda a shuga. Posachedwa, mankhwala a glycosaminoglycans ochokera ku Alfa Wassermann (Italy) Veselential F (INN - sulodexide) adapezeka pamsika wama Russia waku Russia. Mankhwala ali ndi glycosaminoglycans - ochepa maselo kulemera heparin (80%) ndi dermatan (20%).
Asayansi adafufuza ntchito ya nephroprotective ya mankhwalawa odwala omwe ali ndi matenda a shuga 1 omwe amakhala ndi magawo osiyanasiyana a matenda ashuga. Odwala omwe ali ndi microalbuminuria, kwamikodzo albumin excretion amachepetsa kwambiri sabata 1 pambuyo poyambira chithandizo ndikumakhalabe pamiyezi itakwaniritsidwa kwa miyezi 8-9 atachotsedwa ntchito. Odwala ndi proteinuria, kwamikodzo mapuloteni excretion kwambiri amachepetsa masabata 3-4 pambuyo pa kuyamba chithandizo. The zinatheka zotsatira anapitiliza atasiya mankhwala. Palibe zovuta zamankhwala zomwe zidadziwika.
Chifukwa chake, mankhwala ochokera ku gulu la glycosaminoglycans (makamaka, sulodexide) akhoza kuwonedwa ngati othandiza, opanda mavuto a heparin, komanso osavuta pakugwiritsa ntchito njira ya pathogenetic ya matenda ashuga a nephropathy.
Zotsatira zama protein a non-enzymatic glycosylated
Mapuloteni osachita enzymatic glycosylated a protein of the glomerular basement membrane pansi pa zochitika za hyperglycemia amatsogolera kuphwanya kwawo kukhazikika ndi kutayika kwa kusankha kosavomerezeka kwa mapuloteni. Njira yodalirika pakuthandizira matenda a mtima wamatenda a shuga ndi kusaka mankhwala omwe angasokoneze zomwe sizikuchitika enzymatic glycosylation. Chosangalatsa choyeseza chinali kuthekera kwakapezeka kwa acetylsalicylic acid kochepetsa mapuloteni a glycosylated. Komabe, kuikidwa kwake ngati glycosylation inhibitor sikunapeze kufalitsa kachipatala kokwanira, popeza Mlingo womwe mankhwalawo umathandizira uyenera kukhala wokulirapo, womwe umakhala wofukidwa ndi kukulitsa zovuta.
Kusokoneza zomwe sizimapanga enzymatic glycosylation m'maphunziro oyesera kuyambira zaka za m'ma 80 zapitazi, mankhwala aminoguanidine agwiritsidwa ntchito bwino, omwe amakanika ndi magulu a carboxyl a zinthu zomwe zimasinthidwa glycosylation, kuimitsa njirayi. Posachedwa, choletsa chokhazikika cha mapangidwe a pyridoxamine glycosylation end apangidwa.
Zambiri
Matenda a shuga ndi nephropathy ndimatenda omwe amadziwika ndi kuwonongeka kwamitsempha yama impso, ndipo amakula motsutsana ndi maziko a matenda a shuga. Ndikofunikira kuzindikira matendawa munthawi yake, chifukwa pamakhala chiopsezo chachikulu chotenga kulephera kwa impso. Mtundu wa complication uwu ndi chimodzi mwazomwe zimapangitsa kuti anthu azifa. Sikuti mitundu yonse ya shuga imayendera limodzi ndi nephropathy, koma mtundu woyamba ndi wachiwiri wokha. Kuvulala kwa impso kumachitika mwa anthu 15 mwa 100 a matenda ashuga. Amuna amakonda kwambiri matenda. Wodwala wodwala matenda ashuga, pakapita nthawi, minofu ya impso imavulala, zomwe zimayambitsa kuphwanya ntchito zawo.
Pokhapokha pa nthawi, kuzindikira koyambirira komanso njira zoyenera zochiritsira zingathandize kuchiritsa impso ndi matenda a shuga. Kugawidwa kwa matenda a shuga a nephropathy kumapangitsa kuti azindikire kukula kulikonse kwamatenda.Ndikofunika kulingalira kuti magawo oyambawa a matendawa samatsatiridwa ndi zizindikiro zotchulidwa. Popeza ndizosatheka kuthandiza wodwalayo pamafuta opaka, anthu omwe ali ndi matenda a shuga ayenera kuyang'anitsitsa thanzi lawo.
Pathogenesis wa matenda ashuga nephropathy. Munthu akayamba matenda ashuga, impso zimayamba kugwira ntchito kwambiri, zomwe zimafotokozedwa ndikuti kuchuluka kwa glucose kumasefedwa kudzera mwa iwo. Izi zimatenga madzi ambiri, zomwe zimawonjezera katundu pa impso glomeruli. Pakadali pano, nembanemba wa glomerular imakhala wofinya, monganso minofu yoyandikana nayo. Njira izi pakapita nthawi zimatsogolera kusamutsidwa kwa ma tubules kuchokera ku glomeruli, komwe kumapangitsa magwiridwe ake ntchito. Izi glomeruli m'malo ndi ena. Popita nthawi, kulephera kwa impso kumayamba, ndipo kudziyambitsa poizoni m'thupi kumayamba (uremia).
Zoyambitsa Nephropathy
Zowonongeka za impso mu matenda a shuga sizimachitika nthawi zonse. Madokotala sanganene motsimikiza kuti chomwe chimayambitsa zovuta za mtundu uwu ndi chiyani. Zakhala zangotsimikiziridwa kuti shuga yamagazi sichikhudza mwachindunji matenda a impso mu shuga. Theorists amati matenda ashuga nephropathy ndi chifukwa cha zovuta zotsatirazi:
Masiteti ndi zizindikiro zawo
Matenda a shuga komanso matenda a impso samatenga masiku ochepa, zimatenga zaka 5-25. Gulu la odwala matenda ashuga nephropathy:
- Gawo loyamba. Zizindikiro palibe. Njira zakuzindikirira ziziwonetsa kuchuluka kwa magazi mu impso ndi ntchito yawo yambiri. Polyuria mu shuga angayambike kuchokera gawo loyamba.
- Gawo lachiwiri. Zizindikiro za matenda a shuga a nephropathy sanawonekere, koma impso zimayamba kusintha. Makoma a glomeruli amakula, minyewa yolumikizana imakula, ndipo kusefera kumakulirakulira.
- Gawo loyesera. Mwina kuwoneka kwa woyamba chizindikiro mu mawonekedwe a kupanikizika kowonjezereka. Pakadali pano, kusintha kwa impso ndikusinthanso, ntchito yawo imasungidwa. Ili ndiye gawo lotsiriza.
- Gawo la Nephrotic. Odwala amangokhalira kudandaula za kuthamanga kwa magazi, kutupa kumayamba. Kutalika kwa magawo - mpaka zaka 20. Wodwalayo amatha kudandaula za ludzu, nseru, kufooka, kutsika pang'ono, kupweteka mtima. Munthu akuchepetsa thupi, kupuma movutikira kumawonekera.
- Gawo lachigawo (uremia). Kulephera kwamphamvu m'magazi a shuga kumayamba ndendende nthawi imeneyi. Pathology imayendera limodzi ndi kuthamanga kwa magazi, edema, kuchepa magazi.
Kuwonongeka kwa ziwiya za impso mu shuga kumawonekera chifukwa cha kutupa, kupweteka kumbuyo, kuchepa thupi, kulimbitsa thupi, kupweteka pokodza.
Zizindikiro za matenda ashuga oopsa:
Bweretsani ku zomwe zalembedwa
Njira zopezera matenda ashuga
Vuto la impso ndi odwala matenda ashuga sizachilendo, chifukwa chake, kuwonongeka konse, kupweteka kumbuyo, kupweteka mutu kapena vuto lililonse, wodwalayo ayenera kufunsa dokotala nthawi yomweyo. Katswiri amatenga anamnesis, amayesa wodwalayo, pambuyo pake amatha kudzipangira matenda, kuti atsimikizire kuti ndikofunikira kufufuza bwino. Kuti mutsimikizire matenda a matenda ashuga a nephropathy, ndikofunikira kuti mukayezetse mayeso otsatirawa:
Albumin Assay
Albumin ndi puloteni ya mainchesi ochepa. Mwa munthu wathanzi, impso sizimangodutsitsa mkodzo, motero, kuphwanya ntchito yawo kumabweretsa kuchuluka kwa mapuloteni mumkodzo.Tiyenera kukumbukira kuti sikuti mavuto a impso okha amakhudzidwa ndi kuwonjezeka kwa albumin, chifukwa chake, kutengera kupendeketsaku kokha, kufufuza kumachitika. Santhula mwatsatanetsatane kuchuluka kwa albumin ndi creatinine. Ngati simuyamba kulandira chithandizo panthawiyi, impso zimayamba kugwira ntchito molakwika pakapita nthawi, zomwe zimapangitsa kuti proteinuria (mapuloteni amakulu azioneka mkodzo). Izi ndizodziwika bwino mu gawo 4 la matenda ashuga nephropathy.
Kuyesa kwa shuga
Kutsimikiza kwa shuga mu mkodzo wa odwala matenda a shuga kuyenera kumwedwa nthawi zonse. Izi zimapangitsa kuwona ngati pali vuto la impso kapena ziwalo zina. Ndikulimbikitsidwa kuyang'anira chizindikiritso chilichonse miyezi isanu ndi umodzi. Ngati shuga ali okwera nthawi yayitali, impso sizigwira, ndipo imalowa mkodzo. Chopuma chaimpso ndi mulingo wa shuga womwe impso sizingatheke kugwiranso ntchito. Njira yolumikizira impso imatsimikiziridwa payokha kwa dokotala aliyense. Ndi m'badwo, kudwala kumeneku kumatha kukula. Pofuna kuthana ndi zizindikiro za shuga, tikulimbikitsidwa kutsatira zakudya ndi upangiri wina waluso.
Zakudya zamankhwala
Impso zikalephera, zakudya zamankhwala zokha sizingathandize, koma poyambira kapena kupewa mavuto a impso, chakudya cha impso cha anthu odwala matenda ashuga chimagwiritsidwa ntchito. Zakudya zopatsa thanzi zimathandizira kuchepetsa shuga komanso kukhala ndi thanzi labwino. Pasakhale mapuloteni ambiri muzakudya. Zakudya zotsatirazi zikulimbikitsidwa:
Zosinthazi zimapangidwa ndi dokotala. Makhalidwe ake amtundu uliwonse amathandizidwa. Ndikofunika kutsatira miyezo yamakudya amchere, nthawi zina amalimbikitsidwa kuti athetse izi kwathunthu. Ndikulimbikitsidwa kusintha nyama ndi soya. Ndikofunikira kuti muzitha kusankha bwino, chifukwa soya nthawi zambiri imasinthidwa ma genetic, zomwe sizibweretsa phindu. Ndikofunikira kuti mulamulire kuchuluka kwa glucose, popeza mphamvu yake imadziwika kuti ndi yoyambitsa matenda.
Kodi kuchitira odwala matenda ashuga nephropathy?
Chithandizo cha impso kwa matenda ashuga chimayamba pambuyo popezeka. Chinsinsi cha mankhwalawa ndikupewa kupititsa patsogolo njira zamatenda ndikuchedwa kutha kwa matendawa. ZonseMatenda omwe amakhalapo chifukwa cha matenda ashuga sangathe kuthandizidwa popanda kuwongolera shuga. Ndikofunikira kuyang'anitsitsa kukakamiza konse. Ngati wodwala ali pachakudya, mverani zomwe dokotala wamukulangizani, sangakumane ndi matenda ashuga, chifukwa kuyambitsidwa kwa matenda amisempha kumafuna zaka zosachepera zisanu ndi chimodzi kuyambira pachiwopsezo cha matenda ashuga. Pakadali pano, kudya kokha kungakhale kokwanira.
Zowonongeka za matenda ashuga m'matumbo a impso zimathetsedwa ndi okodzetsa, beta-blockers, anzanu okwanira, othandizira calcium.
Matendawa akamakula, mpaka impso zalephera, chithandizo chamankhwala chamankhwala nthawi zambiri chimakhala chokwanira. ACE inhibitors amagwiritsidwa ntchito. Mankhwalawa amachepetsa kuthamanga kwa magazi. Nditetezero zabwino za mtima ndi impso. Ndikwabwino kugwiritsa ntchito mankhwala osokoneza bongo kwa nthawi yayitali. Chithandizo cha nephropathy mu matenda a shuga nthawi zina chimachitikanso:
Ngati matendawa adapezeka m'magawo apambuyo pake, chithandizo cha matenda a shuga a nephropathy amachitika ndi hemodialysis kapena peritoneal dialysis. Ndondomekozi zimachitika ngati ntchito za thupi sizingatheke. Mulimonsemo, odwala otere amafunika kumuwonjezera impso, pambuyo pake odwala onse amachira kwathunthu chifukwa cha kulephera kwa impso.
Diabetes nephropathy: Zizindikiro, magawo ndi chithandizo
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 kupatsidwa dialysis kapena kupatsirana kwa impso.
Zifukwa zoyambitsa matenda a shuga:
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:
Zokhudza chifuwa chachikulu cha impso:
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.
Zotsatira zamatenda a polyol glucose
Kuchulukitsidwa kwa glucose kagayidwe kamene kamayendetsa njira ya polyol mothandizidwa ndi aldose reductase enzyme kumabweretsa kudzikundikira kwa sorbitol (chinthu chosagwira ntchito) muzinthu zosadalira insulini, zomwe zimathandizanso kukulitsa zovuta zakumapeto kwa matenda ashuga. Kusokoneza njirayi, chipatalachi chimagwiritsa ntchito mankhwala ochokera ku gulu la aldose reductase inhibitors (tolrestat, statil). Kafukufuku angapo adawonetsa kuchepa kwa albuminuria mwa odwala omwe ali ndi matenda amtundu wa 1 omwe adalandira aldose reductase inhibitors. Komabe, chithandizo chachipatala cha mankhwalawa chimatchulidwa pochiza matenda a shuga kapena retinopathy, komanso kuchepera kwa matenda a shuga. Mwina izi zimachitika chifukwa chakuti njira ya polyol ya kagayidwe kachakudya imagwira ntchito yocheperako pathogenesis ya kuwonongeka kwa impso ya matenda ashuga kuposa ziwiya zina zama cell zomwe sizimadalira insulini.
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.
Zizindikiro zoyambira ndi zizindikiro
Chikhalidwe cha odwala matenda ashuga ndi kufalikira pang'onopang'ono kwa zizindikiro zosalimbikitsa, kupita patsogolo kwapang'onopang'ono kwa matenda. Nthawi zambiri, kuwonongeka kwa impso kumakhudza odwala omwe ali ndi matenda osokoneza bongo kwa zaka 15-20. Zopatsa: kusinthasintha kwazowonetsa za shuga, pafupipafupi kuchuluka kwa miyeso molingana ndi mulingo, kulephera kwa wodwala, kusakwanira kwa zizindikiro za shuga.
Gawo la matenda ashuga nephropathy:
- asymptomatic. Kusowa kwa chithunzi cha chipatala. Kafukufuku akuwonetsa kuwonjezeka kwa kusefera kwa glomerular, zizindikiro za microalbumin mu mkodzo sizifika 30 mg patsiku. Mwa odwala ena, ma ultrasound amawonetsa ma hypertrophy ooneka ngati nyemba, kuwonjezereka kwa kuthamanga kwa magazi mu impso,
- Gawo lachiwiri ndi chiyambi cha kusintha kwa kachitidwe. Mkhalidwe wa impso glomeruli umasokonezeka, kusefukira kwamadzimadzi komanso kuchuluka kwa mkodzo kutsalira, kusanthula kukuwonetsa mapuloteni ochepa,
- gawo lachitatu ndi prenephrotic. Kukumana kwa microalbumin kumakwera (kuyambira 30 mpaka 300 mg patsiku), proteinuria imayamba kamodzikamodzi, kudumpha mu magazi. Nthawi zambiri, kusefedwa kwa msambo komanso kutsika kwa magazi ndi kwabwinobwino kapena kupatuka ndikochepa,
- gawo lachinayi. Prosturia wolimba, mayeso amawonetsa kupezeka kwa mapuloteni mu mkodzo. Nthawi ndi nthawi, ma silaline a hyaline komanso kaphatikizidwe ka magazi kamatuluka mkodzo. Kulimbikira kwamtenda wamagazi, kutupa kwa minofu, magazi owonongeka. Zolemba zowunikira zikuwonetsa kuchuluka kwa cholesterol, ESR, beta ndi alpha-globulins. Mitundu ya Urea ndi creatinine imasiyana pang'ono,
- Lachisanu, gawo lovuta kwambiri. Ndi kulimbikira kwa uremia, kukula kwa nephrosulinosis, kugwiritsidwa ntchito mwamphamvu ndi kusefedwa kwa ziwalo zooneka ngati nyemba zimachepa kwambiri, ndipo azothermia imayamba. Mapuloteni am'magazi ali pansipa, kutupa kumawonjezeka. Zotsatira zapadera zoyesa: kukhalapo kwa mapuloteni, masilindala, magazi mkodzo, shuga mu mkodzo sanatsimikizike. Mu odwala matenda ashuga, kuthamanga kwa magazi kumakwera kwambiri: mpaka 170-190 kapena kuposa (kumtunda) ndi 100-120 mm RT. Art. (pansi). Mbali yofunikira ya gawo la nephroscrotic ndi kuchepa kwa kuchepa kwa insulin, kuchepa kwa kufunika kwa kupanga kwakunja kwa mahomoni ndi kuchuluka kwa shuga, komanso chiwopsezo. Mu gawo lachisanu la matenda ashuga nephropathy, zovuta zowopsa zimayamba - kulephera kwa impso (mitundu yosiyanasiyana).
Zindikirani! Asayansi akukhulupirira kuti matenda ashuga a nephropathy amapezeka ngati zinthu za magulu atatu zimayenderana. Ndikosavuta kuphwanya bwalo loipa ndikusalamulira bwino kwa shuga: zotsatira zoyipa za njira zonse zimawonekera, zomwe zimabweretsa kulephera kwa impso, kuphwanya kwakukulu kwa zomwe zimachitika.
Malamulo onse ndi kulembera moyenera
Kuzindikiritsa kuchuluka kwamapuloteni onse mu mkodzo ndi chifukwa chowunikira mozama komanso kuyamba kwa chithandizo. Ndikofunikira kukhazikitsa magwiridwe antchito mpaka impso zovuta kuti zipangidwe.
Zolinga zazikulu za chithandizo:
- Tetezani zosefera zachilengedwe ku zotsatira zoyipa kumbuyo,
- chepetsa kuthamanga kwa magazi, chepetsa katundu pazida za impso,
- bwezeretsani magwiridwe antchito a nyemba.
Mukazindikira microalbuminuria (mapuloteni mu mkodzo), chithandizo chovuta chimatsimikizira kusinthika kwa njira za metabolism, zimabwezeretsa zidziwitso kuzinthu zabwino. Khalidwe loyenera la mankhwalawa limabwezeretsa kuchuluka, kusefedwa, mawonekedwe a zosefera zachilengedwe.
Kuti muchepetse zovuta, wodwala matenda ashuga amatenga mankhwala osokoneza bongo:
- kuphatikiza kwa zoletsa za ACE ndi angiotensin receptor blockers,
- okodzetsa kuchotsa madzi ochuluka ndi sodium, kuchepetsa kutupa,
- opanga beta.Mankhwala osokoneza bongo amachepetsa kuthamanga kwa magazi ndi kuchuluka kwa magazi ndi gawo lililonse la minofu yamtima, kuchepetsa kugunda kwa mtima,
- calcium tubule blockers. Cholinga chachikulu cha mankhwalawa ndikuthandizira kuyenderera kwa magazi kudzera m'mitsempha ya impso,
- monga adokotala adalembera, muyenera kutenga zopakika magazi: Cardiomagnyl, Aspirin Cardio. Ndikofunika kusunga mlingo wa tsiku ndi tsiku, nthawi ya maphunzirowa, malamulo a zamankhwala, kuti mupewe chiopsezo chotaya magazi.
- sonyezani zizindikiro za shuga, imwani mankhwala omwe amachititsa kuti matenda a glucose akhale abwino. Ndikofunika kupewa hyperglycemia, yomwe matenda a shuga amayamba ndi,
- kusiya kusuta, kumwa mowa,
- kutsatira zakudya zamafuta ochepa, kusiya kudya pafupipafupi zakudya zama protein,
- Chitani zolimbitsa thupi kuti muchepetse kunenepa, sinthani magawo a mitsempha yamagazi,
- samachita mantha
- mogwirizana ndi a mtima
- kupewa cholesterol yayikulu ndi triglycerides: amamwa mafuta ochepa a nyama, kumwa mapiritsi kukhazikitsa lipid chinthu: finofibrate, lipodemin, atorvastatin, simvastatin,
- Onetsetsani kuti mwayezera kuchuluka kwa shuga tsiku lonse: pambuyo pake matenda a shuga, nephropathy, matenda a hypoglycemia amakula.
Dziwani zomwe zimayambitsa ndi zosankha zamankhwala.
Malamulo ndi mawonekedwe ogwiritsira ntchito mapiritsi a Metformin a shuga a mtundu woyamba ndi wachiwiri akufotokozedwa patsamba.
- njira zodzitetezera zimasinthidwa ndi njira zochizira zotsutsana ndi maziko amakula gawo lachitatu la matenda a shuga. Ndikofunikira kukhazikitsa cholesterol, kuchepetsa kwambiri kupanga mapuloteni amchere ndi mchere. Kuthetsa matenda a mtima ndi mitsempha ya magazi, chithandizo cha matenda oopsa, ACE inhibitors, mankhwala omwe amalimbitsa magazi amafunikira,
- ngati wodwalayo adayamba kuyesedwa pa gawo 4 DN, ndikofunikira kutsatira zakudya zopanda mchere komanso zochepa zama protein, pewani zoletsa za ACE, onetsetsani kuti mumachepetsa triglycerides ndi cholesterol "yoyipa" yogwiritsa ntchito mankhwala omwe atchulidwa pamwambapa,
- mwaukali, gawo lachisanu la DN, madotolo amawonjezera njira zochizira ndi mitundu ina ya mankhwala. Wodwala amalandira vitamini D3 yoletsa matenda am'matumbo, erythropoietin kuti azigwiritsa ntchito bwino. Kukula kwa kulephera kwa impso ndi chifukwa chofotokozera za kuyeretsa magazi kwa peritoneal, hemodialysis, kapena kupatsirana kwa impso.
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 ndimayendedwe amomwe masinthidwe am'mitsempha yama impso, omwe amayamba chifukwa cha matenda ashuga.Matendawa amatsogolera pakukula kwa aimpso kulephera, pamakhala chiopsezo chachikulu cha kufa. Kuzindikira kumachitika osati pongowunika wodwalayo, njira zoyeserera zasayansi zimafunikanso.
Nthawi zambiri, chithandizo cha matenda a shuga a nephropathy amachitika kudzera mu mankhwala ndi mankhwala. Nthawi zina, odwala amapatsidwa hemodialysis; kupatsirana kwa impso kungafunikenso.
Malinga ndi magulu apadziko lonse a matenda obwezeretsa kachikhumi, matenda ashuga nephropathy ali ndi matanthawuzo awiri. Chifukwa chake, nambala ya ICD-10 idzakhala E10-14.2 (shuga mellitus ndi kuwonongeka kwa impso) ndi N08.3 (zotupa za glomerular mu shuga mellitus).
Amadziwika kuti kukulira kwa zovuta zotere kumadziwika kwambiri ndi mtundu wodalira insulini. Mu 40-50% ya milandu, matenda a shuga a nephropathy amapha.
Matenda a shuga a nephropathy amayamba chifukwa cha kusintha kwa matenda a m'mitsempha. Dziwani kuti mu zamankhwala muli malingaliro angapo ponena za makina amomwe amapangidwira motere:
- chiphunzitso cha metabolic - malinga ndi izi, chinthu chofunikira kwambiri chokhudza chilengedwe,
- chiphunzitso cha hemodynamic - pankhaniyi, ndikumvetsetsa kuti zomwe zimapangitsa
- chiphunzitso cha chibadwidwe - pamenepa, akatswiri azachipatala amati kupezeka kwa zovuta zoterezi kumachitika chifukwa cha chibadwa chamunthu.
Kuphatikiza apo, gulu la zinthu liyenera kusiyanitsidwa lomwe siliyenera kuwonedwa mwachangu, koma zimakulitsa chiwopsezo chotenga mwana kapena wamkulu yemwe ali ndi matenda ashuga:
- ochepa matenda oopsa
- hyperglycemia wosalamulira,
- onenepa kwambiri
- matenda a kwamkodzo thirakiti
- kumwa mankhwala a nephrotoxic,
- kusuta ndi uchidakwa,
- osagwirizana ndi zakudya, zomwe ndizovomerezeka kwa anthu odwala matenda ashuga.
Gulu
Pakupanga kwa matenda a shuga a nephropathy, madigiri 5 amadziwika:
- digiri yoyamba - Hyperfunction a impso. Poyambirira, ziwiya za ziwalo zimakulirakulira kukula, komabe, mulibe mapuloteni mumkodzo, palibe zizindikiro zakunja za chitukuko cha matenda.
- digiri yachiwiri - kusintha koyambirira kwa impso. Pafupifupi, gawo ili la kukula kwa matendawa limayamba zaka ziwiri itatha matenda ashuga. Makoma a ziwiya za impso amakhuthala, komabe, palibe chizindikiro,
- digiri yachitatu - matenda ashuga a m'mbuyomu. Kuchuluka kwamapuloteni ena kumapezeka mkodzo, koma palibe zizindikiro zakunja kwa matendawo.
- digiri yachinayi - Matenda akulu a shuga. Monga lamulo, gawo ili lachitukuko cha matendawa limayamba pambuyo pa zaka 10-15. Pali chithunzi chotchedwa chipatala, protein yambiri imatulutsidwa mkodzo,
- digiri yachisanu - siteji. Potere, munthu akhoza kupulumutsidwa pokhapokha ngati hemodialysis kapena kufalikira kwa chiwalo chokhudzidwa.
Tiyenera kudziwa kuti madigiri atatu oyamba amakula matendawa ndi oyambukira, amatha kukhazikitsidwa ndi njira zodziwira matenda, popeza alibe mawonekedwe akunja. Ichi ndichifukwa chake odwala omwe ali ndi matenda ashuga amafunika kukayezetsa magazi ndi madokotala pafupipafupi.
Zotsatira pa endothelial cell zochita
M'maphunziro oyesera komanso azachipatala, gawo la endothelin-1 monga mkhalapakati wa kupitirira kwa matenda ashuga nephropathy adakhazikitsidwa momveka. Chifukwa chake, chidwi chamakampani ambiri opanga mankhwala atembenukira ku kaphatikizidwe kamankhwala omwe angalepheretse kuchulukitsidwa kwa chinthuchi. Pakadali pano, mayesero oyeserera a mankhwala omwe amateteza ma receptor a endothelin-1.Zotsatira zoyambirira zikuwonetsa kuchepa mphamvu kwa mankhwalawa poyerekeza ndi ACE inhibitors.
Kuunikira kwa chithandizo chamankhwala
Njira zothandizira kupewa ndi kuchiza matenda ashuga nephropathy zimaphatikizanso njira zina zochizira matenda ashuga, komanso kupewa matenda obwera chifukwa cha matenda ashuga komanso kuchepa kwa kuchepa kwa impso.
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.
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. "
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.
- 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.
- 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).
- 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.
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.
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.
3. Matenda a shuga
Amatembenukira gawo lomaliza la matenda ashuga. Palibe zizindikiro zapadera. Nthawi ya siteji imachitika ndi SCFE yabwinobwino kapena yokwezeka pang'ono ndikuwonjezera magazi aimpso. Kuphatikiza:
Gawo lachinayi kapena gawo la microalbuminuria (30-300 mg / tsiku) limawonedwa zaka 5 pambuyo poyambika kwa matenda ashuga.
Magawo atatu oyamba a matenda a shuga a nephropathy amathandizika ngati chithandizo chanthawi yake chaperekedwa ndipo shuga ya magazi ikonzedwa. Pambuyo pake, mapangidwe a impso samadzichiritsa okha kuti abwezeretse, ndipo cholinga chamankhwala ndicho kuteteza izi. Vutoli limakulirakulira chifukwa chosowa zizindikiro. Nthawi zambiri ndikofunikira kuti musinthe njira yogwiritsira ntchito labotale yopendekera.
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Gulu la mitundu ya insulini ndikugwiritsa ntchito
Ndi mitundu yanji ya insulini ndipo imakhala nthawi yayitali bwanji? Kupanga kwa insulini m'thupi lathu kumasiyanasiyana. Kuti mahomoni alowe m'magazi kuti atsanzire kutulutsa kwake komwe, odwala matenda ashuga amafunika mitundu yosiyanasiyana ya insulin. ... -
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