Focal segmental glomerulosulinosis: Zizindikiro, matenda, mankhwala, zaperezi

Focal segmental glomerulosulinosis (FSH) ndiye kutsogolera kwa matenda a impso padziko lonse lapansi. Kuganiza kogwirizana kwa pulayimale ya FSHC ndi vuto la plasma lomwe limayambiranso ku matenda a immunosuppressive komanso limatha kuyambiranso kupatsirana impso. Adaptive FSGS imalumikizidwa ndi kuphatikiza kwambiri nephron chifukwa cha kukula kwa thupi, kuchepa mphamvu ya nephron, kapena Hypomerular hyperfiltration yolumikizidwa ndi matenda ena.

Focal segmental glomerulossteosis ndi kutsogoletsa glomerular chifukwa aimpso kulephera. Amatchula chithunzi cha m'mbiri zomwe zimapangidwa kuti ndizofunikira 6, ndikugawana mutu wanthawi yonse ya kuvulaza ndi kufooka kwa podocytes.

Kuzindikira kwa gawo loyang'ana glomerulossteosis kumadalira kuphatikizidwa kwa mbiri yamankhwala (matenda am'banja, mbiri yakubadwa, kulemera kwakukulu ndi kulemera kwa thupi, phindu la mankhwala), zotsatira za chipatala cha zasayansi (serum albin, mapuloteni a mkodzo, ndi ma serotic) komanso renal histopathology. Proteinuria ikhoza kukhala mu gulu la nephrotic kapena subnephrotic. Chofunika kwambiri ndikuchotsa matenda ena mwatsatanetsatane kapena matenda oyamba a impso, omwe angayambitse chiwonetsero chofananira.

Epidemiology ndi katundu wapadziko lonse lapansi

Kuchulukana kwa zigawo zikuluzikulu za glomerulosclerosis, poyerekeza ndi matenda ena, zikukula padziko lonse lapansi. Komabe, kufalikira kwamtheradi komanso kufalikira ndizovuta kukhazikitsa, chifukwa cha kusiyana kwakukulu kwazomwe zikuwonetsa, kupezeka, komanso kuthandizira kwa aimpso a impso.

Kuunika kolemba zofalitsa padziko lonse lapansi kunachitika, zomwe zikuwonetsa kuti chiwopsezo cha pachaka chimachokera ku 0.2 mpaka 1.8 pa 100,000 anthu pachaka. Chiyerekezo chapakati chinali odwala 2.7 pa miliyoni. Pali kusankhana mitundu. Kuphatikiza apo, zizindikiro za kulephera kwa impso mwa akazi sizimatchulidwa kuposa amuna.

Kugawika kwa zigawo zikuluzikulu za glomerulossteosis ndi njira imodzi. Zimaphatikizanso pathophysiological, histological ndi genetic. Poyamba, FSGS idagawidwa m'mafomu oyambira (idiopathic) ndi mawonekedwe apamwamba. Zotsirizazi zimatha kukhala ndi mabanja (ma genetic), omwe ali ndi kachilombo ka HIV, mitundu yophatikizira mankhwala.

Malangizo azachipatala a zigawo zikuluzikulu za glomerulosulinosis zomwe zingayambike zimakhudzana ndi zochitika zam'mbuyomu, makamaka ku glucocorticoid reacaction ya zotupa za nsonga ndiukali, wopatsa mphamvu wa kusiyana kwakukhazikika.

Mitundu 6 yazachipatala

Kuphatikiza kutengera kwachilengedwe, zochitika za pathophysiological, mbiri yachipatala komanso kuyankha kwa chithandizo, ndikofunikira kuti gulu la FSGS likhale mitundu isanu ndi umodzi yamankhwala. Mulinso:

choyambirira
chosinthika
kwambiri majini
kachilombo koyimira pakati
zokhudzana ndi mankhwala
APOL1 yolumikizidwa.

Mbiri ya matendawa

Zizindikiro zochepa za glomerulonephritis mwa akulu zimawonetsedwa ndi kusowa kwa tubulointerzital scarring. Kugonjetsedwa kwa nsonga ndikuwunikidwa kwathunthu kwaunyolo wamtengo wapatali kwa bulodyamu ya Bowman pafupi ndi proximal off-tubule.

Njira yodziwika bwino kwambiri ikutha. Chitsanzo chotsimikizika chikhoza kuyesedwa pakukhazikitsa endothelial tubule reticular inclusions yomwe imawunikidwa mu kusanthula kwa ultrastructural. Amatha kuwonedwa m'malo apamwamba a interferon, kuphatikiza kachilombo ka virus. Kusintha kwamatenda pang'ono ndi kuwonongeka kwa nsonga ndizomwe zimayankha kwambiri komanso ndizochepa pang'onopang'ono, ndikugwa kwa glomerulopathies, osagwirizana ndi mankhwalawa komanso kupita patsogolo msanga.

Zizindikiro zowonetsa matenda

Zizindikiro zake za glomerulonephritis mwa akulu zimadalira kupezeka kwa mawonekedwe owopsa kapena osakhazikika. Mulinso:

Mkodzo wapinki kapena wa bulauni chifukwa cha kuchuluka kwa maselo ofiira a magazi (hematuria).
Minyewa ya Foamy chifukwa cha mapuloteni ochulukirapo (proteinuria).
Kuthamanga kwa magazi (matenda oopsa).
Kusungunuka kwa madzi (edema). Amawoneka pa nkhope, mikono, miyendo ndi m'mimba.

Payokha, zizindikiro za kulephera kwa impso mwa akazi ndizosiyanitsidwa:

Kutsika kwamkodzo.
Kusungunuka kwamphamvu komwe kumayambitsa miyendo.
Kupuma pang'ono.
Kutopa
Chikumbumtima chosokonezeka.
Kuchepetsa mseru
Zofooka.
Kugunda kwamtima kosagwirizana.
Ululu m'dera la impso.
Kukomoka kapena kukomoka movutikira.

Njira yolimba yodziwira FSGS

Choyambirira kuchita ndikuyesa mkodzo wa impso. Mulinso mayeso awiri:

Chiwerengero cha albumin kuti creatinine. Kuchulukitsa kwambiri kwa albumin mkodzo ndi chizindikiro choyambirira cha kuwonongeka kwa impso. Zotsatira zitatu zabwino kwa miyezi itatu kapena kupitilira apo ndi chizindikiro cha kudwala.
Mlingo wosefera. Magazi amayesedwa ngati zinyalala zotchedwa creatinine. Amachokera kumisempha yamatumbo. Impso zikawonongeka, mavuto amayamba ndi kuchotsa kwa creatinine m'magazi. Zotsatira zoyeserera zimagwiritsidwa ntchito munjira ya masamu ndi zaka, mtundu ndi jenda kuti mudziwe kuchuluka kwa kusefedwa.

Zifukwa zazikulu

Zinthu zomwe zingayambitse kutukusira kwa impso ndi:

Matenda opatsirana. Glomerulonephritis imatha kukhala masiku 7 mpaka 14 pambuyo pa matenda am'mbuyomu apakhungu (impetigo) kapena matenda a pakhosi la streptococcal. Kuti muthane nawo, thupi limakakamizidwa kupanga ma antibodies ena owonjezera, omwe amatha kukhazikika m'glomeruli, ndikupangitsa kutupa.
Bacterial endocarditis. Bacteria imatha kufalikira m'magazi ndikukhazikika mumtima, ndikupangitsa matenda amtundu umodzi kapena zingapo. Bacterial endocarditis imalumikizidwa ndi matenda a glomerular, koma mgwirizano pakati pawo suwadziwika.
Matenda a ma virus. Virus wa Human Immunodeficiency Virus (HIV), Hepatitis B ndi C angayambitse matenda.
Lupus Imathanso kukhudza ziwalo zambiri zam'magawo athupi lathu, kuphatikiza maselo amwazi, khungu, impso, mtima, mafupa, ndi mapapu.
Matenda a Goodpasture Syndrome. Ichi ndi matenda osowa kwamapapu omwe amatsata chibayo. Zitha kuyambitsa glomerulonephritis komanso magazi m'mapapu.
Nephropathy Matenda oyamba a glomerular amenewa amapezeka chifukwa cha ma glomerular immunoglobulin amana. Zimatha kupita patsogolo kwa zaka popanda zizindikiro zooneka.

Zowonjezera

Zina zomwe zimayambitsa matendawa ndi monga:

Polyarteritis. Mtundu uwu wa vasculitis umakhudza mitsempha yamagazi yaying'ono komanso yapakati. Amadziwika kuti Wegener's granulomatosis.
Kuthamanga kwa magazi. Ntchito ya impso ikuchepa. Amapanga sodium moyipa.
Focal segmental glomerulosulinosis. Amadziwika ndi kupukusa kwamaso kwa glomeruli. Vutoli limatha kukhala chifukwa cha matenda ena kapena lingachitike pazifukwa zosadziwika.
Matenda a impso a shuga (diabetesic nephropathy).
Alport Syndrome. Fomu yolowa. Zingathenso kuletsa kumva kapena kuwona.
Multipoma myeloma, khansa yamapapo, komanso khansa ya m'mimba yotupa.

Njira yamatenda

Focal segmental glomerulosulinosis ndi matenda osiyanasiyana omwe amachitika pambuyo povutikira kuti podocytes pazifukwa zosiyanasiyana. Zowonongeka ndizosiyana:

zinthu zozungulira
zonyansa zamtundu
kachilombo
mankhwala.

Nthawi zambiri, kulumikizana kwa madalaivala awa sikumveka bwino komanso zovuta. Mwachitsanzo, FSGS yolumikizira imaphatikizira kupsinjika kwa podocyte (kulakwitsa pakati pa katundu wa glomerular ndi mphamvu ya glomerular) ndi kutengera kwachilengedwe.

Kuwonongeka kwa podocytes kuchokera ku mtundu uliwonse wa FSHC (kapena matenda ena obisika) kumayambitsa njira yomwe imatsogolera ku pachimake nephritic syndrome. Kuwonongeka kwapang'onopang'ono kwa podocytes m'malo a kwamikodzo kumachitika. Kuti muchepetse chinyengo, maselo amenewa amawerengera ma hypertrophy, omwe amavala pamwamba pa glillerular capillaries.

Ndi FSGS yosuntha, glomerular hypertrophy imapezeka kumayambiriro kwa matendawa. Mwanjira zina, glomerular hypertrophy imachitika ndikutayika kwa nephron pang'onopang'ono. Izi zimabweretsa zowonjezera kukakamiza ndi mafunde mu glomeruli yotsala ya patent.

Gawo lotsatirali limakambirana njira zopangira matenda, kuchiza, ndi kuchiza kwa zigawo zikuluzikulu za glomerulosclerosis.

FSGS yoyamba

Kuphatikiza ma genetic, ma virus, komanso mankhwala okhudzana ndi mankhwala. Makina owonongeka a podocytes amaphatikizapo chinthu chozungulira, mwina cytokine, chomwe chimapangitsa odwala enieni kuti atengeke. Uwu ndi mtundu wofala kwambiri pakati pa achinyamata ndi achinyamata. Amakonda kuphatikizidwa ndi nephrotic mfululizo proteinuria (nthawi zina yayikulu), kutsika kwa plasma albumin, ndi hyperlipidemia.

Pakadali pano, chithandizo choyambirira cha FSGS chimakhazikitsidwa ndi othandizira a immunosuppression. Awa ndi ma glucocorticoids ndi ma calcinurin zoletsa omwe amasintha mwachindunji phenotype ya podocytes. Ma FSHF omwe amapezekanso amakhala vuto lamavuto azachipatala. Amodzi mwa amisala 77 oyamba a impso mwa odwala omwe adatsitsimuka adawonekeranso mosiyanasiyana. Mankhwala osinthana ndi plasma angayambitse chikhululukiro kwakanthawi.

Ma FSGS osintha

Imachitika pakapita nthawi ya kukhathamiritsa koopsa mu mphuno komanso matenda oopsa pambuyo pathophysiology. Zomwe zimalumikizidwa ndi chitukuko chake ndizophatikizira:

matenda obwera ndi mtima a chyanotic,
sickle cell anemia,
kunenepa
androgen
kugona tulo
kudya mapuloteni ambiri.

Kutalika kwa nthawi yayitali-glomerular hyperfiltration nthawi zambiri kumawerengeredwa zaka zambiri glomerulosclerosis isanayambe. FSGS yotsogola imatsogolera kuzungulira kwa glomerular hypertrophy mizere, kupsinjika ndi kutopa, kufotokozera mopitirira muyeso kwa matrix amtundu wa extracellular mu glomerulus. Zizindikiro za kuphatikizidwa kwa impso zimaphatikizapo lalikulu glomeruli, kuchuluka kwa zipsera zosasunthika zomwe zikuwonetsa kusintha kwa sclerotic. Zochitika zamankhwala zimaphatikizapo serum albin yokhazikika, zomwe sizachilendo mu FSHS yoyamba.

Mitundu ya FSGS

Zimatenga mitundu iwiri. Odwala ena omwe ali ndi vuto lotengera mtundu wina amakhala ndi matendawa, pomwe ena sangatero. Chiwerengero cha majini omwe amagwirizanitsidwa ndi FSHC chikukula chaka chilichonse, makamaka chifukwa cha kufalikira kwa kutsatizana kwathunthu. Mpaka pano, osachepera 38 adadziwika.

Mitundu ina imalumikizidwa ndi vuto lomwe limaphatikizapo mawonetseredwe owonjezera. Izi zitha kupereka chidziwitso chodwala kuti wodwala atha kusintha maselo enaake. Ena amagwirizanitsidwa ndi kusintha kwa ma morphology a membrane wapansi kapena morphology ya mitochondria.

Ngati banja silinayesedwe kale, njira yothandiza kwambiri ndikugwiritsa ntchito mapanelo omwe amayang'ana FSGS yoyambirira (khanda ndi mwana). Zoyeserera za genetic padziko lonse lapansi zimapezeka ku National Center for Biotechnological Information and National Institutes of Health.

Tanthauzo la lingaliro

Matenda a shuga a diabetesic glomerulosulinosis amatchedwanso diabetesic nephropathy ndi Kimmelstil-Wilson syndrome - dzinali lidapezeka chifukwa cha akatswiri awiri am'mawu omwe adazindikira kuwonongeka kwa impso. Mwa anthu odwala matenda ashuga pambuyo pa zaka 20, matendawa amapezeka 20-60% ya milandu (munjira zosiyanasiyana zidziwitso ndizosiyana), ndipo azimayi amatenga nawo vutoli.

Mwambiri, odwala matenda ashuga glomerulosulinosis amakhala ndi odwala matenda ashuga omwe amadalira insulin, ndipo anthu osagwirizana ndi insulin amadwala kangapo.

Impso zimakutidwa ndi minofu yapadera - fascia, yomwe imatiteteza ku kuwonongeka kwamakina. Pansi pa fascia, impso zimayimiriridwa ndi medulla ndi kotekisi. Malo omwe cortical chinthu chimatsutsana ndi dongosolo laubongo imatchedwa mapira a impso. Ndizofanana ndi lobules ndipo zimaphatikizapo glomeruli yotchedwa glomeruli. Kunali glomeruli komwe kunapatsa dzinalo matendawa.

Pali zovuta zambiri komanso zovuta mu pathogenesis ya diabetesic glomerulosulinosis. Palibe mgwirizano pavutoli. Pali malingaliro osiyanasiyana okhudza matendawo, kuphatikizapo:

chibadwa
Katemera
hemodynamics
neuroendocrine hypothesis
kagayidwe kachakudya.

Chiphunzitsochi chibadwa chotengera matenda obwera chifukwa cha matenda ashuga, ndiko kuti, kupezeka kwa matendawa kwa abale. Lingaliro ili likuwonetsa kuti kusokonezeka kwa mitsempha ndi kagayidwe kachakudya, komanso kusinthika kwa kololera wamafuta, zimabadwa.

Chiphunzitso cha immunological chikugwirizana kwambiri ndi chibadwa. Ubwenzi wapakati pa kuvuta kwa pafupipafupi ndi kuphatikizika kwa ma microangiopathy (zotupa zazing'onoting'ono) komanso kuchuluka kwa chitetezo cha mthupi komwe kumazungulira m'magazi kumatsimikiziridwa.

The neuroendocrine hypothesis ikuwonetsa kuti kupanikizika kwamankhwala kwa shuga kumachitika pamene hypothalamus, gustine pituitary gland, ndi glucocorticosteroids achulukitsidwa. Zotsatira zake, kuchuluka kwa capillary kumachulukanso, ndipo mamolekyulu a peptide amaikidwa mu khoma lamankhwala.

Malinga ndi chiphunzitso cha metabolic, pamene kaphatikizidwe wa mapuloteni komanso njira ya metabolic ya glycoproteins ikasokonekera, paraproteins (immunoglobulins) amapangidwa. Kukula kwa kuchuluka kwa zipinda zapansi kumapangitsa kudzikundikira kwa paraproteins mu aimpso glomeruli ndikusintha kukhala chinthu cha hyaline.

Mawonekedwe a matenda ashuga glomerulosulinosis atha kukhala:

Mawonekedwe a Nodular yokhudza matenda ashuga. Ndi iye yemwe adafotokozedwa ndi Kimmelstil ndi Wilson, pambuyo pake adatchulidwa mayesowo. Ndi mtundu uwu wa matendawa, timinofu tambiri timapangidwa mu impso glomeruli - eosinophilic formations. Amatha kukhala ndi mawonekedwe ozungulira kapena ozungulira, okhala ndi gawo lonse la glomerulus kapena gawo lokha. Tizilombo timene timatchedwa-membrane-like, popeza ndi ofanana ndi thunthu lamkati wapansi.

At kuphatikiza mawonekedwe kuchuluka kwa mawonekedwe a mesangium kumachitika mu matendawa, koma matupi oyambira sanapangidwe, ngakhale zigawo za pansi pa capillaries zimaphatikizidwa.

At mawonekedwe exudative pamphepete mwa malo obisalamo glomerular, mawonekedwe ozungulira ofanana ndi zipewa amawoneka. Kafukufuku wa Immunohistochemical akuwonetsa kuti mawonekedwe awa ali ndi ma immunoglobulins ambiri othandizira, omwe ali ndi chitetezo cha mthupi.

Fomu yosakanizika Matenda amatanthauza kuti pali timinofu tambiri tomwe timayamwa, ndipo timasokoneza kutsitsa kwa mesangium, komanso kukula kwa zigawo zam'munsi.

Mosasamala mtundu wa matendawa, amatsogolera pakufa kwa glomeruli ndi kukula kwa periglomerular fibrosis.

Zizindikiro za diabetesic glomerulossteosis

Matendawa ali ndi zisonyezo zingapo, koma mawonekedwe a onse nthawi imodzi ndiosankha:

Matenda oopsa. Ichi ndiye chizindikiro chachikulu chamatenda a Kimmelstil-Wilson. Zowopsa mu shuga zimasiyana ndi kukakamizidwa kowonjezereka mu atherosulinosis kapena matenda oopsa chifukwa chakuti zimayendera limodzi ndi proteinuria ndi retinopathy.
Kutupa. Kwenikweni, nkhope, miyendo ndi miyendo zimakhudzidwa. M'mawa, kutupa kumadziwika.
Proteinuria Mawuwa amatanthauza kuchuluka kwa mapuloteni omwe amakhala munkodzo. Poyamba, zizolowezizo zidapitilira pang'ono - mpaka 0,033 g / l, kenako proteinuria imakhala yokhazikika, yolimbitsa kapena kutchulidwa kwambiri - 1-30 g / l.Prosturia yofunikira nthawi zambiri imadziwika ndi mawonekedwe a nodular a matenda.
Retinopathy Liwuli limatanthawuza kuwonongeka kwa retina yama eyeb eye. Chizindikiro chikuwonekera mu 80% ya odwala omwe ali ndi matenda ashuga glomerulossteosis. Mu matenda a shuga a retinopathy, kusintha kwa zam'mbuyo kumawonekera mu retina, kuwonetsedwa ndi micaneurysms, exudates ndi zotupa.
Matenda a metabolism. Zimatha kuthana ndi ma lipids, mapuloteni, mapuloteni-polysaccharide.
Microangiopathy ndi zotupa zazing'onoting'ono. Mu matenda a diabetes a glomerulossteosis, izi ndizodziwika kwambiri kuzinthu zakumapeto ndi fundus.
Kulephera kwina. Potere, mkodzo umamasulidwa pang'ono, kupuma movutikira kumawonekera, khungu louma. Nthawi zambiri pamakhala zizindikiro za kuledzera, kutsekula m'mimba kumayamba.
Nephrotic syndrome. Itha kuchitika kumapeto kwa matenda ashuga glomerulossteosis. Pankhaniyi, proteinuria yayikulu imawoneka (woposa 50 g / l), edema yotchuka, hypoproteinemia (protein yochepa m'madzi a plasma), hypoalbuminemia (albumin yochepa mu seramu yamagazi).
Uremia. Impso zakhudzidwa sizipanga zinthu zina, chifukwa chake thupi limapatsidwa poizoni. Odwala omwe ali ndi matenda a diabetes a glomerulosulinosis ali aang'ono komanso aang'ono nthawi zambiri amafa ndendende chifukwa cha uremia.
Cylindruria (excretion wa masylini amkodzo kuchokera kumapuloteni).
Shuga wochepa m'magazi ndi mkodzo (glucosuria). Chodabwitsachi chimawonedwa ndi pang'onopang'ono glomerulossteosis.
Ndi matenda opita patsogolo - zotupa zam'mimba kwambiri. Nthawi zambiri izi zimabweretsa polyneuritis.
Pyelonephritis mu mawonekedwe owopsa kapena aakulu. Nthawi zambiri imadziwonekera kumapeto kwa matendawa.

Zizindikiro

Glomerulosulinosis imapezeka ngati wodwala matenda ashuga m'njira zingapo:

Kuyendera kozungulira. Mulinso kupenda khungu, palpation mu impso, kuyang'ana magazi.
Kuyesedwa kwa magazi. Kuwonjezeka kwa maselo oyera, kuchepa kwa magazi ndi kusintha kwa magawo ena a magazi kukuwonetsa kuwopsa kwa matendawa.
Urinalysis Maphunziro ofanana amatha kudziwa proteinuria ndi albuminuria (kuchuluka kwa mapuloteni mu mkodzo). Kuchulukitsa mtengo wabwinobwino kumawerengedwa kuti kumachokera 30 mg / tsiku. Zizindikiro zamagulu 30-3000 mg / tsiku zimawonetsa microalbuminuria, ndipo zopitilira 300 mg / tsiku - za macroalbuminuria. Gulu la KDIGO laposachedwa limasankha izi monga gulu la A2 ndi A3.
Mlingo wosefera wa glomerular (wotsimikizika ndi kuwonongeka kwa Reberg-Tareev ndi maphunziro ena angapo). Chizindikiro chimanenedwa kuti chikuwonjezeka kuchokera pa 130-140 ml / min. Ngati vuto la impso likuyenda, ndiye kuti chizindikiro chikuchepa.
Zotsatira za diagnostics a ultrasound (kuphatikizapo kupimidwa kwa mtima).
Impso. Phunziro lotere limapereka zotsatira za odwala 80-90%. A biopsy amatha kudziwa matenda a shuga a shuga.
Ophthalmoscopy chifukwa cha kuzindikira kwa retinopathy.
Aortography. Zimathandizira kuzindikira kupendekera kwapakati kwa aimpso.
Njira za Radionuclide.

Kuzindikira matenda ashuga glomerulosulinosis kumakhala kovuta kwa okalamba, popeza zizindikiro zina ndizofala matenda ena.

Chithandizo cha matenda ashuga glomerulossteosis

Mosasamala mtundu wa matendawa, mankhwalawa amayenera kuyamba ndi chithandizo cha zomwe zimayambitsa, ndiko kuti, shuga mellitus.

Kumayambiriro kwa matendawa, pamene impso zimatha kugwira ntchito, cholinga chachikulu cha chithandizo ndikulipira matenda a shuga. Chithandizo cha magawo ena a glomerulossteosis ndikofunikira kuti kuthetsedwe kwathunthu kapena kusachepetsa mphamvu yake ya syndromes (nephrotic syndrome, matenda oopsa, etc.).

Ngati matendawa akuphatikizidwa ndi kuphwanya kwa lipid metabolism, ndiye kuti wodwalayo amafunikira mankhwala okhala ndi lipolytic ndi hypocholesterolemic. Izi zikuphatikizapo Atromide, Cetamifen, Nigeskin.

Ngati kusinthana kwasokonezeka, njira zina zimafunikiranso:

mavitamini (A, B, C, P),
anabolic steroids (Retabolil, Nerobol).

Pochiza matenda a shuga a diabetesicangiangi, mankhwala antispasmodic monga Nigexin, Anginin kapena Complamine amafunikira.

Mu matenda a shuga a retinopathy, amatembenukira ku laser coagulation, ndiko kuti, cauterization yamitsempha yam'mimba. Izi zimakuthandizaninso kupanga njira yocheperamo yotulutsa madzi mkati mwa retina.

Ngati nthendayo imapanikizika ndi matenda amkodzo thirakiti, ndiye kuti maantibayotiki omwe ali ndi zochita zambiri amalembedwa. Kuphatikiza apo, mankhwala a sulfonamides kapena nitrofuran angakhale ofunikira.

Mankhwalawa diabetesic glomerulossteosis, heparin amagwiritsidwa ntchito. Nthawi zambiri amatumizidwa kwa mwezi kudzera m'mitsempha kapena m'mitsempha. Mankhwala ali ndi hypolipemic, anticoagulant, hypotensive ndi hypohistamine. Kugwiritsa bwino magazi aimpso kumawonjezeka, proteinuria imachepa, ndipo kupatsanso kwa capillary kumatengera.

Ngati wodwalayo amatha kuphwanya magazi ake, ndiye kuti, Hypercoagulation imafotokozeredwa ndipo microthrombosis imayamba, ndiye kuti tikugwiritsanso ntchito reocorreector. Ikhoza kukhala Hemodez kapena Reopoliglyukin.

Ngati ochepa matenda oopsa limodzi ndi matenda ashuga glomerulosranceosis, antihypertensive mankhwala amagwiritsidwa ntchito. Nthawi zambiri amakonda Reserpine, Klofelin kapena Dopegit.

Ngati nephrotic syndrome ikufotokozedwa, ndiye kuti amayamba kumuwonjezera plasma kapena mapuloteni ake - albumin.

Ngati vuto la impso layamba kufooka kwambiri ndipo vuto la chiwindi layamba, ndiye kuti pali zofunika kuchita:

hemodialysis (kukonza magazi kuyeretsa),
peritoneal dialysis (dialysis solution imayendetsedwa kangapo patsiku)
kupatsirana kwa impso (nthawi zina nthawi imodzi ndi kapamba).

Zakudya zamankhwala

Pa matenda a shuga a glomerulosulinosis, mfundo zina za mankhwala azakudya ziyenera kutsatiridwa:

Thanzi liyenera kukhala hypocaloric. Izi zikutanthauza kuchepetsa kwakukulu mu gawo la mafuta ndi chakudya. Kwenikweni, muyenera kuchepetsa mafuta - mpaka 30-50 magalamu patsiku. Werengani zambiri za zakudya zamafuta ochepa pano.
Onetsetsani kuti mumamwa mapuloteni oyenera. Zomwe zimawerengedwa zimawerengeredwa molingana ndi kuchuluka kwa thupi la wodwala. Pafupifupi, 1 gramu ya kulemera kwa thupi patsiku iyenera kuwerengera 0,8 magalamu a mapuloteni.
Ngati kusefukira kwa glomerular kuchepetsedwa, ndiye kuti zakudya zama protein ochepa ndizofunikira. Pankhaniyi, wodwalayo ayenera kuphatikiza 30-30 magalamu a mapuloteni patsiku. Ndikofunika kuti pankhaniyi pamakhala zopatsa mphamvu zokwanira zamagulu ena, apo ayi wodwalayo amatha kuperewera mphamvu zama protein. Njirayi iyenera kuyang'aniridwa ndi dokotala.
Chepetsani kudya kwanu kokhala ndi mafuta m'thupi. Iyenera kusinthidwa ndi mafuta a masamba.
Chakudya chizikhala chopindika - chakudya 5-6 patsiku ndi chofunikira. Izi zimakuthandizani kuti muwonetsetse magazi amodzimodzi tsiku lonse, chifukwa kusinthasintha kwakuthwa kwa chizindikirochi kumakhudzanso ziwiya.
Ngati matenda oopsa amachitika chifukwa cha matenda ashuga glomerulossteosis, wodwalayo amafunika kudya mchere wochepa. Tsiku, sayenera kudya zosaposa 4-5 magalamu a mchere wa patebulo.
Kuletsa kwaphokoso. Ndi matenda a shuga, amatha kuledzera popanda choletsa, koma zovuta zokhudzana ndi impso zimathetsa chilolezochi. Mowa ndi zakumwa zochokera mu kaboni ziyenera kutayidwa kwathunthu.
Kuchotsedwa kwazinthu zomwe zili ndi diuretic. Lamuloli liyenera kukumbukiridwa mukamamwa mankhwala, omwe amaloledwa ndi shuga.

Njira ya matenda ashuga glomerulossteosis zimatengera zingapo:

zaka odwala
kuopsa kwa matendawa
kusintha kwa matenda ashuga
matenda ophatikizika
chithunzi cha chipatala.

Mu matenda a diabetes a glomerulossteosis, zaka zomwe munthu amakhala ndi moyo zaka pafupifupi 5-8 kuchokera pachiwonetsero cha matenda oyamba.

Ndi matenda pamlingo wa proteinuria, kukula kwake kungathe kupewedwa. Ngati pali matenda a diabetes a nephropathy pa odwala, ndiye kuti izi sizikugwirizana ndi moyo.

Ngati matenda ashuga nephropathy ndi glomerulosulinosis ndi mtundu I shuga amachititsa kuti matenda aimpso alephere, ndiye kuti mu 15% ya milandu yomwe imawona.

Zotsatira zakupha za zaka 50 zimagwirizanitsidwa makamaka ndi uremia. Pakatha zaka 50 ,imfa imachitika kawirikawiri poyerekeza ndi kuwonongeka kwa mtima. Kwa magulu onse awiri azaka, chifuwa chimapangitsa kuti munthu azifa nthawi zonse.

Kupewa matenda ashuga glomerulossteosis

Njira zodzitetezera: kudziwika koyambirira, chithandizo komanso kubwezeretsa matenda ashuga. Ndikofunikira kuyang'anira kuchuluka kwa shuga m'magazi ndikupewa kusinthasintha kwamphamvu mu glycemia. Pazifukwa izi, ndikofunikira kusankha bwino kuchuluka kwa insulini kapena wothandizila wina wotsitsa shuga ndikuphatikiza muyeso uwu ndi zakudya zoperewera.

Wodwalayo ayenera kutsatira zakudya - izi ndizofunika kuti azitsatira.

Mu matenda a diabetes a glomerulossteosis, kutsata ndikofunikira. Njira yamatendawa imayang'aniridwa ndi katswiri, endocrinologist, urologist ndi nephrologist. Wodwala amayenera kuwerengedwa maphunziro kamodzi kamodzi miyezi isanu ndi umodzi.

Matenda a shuga a shuga ndi matenda oopsa. Ndikofunikira kudziwa kuti ndi yofunikira munthawi yake ndikupitilira chithandizo chamankhwala choyenera. Pozindikira matendawa kumayambiriro, chithandizo chamankhwala choyenera komanso chithandizo chamankhwala, matendawa ndiabwino kwambiri. Ndikofunika kuti odwala matenda ashuga apatsidwe mayeso angapo kuti adziwe zovuta za matendawa akadali achichepere.

Kodi matenda a shuga a Diabetes ndi ati:

Matenda a shuga a shuga - Imodzi mwanjira zovuta kwambiri za mtundu wa matenda ashuga. Imatchedwa Kimmelstil-Wilson syndrome, atalemba omwe adafotokoza kale mu 1936. Pali mayina ena angapo amtunduwu - impso ya matenda ashuga, matenda a shuga.

A. S. Efimov (1989) amawona kuti mawu akuti "diabetesic nephropathy" ndiwofunikira kwambiri, chifukwa palibe zotupa za glomerular capillaries popanda kukhudzidwa ndi ziwiya zina ndi matubu, ndipo ndizosavuta kudziwa mothandizidwa ndi njira zamakono zoyesera zomwe ndi lesion komanso gawo liti la impso. Komabe, mawu akuti "diabetesic glomerulossteosis" ndi othandizanso.

Kukula kwa mawonetsedwe azachipatala a matenda ashuga glomerulossteosis, malinga ndi olemba osiyanasiyana, kuyambira 6 mpaka 64% (Burger, 1970, A. S. Efimov, 1973, A. Astrug, 1976, etc.). Matenda a diabetesic glomerulosulinosis amakhala ochulukirapo mwa akazi kuposa amuna - 30% ndi 19,5%, motsatana (A. S. Efimov, 1973, A. Astrug, 1976).

Ofufuza amakono ambiri amadziwa mgwirizano womwe umakhala pakati pa mawonekedwe a glomerulossteosis ndi nthawi yayitali ya matenda ashuga. Nthawi zambiri sizimadzipatula, koma zimaphatikizidwa ndi microangiopathies a malo ena, mwachitsanzo, ndi retinopathy, olembedwa mu 70-90% ya milandu.

Pathogenesis (chikuchitika ndi chiani?) Pa matenda a shuga a Diabetesic glomerulosulinosis:

Zomwe zimayambira matenda ashuga glomerulosulinosis sizimamveka bwinobwino. Pali malingaliro osiyanasiyana, omwe olemba omwe amafuna kufotokoza njira zovuta zomwe zimayambitsa matendawa. Chifukwa chake, chiphunzitso cha zovuta zoyambira metabolic chimalongosola kuwonongeka kwa mitsempha yamagazi m'magazi a shuga ndikazungulira m'magazi pamiyeso yambiri yazinthu zambiri zamapuloteni osokoneza, lipid ndi kagayidwe kazakudya zam'mimba zomwe zimapangitsa kuti ziwonongeke zapansi zamitsempha yamagazi, makamaka, aimpso glomeruli. V. Serov, 1962, V.V. Serov et al., 1981). Mwachitsanzo, kusokonekera kwa mapuloteni osakanikirana ndi kagayidwe ka glycoprotein kumayambitsa mapangidwe a paraprotein, omwe, chifukwa cha kuchuluka kwa ziphuphu zakumaso, amadziunjikira mu impso glomeruli, pomwe amasintha kukhala chinthu cha hyaline. Komabe, metabolic hypothesis ya diabetesic microangiopathies sapereka mafotokozedwe okhutiritsa chifukwa cha chitukuko chawo mu gawo la prediabetes, pomwe zovuta zamtunduwu sizikupezeka.

Lingaliro la immunological la microangiopathies ndi diabetesic glomerulosranceosis limakambidwa, potengera lingaliro lamomwe lilipo lakudziwikiratu kwa matenda ashuga. Pali umboni wa kulumikizana pakati pa kuchuluka kwa zinthu zamagetsi zomwe zimachitika mozungulira komanso pafupipafupi komanso kuuma kwa microangiopathy.

The neuroendocrine hypothesis imagwirizanitsa zovuta zamagulu a shuga ndi ntchito yowonjezera ya glucocorticoids, adenohypophysis ndi hypothalamus, zomwe zimapangitsa kukulira kwa kuvunda kwa capillary komanso mawonekedwe a peptide mamolekyulu khoma la mtima.

Malingaliro amtunduwu amachokera mbanja lomwe limayambitsa matenda ashuga, omwe amapezeka mwa abale a odwala matenda a shuga. Ochirikiza chiphunzitsochi amavomereza kuthekera kwa kufalikira kwamatenda a mtima komanso kagayidwe kachakudya ka matenda ashuga, kusintha kwa kulolerana kwa chakudya.

Chifukwa chake, palibe lingaliro limodzi lokha la pathogenesis la diabetesic glomerulossteosis. Zikuwoneka kuti, njira zazikulu za pathogenetic zimagwirizanitsidwa ndi matenda a polymetabolic pawokha - matenda a shuga. Zinthu zomwe zimasokoneza ma metabolic osokoneza bongo a mapuloteni, glycoproteins, lipids amalowa mu impso kudzera mumsewu wamatumbo ndipo amayikidwa mu minofu yake.

The pathological anatomy of diabetesic glomerulossteosis ndi polymorphic. Siyanitsani mitundu ya mutu, yosiyanitsa ndi yopindulitsa. Olembanso ena amasiyanitsanso mawonekedwe osakanikirana (A.M. Wichert, 1972). Fomu ya nodular imafotokozedwa ndi Kimmelstil ndi Wilson ndipo amadziwika kuti ndi amisala. Amadziwika ndi kupezeka kwa aimpso glomeruli a eosinophilic formations (mawonekedwe oyenda mozungulira) kapena ozungulira mawonekedwe, okhala gawo limodzi kapena glomerulus yonse. Tizilombo tambiri timene timapezeka tinthu tambiri tomwe timayambira ndi michere ya michere yosiyanasiyana, yofanana ndi thunthu lamkati mwa glomerular chapansi motero timatchedwa membranous. Pa nthawi yomweyo, kukulitsa ndi aneurysms a glomerular capillaries, makulidwe am'munsi awo zimayang'aniridwa. Mu mawonekedwe osokoneza bongo a diabetesic glomerulossteosis, kusintha kwa maumbidwe am'magazi kumawonetsedwa mu kufalikira kwamtunduwu ndi kukomoka kwa mesangium popanda kupangika kwamabowo wamba, koma ndi gawo la capillary basement membranes mu pathological process, yomwe imakulitsidwa. Kusintha kwodziwikiratu kumadziwika ndi kuwonekera kwa kufalikira kwa maunyolo a glomerulus a mawonekedwe ozunguliridwa monga mawonekedwe a zisoti pazotseka za capillary. Kafukufuku wokhudza immunohistochemical m'mapangidwe awa adazindikira kuchuluka kwamagulu angapo othandizira, omwe adapereka chifukwa chakuwonera kuti ndi chitetezo cha mthupi. Kupezeka kwa timinofu tambiri timene timaphatikizira kuphatikiza kwa mesangium densation ndi makulidwe a glomerular capillary basement membrane ndi mawonekedwe a mawonekedwe osakanikirana.

Kusintha kwachiwiri kwa matenda ashuga glomerulossteosis kumaphatikizapo kuwonongeka kwa aimpso kuwonongeka kosasintha kwa epithelium, hyalinization wa chapansi membranes ndi mafuta kunenepa. Pamodzi ndi kugonjetsedwa kwa glillerular capillaries, omwe ndi tanthauzo la matenda ashuga glomerulossteosis, zizindikiro za arteriosranceosis ndi atherosclerosis ya ziwiya za impso zimapezeka. Zotsatira zamitundu yonse ya diabetesic glomerulosulinosis ndi kuwonongeka kwathunthu (kufa) kwa glomeruli komanso kukula kwa periglomerular fibrosis.

Zizindikiro za Diabetesic Glomerulosulinosis:

Palibe gulu la anthu odwala matenda ashuga amene amavomereza. Amapangidwa makamaka chifukwa cha zovuta za m'magazi zotupa zam'mimba (matenda ashuga retinopathy, nephropathy) kapena zimakhazikika makamaka pakusintha kwazinthu zina.

Malinga ndi gulu la N. F.Skopichenko (1973), kusiyanitsa pakati poyambira (chizindikiro chotsika-pang'ono), kusintha (kovuta kusiyanasiyana) ndi magawo omaliza (a nephrotic-azotemic) a matenda ashuga glomerulossteosis. Ndi chikhalidwe cha maphunzirowa - mitundu pang'onopang'ono komanso yomwe ikupita patsogolo (zosankha). Mfundo zotsatirazi za gawoli zitha kudziwa kuphatikiza kwa matenda ashuga glomerulosranceosis ndi micangiopathies yamitundu ingapo komanso kuyambitsidwa kwa matenda ena a impso (pyelonephritis, amyloidosis).

Zizindikiro zazikulu za matendawa ndi proteinuria, retinopathy ndi matenda oopsa. Proteinuria poyamba ndi yaying'ono komanso yosakhazikika (kuyambira pamtengo mpaka 0,033 g / l), kenako imakhala yokhazikika, mokhazikika kapena kutchulidwa kwambiri (kuyambira 1.0-2.0 mpaka 30 g / l). Proteuria wotchulidwa kwambiri amawonedwa ndi mitundu ya nodular ya zotupa za glomerular capillary. Komabe, mwa odwala ena omwe ali ndi matenda a shuga a nthawi yayitali, proteinuria ikhoza kusowa (N.F. Skopichenko, 1972). Chimodzi mwazomwe chimapangitsa kupezeka kwa matenda osakanikirana ndi matenda a shuga ndi proteinuria mu pyelonephritis, impso ndi matenda oopsa amatha kuchuluka kwake (ndi matenda ashuga a shuga ndi matenda oopsa) ndipo, koposa zonse, kuphatikiza kwa matenda oopsa ndi retinopathy.

Kusintha kwamikodzo mumkodzo (hematuria, cylindruria), makamaka wokhala ndi nthawi yochepera zaka 10, sikofunika. Pokhapokha gawo lovuta la matendawa, makamaka nephrotic syndrome, ndi cylindruria wofanana ndi ena, pomwe hematuria imadziwika. Ma cylinders a waxy amawonedwa pokhapokha kulephera kwa impso.

Matenda a shuga a retinopathy amapezeka mu 80% ya milandu ndipo amadziwika ndi kusintha kwa pathological mu retina: ma micaneurysms, zotupa, ma exudates amawoneka. Ma Microaneurysms amitsempha yamaaso ndi achidziwikire kuti ngakhale atapezeka mwangozi, kukhalapo kwa matenda abwinobwino sayenera kuphatikizidwa. Kutsatira kwampweya kwotsatira kumatha kuchitika. Zonsezi zimabweretsa kufooketsa kwakukulu ndikuwonongeka kwamaso. Amakhulupirira kuti kusintha m'matumbo a retina kumakhala ndi genesis yofanana ndi kuwonongeka kwa ma glillerular capillaries, i.e., amayamba chifukwa cha kuwonongeka kwa ziwalo zapansi panthaka. Nthawi zina retinopathy amakhala patsogolo pa nephropathy.

Ndi chitukuko cha matenda ashuga glomerulossteosis, chachikulu matenda ndi ochepa matenda oopsa. Mosiyana ndi matenda oopsa chifukwa cha matenda oopsa komanso atherosulinosis, amadziwika ndi kuphatikiza kwa proteinuria komanso matenda ashuga a retinopathy. Ngati kuchuluka kwa kuthamanga kwa magazi kusanachitike shuga kapena kumachitika nthawi yomweyo, ndiye izi zikuwonetsa matenda oopsa.

The pathogenesis of arterial hypertension in diabetesic glomerulosulinosis ndi zovuta ndipo zimagwirizanitsidwa, makamaka, ndi kuwonjezeka kwa ntchito ya renin-angiotensin-aldosterone dongosolo, yomwe imayambika chifukwa cha kuwonongeka kwa ziwiya zazing'onoting'ono za impso - kubweretsa arterioles hyalinosis, kuwonongeka kwa kuchuluka kwa glomeruli komanso kuchepa kwa magazi a re.V. , A. Ts. Anasashvili, 1983).

Pakapita nthawi, matenda ashuga glomerulossteosis nthawi zambiri amagwirizanitsidwa ndi nephrotic syndrome, chipatala chomwe sichimasiyana ndi chiwonongeko cha impso.

Uremic syndrome mu diabetesic glomerulosulinosis imachitika chifukwa cha kulephera kwathunthu kwaimpso ndipo zimawonetsedwa ndi zonse zomwe zimayambitsa matenda a matenda a impso. Uremia amadziwika kuti ndi chifukwa chachikulu cha imfa kwa odwala omwe ali ndi matenda ashuga glomerulossteosis, makamaka ali a zaka zapakati komanso zapakati. Odwala okalamba amafa chifukwa cha zovuta zina za atherosulinosis, osangokhala mpaka kufooka kwa impso.

Diabetesic glomerulosulinosis imayendera limodzi ndi kuwonongeka kwamitsempha yama mtima, ubongo, m'munsi, mpaka kukula kwa myocardial infarction, stroko ndi thrombosis, ndi matenda osokoneza bongo odwala matenda am'mimba. Nthawi zambiri pamakhala polyneuritis. Matendawa akangomaliza, matendawa amatha kudwala nawo.

Chimodzi mwazomwe zimachitika ndi matenda ashuga glomerulossteosis ndi chizolowezi, pamene matendawa akupita, kutsika kwa glucose wamagazi ndi kuchepa, mpaka kutsiriza kwathunthu, kwa glucosuria. "Chikhululukiro" cha matenda a shuga chimawonedwa mwa ena mwa odwala ndipo samawerengedwa ngati chizindikiro chodwala. Zifukwa zakutha kwa hyperglycemia sizodziwika bwino. Amakhulupirira kuti kuchepa kwa glycemia kungafotokozedwe ndi kuchepa kwa ntchito ya impso insulinase, kuchepa kwa kagayidwe kazakudya ka mapuloteni omangidwa ndi insulin komanso mapangidwe a anti-insulin antibodies, kuchepa kwa hypoglycemic kwa zinthu za nayitrogeni metabolism, glucocorticoid kusakwanira chifukwa cha atrophy ya adrenal cortical 1972, V. V. T V. R. Klyachko, 1974).

Mu diabetesic glomerulossteosis, palinso kuphwanya kagayidwe ka mapuloteni, lipids, mapuloteni a polysaccharide. Matendawa akamayamba, hypoalbuminemia, hypergammaglobulinemia ikamakula, mapuloteni onse m'magazi amayamba kuchepa, makamaka ndi kukula kwa aimpso. Pathogenesis ya dysproteinemia mu diabetesic glomerulosulinosis sichimveka bwino, koma mwina imalumikizidwa ndi kuchepa kwa insulini yofunikira kuti ikhalebe bwino, kaphatikizidwe ka mapuloteni mumkodzo komanso kuwonongeka kwa chiwindi chifukwa cha kuwonongeka pafupipafupi kwa chiwindi mu shuga (P. N. Bodnar, 1974, B. S Jonushas, N.A. Mkrtumova, 1976). Palinso kuwonjezeka kwa kuchuluka kwa potaziyamu m'magazi, kuwonjezereka kwa cholesterol ndi kuphwanya kwa electrolyte bwino ndikukula kwa hyperkalemia.

Zomwe zimachitika ndi matenda a diabetesic glomerulossteosis zimaphatikizapo kukula monga matendawa pang'onopang'ono, chifukwa chake kuyambika nthawi zambiri kumakhala kosadziwika, kusowa kwamayendedwe a urin, kuchepa kwa zovuta za odwala omwe ali ndi shuga, komanso kuphatikiza kwa shuga ndi micangiopathies ena (makamaka ndi retinopathy ndi microangiopathies of the malengo).

Mu matenda a shuga a glomerulossteosis, matendawa, ngakhale amagwira ntchito, amakhala osavomerezeka.

Chithandizo cha odwala matenda ashuga Glomerulosulinosis:

Odwala odwala matenda ashuga glomerulossteosis, chithandizo zimadalira magwiridwe antchito, kuopsa kwa matendawa, komanso kupezeka kwa zovuta. Poyambirira, pogwiritsa ntchito impso yabwino, mankhwalawa amatengera njira zomwe zingalimbikitse matenda a shuga. Mtsogolomo, chithandizo chamankhwala chimalimbikitsa kuthetsa kapena kuthana ndi ma syndromes amtundu wina - hypertensive, nephrotic, azotemic, anemic, etc. (V. G. Baranov, N. F. Skopichenko, 1973). M'pofunikanso kuganizira kuthekera kwa stratization a impso ndi kwamikodzo matenda matenda a matenda ashuga glomerulossteosis.

Zakudya mankhwalawa a matenda a shuga a glomerulossteosis ayenera kukhala ochulukirapo, okhala ndi chakudya komanso mafuta ochepa (30-50 g patsiku) ndi zoletsa zamafuta a cholesterol ndikuzisintha ndi mafuta. Zakudya zofananazo zimayikidwa pamaziko akuti kuchuluka kwa mafuta a nyama m'zakudya za odwala omwe ali ndi matenda ashuga kumathandizira kukulitsa kwamitsempha yama mtima. Ndikofunikira kuyesetsa kuteteza kulemera kwa odwala omwe ali ndi matenda osokoneza bongo, chifukwa chakuti kunenepa kwambiri ndi imodzi mwazinthu zofunika kwambiri pakulimbana ndi matenda ashuga. Chifukwa cha kuchuluka kwa zotupa m'matumbo, sikuti hyperglycemia imasinthasintha kwambiri m'magazi a shuga kotero kuti odwala omwe amapatsidwa zakudya zochepa, zisanu, zisanu ndi chimodzi, omwe amapereka msana wamagazi kwambiri masana. Chifukwa cha kuchuluka kwa chidwi cha odwala kuti apange insulin, makonzedwe ake ndi zakudya ziwiri pambuyo poti jekeseni aliyense walimbikitsidwa (pambuyo pa mphindi 15 mpaka 20 ndi maola 1.5-2). Lonjezo ndilabwino kwambiri la insulin Therapy, lomwe lili pafupi kwambiri ndi mtundu wa insulin katulutsidwe, pogwiritsa ntchito zida za jakisoni wa mtundu wa Novo Reu, zida zamagetsi (A. S. Efimov, 1989).

Zakudya mankhwala pokonza matenda aimpso kulephera sizosiyana ndi mankhwalawa odwala matenda aimpso kulephera popanda matenda ashuga glomerulossteosis.

Kugwiritsidwa ntchito moyenera kumatanthauza kukonza mitundu yosokoneza ya metabolism. Izi zikuphatikizapo mavitamini a magulu C, A, B, rutin kwa masiku 10-20 mwezi uliwonse (V. R. Klyachko, 1974), anabolic steroids - nerobol, retabolil, silabolin, chithandizo mpaka miyezi 1-3, ndikutsatiridwa ndi kupuma kwa miyezi iwiri mu Zaka 1-2 (A.F. Malenchenko, 1965, A.S. Efimov, 1973).

Popeza kuphwanya kwa lipid metabolism, mankhwala okhala ndi lipolytic ndi hypocholesterolemic zotsatira amalembedwa: atromide, miscleron, cetamiphene, kuyamika, nigexin, zotsatira zabwino za miskleron pa glomerular filtration amadziwika (V. G. Spesivtsev et al., 1974). Olemba ena (P. N. Bodnar et al., 1973, A. S. Efimov et al., 1974) amadziwa zabwino za heparin, zomwe zimakhala ndi anticoagulant, hypotensive, hypolipemic, and hypohistamine. Kuphatikiza apo, heparin imathandizira kupatsirana kwa capillary), imawonjezera kuyenda kwa magazi aimpso, ndikuchepetsa proteinuria. Heparin amaperekedwa tsiku lililonse la 10 mpaka 10,000 mayunitsi intramuscularly kapena kudzera m'mitsempha 3-4.

Mankhwala a antispasmodic amagwiritsidwa ntchito pochiza matenda ashuga a shuga: anginin (prodectin), kutsatira, nigexin, etc. Anginin amachepetsa kulowetsedwa kwa khoma la mtima ndi J3-lipoproteins, kutsitsa kwamitsempha yamagazi, komanso zimakhudza nthawi ya matenda ashuga a retinopathy ndi nephropathy (V.R. Klyachko, 1972, T.N. Tirkina et al., 1974). Kuphatikiza kwa laser ndi hemocarbperfusion kumakhala kothandiza. Otsatirawa akuwonetsa njira yatsopano pochiza matenda ashuga a retinopathy (L. A. Katznelson et al., 1991). Dicinon imachepetsa kupezeka kwamitsempha, imalimbikitsa kukonzanso kwamatumbo, imawonjezera mawonekedwe owoneka (V.R. Klyachko et al., 1972).

Pokhudzana ndi kuphwanya kwakukulu kwazinthu za rheological zamagazi mwa odwala omwe ali ndi matenda a shuga, matenda oopsa kwambiri komanso kukula kwa micothrombosis, reocorrectors - hemodeis, reopoliglyukin kuphatikiza ndi mankhwala omwe amasintha minofu ya oxygenation (solcoseryl), komanso kuchepetsa mphamvu yakuphatikiza yama cell m'magazi (trental, chimes, used). )

Zothandizanso ndi angioprotectors - Doxium, Prodectin, Zofunikira, poganizira kuphwanya kwa lipid peroxidation mwa odwala omwe ali ndi matenda ashuga, ndikulonjeza antioxidants - vitamini B, 30% yankho (8 mg / kg ya odwala thupi kwa masiku 14).

Kugwiritsa ntchito koyambirira kwamatenda a tubuloglomerular amatha kugwira ntchito ngati prophlaxis ya nephroangiopathy (3. S. Mehdiyeva, 1989).

Chithandizo chatsopano cha mankhwalawa zotupa zam'mimba mu matenda a shuga ndi isodibut - choletsa wa encyme ya aldoreductase yomwe imayambitsa mapiritsi a glucose okhathamira a sorbitol amalembedwa mapiritsi a 0.5 g katatu patsiku kwa masabata awiri mpaka 6 (I M. Kakhnovsky , T.V. Koroleva, 1990). Mankhwalawa adapangidwa ndi Kiev Research Institute of Endocrinology ndi Chemistry of Hormones. Mwa njira zosagwiritsa ntchito mankhwala osokoneza bongo, hyperbaric oxygenation imagwira, yomwe imathandizira impso (T. A. Malkova, 1990).

Ndi ochepa matenda oopsa, antihypertensive mankhwala amagwiritsidwa ntchito (dopegitis, hemiton, clonidine, reserpine, etc.). Pofuna kuthana ndi edema, saluretics amalimbikitsa kuphatikiza ndi aldosterone antagonists (aldactone, veroshpiron). Mukamamwa mankhwala a thiazide, muyenera kusamala, chifukwa akamagwiritsira ntchito nthawi yayitali amalipira matenda a shuga chifukwa kuchepa kwa ntchito ya insulin. Mwa okodzetsa, makonda ayenera kuperekedwa kwa anthranilic acid kukonzekera (furosemide, lasix). Mu kwambiri nephrotic syndrome, kutulutsa kwa plasma kapena albumin kumasonyezedwa.

Kuchepetsa acidosis pakukula kwa impso kulephera, mchere wamchere, madzi amchere, zipatso zam'mimba, kukoka kwa mtsempha wa 5% wa sodium bicarbonate, hemodeis imagwiritsidwa ntchito. Ndi chitukuko cha CPI, chakudya chosadziwika komanso njira zodziwika bwino, odwala amasamutsidwa hem hemalal. Mu matenda a shuga a glomerulosulinosis omwe ali ndi matenda a kwamikodzo thirakiti, mankhwala oletsa kuphatikiza amayenera kuperekedwa, ngati ndi kotheka kuphatikiza ndi sulfonamides, mankhwala ena a nitrofuran.

Kupewa kwa matenda ashuga a Glomerulosulinosis:

Imachitika ndi kudziwitsidwa koyambirira ndi chithandizo cha matenda osokoneza bongo, kuwunika mosamala kuchuluka kwa shuga m'magazi ndikuchotsa kusinthasintha kwamphamvu mu glycemia, komwe kumatheka ndi zakudya zambiri ndikusankhidwa kwa mitundu yayikulu ya insulin kapena mankhwala ena ochepetsa shuga. Odwala amafunikira chithandizo choyenera cha zakudya, ntchito yoyenera. Kupewetsa matenda a kwamkodzo mosamala kumafunikiranso.

Kuyan'anila kwa odwala omwe ali ndi matenda ashuga glomerulosulinosis kumachitika ndi katswiri wamkulu wam'deralo molumikizana ndi endocrinologist. Kufufuza komweku kumalimbikitsidwa monga momwe zimakhalira ndi mitundu yofananira ya glomerulonephritis - kamodzi pa miyezi 3-6. Makamaka chidwi amayenera kulipidwa kuwunika kuthamanga kwa magazi, shuga mkodzo ndi magazi.

Ndi madokotala ati omwe ayenera kupezedwa ngati muli ndi matenda a Diabetesic glomerulosclerosis:

Kodi pali china chomwe chikukuvutitsani? Kodi mukufuna kudziwa zambiri zokhudzana ndi matenda a shuga (diabetesic glomerulosulinosis), zomwe zimayambitsa, zizindikiro, njira zamankhwala othandizira komanso kupewa, njira ya matenda ndi zakudya pambuyo pake? Kapena mukufuna kuyesedwa? Mutha kutero pangana ndi adokotala - Euro yachipatala labu nthawi zonse pantchito yanu! Madokotala abwino adzakuunikirani, kuyesa zizindikiro zakunja ndikuthandizirani kudziwa matendawa ndi zizindikiro, kukulangizani ndikupereka chithandizo chofunikira ndikupanga matenda. Mukhozanso Itanani dokotala kunyumba. Chipatala cha Euro labu tsegulani kwa inu nthawi yonse yoyandikira.

Momwe mungalumikizane ndi chipatala:
Foni ya chipatala chathu ku Kiev: (+38 044) 206-20-00 (makina ambiri). Mlembi wa chipatalachi adzakusankhirani tsiku labwino ndi nthawi yoti mudzayendere dokotala. Zogwirizanitsa ndi mayendedwe athu zikuwonetsedwa apa. Onani mwatsatanetsatane zantchito zonse za chipatalachi patsamba lake.

Ngati mudachita kafukufuku kale Onetsetsani kuti mwatenga zotsatira zawo kuti mukambirane ndi dokotala. Ngati maphunzirowa sanamalize, tichita zonse zofunikira kuchipatala chathu kapena ndi anzathu azachipatala.

Ndi inu? Muyenera kusamala kwambiri zaumoyo wanu wonse. Anthu samvera chidwi chokwanira matenda ndipo sazindikira kuti matendawa atha kukhala pachiwopsezo cha moyo. Pali matenda ambiri omwe poyamba sadziwonetsa m'matupi athu, koma pamapeto pake zimapezeka kuti, mwatsoka, yachedwa kwambiri kuwachiritsa. Matenda aliwonse ali ndi zizindikilo zake, mawonekedwe akunja - otchedwa matenda. Kuzindikira zizindikiro ndi gawo loyamba lazidziwikire matenda ambiri. Kuti muchite izi, ndizofunikira kangapo pachaka dokotala, osati kungopewa matenda oyipa, komanso kukhalabe ndi malingaliro oyenera m'thupi ndi m'thupi lathunthu.

Ngati mukufuna kufunsa dokotala funso - gwiritsani ntchito gawo loyang'ana pa intaneti, mwina mungapeze mayankho a mafunso anu pamenepo ndi kuwerenga malangizowo. Ngati mukufuna malingaliro a zipatala ndi madotolo, yesani kupeza zomwe mukufuna mu gawo la Mankhwala Onse. Komanso lembetsani ku portal yachipatala ku Euro labukuyang'anira zatsopano zaposachedwa ndi zosinthika zatsamba lino, zomwe zidzatumizidwa zokha ku imelo yanu.

Matenda achifundo

Kusintha kwa mbiri ya impso pa G. ndi polymorphic, njira zazikulu zitatu zowonongeka zimasiyanitsidwa - nodular, dissuse and exudative. Olemba ena m'malo mwakunyengeza amatulutsa mawonekedwe osakanikirana.

Fomu ya nodular imadziwika ndi kupezeka kwa glomeruli ya eosinophilic formations (ma fupa) ozungulira kapena mawonekedwe ozungulira omwe ali ndi vacuoles. Amatha kukhala gawo limodzi kapena gawo lonse la glomerulus, pamtunda womwe, kumapeto kwake, malupu omwe amakhala osungika amapezeka. Pa nthawi yomweyo, kukulitsa ndi aneurysms a glomerular capillaries, makulidwe am'munsi awo zimayang'aniridwa. Mukafufuza zam'mbuyo zam'magazi, zimayambira ngati zodimbirira, ndipo kenako monga collagen. Tizilombo timene timakhala ndi mitundu yambiri ya kulemera kwamankhwala ambiri mucocysaccharides, asidi achulukane a mucopolysaccharides, mafuta ochulukirapo, makamaka mafuta osaphatikizika amafuta acid ndi cholesterol esters. Kuunika kwa ma elekitrononi kumaonetsa kuti mapangidwe a timinofu timapezeka mu mesangium mwanjira yodzikundikira timinyewa ndi ma trabeculae mmenemo, ofanana ndi thunthu lamkati wapansi.

Fomu yotambasulira ikuwonetsedwa mu kufalikira ndi kusanjika kwa mesangium ndikuphatikizika kwa capillaries mu membranes apansi, omwe adakomoka kwambiri. Zomwe zimapangidwa ngati Membrane zomwe zimapangidwa mu mesangium siziphatikizana ndi maselasi opitilira, ndipo mapangidwe a mutu samachitika. Zidutswa zam'munsi za capillary malupu a glomeruli zimakhuthala, kapangidwe kake kamasowa.

Fomu yosakanikirayo imadziwika ndi kuphatikiza kwa timinofu tomwe timatulutsa timadzi tokhathamira komanso kukula kwa mbali zoyambira za glillerular capillaries. Malinga ndi kafukufuku wa ma elekitironi a microncopic, kukulira kwa michere yam'maso ya ma glillerular capillaries kumachitika koyambirira, nthawi zambiri musanawonekere kuchipatala kuwonongeka kwa impso, ndipo zimachitika, zikuwoneka, ndi mitundu yonse ya G. anthu ochokera m'mabanja odwala matenda ashuga.

Fomu yachikulire ndi yocheperako kuposa yakale, ndipo imadziwika ndi omwe amatchedwa. "Zovala za Fibrinoid", zomwe ndi ma positi a PAS osavomerezeka pakati pa endothelium ndi chapansi pa membala wa capillaries. Kafukufuku wa immunohistochemical m'mapangidwe awa akuwonetsa kuchuluka kwa ma immunoglobulins othandizira, omwe amawonetsa kuti ndi zovuta za antigen-antibody, osati serum. "Zida za Fibrinoid" sizikulunjika kwa G. d., Koma nthawi yomweyo zimapezeka pamafomu ake olemera komanso omwe akupita patsogolo mofulumira. Nthawi zambiri amaphatikizidwa ndi otchedwa. "Capsule akutsikira" yomwe ili mkati mwa kapu yam'mutu.

Zosintha mu tubules zimadziwika ndi kulowerera kwa glycogen ndi kutengera kwa mchitidwe mu corticomedullary zone, koyamba magawo a terminal a proximal convoluted tubules ndikufalikira kudera loonda la lole la Henle. Malire a burashi a epithelium amamasulidwa, ma granules a protein amapezekanso mu cytoplasm. Milandu yayikulu, yayitali kwambiri ya G. d. Pali kutchulidwa kwa ma tubules, kukulira kwa mipata yawo ndi kukhalapo kwa ma cylinders mwa iwo. Zigawo zapansi pa tubules zimakhala zazidutswa komanso zokhuthala. M'mitsempha yaying'ono ya impso ndi ziwalo zina, plasma impregnation, kuchuluka kwa endothelium, makulidwe apansi apansi ndi kuwonjezeka pang'onopang'ono kwa kusintha konse mpaka hyalinization ya arterioles.

Pathogenesis. G. d. - kuwonongeka kwa impso kwa matenda a shuga komanso kumayenderana ndi matenda a endocrine-metabolic.

Dysproteinemia yomwe imapezeka mwa odwala omwe ali ndi kuchuluka kwa alpha2-globulins ndi mawonekedwe a pathological paraproteins, kuchuluka kwa mucopolysaccharides, lipids yonse, triglycerides, p-lipoproteins palimodzi ndi kuwonjezeka kwa kupezeka kwamitsempha kwam'mimba kungayambitse kulowetsedwa kwawo kwa matrix osokoneza, kuchedwa, polymer kupanga mapangidwe a timiyendo. Kufanana kwa zotupa za impso mu G. d. Ndi kusintha kwa impso komwe kumayang'aniridwa ndikuwongolera kwa milingo yayikulu ya corticosteroids ku nyama kumapangitsa kuti zotumphukazi zimagwirizanitsidwa ndi kupindika kwa ma adrenal gland.

Chithunzi cha kuchipatala

Kupezeka kwa proteinuria, ochepa matenda oopsa, ndi edema ndizodziwika. Proteinuria (onani) ndiye chiwonetsero choyamba komanso chosasinthika cha G. d. Kutayika kwa mapuloteni kumafika 40 g patsiku. Matenda a shuga a retinopathy amapezeka pafupipafupi (onani), amakhala ndi ma hemaneurysms omwe amatuluka malo owoneka, ma exudates, malo osintha ngati mawonekedwe amtundu-wachikaso, komanso mu mitundu yoopsa kwambiri - kufalikira kwa retinitis (onani). Matope a urine nthawi zambiri amakhala ochepa. Matenda oopsa a arterial amapezeka mu 60% ya odwala ndipo, monga proteinuria, ikhoza kukhala kuwonekera kwake kachipatala koyamba. Kuchulukana kwa matenda oopsa kumawonjezereka ndikutalika kwa matendawa. Kwa achinyamata nephrotic syndrome imawonedwa kwambiri, pa okalamba - ochepa matenda oopsa, m'mphepete amatha kuphatikizidwa ndi kulephera kwa mtima. Muzochitika izi, edema imakhala yosakanikirana ndi mtima ndi chilengedwe.

Hypema ya hypoproteinemic edema nthawi zambiri imawonedwa - mu 47% ya odwala malinga ndi Henderson (L. Henderson et al., Nephrotic syndrome (onani) - pafupipafupi kwambiri - kuyambira 6 mpaka 26%. Nephrotic syndrome kwa odwala omwe ali ndi matenda ashuga ndi chizindikiro choopsa kwambiri kuposa cha odwala a cron, nephritis.

Kuchuluka kwa mapuloteni komanso kuchuluka kwa mapuloteni am'magazi a seramu pakalibe kutchulidwa kwa proteinuria kumakhalabe pakati pa malire, ndi nephrotic syndrome, pamodzi ndi hypoproteinemia ndi hypoalbuminemia, kuwonjezeka kwa alpha2 komanso kuchuluka kwa gamma globulins nthawi zambiri. Milingo ya Lipid imachuluka ndi nephrotic syndrome. Mlingo wa mucopolysaccharides ndi mucoproteins nawonso umakulitsidwa.

Pathogenetic mankhwala a G. of D. kulibe. Pali malipoti azotsatira zopindulitsa za mahomoni a anabolic (retabolil, nerobol, etc.), heparin. Ndikofunika kuchulukitsa chakudya cham'mimba chambiri ndi fructose wokwanira chakudya ndi mapuloteni (pakakhala kulephera kwa aimpso) ndi kuletsa mafuta. Chithandizo cha mankhwala chimatsimikiziridwa ndi mphero, mawonetseredwe: matenda oopsa, edema, mphamvu ya impso ndi mtima dongosolo. Njira zopangira opaleshoni - pituitary and adrenalectomy, kupatsirana kwa impso nthawi yomweyo ndi kapamba sikufalikira.

Njira ya a d. Amasiyana malinga ndi zaka za odwala, kuopsa kwa matenda ashuga komanso kukonza kwake. Mwa achinyamata, matendawa amakula msanga. Kukula kwa aimpso kulephera kumathandizira kuwonjezera pa pyelonephritis. Nthawi yayitali yokhala ndi moyo wa odwala pambuyo poyambira zizindikiro zoyambirira za G. ndi zaka 5-6, koma amatha kuyambira zaka ziwiri mpaka 12.

Diabetesic glomerulosulinosis ndi glomerulopathy: ndi chiyani?

Matenda a impsoimafotokoza za kusintha kwa pathological komwe makamaka kumachokera ku mtima (microangiopathy) ndipo kuli ndi tanthauzo lokwanira la matenda ashuga (kuperewera kwa metabolism mu minofu ya impso).

Poganizira kuti osati zida zapamwamba zokha zomwe zimakhudzidwa, komanso zida zina za impso, dzinali limalungamitsidwa - matenda ashuga nephropathy.

Ndi matenda a shuga omwe amadalira insulin, zovuta za impso ndizofala kwambiri kuposa matenda osokoneza bongo omwe amadalira insulin (30% ndi 20%). Kukula kwa glomerulosulinosis kumalumikizidwa ndi zizindikiro zosakhalitsa za matenda a shuga. Zizindikiro zolakwika za matendawa (proteinuria, matenda oopsa) zimapezeka, monga lamulo, patatha zaka 15 kuchokera pomwe zapezeka.

Koma kusintha koyamba - kuwonjezeka kwa kupanikizika kwa glomeruli komanso kuchuluka kwa kusefedwa kwa glomerular kumawonekera pafupifupi nthawi imodzi ndi matenda ashuga. Kutayika kwa albumin (microalbuminuria) kumayamba kuchitika zaka 5, koma sikumvera m'mayeso amachitidwe wamba.

Gawo lachitukuko (proteinuria, kukakamiza, kusokonezeka kwa kusefa kwa glomerular) limapezeka pambuyo pazaka zina 5-10. Uremia amakula pambuyo pazaka 5 kuchokera pakudziwika kwa kuwonongeka kwa mapuloteni.

Mukazindikira zizindikiritso zoyambirira za matenda ashuga, ndikofunikira kumayesedwa pafupipafupi kuyezetsa matenda a impso kupewa nthawi yayitali.

Zolinga zakukula kwa matenda amisala

Mu matenda a shuga, etiopathogenesis ya kuwonongeka kwa impso imagwirizanitsidwa ndi njira ziwiri zotsatana:

vuto linalake la metabolic (kusinthana),
kusokonezeka kwa hemodynamic.

Imbalance yafupika, choyambirira, kukulitsa glycosylation wa zinthu zomaliza chifukwa chosowa insulini.

Ndiye kuti, pali kuwonjezeka kwa shuga kwa mamolekyulu achilengedwe, omwe amawapangitsa kulemera ndi kupunduka. Izi zimabweretsa kukula kwa membrane wamkulu wa glomerular capillaries komanso kuwonjezereka kwa intervascular wosanjikiza (mesangial matrix).

Chinthu cha hemodynamic chimapangitsa kuchuluka kwa kusefedwa kwa glomerular ndi kufalikira kwa malo ake, zomwe zimachitika poyankha minofu hypoxia.

Zotsatira zake, kupsinjika mkati mwa capillaries a glomeruli kumawonjezeka, komwe kumayambitsa hypertrophy ya glomerular. Kuchulukanso kwamitsempha yamagetsi kumathandizira kulowetsa mapuloteni a pathological, lipids ndi mamolekyulu ena mu mesrium matrix.

Palinso ma hypotheses osiyanasiyana omwe cholinga chake ndi kufotokozera pathogenesis ya kuwonongeka kwa impso mu shuga:

Katemera, kufotokozera kuopsa kwa angiopathies ndi kufalikira kwa maselo oteteza kumatenda omwe angawononge mitsempha ya magazi,
neuroendocrine, yolumikiza angiopathy ndi kuchuluka kwa mahomoni a adrenal glands, hypothalamus, adenohypophysis,
chibadwa, kulola kulumikizidwa kwa kagayidwe kachakudya matenda ashuga ndi kusamutsa ena loci mu majini.

Ndikofunikira, ngati pali matenda ashuga m'banjamo, makamaka mtundu 1, kuti musamale poyambitsa kuyambitsa matenda obadwa nawo a metabolic: ndikofunikira kwambiri kuyesedwa, kuti muchepetse kunenepa.

Zizindikiro mu matenda ashuga

Kuwonongeka kwa impso mu shuga kumalandira chisamaliro chokwanira chifukwa cha kusintha kwa nthawi yayitali, chizolowezi chomangokakamira, komanso kupweteka kwa mawonekedwe akunja.

Matendawa nthawi zambiri amakhazikitsidwa paziwonetsero zambiri:

hypoproteinemia,
albinuria
kuchuluka kwa matenda oopsa (koyambirira),
retinopathy
chizolowezi chotupa.

Chizindikiro chofunikira cha kuwonongeka kwa matenda a shuga ndi retinopathy, yomwe imawonedwa mu 90% ya odwala omwe amadalira insulin komanso 60% ya odwala omwe samadalira insulin.

Zosintha mu fundus ndizodziwika bwino (ma micaneurysms, mawanga achizungulire kuzungulira zombo, macula, hemorrhages mu mawonekedwe a madontho ofiira mu retina) kotero kuti odwala matenda ashuga glomerulopathy amatha kukayikiridwa.

Magawo a chitukuko cha matendawa amagawidwa m'magulu:

zoyambirira (zowonetsera zazing'ono),
wosakhalitsa (wokhala ndi proteinuria),
chomaliza (ndi kulephera kwa aimpso).

Ndi matenda ashuga aakulu a nephropathy, zovuta zingapo zimawonedwa pobwezera shuga.

Woopsa milandu, gawo lotsogolera chithunzi cha matendawa ndi aimpso, ndipo vuto la matenda ashuga limakhalabe kumbuyo.

Pangakhale kusintha kowoneka poyesa matenda a shuga (kutsika kwa shuga mumkodzo ndi magazi, kufunikira kwa insulin kungathe kuchepa). Kupitilira kwa nephropathy kungayambitse nephrotic syndrome, yomwe imafuna kuzindikira mosiyanitsa ndi glomerulonephritis ndi ena aimpso komanso a systemic pathologies.

Ngati kusintha kwakakhudzana ndi matenda ashuga m'matumbo am'mimba kwapezeka, muyenera kuyang'anitsitsa impso.

Mfundo Zazidziwitso

Matenda a shuga amawopa mankhwalawa, ngati moto!

Muyenera kungolemba ...

Sizotheka kudziwa zizindikiro zoyambirira za kusintha kwa matenda a shuga. Kufunika kodziwitsa matenda anu ndikofunikira, chifukwa kudziwika kwakanthawi kumakupatsani mwayi woyambira ndikuletsa matenda.

Zizindikiro zamatumbo za glomerulopathy zisanachitike, njira zotsatirazi zamomwe zimagwiritsidwa ntchito:

kutsimikiza glomerular kusefera (amachepetsa m'miyezi yoyambirira matenda),
kutsimikiza kwa secretion ya magnesium (kutsekera kwake kumachepa),
kuphunzira kwa radionuclide
kuwongolera kwa albumin ndi creatinine mu mkodzo wa gawo lam'mawa (kutayika kwa albumin kwapezeka).

Ubwino wa biopsy kumayambiriro koyambirira ndikuzindikira gawo linalake lamatumbo a impso. Chidutswa cha minofu amatengedwa kuti mbiri.

Kukula pansi pa makina oonera zinthu zing'onozing'ono kumawululira kukula kwa chipinda chapansi pa capillaries glomeruli kale m'zaka 1-2 kuyambira chikhomo cha matenda ashuga. Kupititsa patsogolo kwazinthu kukuwonetsedwa pakukula kwa mipando, kugonjetsedwa kwa mesangium.

Kusintha kwa morphological kumaimiridwa ndi mitundu inayi:

Nodular ndizofala kwambiri. Amadziwika ndi mapangidwe ozungulira mabowo okhala ndi micros kulemera kwakukulu mucopolysaccharides, mafuta osiyanasiyana.

Amadzaza gawo kapena glomerulus yonse, kupondaponda malupu a capillary. Ma anneurysms amadziwika m'matumba, membrane wamkulu ndi wothinitsidwa.

Ndi mawonekedwe osokoneza, kusinthika kozungulira mwa zosakanikirana kumachitika ndikupanga mapangidwe ofanana ndi nembanemba momwemo. The oyambira nembanemba zombo kwambiri kukula. Mapangidwe a glomerular mtima malupu amazimiririka.

Fomu yachikulire nthawi zambiri imakhala ndi mafomu olimba, omwe amapita patsogolo mofulumira. "Zida za" fibrinoid "pakati pa endothelium ndi membrane wamkulu wa capillary, woperekedwa mu micropreparation, amakhala ndi ma immunoglobulins (antigen-antibody tata) omwe samadziwika kwenikweni. "M'malovu a Capsule" atha kupezekanso mkati mwa kapangidwe ka Bowman.

Kuphatikiza kwa mabowo ndi mawonekedwe osinthika mu mesangial wosanjikiza ndi mawonekedwe a mawonekedwe osakanikirana. Ma membala otupa a capillary amapezeka mitundu yonse ya morphological. Kukula kwa kusintha kwa morphological kumabweretsa impso zokhazikika pakapita nthawi.

Zosintha mu anatomy of diabetesic nephropathy zimafotokozedwa pofotokozera za macrodrug:

kukula kwa impso
chifukwa kuchulukana kwa minofu yolumikizika, kachulukidwe kakulidwe,
woonda wozungulira
pansi amawoneka bwino.

Pathogenetic chithandizo cha matenda a impso a shuga chimatheka pokhapokha kusintha koyamba.

Mwina mavuto a matenda ashuga nephropathy

Kusintha kwa impso ndi matenda ashuga ndi omwe amafa kwambiri mwa odwala. Mavuto a nephropathy amatha kuchitika zaka zoyambirira komanso patapita nthawi yayitali.

Mavuto akuphatikizapo:

kuchepa magazi
kuchuluka kopitiliza kupanikizika,
kusintha kwa mtima
kukula kwa matenda a mtima ndi stroko.

Ndi kukula kwa proteinuria yosatha, zotulukapo za matendawa ndizosavomerezeka kwambiri. Kukula kwa aimpso kumabweretsa uremia wokhala ndi imfa zambiri.

Ndikofunikira kutsatira malingaliro onse omwe mwatsimikizidwa, kupimidwa pafupipafupi.

Njira zochizira

Chithandizo, choyambirira, chimayenera kukhala chothandiza kukonza matenda oyambitsidwa.

Mfundo za mankhwala a nephropathy ndi izi:

chakudya chomwe chili ndi mafuta osavuta pang'ono, komanso kuchepa kwa kusefedwa kwa impso - kuchuluka kwa mapuloteni,
kulimbana ndi kuchepa magazi,
matenda a kukakamiza kugwiritsa ntchito mankhwala (ACE inhibitors),
lipid kagayidwe kachakudya,
angioprotectors
Ndi kukula kwa aimpso kulephera - kusamutsa insulin,
ndi zizindikiro za uremia - hemodialysis.

Ndikofunikira kuwunika pafupipafupi zisonyezo zonse zofunikira zasayansi, kuonana ndi endocrinologist, nephrologist.

Zotsogola ndi kupewa

Zizindikiro zofunikira pakumangirira kwanuko ndi:

mulingo wa albuminuria-proteinuria,
kuthamanga kwa magazi
kuwongolera matenda ashuga.

Kuzindikiritsa kwa microalbuminuria ndi proteinuria ndi kupita patsogolo kwamtsogolo kumatilola kuti tiwone momwe ngozi zakuyambitsidwira zazotsatira.

Kupewa nephropathy kumachepetsedwa: