Matenda a shuga - nephropathy: Zizindikiro, magawo, 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 kuyimba kapena.

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

Zifukwa zoyambitsa matenda a shuga:

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

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

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

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

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

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

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

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

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

Matenda a shuga

Matenda a diabetes nephropathy si matenda amodzi okha. Mawuwa amaphatikiza mavuto angapo osiyanasiyana, omwe tanthauzo lake limakhala chinthu chimodzi - ichi ndi kuwonongeka kwa ziwonetsero za impso motsutsana ndi maziko a matenda ashuga a mellitus.

Mu gulu la odwala matenda ashuga nephropathy, zotsatirazi nthawi zambiri zimapezeka:

• aimpso arteriosclerosis,
• matenda ashuga glomerulossteosis,
• mafuta am'mimbamo yaimpso,
• pyelonephritis,
• necrosis ya aimpso tubules, etc.

Nephropathy yomwe imayambitsidwa ndi matenda a shuga imatchedwa Kimmelstil-Wilson syndrome (amodzi mwa mitundu ya glomerulossteosis). Kuphatikiza apo, malingaliro a diabetesic glomerulosulinosis ndi nephropathy nthawi zambiri amagwiritsidwa ntchito pazachipatala monga zofanana.

Khodi ya ICD-10 (boma la International Classization of Disease of the 10th revision), lomwe lakhala likugwira ntchito ponseponse kuyambira 1909, limagwiritsa ntchito mitundu iwiri ya matendawa. Ndipo mmagulu osiyanasiyana azachipatala, mbiri ya odwala ndi mabuku owerengera, mutha kupeza zonse ziwiri. Awa ndi E.10-14.2 (Matenda a shuga ndi kuwonongeka kwa impso) ndi N08.3 (zotupa za glomerular mu shuga mellitus).

Nthawi zambiri, mitundu yambiri yaimpso imalembedwa mu matenda amtundu 1, ndiye kuti, amadalira insulin. Nephropathy imachitika mu 40-50% ya odwala matenda ashuga ndipo amadziwika kuti ndiye chifukwa chachikulu cha imfa chifukwa cha zovuta zomwe zili mgululi. Mwa anthu omwe akudwala mtundu wa 2 matenda (a insulin odziimira pawokha), nephropathy amalembedwa mwa milandu 15-30% yokha.

Impso za matenda ashuga

Zomwe zimayambitsa matendawa

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

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

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

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

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

Gulu

Masiku ano, madokotala pantchito yawo amagwiritsa ntchito gulu lomwe limavomerezeka malinga ndi gawo la matenda ashuga nephropathy malinga ndi Mogensen (wopangidwa mu 1983):

Koma nthawi zambiri m'mabuku ofotokoza pamakhala magawikidwe a matenda ashuga nephropathy potengera kusintha kwa impso. Magawo otsatirawa a matendawo amadziwika pano:

1. Hyperfiltration. Pakadali pano, magazi amatuluka m'magazi a impso (ndiye fungulo lalikulu), kuchuluka kwa mkodzo kumawonjezeka, ziwalo zimangokulira pang'ono kukula. Gawo limatenga zaka 5.
2. Microalbuminuria Uku kumawonjezera pang'ono kuchuluka kwa mapuloteni a albumin mu mkodzo (30-300 mg / tsiku), omwe njira zachilendo za labotale sizingadziwike. Ngati mungazindikire kusintha kwakanthawi ndikuwongolera chithandizo, gawo limatha pafupifupi zaka 10.
3. Proteinuria (m'mawu ena - macroalbuminuria). Apa, kuchuluka kwa kusefera kwa magazi kudzera mu impso kumachepetsa kwambiri, nthawi zambiri kumatha kulumikizidwa mwamphamvu kwambiri (BP). Mlingo wa albumin mu mkodzo panthawiyi umatha kuyambira 200 mpaka kuposa 2000 mg / tsiku. Gawoli limadziwika mchaka cha 1010 kuchokera pamene matenda adayamba.
4. Kwambiri nephropathy. GFR imachepera kwambiri, zombo zimakutidwa ndi kusintha kwa sclerotic. Imapezeka zaka 15 mpaka 20 pambuyo pakusintha koyamba kwa minyewa ya impso.
5. Kulephera kwa impso. Amawonekera zaka 20-25 zokhala ndi matenda ashuga.

Diabetesic Nephropathy Development Scheme

Magawo atatu oyamba a matenda a impso molingana ndi Mogensen (kapena nthawi ya hyperfiltration ndi microalbuminuria) amatchedwa preclinical. Pakadali pano, zizindikiro zakunja sizipezeka konse, kuchuluka kwamkodzo ndikwabwinobwino. Pazinthu zina zokha, odwala amatha kuwona kuwonjezeka kwakanthawi kwamapeto kumapeto kwa gawo la microalbuminuria.

Pakadali pano, ndi mayeso apadera okha ochulukitsa kutsimikiza a albumin mu mkodzo wa wodwala matenda ashuga omwe angadziwe matenda.

Gawo la proteinuria lili kale ndi zizindikiro zakunja:

• kulumikizidwa pafupipafupi m'magazi a magazi,
• Odwala amadandaula za kutupa (koyamba kutupa kwa nkhope ndi miyendo, kenako madzi amadziunjikira kumiyendo ya thupi),
• Kulemera kumatsika kwambiri ndikulakalaka kumachepa (thupi limayamba kugwiritsa ntchito mapuloteni kuti apange kuchepa),
• kufooka kwambiri, kugona,
• ludzu ndi mseru.

Pa gawo lomaliza la matendawa, zonse zomwe zili pamwambapa zimasungidwa ndikukula. Kutupa kumayamba kulimba, m'malovu akuwonekera mkodzo. Kuthamanga kwa magazi m'mitsempha ya impso kumakwera ndikuwopsa.

Zizindikiro

Kuzindikira kwa matenda a impso a shuga a shuga kumakhazikika pazisonyezo zazikulu ziwiri. Izi ndi mbiri ya wodwala wodwala matenda ashuga (mtundu wa matenda osokoneza bongo, matendawa amatenga nthawi yayitali, etc.) ndi zisonyezo za njira zofufuzira zasayansi.

Pa gawo prequinical chitukuko cha mtima kuwonongeka kwa impso, njira yayikulu ndi kuchuluka kwa kutsimikiza kwa albumin mu mkodzo. Kuti mupeze kusanthula, mwina mkodzo wonse patsiku, kapena mkodzo wam'mawa (kutanthauza gawo logona usiku).

Zizindikiro za Albumin zimayikidwa motere:

Njira ina yofunika yodziwira matenda ozizira ndi kuzindikiritsa magwiridwe antchito a impso (kuchuluka kwa GFR poyankha kukondoweza kwakunja, mwachitsanzo, kuyambitsa dopamine, katundu wa protein, ndi zina). Zomwe zimadziwika kuti ndizowonjezera GFR ndi 10% pambuyo pa njirayi.

Chizindikiro cha GFR index palokha ndi ≥90 ml / min / 1.73 m2. Ngati manambala agwera pansipa, izi zikuwonetsa kuchepa kwa impso.

Njira zowonjezera zowunikira zimagwiritsidwanso ntchito:

• Mayeso a Reberg (kutsimikiza kwa GFR),
• kusanthula kwa magazi ndi mkodzo,
• Ultrasound impso ndi Doppler (kudziwa kuthamanga kwa magazi m'mitsempha),
• kupweteka kwa impso (malinga ndi momwe munthu akuwonera).

M'magawo oyambilira, ntchito yayikulu pakuchiza matenda ashuga nephropathy ndikukhala wokwanira shuga komanso kuthana ndi matenda oopsa. Gawo la proteinuria likayamba, njira zonse zochiritsira ziyenera kukhala zothandiza kupewetsa kuchepa kwa impso ndi kuchitika kwa kulephera kwa impso.

Mankhwala otsatirawa amagwiritsidwa ntchito:

• ACE inhibitors - angiotensin otembenuza enzyme kuti akonzere kukakamiza (Enalapril, Captopril, Fosinopril, etc.),
• mankhwala osintha a hyperlipidemia, ndiko kuti, kuchuluka kwamafuta m'magazi ("Simvastatin" ndi ma statin ena),
• okodzetsa ("Indapamide", "Furosemide"),
• kukonzekera kwazitsulo pokonza magazi m'thupi, ndi zina zambiri.

Zakudya zomanga thupi zotsika pang'ono zimalimbikitsidwa kale m'magawo a matenda ashuga nephropathy - ndi hyperfiltration ya impso ndi microalbuminuria. Munthawi imeneyi, ndikofunikira kuchepetsa "gawo" la mapuloteni a nyama muzakudya za tsiku ndi tsiku mpaka 15-18% ya zonse zopatsa mphamvu. Uku ndi 1 g pa 1 makilogalamu a thupi la wodwala matenda ashuga. Mchere wamasiku onse umafunikanso kuchepetsedwa kwambiri - mpaka 3-5 g Ndikofunikira kuchepetsa kuchepa kwa madzimadzi kuti muchepetse kutupa.

Ngati gawo la proteinuria layamba, zakudya zina zapadera ndi njira yodziwika kale yothandizira odwala. Chakudyacho chimasanduka mapuloteni otsika - 0,7 g mapuloteni pa 1 kg. Kuchuluka kwa mchere womwe umadulidwa uyenera kuchepetsedwa monga momwe kungathekere, kuti 2-2,5 g patsiku.

Nthawi zina, odwala matenda ashuga nephropathy amapatsidwa mankhwala a amino acid kupatula thupi kuti ligawanike mapuloteni ena omwe amakhala nawo.

Hemodialysis ndi peritoneal dialysis

Kuyeretsa magazi mwa kupanga kwa hemodialysis ("impso ya kupanga") ndi dialysis nthawi zambiri kumachitika kumapeto kwa nephropathy, pomwe impso zakomwe sizingathe kuthana ndi kusefera. Nthawi zina hemodialysis imalembedwa kale, pomwe matenda a shuga akupezeka kale, ndipo ziwalo zimafunikira kuthandizidwa.

Pa hemodialysis, catheter imayikidwa mu mtsempha wa wodwala, wolumikizidwa ndi hemodialyzer - chida chosinthira. Ndipo dongosolo lonse limatsuka magazi a poizoni m'malo mwa impso kwa maola 4-5.

Njira ya peritoneal dialysis imachitika molingana ndi chiwembu chofananira, koma catheter yoyeretsa sanayikidwe mu mtsempha, koma mu peritoneum. Njirayi imagwiritsidwa ntchito pamene hemodialysis siyotheka pazifukwa zosiyanasiyana.

Kangati njira zoyeretsera magazi ndizofunikira, dokotala yekha ndi amene amasankha pamayeso a wodwala yemwe ali ndi matenda ashuga. Ngati nephropathy sinasunthire kulephera kwa aimpso, mutha kulumikiza "impso yakupangika" kamodzi pa sabata. Pamene ntchito ya impso ikutha, hemodialysis imachitika katatu pasabata. Peritoneal dialysis imatha kuchitidwa tsiku ndi tsiku.

Kuyeretsa kwa magazi kwa nephropathy ndikofunikira pamene cholumikizira cha GFR chikutsikira mpaka 15 ml / mphindi / 1.73 m2 ndi potencyum yayikulu kwambiri (oposa 6.5 mmol / l) yalembedwa pansipa. Komanso ngati pali chiwopsezo cha pulmonary edema chifukwa cha kuchuluka kwa madzi, komanso zizindikiro zonse za kuchepa kwa mapuloteni.

Kupewa

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

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

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

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:

• Kuthamanga kwa magazi kumayambitsa kukodza kwambiri, ndipo minyewa yolumikizana ikamakula, kusefedwa kumachepa kwambiri.
• shuga wamagazi atakhala kunja kwa masiku onse, njira zakukula za m'magazi zimapangika (shuga amawononga mitsempha yamagazi, magazi amayenda m'masokonekera, mafuta ochulukirapo, mapuloteni ndi zakudya zimadutsa impso), zomwe zimatsogolera kuwonongeka kwa impso pamaselo a ma cell,
• pali makonzedwe amtundu wamavuto amtundu wa impso, omwe motsutsana ndi maziko a shuga mellitus (shuga yayikulu, kusintha kwa kagayidwe kachakudya) kamabweretsa kuphwanya.

Masiteti ndi zizindikiro zawo

Matenda a shuga komanso matenda a impso samatenga masiku ochepa, zimatenga zaka 5-25. Gulu la odwala matenda ashuga nephropathy:

1. Gawo loyamba. Zizindikiro palibe. Njira zakuzindikirira ziziwonetsa kuchuluka kwa magazi mu impso ndi ntchito yawo yambiri. Polyuria mu shuga angayambike kuchokera gawo loyamba.
2. Gawo lachiwiri. Zizindikiro za matenda a shuga a nephropathy sanawonekere, koma impso zimayamba kusintha. Makoma a glomeruli amakula, minyewa yolumikizana imakula, ndipo kusefera kumakulirakulira.
3. 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.
4. 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.
5. Gawo lachigawo (uremia). Kulephera kwamphamvu m'magazi a shuga kumayamba ndendende nthawi imeneyi. Pathology imayendera limodzi ndi kuthamanga kwa magazi, edema, kuchepa magazi.

Zizindikiro za matenda ashuga oopsa:

• mutu
• Fungo la ammonia loyenda mkamwa.
• kupweteka mumtima,
• kufooka
• kupweteka pokodza
• kutaya mphamvu
• kutupa
• kupweteka kumbuyo
• kusowa chilakolako chofuna kudya
• kuwonongeka kwa khungu, kuuma,
• Kuchepetsa thupi.

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:

• urinalysis wa creatinine,
• kuyesa kwa mkodzo,
• kusanthula kwamkodzo kwa albumin (microalbumin),
• kuyezetsa magazi kwa creatinine.

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

Odwala odwala matenda ashuga ayenera kuyesedwa mosalekeza. 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:

• mbewu monga mkaka,
• supu zamasamba
• saladi
• chipatso
• masamba othandizira kutentha
• zopangidwa mkaka,
• mafuta a azitona.

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.

Matenda a shuga ndi oopsa kwa anthu osati kokha chifukwa cha chiwonetsero chake chachikulu, komanso zovuta zomwe zimadza chifukwa cha matendawa ndizovuta zambiri.

Matenda a diabetesic nephropathy amatha kudziwitsidwa ndi gulu la zovuta zazikulu za matenda ashuga a mitundu yonse iwiri, mawuwa amaphatikiza zovuta zowonongeka zimakhala zonse ndi mitsempha ya magazi a impso, yowonetsedwa ndi mitundu yosiyanasiyana ya matenda.

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.

1. 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.

1. 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.
2. 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.

Odwala omwe ali ndi matenda monga matenda ashuga, impso imakumana ndi vuto lalikulu, zomwe zimapangitsa kuti pakhale zovuta, chimodzi chomwe ndi matenda a shuga. Kuchuluka kwa matenda a impso a shuga mu shuga ndi 75%.

Zomwe zimayambitsa matendawa

Kodi matenda a shuga ndi nephropathy ndi ati? Awa ndi mawu ambiri pazovuta zambiri zomwe zimapangitsa kuwonongeka kwa impso mu shuga. Amatuluka chifukwa chophwanya zakudya za m'mimba ndi ma lipid metabolism mu glomeruli ndi tubules a impso.

Matenda a shuga ndi nephropathy ndi omwe amavutitsa kwambiri matenda ashuga onse. Pankhaniyi, impso zonse zimakhudzidwa. Ngati simutsatira zakudya zokhwima, ndiye kuti wodwala atha kulumala, chiyembekezo chake chamoyo chichepe. Diabetes nephropathy ndi mtsogoleri wazomwe zimayambitsa kufa kwa matenda ashuga.

Mankhwala amakono, pali malingaliro osiyanasiyana okula kwamatenda:

1. Mitundu. Chikhulupiriro ichi chikuti pathogenesis ya matenda ashuga nephropathy zimatengera kupezeka kwa chibadwa chathu. Odwala omwe ali ndi matenda ashuga, njira yoyambira yopanga zovuta zimagwira ntchito motsutsana ndi maziko amomwe amalephera munthawi ya kagayidwe kachakudya, komanso vuto la mtima.
2. Hemodynamic. Malinga ndi chiphunzitso ichi, chomwe chimayambitsa matendawa ndi kuphwanya koyenda kwamatenda a impso, zomwe zimapangitsa kuwonjezeka kwakukulu kwa kupanikizika mkati mwa glomeruli. Zotsatira zake, mkodzo woyamba umapangidwa mwachangu, zomwe zimapangitsa kuti mapuloteni awonongeke. Minofu yolumikizana imachulukana, kusokoneza magwiridwe antchito a impso.
3. Sinthana. Mafuta ochulukirapo amakhala ndi poizoni m'mitsempha ya impso, yomwe imasokoneza kagayidwe ndi magazi kulowa mthupi. Kukula kwa nephropathy kumachitika chifukwa cha kuchuluka kwa lipids, mapuloteni ndi zakudya zomwe zimadutsa impso.

Komabe, potengera zomwe akumana nazo, madokotala ambiri amati zomwe zimafotokozedwazo zimapangitsa pafupifupi matenda onse.

Kuphatikiza apo, pali zinthu zinanso zomwe zimathandizira kuti matendawa akhazikike mwachangu. Izi zikuphatikiza:

• shuga owonjezera
• kuthamanga kwa magazi
• kuchepa magazi
• chikumbumtima.

Zizindikiro ndi magawo a matendawa

Matenda a shuga ndi matenda oopsa. Chinyengo chake chimakhala chakuti kwa zaka zambiri wodwalayo sangakayikire chilichonse chokhudza mavuto a impso. Nthawi zambiri, odwala amatembenukira kwa dokotala pakaonekera zizindikiro za kulephera kwa impso, zomwe zikusonyeza kuti thupi silitha kulimbana ndi ntchito yake yayikulu.

Kusowa kwa zizindikiro kumayambiriro kumapangitsa kuti matendawo adziwe mochedwa. Ndiye chifukwa chake odwala onse kuti asatenge matenda amtunduwu, ndikofunikira kuti azichita kafukufuku wazaka zonse.Zimachitika m'njira yoyesera magazi kuti muwerenge kuchuluka kwa creatinine, komanso kuwunika mkodzo.

Mu matenda a diabetes nephropathy, Zizindikiro zimadalira gawo la matendawa. Poyamba, popanda kudziwika, matendawa amapita patsogolo, akukhudza kwambiri thanzi la wodwalayo. Gawo la matenda ashuga nephropathy:

Kugawidwa kwa matenda a shuga a nephropathy amachitika molingana ndi magawo omwe matendawa amadutsa. Motsatira kapangidwe kazinthu zam'mimba ndi kupitirira kwa matenda a shuga:

1. Hyperfiltration (kuchuluka kwa magazi mu glomeruli la impso, kukula kwa impso).
2. (kuchuluka mkodzo albumin).
3. Proteinuria, macroalbuminuria (kuchuluka kwa mapuloteni ochulukitsa mu mkodzo, kuwonjezeka kwa kuthamanga kwa magazi).
4. Nephropathy kwambiri, kuchepa kwa kuchuluka kwa kusefera kwa matumbo (zizindikiro za nephrotic syndrome).
5. Kulephera kwina.

Zimayambitsa kuwonongeka kwa impso mu shuga

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

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

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

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

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

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

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

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

Zizindikiro za Nephropathy

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

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

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

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

Kukula kwa kuchuluka kwa impso kwa mapuloteni kumayenderana ndi izi:

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

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

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

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

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

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

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

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

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

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

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

Njira zopezera nephropathy mu shuga

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

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

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

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

Njira zopewera komanso zochizira matenda a nephropathy

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

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

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

Njira zazikulu zamankhwala:

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

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

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

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

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

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

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

Mankhwala othandizira odwala matenda a shuga

Mukamasankha antihypertensive mankhwala ochizira odwala matenda a shuga, momwe zimawakhudzira kagayidwe kazakudya zam'mimba komanso lipid metabolism, pazotsatira zina za matenda osokoneza bongo komanso kutetezedwa ngati vuto laimpso liyenera kuzindikirika.

ACE inhibitors adanenapo katundu wa nephroprotective, kuchepetsa kuwonongeka kwa intracranial matenda oopsa ndi microalbuminuria (malinga ndi kafukufuku wa BRILLIANT, EUCLID, REIN, etc.). Chifukwa chake, zoletsa za ACE zimawonetsedwa kwa microalbuminuria, osati kokha ndi kuthamanga, komanso ndi kuthamanga kwa magazi:

• Captopril pakamwa 12.5-25 mg katatu patsiku, mosalekeza kapena
• Hinapril pakamwa 2.5-10 mg kamodzi patsiku, mosalekeza kapena
• Enalapril pakamwa 2.5-10 mg 2 kawiri pa tsiku, mosalekeza.

Kuphatikiza pa ACE inhibitors, otsutsana ndi calcium ochokera ku gulu la verapamil ali ndi nephroprotective ndi mtima.

Udindo wofunika kwambiri pa matenda oletsa kuthamanga kwa magazi umayimbidwa ndi angiotensin II receptor antagonists. Ntchito yawo ya nephroprotective mu mtundu wa 2 matenda a shuga ndi matenda ashuga amasonyezedwa m'maphunziro atatu akulu - IRMA 2, IDNT, RENAAL. Mankhwalawa amadziwikiratu vuto la ACE zoletsa (makamaka odwala 2 matenda a shuga):

• Valsartan pakamwa 8O-160 mg kamodzi tsiku lililonse, mosalekeza kapena
• Irbesartan pakamwa 150-300 mg kamodzi patsiku, mosalekeza kapena
• Condesartan cilexetil pakamwa 4-16 mg kamodzi tsiku lililonse, mosalekeza kapena
• Losartan pakamwa 25-100 mg kamodzi patsiku, mosalekeza kapena
• Telmisatran mkati 20-80 mg kamodzi patsiku, mosalekeza.

Ndikofunika kugwiritsa ntchito ACE inhibitors (kapena angiotensin II receptor blockers) kuphatikiza ndi nephroprotector sodeode, yomwe imabwezeretsa kuperewera kwa mbali zamkati mwa glomeruli la impso ndikuchepetsa kuwonongeka kwa mapuloteni mu mkodzo.

• Sulodexide 600 LU intramuscularly 1 nthawi patsiku 5 masiku sabata ndikupumula kwa masiku awiri, masabata atatu, ndiye mkati mwa 250 LU kamodzi patsiku, miyezi iwiri.

Ndi kuthamanga kwa magazi, kugwiritsa ntchito mankhwala osakanikirana ndikofunikira.

Chithandizo cha dyslipidemia mu matenda ashuga nephropathy

70% ya odwala matenda ashuga omwe amakhala ndi matenda ashuga nephropathy gawo IV ndipo pamwambapa ali ndi dyslipidemia. Ngati matenda a lipid metabolism apezeka (LDL> 2.6 mmol / L, TG> 1.7 mmol / L), kukonza kwa hyperlipidemia (zakudya zopatsa lipid) ndizovomerezeka, osakwanira - mankhwala a lipid-kuchepetsa.

Ndi LDL> 3 mmol / L, kuchuluka kwa ma statins kumasonyezedwa:

• Atorvastatin - mkati 5-20 mg kamodzi patsiku, kutalika kwa mankhwala kumatsimikiziridwa payekha kapena
• Lovastatin mkati 10-40 mg kamodzi patsiku, kutalika kwa mankhwala kumatsimikiziridwa payekha kapena
• Simvastatin mkati 10-20 mg kamodzi patsiku, nthawi ya mankhwala imatsimikiziridwa payekhapayekha.
• Mlingo wama statins amakonzedwa kuti akwaniritse chandamale LDL
• Mu hypertriglyceridemia yokhayokha (> 6.8 mmol / L) ndi GFR yachilendo, mafupa awonetsedwa:
• Oral fenofibrate 200 mg kamodzi patsiku, kutalika mtima payekha kapena
• Waprofibrate mkati mwa 100-200 mg / tsiku, kutalika kwa mankhwala kumatsimikiziridwa payekhapayekha.

Kubwezeretsanso kwa intracubular hemodynamics pamlingo wa microalbuminuria kungatheke pokhapokha kuchepetsa kumwa mapuloteni a nyama 1 g / kg / tsiku.

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

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 matenda a impso kulephera, monga lamulo, monotherapy sichitha kukhazikika kwa magazi, chifukwa chake, tikulimbikitsidwa kuti pamodzi ndi mankhwala othandizira antihypertensive,Okhala 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.

Chithandizo cha matenda ashuga nephropathy mu kudwala siteji ya aimpso kulephera

Ku United States of America ndi maiko angapo ku Europe (Sweden, Finland, Norway), matenda osokoneza bongo adatulukira bwino mu dongosolo lonse la matenda a impso omwe amafunikira chithandizo chamankhwala a extracorporeal. Nthawi yomweyo, kuwonjezeka kwa odwala koteroko kunawonjezeka kwambiri. Zizindikiro zina zakunja kwa matenda aimpso kulephera kwa matenda osokoneza bongo zimawonekera kale kuposa odwala omwe ali ndi matenda a impso. Zizindikiro za dialysis kwa odwala omwe ali ndi matenda osokoneza bongo ndi kuchepa kwa GFR mpaka 15 ml / min ndi serum creatinine wambiri kuposa 600 μmol / l.

Pakadali pano, pali njira zitatu zochiritsira odwala omwe ali ndi vuto lothana ndi vuto la impso - hemodialysis, peritoneal hemodialysis, ndi kupatsirana kwa impso.

Ubwino wopitilira dialysis:

• njira ya machiritso a magazi imachitidwa katatu pa sabata (osati tsiku ndi tsiku),
• kuwunikira pafupipafupi ogwira ntchito zachipatala (katatu pa sabata),
• kupezeka kwa njira kwa odwala omwe ataya kuwona (kulephera kudzisamalira).

Zovuta za kuyimba kosalekeza:

• kuvuta popereka mphamvu ya mtima (chifukwa cha kuchuluka kwa ziwiya zowonongeka),
• kukulira kwa kusokonezeka kwa hemodynamic,
• zovuta pakuwongolera kuthamanga kwa magazi,
• kupita patsogolo kwamphamvu kwa matenda amtima,
• kupitirira kwa retinopathy,
• kuvutika kuyang'anira glycemia,
• kudziphatikiza kosatha kuchipatala.

Chiwopsezo cha kupulumuka kwa odwala omwe ali ndi matenda a shuga ku hemodialysis ndi 82% patatha chaka chimodzi, 48% patatha zaka zitatu, ndi 28% pambuyo zaka 5.

Ubwino wa peritoneal dialysis:

• sifunikira chithandizo chakanthawi (chololedwa panyumba),
• imapereka zambiri zokhazikika za systemic ndi aimpso hemodynamics,
• imapereka chilolezo chambiri cha mamolekyulu oopsa,
• amakulolani kupereka insulin mwachangu,
• palibe zotheka mtima
• 2-3 nthawi zotsika mtengo kuposa hemodialysis.

Zovuta za peritoneal dialysis:

• njira za tsiku ndi tsiku (4-5 patsiku),
• kuthekera kodziyimira pawokha kuchititsa kuti pakuwoneke,
• chiopsezo cha peritonitis,
• kupitirira kwa retinopathy.

Malinga ndi United States of America ndi Europe, kuchuluka kwa odwala omwe ali ndi matenda a shuga ku peritoneal dialysis sikukutsika kuposa komwe kumachitika pa hemodialysis, ndipo kwa odwala omwe ali ndi matenda osokoneza bongo amakhala okwera kwambiri kuposa momwe amagwiritsira ntchito hemodialysis. Chiwopsezo cha kupulumuka kwa odwala omwe ali ndi matenda a shuga mellitus on perponeent dialysis (CAPD) yachaka chatha ndi chaka choyamba ndi 92%, zaka 2 - 76%, zaka 5 - 44%.

Ubwino wopatsirana impso:

• machiritso athunthu a kulephera kwa impso nthawi yomwe akufalikira,
• kukhazikika kwa retinopathy,
• kukonzanso kwa polyneuropathy,
• kukonza bwino
• kupulumuka kokwanira.

Zovuta za kupatsirana kwa impso:

• kufunika kwa opaleshoni,
• chiopsezo chokanidwa,
• zovuta kuperekera kagayidwe kachakudya poyamwa mankhwala a steroid,
• chiopsezo chachikulu cha zovuta zopatsirana chifukwa cha kugwiritsa ntchito ma cytostatics,
• Kukonzanso kwa matenda ashuga glomerulosulinosis mu impso yotsekedwa.

Kupulumuka kwa odwala omwe akuwonjezeka impso kwa chaka chimodzi ndi 94%, zaka 5 - 79%, zaka 10 - 50%.

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.

Zoyambitsa Nephropathy

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

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

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

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

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

Zosankha: Matenda a shuga a shuga ndi matenda amitsempha chifukwa cha matenda a impso.

Zizindikiro za kupezeka kwa DN

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

Pachizindikiro choyamba, funsani katswiri kuti musayambitse matenda!

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

Njira zoyesera

Kuti mupewe zovuta zovuta komanso kuti mupeze zomwe zimayambitsa matenda mu nthawi, ndikofunikira kuti muzindikire kamodzi pachaka kwa odwala omwe ali ndi matenda amtundu wa 1 komanso a 2.

Kuzindikira koteroko kumaphatikizapo:

• kuyesa kwamagazi ndi kwamilandu yambiri,
• kupenda kwamkodzo kambiri ndi kawonedwe kazinthu zosiyanasiyana.
• kusanthula kwa mkodzo malinga ndi njira ya Zimnitsky,
• kusanthula kwa mkodzo malinga ndi Reberg,
• Ultrasound ya impso ziwiya.

Mlingo wa kusefera wa glomerular ndi microalbuminuria ndizizindikiro zazikulu zomwe zingagwiritsidwe ntchito kudziwa diabetesic nephropathy kumayambiriro kwa chitukuko chake.

Gawo la proteinuria limatha kupezeka pamaso pa mapuloteni mumkodzo, ngakhale mutapanda kuganizira za zolumikizika (kuthamanga kwa magazi, kutupa, ndi zina). Gawo lomaliza la matendawa silovuta kudziwa, kuwonjezera pa kuchepa kwakukulu kwa kusefedwa komanso kutchulidwa kwa proteinuria, ma pathologies ena amalowa (hyperphosphatemia, hypocalcemia, azotemia, kuchepa magazi, kuchuluka kwa magazi a metabolinine, kutupa ndi ena).

Ngati wodwala akudwala matenda a impso (glomerulonephritis, pyelonephritis, ndi ena otero), njira zowonjezera zokhudzana ndi iwo zimachitika, monga:

• Ultrasound a impso
• urinalysis kwa microflora,
• malingaliro owerengeka,
• biopsy (makamaka ndi kufalikira kwamatenda).

Choyamba, pothana ndi mavuto a shuga ndi impso, muyenera kudya mchere wochepa monga momwe mungathere. Izi zimathandizira kuchepetsa edema, kuthamanga kwa magazi komanso kuchepetsa kuchepa kwa matendawa. Mukapanikizika, simungadye mchere wambiri wopitilira 6 patsiku. Ngati muli ndi hypertonic - osaposa 2 g.

Akatswiri amalangizidwa kuti azikhala ndi zakudya zoyenera kwa odwala matenda ashuga, komanso nephropathy - kuchepetsa kuchuluka kwa mapuloteni mpaka ochepa. Sizoletsedwa kudya nyama, mkaka, ufa, mafuta.

Cholinga cha kadyedwe ndikuwapatsa thupi kuchuluka kwa chakudya chochuluka ndi mchere wambiri. Wodwala amayenera kumwa madzi ambiri, chifukwa ndi kukodza kwa poizoni wambiri m'thupi.

Chimodzi mwazakudya zambiri: pakudya cham'mawa mumatha kudya oatmeal mkaka kapena vinaigrette, nthawi zina cutlets kabichi. Kwa nkhomaliro - saladi wa masamba kapena msuzi wopanda nyama. Chakudya chamadzulo - kolifulawa mu mkate, mapira apulosi. Usiku amaloledwa kumwa kefir.

Mkate suyenera kumadyedwa osaposa 300 magalamu, shuga - osaposa 30 magalamu. Zakudya zimakonzedwa popanda mchere.Mutha kumwa tiyi (wokhazikika kapena ndi ndimu) kapena khofi ndi mkaka.

Sizotheka kugwiritsa ntchito zakudya zokhala ndi mapuloteni obzala masamba nthawi zonse, kutengera zomwe amakonda ndi zomwe wodwala amadya. Nthawi zina katatu kapena kanayi pa sabata ndizokwanira.

Kutsatira malingaliro onse a madokotala kumene kumakuthandizani kuti muchepetse magazi ndikuwonjezera thanzi lanu.

Mankhwalawa a matenda a shuga a nephropathy pa gawo lililonse ndi osiyana.

Mu magawo oyamba ndi achiwiri a chitetezo chokwanira kuyambira pomwe matenda a shuga akhazikitsidwa, pofuna kupewa kusintha kwa m'mitsempha ndi impso. Mulingo wokhazikika wa shuga m'thupi umapangidwanso mothandizidwa ndi mankhwala omwe amachepetsa mulingo wake.

Pa gawo la microalbuminuria, cholinga cha mankhwalawa ndikutanthauza kuchepa kwa magazi, komanso shuga wamagazi.

Akatswiri amatembenukira ku angiotensin-converting enzyme inhibitors (ACE inhibitors): Enalapril, Lisinopril, Fosinopril. Mankhwalawa amathandizira kuthamanga kwa magazi, kukhazikika kwa impso. Mankhwalawa okhala ndi mphamvu yayitali, omwe samamwa mopitilira kamodzi patsiku, ndiwo akufunika kwambiri.

Zakudya zimapangidwanso momwe mapuloteni sayenera kupitirira 1 mg pa 1 kg ya wodwala.

Pofuna kupewa njira zosasinthika, magawo atatu oyamba a matenda a impso, ndikofunikira kuwongolera glycemia, dyslipidemia ndi kuthamanga kwa magazi.

Pa siteji ya proteinuria, limodzi ndi ACE zoletsa, calcium blockers ndi omwe amapatsidwa. Amalimbana ndi edema mothandizidwa ndi okodzetsa (Furosemide, Lasix, Hypothiazide) ndikutsatira regimen. Kukhala ndi chakudya chopatsa mphamvu. Cholinga cha mankhwalawa pakadali pano ndikuthandizira kuti magazi azithamanga komanso magazi azithamanga kuti magazi asiye kulephera.

Pomaliza la matenda a shuga a nephropathy, mankhwalawa ndi akulu. Wodwala amafunikira dialysis (kuyeretsa magazi kuchokera ku poizoni. Kugwiritsa ntchito chipangizo chapadera) kapena kumuika impso.

Dialyzer imakulolani kuyeretsa magazi a poizoni

Thanzi la odwala matenda ashuga nephropathy liyenera kukhala ochepa mapuloteni, osakwanira komanso odzola ndi michere yofunika kuti mukhale ndi thanzi labwino la odwala matenda ashuga. M'magawo osiyanasiyana a pathological process mu impso, zakudya zapamwamba zama protein ochepa 7P, 7a ndi 7b zimagwiritsidwa ntchito, zomwe zimaphatikizidwa ndi chithandizo chovuta cha zovuta.

Pambuyo pokambirana ndi dokotala, ndizotheka kugwiritsa ntchito njira zina. Sangakhale ngati chithandizo chodziyimira pawokha, koma chokwanira chothandizira cha mankhwala: