Matenda a shuga - nephropathy: mawonekedwe a matenda ndi njira zamankhwala

Tanthauzo la "matenda ashuga nephropathy" ndi lingaliro lophatikiza lomwe limaphatikiza zovuta za matenda zomwe zimapangitsa kuwonongeka kwa mtima mu impso motsutsana ndi maziko a matenda a shuga oopsa.

Nthawi zambiri mawu akuti "Kimmelstil-Wilson syndrome" amagwiritsidwa ntchito pothandiza matenda awa, chifukwa malingaliro a nephropathy ndi glomerulossteosis amagwiritsidwa ntchito ngati mawu amodzimodzi.

Pa ICD 10, 2 code imagwiritsidwa ntchito pa matenda ashuga nephropathy. Chifukwa chake, code ya matenda ashuga a nephropathy malinga ndi ICD 10 imatha kukhala ndi onse a E.10-14.2 (shuga mellitus ndi kuwonongeka kwa impso) ndi N08.3 (zotupa za glomerular mu shuga). Nthawi zambiri, kuwonongeka kwa impso kumawoneka modalira insulin, mtundu woyamba - 40-50%, ndipo mu mtundu wachiwiri wa nephropathy ndi 15-30%.

Zifukwa zachitukuko

Madokotala ali ndi malingaliro atatu ofunikira pazomwe zimayambitsa nephropathy:

kusinthana. Chofunika pa chiphunzitsocho ndichakuti gawo lalikulu lowononga limadziwika ndi kuchuluka kwa glucose m'magazi, chifukwa chomwe magazi amitsempha amasokonekera, ndipo mafuta amayikidwa mumitsempha, yomwe imatsogolera ku nephropathy,
chibadwa. Ndiye kuti, cholowa chamtsogolo ku matendawa. Tanthauzo la chiphunzitsochi ndikuti ndi mitundu ya majini yomwe imayambitsa matenda monga matenda ashuga komanso matenda a shuga.
hemodynamic. Chiphunzitsochi ndichakuti ndi matenda ashuga pali kuphwanya hemodynamics, kutanthauza magazi mu impso, zomwe zimapangitsa kuchuluka kwa albumin mkodzo - mapuloteni omwe amawononga mitsempha yamagazi, kuwonongeka komwe kumakhala kovuta (sclerosis).

Kuphatikiza apo, zifukwa zomwe zimapangidwira kukula kwa nephropathy malinga ndi ICD 10 nthawi zambiri zimaphatikizapo:

kusuta
shuga wamagazi ambiri
kuthamanga kwa magazi
triglycerides osauka ndi cholesterol
kuchepa magazi

Nthawi zambiri, matenda otsatirawa amapezeka mu gulu la nephropathy:

matenda ashuga glomerulossteosis,
aimpso mtsempha wamagazi,
aimpso canal necrosis,
mafuta m'mitsempha ya impso,
pyelonephritis.

Choyamba, ndikofunikira kunena kuti shuga imatha kukhala yowononga impso za wodwalayo kwanthawi yayitali, ndipo wodwalayo sadzakhala ndi zosasangalatsa.

Nthawi zambiri, zizindikiro za matenda a shuga a nephropathy zimayamba kupezeka panthawi yomwe kulephera kwa impso kumayamba.

Panthawi yam'mbuyomu, odwala amatha kuwonjezeka kuthamanga kwa magazi, proteinuria, komanso kuwonjezeka kwa 15-25%. Pa kupita patsogolo, odwala ali ndi diuretic-immune nephrotic syndrome, matenda oopsa, komanso kutsika kwa kusefukira kwa glomerular. Gawo lotsatira - matenda a impso - amadziwika ndi kukhalapo kwa azotemia, aimpso osteodystrophy, ochepa matenda oopsa komanso kulimbikira kwa edematous syndrome.

M'magawo onse azachipatala, neuropathy, hypertrophy yamanzere yamanzere, retinopathy ndi angiopathy amapezeka.

Kodi imapezeka bwanji?

Kuti mudziwe nephropathy, mbiri ya wodwala ndi mayeso a labotale imagwiritsidwa ntchito. Njira yayikulu mu gawo loyambirira ndi kudziwa mulingo wa albumin mumkodzo.

Njira zotsatirazi zingagwiritsidwe ntchito kuzindikira matenda a shuga ndi nephropathy malinga ndi ICD 10:

kutsimikiza kwa GFR pogwiritsa ntchito mayeso a Reberg.
impso.
Dopplerography ya impso ndi zotengera zotumphukira (ultrasound).

Kuphatikiza apo, ophthalmoscopy ithandizanso kudziwa mtundu ndi gawo la retinopathy, ndipo electrocardiogram ithandizanso kuzindikira hypertrophy yamanzere yamanzere.

Matenda a shuga amawopa mankhwalawa, ngati moto!

Muyenera kungolemba ...

Pochiza matenda a impso, chikhalidwe chachikulu ndicho kuvomerezedwa kwa matenda a shuga. Udindo wofunikira umachitika ndi kufalikira kwa matenda a lipid ndi kukhazikika kwa kuthamanga kwa magazi. Nephropathy amathandizidwa ndimankhwala omwe amateteza impso komanso kutsitsa magazi.

Zitsanzo za zakudya zomwe zimakhala ndi mafuta osavuta

Njira imodzi yochiritsira ndi kudya. Zakudya za nephropathy ziyenera kukhala kuchepetsa kuchuluka kwa zopatsa mphamvu zamafuta ndipo zimakhala ndi mapuloteni ofunikira.

Mukamadya, madzi sakhala ochepa; Komanso, madziwo amayenera kukhala ndi potaziyamu (mwachitsanzo, madzi osaphatikizika). Ngati wodwalayo achepetsa GFR, zakudya zama protein ochepa, koma nthawi yomweyo zimakhala ndi kuchuluka kwa zopatsa mphamvu, zimalimbikitsidwa. Ngati nephropathy ya wodwala ikuphatikizidwa ndi matenda oopsa, magazi ochepa mchere amalimbikitsidwa.

Palliative aimpso mankhwala

Ngati wodwala akuchepetsa kwambiri kuchuluka kwa kusungunuka kwa glomerular ku chisonyezo chotsika ndi 15 ml / mphindi / m2, dokotala wopanga amapanga lingaliro loti ayambirenso kulandira chithandizo chamankhwala, chomwe chingayimiridwe ndi hemodialysis, peritoneal dialysis kapena kupatsidwa zina.

Chinsinsi cha hemodialysis ndikudziyeretsa magazi ndi zida "zochitira impso". Ndondomeko ziyenera kuchitidwa katatu pa sabata, pafupifupi maola 4.

Peritoneal dialysis imaphatikizapo kuyeretsa magazi kudzera mu peritoneum. Tsiku lililonse, nthawi 3-5 wodwala amapaka jakisoni ndi dialysis solution mwachindunji pamimba. Mosiyana ndi hemodialysis pamwambapa, peritoneal dialysis imatha kuchitika kunyumba.

Kuthana kwa impso ndi njira yowonjezereka yolimbana ndi nephropathy. Pankhaniyi, wodwalayo ayenera kumwa mankhwala omwe amachepetsa chitetezo cha mthupi pofuna kupewa kukana.

Njira zitatu zopewera

Njira yodalirika yopewera kukula kwa nephropathy ndi chindapusa chovomerezeka cha matenda ashuga:

Kupewera kwakukulu ndikupewa wa microalbuminuria. Zinthu zazikuluzikulu zomwe zingayambitse kukula kwa microalbuminuria ndi: kutalika kwa shuga kuyambira zaka 1 mpaka 5, cholowa, kusuta fodya, retinopathy, hyperlipidemia, komanso kusowa kwa malo omwe amagwira ntchito aimpso.
Kupewera kwachiwiri kumakhala kukuchepetsa kukula kwa matendawa kwa odwala omwe athetse kale GFR kapena kiwango cha albumin mkodzo wambiri kuposa wabwinobwino. Gawo ili la kupewa limaphatikizapo: chakudya chama protein ochepa, chiwongolero cha magazi, kukhazikika kwa mawonekedwe a lipid m'magazi, kayendetsedwe ka glycemia komanso matenda a intrarenal hemodynamics,
kupewa kwapamwamba kumachitika pa gawo la proteinuria. Cholinga chachikulu cha siteji ndikuchepetsa chiopsezo cha kuchepa kwa impso, komwe, kumadziwika ndi: matenda oopsa, chindapusa chokwanira cha kagayidwe kazakudya, proteinuria yayikulu ndi hyperlipidemia.

Makanema okhudzana nawo

Pazifukwa ndi chithandizo cha matenda a nephropathy mu shuga muwonetsero wa TV "Live wathanzi!" Ndi Elena Malysheva:

Ngakhale kuti pakati pa zovuta zonse za matenda a shuga, nephropathy ndi amodzi mwa malo otsogola, kuyang'anira mosamala njira zopewera kuphatikiza ndi kupezeka kwa nthawi yeniyeni komanso chithandizo choyenera chithandizira mochedwa kukula kwa matendawa.

Zolemba za asayansi pa mutu wa "Diabetesic nephropathy: njira zamakono zamankhwala"

UDC 616.61 -08-02: 616.379-008.64.001

DIABETIC NEPHROPATHY: NTHAWI ZABWINO ZOPHUNZITSIRA TULI

Department of Propaedeutics of Internal Matenda, St. Petersburg State Medical University Acad. I.P. Pavlova, Russia

Mawu ofunika: matenda a shuga, matenda ashuga nephropathy.

Diabetesic nephropathy (DN) pakali pano ndiyomwe imapangitsa kwambiri kufooka kwa matenda a mafupa. Kuwonjezeka kwa odwala amtunduwu ndikodabwitsa kwambiri - mu 1984, kwa odwala omwe akufuna chithandizo cha impso, 11% ku Europe ndi 27% ku USA anali odwala ndi DN, mu 1993 ziwerengerozi zinali 17% ndi 36%, motero 46 , 47. Kuwonjezeka kwa zochitika za kulephera kwa mtima mu gawo la kufooka kwa impso kumalumikizidwa ndi kuwonjezereka kwa pafupipafupi kwa matenda a shuga mellitus (DM) pawokha, makamaka a mtundu II chifukwa cha kukalamba kwa anthu komanso kuchepa kwa kufa chifukwa cha zovuta zamtima. Mwachitsanzo, ziwerengero zotsatirazi zitha kutchulidwa: kuyambira 1980 mpaka 1992, kuchuluka kwa odwala omwe ali ndi matenda ashuga omwe ali ndi PN pazaka 25-44 kwachulukitsa ndi kawiri, munthawi imodzimodziyo chiwerengero cha odwala matenda a shuga azaka zopitilira 65 adachulukitsa ka 10. Popeza kuchuluka kwapakati pakupezeka kwa matenda ashuga komanso kukula kwa proteinuria yotsala pafupifupi zaka 20, ziwerengerozi zikusonyeza kuti zaka 10 mpaka 15, odwala omwe ali ndi matenda ashuga omwe amafunikira njira yothandizira kupatsanso impso - dialysis, kupatsirana kwa impso - ndi zotsatirapo zonse, zitha kugunda Europe. chifukwa chake zachuma ndi zamankhwala. Komanso, kuchuluka kwa odwala omwe ali ndi matenda ashuga omwe ali ndi njira zamankhwala izi ndi kotsika kwambiri poyerekeza ndi njira zina za impso, makamaka chifukwa cha zovuta zamtima 20,23. Zomwe zidatchulidwa pamwambapa zidapanga gawo la kupita patsogolo ndi chithandizo cha DN

Pakadali pano chinthu chomwe chikuyenera kuyang'aniridwa ndi akatswiri azachipatala padziko lonse lapansi.

Njira zothandizira kupewa komanso kuchepetsa kufalikira kwa DN zachokera pamalingaliro amakono pazinthu zosiyanasiyana za pathogenetic zamatenda, mwa zomwe ndizosakwanira pakulamulira kwa glycemic, mapangidwe apamwamba a glycosylation, glomerular hypertension-hyperfiltration motsutsana ndi maziko a kuchuluka kwa magazi ndi dongosolo la aimpso angiotensin .

Glycemic control

Kusakwanira kwa shuga wamagazi m'magazi a shuga, komanso chikhomo chake, kuchuluka kwa glycosylated hemoglobin, kumalumikizidwa kwambiri ndi kukhazikitsidwa kwa ma cellansopathies amtundu woyamba I ndikulemba matenda ashuga II ndipo, makamaka, ndikuyamba kwa magawo oyamba a DN. The pathological limagwirira a hyperglycemia imayang'aniridwa ndi njira zingapo, kuphatikiza kuchuluka kwa zinthu zopanda enzymatic glycosylation, kusokonekera kwa myoinositol metabolism, kuchuluka kwa diacylglycerol ndi kutsegula kwa protein kinase C, komanso kusintha kwama protein ndi kukula kwa zinthu, makamaka, kusintha kwa zinthu (PG). gawo lofunikira pakukula kwa glomerular hypertrophy 22, 52. Komabe, zawonetsedwa kuti kuwongolera glycemic kolimba, palokha, kumachepetsa kukula kwa kufalikira kwa aimpso. atochnosti odwala ndi shuga lembani Ine ndi proteinuria. Komabe, zikuwoneka kuti ngati kuyang'anitsitsa kwa matenda ashuga kumayambitsidwa asanayambike zovuta za impso, ndiye kuti izi zingalepheretse kukula kwawo mtsogolo. Chifukwa chake, kafukufuku wa DCCT adawonetsa

kutsika kwa pafupipafupi osati proteinuria ndi PN kokha kumbuyo kwa chithandizo champhamvu cha hyperglycemia, komanso kuchepa kwakukulu kwa pafupipafupi kwa microalbuminuria, chikhomo cha magawo oyamba a DN. Kuchepetsa chiopsezo cha kugundika kwa mtima kunachokera 40% mpaka 60%. Kuyang'anitsitsa kwa glycemia kumabweretsa chiwonjezero cha kufewetsa pang'ono, komanso kumalepheretsa kuwonekera kwa kusintha kwamkati kwa impso. Chifukwa chake, kuwongolera mwamphamvu milingo ya glycemia kuyambira pachiyambi pomwe cha matenda ashuga ndikofunikira kwambiri poletsa kukula kwa zovuta za matenda a shuga.

Mtengo wazogulitsa

glycosylation ndi kukonza kwawo

Zikuwoneka kuti, zotsatira za hyperglycemia pa impso zimachitika makamaka chifukwa cha kuchuluka kwa mapuloteni a glycosylation (BCP). Zinawonetsedwa kuti zopangidwa ndi zophatikizika zomwe sizimapanga enzymatic zomanga thupi ndi glucose zimadziunjikira tiziwalo timene timayambitsa odwala omwe ali ndi matenda ashuga, kuphwanya kapangidwe kake ka maturusimu a extracellular, zomwe zimapangitsa kukula kwa mzere wapansi ndi kuwonjezeka koyandikira kwambiri osalimba a lipoprbgeids ndi immunoglobulin c. Kuphatikiza apo, PPG imayambitsa masinthidwe angapo amomwe amachititsa kuti kukanika kwa mtima kugwiritse ntchito, kuwonjezeka kwa masanjidwe amkati a extracellular, ndi glomerulossteosis. Zosintha pantchito za maselo a PPG zimatulutsidwa kudzera pamagawo olingana a receptor pamwamba pawo. Zadziwika pamitundu yosiyanasiyana ya maselo - prieloid, lymphoid, monocyte-macrophage, endothelial, yosalala-minofu, fibroblasts, i.e. maselo okhudzidwa mwachindunji pakupanga ndi kupitirira kwa aimpso. Kuphatikiza kwa PPG pachikhalidwe cha maselo a mesangial kumabweretsa kuwonjezeka kwa mRNA ndi kuwonjezeka kwa kupanga kwa fibronectin, mtundu wa collagen lam lam IV ndi platelet grow factor (ROOP), chinthu chofunikira kwambiri mu glomerulosulinosis 14, 47.

Kufunika kwachipatala kwa BCP pakupezeka ndi kupitilira kwa DN kumatsimikiziridwa ndi kuyang'anira kwa nyama zopanda zizindikiro za matenda ashuga. Poyerekeza ndi kugwiritsidwa ntchito kwa nthawi yayitali kwa PPG, chithunzi cha morphological ndi zizindikiro za DN zimayamba. Nthawi yomweyo

mogwirizana makonzedwe a aminoguanidine, mankhwala omwe amachepetsa mapangidwe a BCPs, kapena kutsata ma monoclonal antibodies to glycosylated albumin kwambiri amachepetsa kuopsa kwa kusintha kwamatenda a 15, 47. Zoyesa zamankhwala aminoguanidine mwa odwala pakali pano sizokwanira. Tsopano gawo lachitatu la mayeso likuchitika kwa mtundu woyamba wa shuga ndi DN mu gawo la proteinuria, zomwe ziwonetsetse ngati kuchuluka kwa matendawa kumatsika ndikugwiritsa ntchito amino1uanidine mwa anthu.

Phindu la glomerular hypertension / hyperfiltration pakukula kwa DN ndi njira zazikulu zakukonzedwera

Mu 80s, ubale wapamtima udawonetsedwa, wofanana ndi womwe umakhudzana ndi kuchuluka kwa kayendedwe ka magazi ndi kusintha kwa ma arterioles, koma pokhudzana ndi kuchuluka kwa kuthamanga kwa magazi ndi kuthamanga kwake pakukhululuka, kuwonongeka kwa endothelial, ma capillary microthrombosis, ndi glomerulosulinosis 49, 50. kuphatikiza arteriole chifukwa cha kukanika kwa kayendedwe ka kayendedwe ka magazi ndi kuphipha kwa mphamvu ya arteryole motsutsana ndi maziko akuwonjezera chidwi chake ndi makina oikizira - angiotens ndipo, - noradrenaline, vasopressin, 3, 5, imbaenda chinawonjezeka kwapakati pa-glomerular kuthamanga. Mphamvu yama makina pakhoma la glomerular capillary imapangitsa kuwonjezereka kwa mitundu ya mitundu I ndi IV ya collagen, laminin, fibronectin, ndi TCR- (3, yomwe, pamapeto pake, imabweretsa kuwonjezereka kwa matrix a extracellular, kenako glomerulosranceosis 16, 28. Hyperfiltration, mwachiwonekere, zinthu zotsatirazi ndizofunikira: zokhudza kuchepa kwa magazi (mwa kuchuluka kwa kukakamira pakhomo la glomerulus), kutsegula kwa dongosolo la impso-renin-angiotensin ndi chitukuko cha kuphipha kwa mphamvu ya arteryole, hypergly kudya zam'mimba kwambiri.

Kutsatsa kwa mapuloteni muzakudya

Zaka makumi atatu zokumana nazo pogwiritsa ntchito mapuloteni ochepetsetsa zimawonetsa phindu lake pochepetsa kuchepa kwa matenda a impso, kuphatikizapo

ndi NAM. Tsoka ilo, kafukufuku wina wawukulu pazakudya zama protein ochepa wotsika P8 (M01J) sanaphatikizepo odwala matenda ashuga ndi DM. Komabe, pambuyo pake imagwira ntchito, kuwonetsa bwino zotsatira zakuchepetsa kudya kwa mapuloteni pamlingo wakuchepa kwa ntchito yaimpso kwa odwala omwe ali ndi DN yokhala ndi matenda a shuga a mtundu woyamba ndi PN yoyambirira adawonetsedwa. Zakudya zama protein tsiku lililonse mu kafukufukuyu zinali zochepa 0,6 g / kg. Ndikofunika kudziwa kuti kuchuluka kwa mapuloteni oterewa kwa nthawi yayitali (mpaka zaka 5) sikunayambitse zovuta zina - kusowa bwino mu chakudya, kusintha kwa lipid mbiri ya magazi, kapena mtundu wa kayendetsedwe ka glycemia. Zabwino pazakudya izi pokhudzana ndikusungidwa kwa impso zimatha kupezeka ngakhale kwa odwala omwe ali ndi zovuta zoyambirira ku GFR yoposa 45 ml / min. Chifukwa chake, kuchepetsa kudya mapuloteni kuyenera kukhala kale pazisonyezo zoyambirira za PN.

Chithandizo chamankhwala ochepetsa mapuloteni otsika amafotokozedwa ndikuti zimapangitsa kutsika kwa ma hyperfiltration mu nephrons yotsala, yomwe ndi imodzi mwazinthu zazikulu za pathophysiological zomwe zimatsogolera pakupanga glomerular sclerosis.

Dongosolo la kuthamanga kwa magazi

Chiwerengero chachikulu cha kafukufuku chikuwonetsa kuti odwala omwe ali ndi matenda a shuga omwe amadalira insulin komanso matenda aimpso, kuchepa kwa kuchuluka kwa matenda oopsa a magazi amachepetsa kuchepa kwa PN 11, 31.33. Tiyenera kudziwa kuti m'mabuku osimbidwa, kuthamanga kwa kuthamanga kwa magazi kunali kwakukulu kwambiri ndipo kukonzanso kwathunthu sikunachitike. Ngakhale izi, zotsatira za mankhwala a antihypertensive pokhudzana ndi kuteteza ntchito yaimpso zinali zosiyaniratu, chifukwa chake tingayembekezere kuti kuwongolera kwathunthu kwamwazi wamagazi kumakhala kothandiza kwambiri. Zowonadi, kafukufuku waposachedwa wawonetsa kuti kukwaniritsa kuthamanga kwa kuthamanga kwa magazi pagulu la odwala omwe ali ndi PN, kuphatikiza DN, kumabweretsa kuchepa kwambiri pochepetsa GFR komanso kuchepa kwa proteinuria. Kuphatikiza apo kuchuluka koyamba kwa proteinuria, kuchepa kwambiri kwa magazi munthawi yoyenera kuyenera kukwaniritsidwa.

Kusankhidwa mosamala kwa mankhwala a antihypertensive ndikofunikira kale m'malo oyambira a NAM, monga odwala omwe ali ndi microalbuminuria, kuwongolera kwa magazi kumayambitsa kuchepa kwa kwamikidwe ya albumin, ndipo zotsatira za antihypertensive chithandizo zimachepa pamene albuminuria ikupita.

Kafukufuku wambiri adaphunzira zotsatira zakuchepetsa kuthamanga kwa magazi pa MD panthawi ya matenda ashuga a Type I. Mitundu yofananira imatha kuyembekezeredwa anthu omwe amadalira shuga osadalira insulini, popeza kuchuluka kwa magazi m'thupi mwanjira iyi kumagwirizananso ndi zovuta za albuminuria. Kafukufuku wapadera (ABCS) akuchitika, ntchito yomwe ikufotokozera molondola gawo la matenda oopsa pakukula kwa zovuta zokhudzana ndi matenda a shuga a mtundu II.

Zikuwoneka kuti, njira zamaubwino zochepetsera kuthamanga kwa magazi kwa odwala omwe ali ndi DN zimagwirizanitsidwa ndi kuchepa kwa magazi m'thupi komanso kuchepa kwa kukakamizidwa kwa khoma la glomerular capillaries.

Kubisa kwa renin-angiotensin dongosolo (RAS)

Njira zingapo za pathogenetic zomwe zimatsimikizira kukula ndi kupita patsogolo kwa DN zimagwirizanitsidwa ndi ASD. Amalumikizidwa ndi kupangika kwa systemic arterial hypertension, intracranial hypertension, kuchuluka kwa macromolecule mu mesangium ndikukhazikitsa kusintha kwamphamvu m'maselo a mesangium komanso masanjidwe amtundu wa extracellular zomwe zimatsogolera ku glomerulosulinosis, makamaka kukondoweza kwa kupanga kwa glomerulosulinosis mediators | 3.

Cholinga chothandizira mayesero azachipatala a angiotensin-converting enzyme inhibitors (ACE inhibitors) anali maphunziro angapo a nyama omwe anawonetsa mphamvu yoteteza gulu la mankhwalawa mokhudzana ndi glomerular morphology ndi ntchito yaimpso. Mu makoswe omwe amagwiritsidwa ntchito kwa nthawi yayitali a ACE zoletsa, maimidwe andondomeko za ma DN zimatsika, ndikuchepa kwa transcapillary glomerular pressure. Mankhwala ena sanachitenso chimodzimodzi.

Kuyambitsa kutsika kwa glomerular hyperfiltration koyambirira (microalbumin-uric) gawo la DN mu nyama, cholinga

ACE inhibitors amachepetsa kapena kukhazikika kwa microalbuminuria ndikuletsa kuyambika kwa chithunzi chatsatanetsatane cha matenda 3.4. Kusintha kwakanthawi kachipatala kagwiritsidwe ntchito ka ACE inhibitors kumapitirira ndi magawo apamwamba a DN. Gulu lalikulu la odwala omwe ali ndi matenda a shuga a mtundu woyamba komanso zizindikiritso za nephropathy omwe adalandira Captopril adawonetsa kuchepa kwa 48,5% pokhudzana ndi kukhazikitsidwa kwa PN koyambirira komanso kuchepa kwa 50,5% pokhudzana ndi zotsatira zomaliza - dialysis, kupatsirana, ndi kufa kwaimpso.

Odwala omwe ali ndi matenda ashuga amtundu II, mayesero angapo azachipatala a ACE inhibitor zotsatira zokhudzana ndi kukula kwa proteinuria ndi PN adachitidwanso. Kuwerenga kwa enalapril kunawonetsa zotsatira zabwino za mankhwalawa, zomwe zimaphatikizapo kuchepetsa kuchuluka kwa microalbuminuria, kuletsa kukula kwa proteinuria ndi PN.

Chowonadi cha kuchepa kwa proteinuria munthawi yogwiritsira ntchito zoletsa za ACE ndizofunikira palokha, popeza kutha ndizinthu zodziyimira pawokha za DN ndi zina glomerulopathies 1, 13, 37. Kuchepa kwa proteinuria wogwiritsa ntchito ACE inhibitors kungatheke ngakhale mu magawo apamwamba a DN ndikupanga nephrotic syndrome, kuchepetsa kuchepa kwa mapuloteni mu mkodzo kumayendetsedwa ndi kukhazikika kwa impso.

Tikuyenera kunena kuti antiproteinuric zotsatira ndi kutsika pang'onopang'ono pakukula kwa impso ndi kugwiritsidwa ntchito kwa ACE inhibitors sikudalira mphamvu zawo pakuwonekera kwa magazi. Izi zikutsimikiziridwa ndi kusanthula kwa meta ambiri a maphunziro a antihypertensive mankhwala omwe ali ndi DN ndipo ali ndi kufunikira kofunikira kuchipatala - ACE inhibitors ali ndi mphamvu yoteteza osati kungophatikiza kwa DN ndi ginertzheniyu, komanso kwa odwala omwe ali ndi DN yokhala ndi magazi abwinobwino 35, 39.

Mphamvu ya kukonzanso kwa ACE zoletsa ndi chifukwa cha zinthu zingapo, pakati pawo zomwe ndizachulukidwe ka intra-tubular hemodynamics, chopinga cha zotsatira za trophic za angiotensin II zomwe zimakhudzana ndi kukondoweza kwa ma cellular ndi glomerular hypertrophy 9,17,18, ndi kuponderezana kwa kudziwikirana kwa mesangial matrix. Kuphatikiza apo, ma Ahibuloseti a ACE amachepetsa kuopsa kwa masinthidwe am'magazi mu podocytes, omwe amachepetsa kupezeka kwa membrane wapansi komanso,

Zikuwoneka kuti ndi maziko ake a anti-proteinuric monga chida chodziwika bwino cha gululi.

Kugwiritsa ntchito mankhwala otsutsa calcium

Calcium ya intracellular imachita mbali yayikulu mu pathophysiology ya DN, popeza zotsatira za hemodynamic zama cytokines ambiri, kuphatikizapo angiotensia II, zimathandizidwa ndikuwonjezeka kwa calcium. Izi zikusonyeza kuti zotsatira za impso za ACE zoletsa ndi calcium okana zimatha kufanana, popeza chomaliza chimachetsanso vasoconstriction ndikuletsa zotsatira za hypertrophic ndi hyperplastic zotsatira za angiotensin II ndi zina migogene pazosokoneza minyeial ndi minofu yosalala 5, 43. Komabe, makonzedwe osagwiritsa ntchito michere okha omwe amakhala ndi izi - verapamil ndi diltiazem, mwachiwonekere chifukwa cha mawonekedwe awo apadera pakuvomerezeka kwa glomerular. Ngakhale kunalibe maphunziro okhalitsa opatsirana a calcium omwe ali ndi odwala omwe ali ndi DN, zotsatira zolimbikitsa zapezeka posachedwa - otsutsana ndi calcium, monga lisinopril, adachepetsa kwambiri kuchulukitsa kwa albumin ndikuchepetsa kuchepa kwa kusefera kwa glomerular kwa odwala omwe ali ndi DN. Ndizotheka kuti kuphatikiza mankhwala ndi ACE inhibitors ndi othandizira calcium kungakhale ndi zotsatira zowonjezereka pokhudzana ndikuchepetsa kupitilira kwa DN.

Ndi hyperglycemia, glucose imayamba kugwedezeka panjira ya sorbitol, "yomwe imatsogolera kuchuluka kwa sorbitol ndi kuchepa kwa kuchuluka kwa myoinositol mu glomeruli, mitsempha ndi mandala. Kuletsa njirayi poletsa aldose reductase kungachepetse kuwonekera kwa ma morphological ndi matenda a DN 10, 30. mayesero azachipatala a aldose reductase inhibitors sanatulutsidwebe.

Zomwe zafotokozedwazi zimatithandizanso kunena kuti pochiza DN, ndikotheka kukwaniritsa kutsika kwakanthawi kwa vuto la matenda ashuga komanso kutalikirana, ndipo mwina

komanso kupewa kutukula kwa PN. Ngakhale kuti kulowererapo kumakhala kothandiza kwambiri poyambira - microalbuminuric - magawo a DN, chithandizo chogwira ntchito chitha kuchitikanso muzochitika zapamwamba, ngakhale kukhalapo kwa nephrotic syndrome ndi PN.

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Etiology ndi pathogenesis

Matenda a hyperglycemia, intracubic komanso systemic ochepa matenda oopsa, chibadwa

Microalbuminuria imatsimikiziridwa mu 6-60% ya odwala omwe ali ndi matenda amtundu wa 1 pambuyo pa zaka 5-15 atatha kuwonekera. Ndi CD-2, DNF imakhazikika mu 25% mpikisano waku Europe komanso 50% ya mpikisano waku Asia. Kuchuluka kwa DNF mu CD-2 ndi 4-30%

Mawonetseredwe akulu azachipatala

Mu magawo oyambilira kulibe. Ochepa matenda oopsa, nephrotic syndrome, kulephera kwaimpso

Microalbuminuria (albumin excretion 30-300 mg / tsiku kapena 20-200 μg / min), proteinuria, imakulanso kenako kutsika kwa kusefukira kwa glomerular, zizindikiro za nephrotic syndrome ndi kulephera kwa aimpso.

Matenda ena a impso ndi zomwe zimayambitsa matenda a impso

Kubwezera shuga ndi matenda oopsa, ACE inhibitors kapena angiotensin receptor blockers, kuyambira gawo la microalbuminuria, mapuloteni otsika komanso zakudya zochepa zamchere. Ndi chitukuko cha matenda aimpso kulephera - hemodialysis, peraloneal dialysis, kupatsirana kwa impso

Mu 50% ya odwala matenda amtundu 1 komanso 10% ya odwala 2 omwe amapanga proteinuria, CRF imayamba zaka 10 zikubwerazi. 15% ya imfa zonse za odwala omwe ali ndi matenda a shuga 1 amsinkhu wazaka 50 zimayenderana ndi kulephera kwa impso chifukwa cha DNF