Zizindikiro ndi matenda a matenda ashuga nephropathy

Kukhalapo kwa matenda ashuga kumatanthauza chiopsezo chokhala ndi mavuto ambiri, omwe amachitika ndi matenda a shuga. Kuphatikiza apo, matenda amtunduwu amatsogolera, kuyambira kuwonetsa zizindikiro posakhalitsa matenda atayamba. Gawo lomaliza ndi kulephera kwa impso.

Koma ngati mutsatira njira zodzitetezera, musanyalanyaze zizindikiro zoyipa ndikupanga matenda apakanthawi, matendawa amatha kuchepetsedwa momwe angathere. Ziyenera kumvetsedwa kuti matenda omwe amawerengedwa ndi chiani, chifukwa sagwira ntchito pa matenda odziyimira pawokha. Mawu akuti "matenda ashuga nephropathy" amaphatikiza mavuto osiyanasiyana ndi chinthu chimodzi - kuwonongeka kwa mitsempha ya magazi a impso, yomwe imachitika motsutsana ndi maziko a matenda osokoneza bongo a shuga.

Kodi matendawa amakula bwanji?

Matenda ovuta ngati amenewa amafunika kuwunika mozama, komwe kumaphatikizapo kusanthula mkodzo ndi magazi, maphunziro osiyanasiyana a mitsempha yamagazi ndi impso. Koma, choyamba, muyenera kulingalira zomwe zimayambitsa kukula kwa matendawa, komanso momwe adagawidwira mankhwala.

Dziwani kuti kupangika kwa matenda a metabolism sikugwirizana mwachindunji ndi kuchuluka kwa shuga omwe amapezeka m'magazi. Nthawi zina, pamaso pa matenda a shuga, matenda a diabetes a nephropathy samachitika, monga momwe limapangidwira chitukuko, palibe mgwirizano pa izo. Malingaliro odziwika bwino amaphatikizapo:

• Zamatsenga. Poyerekeza ndi tsogolo la glucose lokwera mosalekeza, matenda osiyanasiyana amtunduwu amapezeka omwe amakhudza kwambiri minyewa ya impso. Mndandanda wa zinthu zotere umaphatikizidwa ndi mapuloteni a glycated omwe amapangidwa kwambiri, hyperlipidemia, matenda amtundu wamatsenga omwe amapezeka m'matumbo, zotsatira zoyipa za kuchuluka kwa shuga.
• Hemodynamic. Kukula kwa matenda a impso a nephropathy amayamba chifukwa cha kuthamanga kwa magazi. Choyamba, mu glomeruli ya limba, m'badwo wa mkodzo woyamba umathandizira, ndipo kumatulutsa mapuloteni. Pambuyo pake, minofu yolumikizana imayamba kukula ndipo kuthekera kwa impso kumasefa.
• Mitundu. Amaganiziridwa kuti matenda a shuga a nephropathy amapangidwa mothandizidwa ndi majini omwe alipo kale omwe amawonetsa kukhalapo kwawo chifukwa cha kusokonezeka kwa metabolic kapena hemodynamic komwe kumachitika mu shuga.

Ndizotheka kuti pakupanga zamatsenga poganizira njira zonsezi zimakhudzidwa ndipo pali kulumikizana pakati pawo.

Ndikofunikira. Ponena za kagawoli, dongosolo la 1983, poganizira magawo a matendawa malinga ndi Mogensen, limavomerezedwa.

Kukula kwa matenda am'mimba kumayambira ndi kuthana ndi impso ndi matenda oopsa, Zizindikiro zoyipa zimawonedwa pafupifupi kumayambiriro kwa matenda. Pakapita kanthawi - kuchokera zaka ziwiri mpaka zisanu - kusintha kwamapangidwe kumachitika, kuphatikiza ma hyperfiltration, makulidwe am'mimba a basal a impalane ndi zina zamomwe zimayang'ana. Pambuyo pazaka zopitilira zisanu, wogwiridwayo amakhala ndi microalbuminuria, kuchuluka kwa GFR - glomerular filtration rate. Kupitilira apo, matenda ashuga nephropathy amasamukira ku gawo lotchuka kwambiri pamene proteinuria, sclerosis, yokhazikika 50 mpaka 75% ya glomeruli imayamba. Matendawa amapezeka zaka 10-15 atadwala matendawa. Ndipo potsiriza, patatha zaka 15 mpaka 20, kusintha kwa matenda ashuga nephropathy kufikira komaliza kumadziwika, pomwe wodwalayo ali ndi uremia, glomerulossteosis yathunthu.

Komabe, gulu la anthu odwala matenda ashuga nephropathy atha kuchitika motsatira kusintha kwa impso. Pankhaniyi, magawo otsatirawa amakula matendawa otsimikiza:

1. Hyperfiltration. Kukula koyambirira kumadziwika ndi kuthamanga kwa magazi mu glomeruli la impso, kuchuluka kwa mkodzo, komanso kuwonjezeka pang'ono kukula kwa ziwalo. Kutalika kwa gawo loyamba kumatha kufika zaka zisanu.
2. Microalbuminuria Mukamayang'ana mkodzo, pamakhala kuchuluka kochepa kwamapuloteni a albumin, amachokera ku 30 mpaka 300 mg / tsiku. Vutoli, komabe, ndikuti mayeso wamba a labotale sangathe kuzindikira zizindikiro zotere za matenda ashuga. Ndipo ngati chithandizo sichinayambike panthawiyi, sitejiyo imatha pafupifupi zaka khumi.
3. Proteinuria Pakadali pano, pakuchepa kwambiri kwa magazi kuyeretsedwa kudzera mu impso, pomwe kulumpha kowopsa m'magazi a impso kumachitika pafupipafupi. Mlingo wa albumin ukhoza kufika 200 mg / tsiku. Kukula kwa gawo ili kumachitika zaka 10-15 pambuyo poyambika kwa matenda.
4. kupezeka kwa nephropathy mu shuga. Zina mwazowonetsa za matenda a shuga ndi kuchepa kwenikweni kwa GFR; kusintha kwa sclerotic kumawonedwa m'matumba. Matendawa amatizindikira pambuyo pa zaka 15 mpaka 20 kuyambira pomwe gawo loyambirira la matendawo lidadziwika.

Gawo lomaliza ndikukhazikitsa kulephera kwa impso. Amawonedwa patatha zaka 20 mpaka 25 pambuyo pomwe matenda ashuga amakhudza thupi.

Zizindikiro zakukula kwa matenda ndi matenda

Zizindikiro za matenda ashuga a nephropathy mu magawo atatu oyamba a matendawa kulibe, mkodzo wothira mu kuchuluka kwake sizokayikitsa. Pazinthu zochepa chabe, pamene matendawa ali kumapeto kwa kukula kwa micro-albinuria, ozunzidwayo amadziwa nthawi ndi nthawi kukakamizidwa. Kudziwitsa koyenerako kwa matenda a shuga a nephropathy pakadali pano amafunika kusanthula kwapadera kwamkodzo komwe kumatha kudziwa kuchuluka kwa albumin pakapangidwe kake.

Pa nthawi ya proteinuria, zizindikiro zowoneka bwino za matenda zimawonekera. Chizindikiro chokwanira "kuyankhula" ndi:

• kuthamangitsa magazi
• kuwuma, komwe kumakhudza miyendo, nkhope, ndipo madzi amadzaza m'mitsempha.
• pamakhala kuchepa kwambiri kwamphamvu kwa thupi, kuwonongeka pakulakalaka chakudya, pomwe thupi limayamba kugwiritsa ntchito ndalama zake kupangira kusowa kwa mapuloteni,
• kugona kuwoneka, kufooka kowonjezereka,
• pamakhala ludzu lamphamvu komanso kugunda kwamiseru.

Pa magawo omaliza a chitukuko cha matenda a m'magazi, zizindikiritso zatsopano sizimayang'aniridwa, koma zonse zomwe zalembedwa sizongopitilizabe, komanso zimawonjezeka - kutupa kumakulirakulira, kuchuluka kwa magazi kumadziwika mu mkodzo. Kuwonjezeka kwa kuthamanga kwa magazi m'mitsempha ya chiwalo mpaka milingo yovuta kumawonedwa.

Kuzindikira matendawa

Chithandizo choyenera cha matenda a shuga a nephropathy amafunika kuzindikira koyenera, komwe kumayang'anira mtundu wa shuga, nthawi yake, komanso nthawi yayitali. Kukhalapo kwa azotemia, microalbuminuria ndi proteinuria kuyenera kukumbukiridwa. Kuzindikira koyambira kwa matenda omwe mukukambirana akuphatikiza maphunziro awa:

1. Kuzindikiritsa microalbuminuria kumachitika katatu.
2. Pambuyo pakupereka mkodzo tsiku ndi tsiku kapena kusanthula mkodzo wapafupipafupi, albuminuria imayesedwa.
3. Mkhalidwe wamtundu wa mkodzo umawunikiridwa.
4. Zizindikiro za urea ndi creatinine zimatsimikiziridwa, kuchuluka kwa kusefedwa kwa glomerular kumawerengeredwa.

Ndi diabetesic nephropathy, kuzindikira kwa magawo apambuyo pake sikovuta, kungakhale kokhazikika pamapuloteni omwe amapezeka mumkodzo, kuchuluka kwa kusefera, komanso chitukuko cha matenda oopsa.

Mukamapangira njira zodziwitsa, munthu ayenera kukumbukira kufunika kosiyanitsa ma pathologies ena, limodzi ndi zizindikilo zofananira ndi zotsatira zoyesa. Chifukwa chake, chiopsezo cholakwa chimawonjezeka pamaso pa matenda a pyelonephritis, chifuwa cha impso, glomerulonephritis, kapena kuperewera. Nthawi zina, kutsimikizira kuti wakupeza ndi matenda amafunika kuti munthu adziwe matenda a impso. Mndandanda wazidziwitso zakupangira kwake ukuphatikiza kupangidwa kwa proteinuria zaka zisanu zisanadutse kuchokera pakupangidwe kwa matenda a shuga a mtundu wa I. Komanso, biopsy imagwiritsidwa ntchito mosalekeza micro- kapena macrohematicsuria, kuwonekera kwadzidzidzi kwa nephrotic syndrome. Ngati khansa yodziwika ya machitidwe ena kapena ziwalo palibe.

Kodi matendawa amathandizidwa bwanji?

Mu magawo oyambilira a chitukuko cha matenda ashuga, nephropathy, cholinga cha mankhwalawa ndikukhazikika m'magazi a shuga pomwe nthawi imodzimodziyo amachotsa matenda oopsa oopsa. Komabe, pofika gawo la proteinuria, njira zochizira zimapangidwira kuti tilepheretse kuwonongeka kwa impso komanso kukula kwa aimpso kulephera. Mankhwala omwe agwiritsidwa ntchito pacholinga ichi ndi monga:

• ACE zoletsa. Pakati pa mankhwalawa, odziwika kwambiri ndi Enalapril, Lisinopril, ndi Fosinopril, omwe amakupatsani mwayi wokonza zowonjezera ndipo ndi eniotensin-yotembenuza enzyme. Mankhwalawa awonetsa ntchito yabwino yaimpso kwa odwala omwe ali ndi vuto la matenda a shuga 1. Ma Inhibitors angachepetse kuwonongeka kwa mapuloteni omwe amapezeka mumkodzo. Amathandizanso kuchepetsa chiwopsezo cha kupangidwa kwa mtima.
• Mankhwala omwe amalamulira hyperlipidemia m'magazi - tikulankhula za kuchuluka kwamafuta. Izi zimaphatikizapo simvastatin ndi mankhwala ena ofanana.
• Ma diuretics omwe amaphatikiza mankhwala monga Furosemide kapena Indapamide.
• Anemia amathandizidwa ndi zowonjezera pazitsulo.

Ndi kuthamanga kwa magazi, mungafunike kumwa mankhwalawa nthawi imodzi, pomwe chofunikira kwambiri kwa iwo ndi chiwerengero chochepa cha mavuto.

Ndikofunikira. Mukamamwa mankhwala angapo nthawi imodzi, mankhwala omwe amatha kuwononga impso amayenera kuchotsedwa - makamaka, lamuloli likugwiranso ntchito kwa mankhwala omwe si a antiidal.

Monga othandizira othandizira, zakudya zapadera zimagwiritsidwa ntchito mwachangu, kuchepetsa kuchuluka kwa mapuloteni a nyama omwe amatengedwa ndi chakudya. Sipayenera kupitirira 15-18% ya zopatsa mphamvu zomwe munthu amadya kwa maola 24. Mankhwalawa a matenda a shuga a nephropathy, mudzafunika kwambiri kuchepetsa kuchuluka kwa mchere womwe umagwiritsidwa ntchito tsiku lonse. Kuchepetsa kutakasuka, chisankho choyenera ndikubwerezanso njira zomwe zimamwa kuti zichepetse.

Malangizo pazakudya

Nthawi yomwe wodwalayo akayamba gawo la proteinuria, zakudya zosinthika bwino zimasanduka mankhwala okhwima. Tikuyankhula za zakudya zama protein ochepa, pomwe kilogalamu iliyonse ya kulemera kwa wodwala, kuchuluka kwa mapuloteni sayenera kupitirira 0,7 magalamu / kg. Mlingo watsiku ndi tsiku umachepetsedwa kukhala magalamu awiri kapena awiri ndi theka. Njirayi imachepetsa kupsinjika ndikuchotsa edema yayikulu. Chakudyacho chimaphatikizapo:

1. Nyama yotsika.
2. Mkate wopanda mchere.
3. Buckwheat, oatmeal ngati mbale yam'mbali.
4. Mapulogalamu, laconberry wachilengedwe, rasipiberi ndi timadziti ta sitiroberi.
5. Mitengo yothira zitsamba, minyewa yam'mimba ndi tiyi wazitsamba.
6. Zakumwa za mkaka ndi mbale zochepa zamafuta.
7. Nsomba yotsala, yomwe imalimbikitsidwa kuphika isanayambe.
8. Supu pa msuzi wamasamba ndi mkaka.

Zakudya zoletsedwa, kuwonjezera pamchere ndi mapuloteni, ndikofunikira kuti muchepetse kudya komwe kumakhala zakudya zosavuta. Mchere ndi marinade, zakudya zonunkhira, nyama yofukiziridwa ndi ufa wa ufa ziyenera kuchotsedwa muzakudya. Chinthu choletsedwa pakupanga matenda a diabetes ndi nephropathy ndi mowa komanso kusungidwa.

Nthawi zina, chithandizo chimaphatikizapo kutenga ketone analogi ya amino acid. Kupezeka kwawo ndikofunikira, chifukwa thupi la munthu limatha kuyambitsa kuwonongeka kwa mapuloteni m'masitolo ake.

Njira zina

Nephropathy, pamodzi ndi mitundu ina ya aimpso, imawerengedwa ngati matenda oopsa, chifukwa chake sibwino kuthandizidwa ndi mankhwala achikhalidwe pankhaniyi. Komabe, mankhwala achire atachitika kapena gawo la matenda litangoyamba kumene, mutha kugwiritsa ntchito mankhwala azitsamba, mukakambirana ndi dokotala:

• Njira zina zochiritsira, kuphatikiza zipatso zaononberry, zimagwira - zimalimbitsa chitetezo cha mthupi komanso kukonza kukodza. Ma lingonberry amayenera kukhala pansi ndi shuga m'magawo ofanana, obisika mufiriji, yomwe kale idayikidwa m'mabanki. Zotsatira zosakanikirana ziyenera kuchepetsedwa ndi madzi ndikuledzera monga compote.
• Kuyeretsa bwino kumachotsedwa ndi masamba a mavwende, omwe amayenera kupangidwa ndi madzi. Msuzi womwe unayambitsidwa ndiwotumwa m'malo mwa tiyi.
• Bearberry amathandiza ndi pachimake kapena matenda aimpso nephritis. Choterera chachikulu chomera chimayenera kudzazidwa ndi 200 ml ya madzi, kuwiritsa ndi kuwiritsa mpaka gawo lachitatu la madzi onse atuluka. Imwani mankhwalawa mutatha kudya, mutatha kudikirira mphindi 15. Chiwerengero cha madyerero patsiku ndi zitatu.

Izi ndi maphikidwe osavuta kwambiri, omwe nthawi zina amatha kukhala othandiza. Mutha kugwiritsanso ntchito mizu yakuda mabulosi kuti mupange decoctions, mbewu zosiyanasiyana za phyto zokhala ndi zida zambiri, kuphatikizapo licorice, tsamba la birch, comfrey ndi mbewu zina zamankhwala.