Zomwe zimayambitsa matenda ashuga nephropathy, gulu ndi momwe angachitire

Matenda a shuga ndi nephropathy ndi matenda a impso a odwala matenda a shuga. Maziko a matendawa ndi kuwonongeka m'mitsempha ya impso, chifukwa, kukulitsa ziwalo zamagulu.

Pafupifupi theka la odwala omwe ali ndi matenda amtundu wa 1 kapena mtundu wa 2 omwe ali ndi zaka zopitilira 15 amakhala ndi zidziwitso zachipatala kapena zasayansi zokhudzana ndi kuchepa kwambiri kwa kupulumuka.

Malinga ndi zomwe zalembedwa mu State Register of Patients ndi matenda a shuga, kuchuluka kwa matenda ashuga pakati pa anthu omwe ali ndi mtundu wodziyimira pawokha ndi 8% yokha (m'maiko aku Europe chizindikirochi chili pa 40%). Komabe, chifukwa cha kafukufuku wambiri, zinavumbulutsidwa kuti kumadera ena ku Russia chiopsezo cha matenda ashuga chimaposa kasanu ndi kamodzi kuposa chomwe ananena.

Matenda a diabetes ndi nephropathy ndiwovuta kwambiri wodwala matenda ashuga, koma posachedwapa, kufunikira kwa matendawa ku mayiko otukuka kwakhala kukuwonjezereka chifukwa cha kuchuluka kwa nthawi ya moyo.

Mpaka 50% ya odwala onse omwe amalandila chithandizo cha impso (kuphatikizapo hemodialysis, peritoneal dialysis, kupatsirana kwa impso) ndi odwala a nephropathy a diabetes.

Zoyambitsa ndi Zoopsa

Choyambitsa chachikulu cha kuwonongeka kwa mtima waimpso ndi kuchuluka kwa shuga m'magazi. Chifukwa cha kulephera kugwiritsa ntchito njira, glucose owonjezera amaikidwa khoma la mtima, zomwe zimapangitsa kusintha kwa matenda:

• Kapangidwe kazinthu zabwino za impso ya zinthu zomaliza za shuga, zomwe, kudziunjikira m'maselo a endothelium (mkati mwa chotengera), kumayambitsa edema yake ndikusintha kwake.
• kuchuluka kwamphamvu kwa kuthamanga kwa magazi muzinthu zazing'ono za impso - nephrons (glomerular hypertension),
• kutsegulira kwa renin-angiotensin system (RAS), yomwe imachita imodzi mwamagawo ofunika kwambiri pakuwongolera magazi,
• albin yayikulu kapena proteinuria,
• kukanika kwa ma podocytes (ma cell omwe amasefa zinthu mu matupi a impso).

Zovuta zomwe zingayambitse matenda a shuga:

• kudziletsa glycemic,
• kupangidwa koyambirira kwa mtundu wa shuga
• kuchuluka kwamphamvu kwa kuthamanga kwa magazi (ochepa oopsa),
• hypercholesterolemia,
• kusuta (chiopsezo chachikulu chotenga matenda ndi pamene mukusuta ndudu 30 kapena kupitilira tsiku),
• kuchepa magazi
• mbiri yakale yabanja
• amuna.

Pafupifupi theka la odwala omwe ali ndi matenda amtundu wa 1 kapena a 2 omwe ali ndi zaka zopitilira 15 amakhala ndi zidziwitso zachipatala kapena zasayansi zovulala.

Mitundu ya matenda

Matenda a shuga a nephropathy amatha kuchitika mwa matenda angapo:

• matenda ashuga glomerulossteosis,
• aakulu glomerulonephritis,
• yade
• atherosulinotic stenosis a mitsempha ya impso,
• tubulointerstitial fibrosis, etc.

Malinga ndi kusintha kwa morphological, magawo otsatirawa a kuwonongeka kwa impso (makalasi) amasiyanitsidwa:

• kalasi I - kusintha kamodzi m'matumbo a impso, omwe apezeka ndi ma maikulosikopu a elekitoni,
• kalasi IIa - kufutukuka kosachepera (25% ya voliyumu) ​​ya mesangial matrix (gulu la zida zolumikizana zomwe zimakhala pakati pa capillaries ya mtima glomerulus la impso),
• kalasi IIb - kufutukuka kwa mesangial (kopitilira 25% yama voliyumu),
• kalasi III - nodular glomerulosulinosis,
• kalasi IV - kusintha kwa atherosclerotic oposa 50% ya aimpso glomeruli.

Pali magawo angapo a kupita patsogolo kwa nephropathy, kutengera kuphatikiza kwa mawonekedwe ambiri.

1. Gawo A1, preclinical (kusintha kwamaonekedwe osagwirizana ndi zizindikiro zina), nthawi yayitali - kuyambira zaka 2 mpaka 5:

• kuchuluka kwa masanjidwe am'mimba ndizachilendo kapena kuwonjezeka pang'ono,
• makulidwe apansi ndi opanda mphamvu,
• kukula kwa glomeruli sikusintha,
• palibe zizindikiro za glomerulosulinosis,
• albuminuria pang'ono (mpaka 29 mg / tsiku),
• proteinuria sichimawonedwa
• kusefera kwa glomerular kukhala kwabwinobwino kapena kuchuluka.

2. Gawo A2 (kutsika koyamba kwa impso), kutalika mpaka zaka 13:

• pali kuwonjezeka kwa kuchuluka kwa masangial matrix ndi makulidwe apansi apansi a madigiri osiyanasiyana,
• albuminuria ifika 30-300 mg / tsiku,
• kusefera kwamtundu wa glomerular kukhala wabwinobwino kapena wosachedwa,
• proteinuria kulibe.

3. Gawo A3 (kuchepa kwapang'onopang'ono kwa ntchito yaimpso), kumayamba, ngati lamulo, patatha zaka 15-20 kuchokera pachiwonetsero cha matendawa ndipo amadziwika ndi izi:

• kuchuluka kwakukulu kwa masenchymal matrix,
• Hypertrophy yam'munsi membrane ndi glomeruli impso,
• kwambiri glomerulosulinosis,
• proteinuria.

Matenda a shuga ndi neopropathy amachedwa.

Kuphatikiza pazomwe tafotokozazi, gulu la matenda ashuga limagwiritsidwa ntchito, lovomerezeka ndi Ministry of Health of the Russian Federation mu 2000:

• matenda ashuga nephropathy, gawo la microalbuminuria,
• matenda a shuga, nephropathy, gawo la proteinuria lomwe limasungidwa ndi improjeni wa nitrogen.
• matenda ashuga nephropathy, gawo la matenda aimpso kulephera.

Chithunzi cha chipatala cha matenda ashuga nephropathy koyambira sichineneke:

• kufooka wamba
• kutopa, ntchito yochepa,
• kuchepa kwa masewera olimbitsa thupi,
• mutu, chizungulire,
• kumverera kwa mutu "wowuma".

Matendawa akamapitilira, mawonekedwe owonetsa owawa amakula:

• kupweteka kosavuta mu dera lumbar
• kutupa (nthawi zambiri kumaso, m'mawa),
• zovuta zamkodzo (kuchuluka masana kapena usiku, nthawi zina zimayenderana ndi kupweteka),
• kudya kwakachepera, nseru,
• ludzu
• kugona tulo masana
• kukokana (nthawi zambiri minofu ya ng'ombe yamphongo), kupweteka pamimba, mafupa
• kuchuluka kwa kuthamanga kwa magazi (matendawa akangofalikira, matenda oopsa amakhala oopsa, osagwirizana).

Pakadutsa pake matendawa, matenda a impso amakula (dzina loyambalo limalephera kupweteka kwa impso), limadziwika ndi kusintha kwakukulu pakugwira ntchito kwa ziwalo ndi kulumala kwa odwala: kuwonjezereka kwa azotemia chifukwa cha kuperewera kwa ntchito, kusunthika kwa mulingo wa acid ndi kusakanikirana kwa chilengedwe chamkati, kuchepa magazi, komanso kusokonezeka kwa ma electrolyte.

Zizindikiro

Kuzindikira matenda a shuga a nephropathy kumakhazikitsidwa ndi chidziwitso cha labotale ndi chothandizira pamaso pa mtundu 1 kapena mtundu wa 2 wodwala mellitus wodwala:

• urinalysis
• kuwunika albuminuria, proteinuria (chaka chilichonse, kupeza albuminuria yoposa 30 mg patsiku imafuna kutsimikiziridwa mu mayeso osachepera awiri motsatizana mwa 3),
• kutsimikiza kwa glomerular kusefera mlingo (GFR) (osachepera 1 pachaka odwala omwe ali ndi magawo I - II komanso nthawi imodzi mu miyezi itatu kukhalapo kwa proteinuria yokhazikika),
• maphunziro a serum creatinine ndi urea,
• magazi lipid kusanthula,
• kuthamanga kwa magazi podziyang'anira, kupenyeza magazi tsiku lililonse,
• Kupenda kwa impso.

Magulu akuluakulu a mankhwalawa (monga momwe angafunire, kuchokera ku mankhwala osankha mpaka mankhwala osokoneza gawo lomaliza):

• kutembenuza kwa angiotensin (angiotensin kutembenuza) ma enzyme inhibitors (ACE inhibitors),
• angiotensin receptor blockers (ARA kapena ARB),
• thiazide kapena malupu okodzetsa,
• calcium blockers,
• α- ndi β-blockers,
• pakati zochita mankhwala.

Kuphatikiza apo, tikulimbikitsidwa kuti mutenge mankhwala a lipid-kuchepetsa (ma statins), othandizira antiplatelet ndi chithandizo chamankhwala.

Ngati njira zochizira matenda a matenda a shuga zimaperewera, onetsetsani kuthekera kwa kupatsanso mankhwalawa. Ngati pali chiyembekezo cha kupatsirana kwa impso, hemodialysis kapena peritoneal dialysis imaganiziridwa ngati gawo lokhalitsa pakukonzekera kwa opaleshoni ya chiwalo chogwira ntchito chosakwanira.

Mpaka 50% ya odwala onse omwe amalandila chithandizo cha impso (kuphatikizapo hemodialysis, peritoneal dialysis, kupatsirana kwa impso) ndi odwala a nephropathy a diabetes.

Mavuto omwe angakhalepo komanso zotsatirapo zake

Matenda a shuga a nephropathy amatsogolera pakukula kwa zovuta zazikulu:

• aakulu aimpso kulephera (matenda a impso),
• kulephera kwa mtima
• kukoma, imfa.

Ndi zovuta pharmacotherapy, matulukidwe ake ndiabwino: kukwaniritsa liwiro la kuthamanga kwa magazi osaposa 130/80 mm Hg. Art. kuphatikiza ndi kuwongolera kwamphamvu kwama glucose kumayambitsa kutsika kwa chiwerengero cha nephropathies oposa 33%, kufa kwa mtima - mwa 1/4, ndi kufa kwa milandu yonse - ndi 18%.

Kupewa

Njira zodzitetezera ndi izi:

1. Kuwunika mwadongosolo komanso kudziyang'anira nokha glycemia.
2. Kuyang'anira mwadongosolo mulingo wa microalbuminuria, proteinuria, creatinine ndi magazi urea, cholesterol, kutsimikiza kwa glamperular kusefera kwa muyeso (pafupipafupi maulamuliro amatsimikiza kutengera gawo la matendawa).
3. Mayeso a prophylactic a nephrologist, neurologist, optometrist.
4. Kutsatira malangizo azachipatala, kumwa mankhwala osokoneza bongo malinga ndi njira zotchulidwa.
5. Kusiya kusuta fodya, kuledzera.
6. Kusintha kwamoyo (zakudya, zochitikachitika zolimbitsa thupi).

Kanema wochokera pa YouTube pamutu wankhani:

Maphunziro: apamwamba, 2004 (GOU VPO "Kursk State Medical University"), apadera "General Medicine", oyenerera "Doctor". 2008-2012 - Wophunzira wa PhD, dipatimenti ya Clinical Pharmacology, SBEI HPE "KSMU", wolemba zamankhwala azachipatala (2013, apadera "Pharmacology, Clinical Pharmacology"). 2014-2015 - katswiri wophunzirira, wapadera "Management mu maphunziro", FSBEI HPE "KSU".

Chidziwitsocho chimapangidwa ndikupatsidwa chidziwitso chokhacho. Onani dokotala wanu chizindikiro choyamba cha matenda. Kudzipatsa nokha mankhwala kuopsa!

Zoyambitsa Nephropathy

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

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

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

Kuphatikiza pa chifukwa chachikulu cha nephropathy - kuchuluka kwa shuga m'magazi, asayansi amatchulanso zinthu zina zomwe zimakhudza chiwopsezo cha matendawa komanso kuthamanga kwa matendawa:

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

Zizindikiro za kupezeka kwa DN

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

Pachizindikiro choyamba, funsani katswiri kuti musayambitse matenda!

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

Gulu la odwala matenda a shuga a Nephropathy

Matenda a diabetes nephropathy amatanthauza matenda a genitourinary system, code malinga ndi ICD-10 N08.3. Amadziwika ndi kulephera kwa impso, momwe kuchuluka kwa kusefedwa mu glomeruli impso (GFR) kumachepa.

GFR ndiye maziko a magawidwe a matenda ashuga nephropathy malinga ndi magawo akukulidwe:

1. Ndi hypertrophy yoyambirira, glomeruli imakulirakulira, kuchuluka kwa magazi osefedwa kumakula. Nthawi zina kuwonjezeka kwa kukula kwa impso kumawonedwa. Palibe mawonekedwe akunja pakadali pano. Ziyeso sizimawonetsa kuchuluka kwa mapuloteni mumkodzo. SCF>
2. Kupezeka kwa kusintha kwamapangidwe a glomeruli kumawonedwa patadutsa zaka zingapo chitadutsa matenda a shuga. Pakadali pano, nembanemba wa glomerular amadzala, ndipo mtunda pakati pa capillaries umakula. Pambuyo pochita masewera olimbitsa thupi komanso kuwonjezeka kwa shuga, mapuloteni amkodzo amatha kuwonekera. GFR imagwera pansi pa 90.
3. Kukhazikika kwa matenda a shuga a nephropathy amadziwika ndi kuwonongeka kwakukulu m'matumbo a impso, ndipo chifukwa chake, kuchuluka kwamapuloteni ambiri mu mkodzo. Odwala, kupanikizika kumayamba kuchuluka, poyamba pokhapokha atagwira ntchito zolimbitsa thupi kapena zolimbitsa thupi. GFR imatsika kwambiri, nthawi zina mpaka 30 ml / mphindi, zomwe zimawonetsa kuyambika kwa kulephera kwa impso. Asanakhale gawo ili, osachepera zaka 5. Nthawi yonseyi, kusintha kwa impso kumatha kusintha ndikusamalidwa bwino ndikutsatira kwambiri zakudya.
4. Matendawa otchulidwa MD amadziwika ngati kusintha kwa impso kusintha, mapuloteni amkodzo amapezeka> 300 mg patsiku, GFR 9030010-155Kwa ma ruble 147 okha!

Mankhwala ochepetsa magazi mu shuga

Gawo 3, othandizira a hypoglycemic amatha kutha kusintha ndi omwe sangadzikundike impso. Pa gawo 4, matenda a shuga a 1 amafunika kusintha kwa insulin.Chifukwa cha kusachita bwino kwa impso, amamuthira nthawi yayitali kuchokera magazi, kotero amafunikira zochepa. Pomaliza, chithandizo cha matenda a shuga a nephropathy amakhala ndikuthandizira thupi, kukulitsa kuchuluka kwa hemoglobin, m'malo mwa impso zomwe sizikugwira ntchito ndi hemodialysis. Pambuyo pokhazikika pamkhalidwewo, funso loti mwina lingasinthidwe ndi chinthu chopereka limaganiziridwa.

Mu matenda a shuga a nephropathy, odana ndi kutupa (NSAIDs) ayenera kupewedwa, chifukwa amayamba kugwira ntchito ngati aimpso pafupipafupi. Awa ndimankhwala wamba monga aspirin, diclofenac, ibuprofen ndi ena. Dokotala yekha yemwe amadziwitsidwa za nephropathy ya wodwala ndi amene angachize mankhwalawa.

Pali zodabwitsa pakugwiritsa ntchito maantibayotiki. Zochizira matenda opatsirana a bakiteriya mu impso ndi matenda a diabetes.

Zofunikira pakudya

Chithandizo cha nephropathy cha magawo oyamba makamaka zimatengera zomwe zili ndi michere ndi mchere, zomwe zimalowa m'thupi ndi chakudya. Zakudya za matenda a shuga a nephropathy ndikuchepetsa kugwiritsa ntchito mapuloteni amtundu. Mapuloteni muzakudya amawerengedwa kutengera kulemera kwa wodwala yemwe ali ndi matenda a shuga - kuyambira 0,7 mpaka 1 g pa kg iliyonse ya kulemera. International Diabetes Federation ikuvomereza kuti zopatsa mphamvu zamapuloteni zikhale 10% ya chakudya chonse. Chepetsani kuchuluka kwa zakudya zamafuta ndikuchepetsa cholesterol ndikuwongolera ntchito ya mtima.

Thanzi la matenda ashuga nephropathy liyenera kukhala kasanu ndi kamodzi kuti chakudya ndi mapuloteni azakudya azilowa mthupi mopitilira.

Zovomerezeka:

1. Masamba - maziko a chakudya, ayenera kukhala osachepera theka la izo.
2. Zipatso zochepa za GI ndi zipatso zimangopezeka m'mawa.
3. Mwa mbewu monga chimanga, barele, barele, dzira, mpunga wa bulauni ndimakonda. Amayikidwa mu mbale zoyambirira ndikugwiritsira ntchito ngati gawo la mbale zam'mbali ndi masamba.
4. Mkaka ndi mkaka. Mafuta, kirimu wowawasa, yogurts wokoma ndi ma curds amatsutsana.
5. Dzira limodzi patsiku.
6. Zopanga monga mbale yakumbuyo ndi soups zochuluka. Puloteni yomera ndiyotetezedwa ndi chakudya nephropathy kuposa mapuloteni amanyama.
7. Nyama yamafuta ochepa ndi nsomba, makamaka 1 nthawi patsiku.

Kuyambira gawo 4, ndipo ngati pali matenda oopsa, ndiye kuti kale, kuletsa mchere kumalimbikitsidwa. Chakudya chimasiya kuwonjezera, kupatula masamba mchere ndi mchere. Kafukufuku wazachipatala awonetsa kuti ndi kuchepa kwa mchere wambiri mpaka 2 g patsiku (theka la supuni), kuthamanga ndi kuchepa kwa magazi. Kuti mukwaniritse izi, simuyenera kungochotsa mchere kukhitchini, komanso kusiya kugula zinthu zotsiriza zomaliza ndi mkate.

Kukhala kothandiza kuwerenga:

• Mkulu shuga ndiomwe amachititsa kuti mitsempha ya magazi iwonongeke, motero ndikofunikira kudziwa momwe mungachepetsere shuga.
• Zomwe zimayambitsa matenda a shuga - ngati onsewa amaphunziridwa ndikuchotsedwa, ndiye kuti mawonekedwe osiyanasiyana osokonezeka amatha kuimitsidwa kwanthawi yayitali.

Onetsetsani kuti mwaphunzira! Kodi mukuganiza kuti kuyamwa kwa mapiritsi ndi insulini kwa nthawi yonse yokhayo ndi njira yokhayo yosungira shuga m'manja? Sichowona! Mutha kutsimikizira izi nokha ndikuyamba kuzigwiritsa ntchito. werengani zambiri >>

Zizindikiro

Monga tafotokozera pamwambapa, magawo oyamba a chitukuko, matenda ashuga nephropathy ndi asymptomatic. Chizindikiro chokha chachipatala chokhudza kupukutira kwa matenda a m'mimba chitha kukhala kuchuluka kwamapuloteni mumkodzo, zomwe siziyenera kukhala zachilendo. Izi, kwenikweni, ndi gawo loyamba chizindikiro cha matenda a shuga.

Mwambiri, chithunzi cha chipatala chimadziwika motere:

• kusintha kwa kuthamanga kwa magazi, nthawi zambiri amapezeka ndi kuthamanga kwa magazi,
• kuwonda mwadzidzidzi
• mkodzo umakhala mitambo, m'magawo omaliza a chitukuko cha matenda, magazi amatha kupezeka,
• kudya kwakachepa, nthawi zina wodwalayo amadana ndi chakudya,
• nseru, nthawi zambiri ndi kusanza. Ndikofunikira kudziwa kuti kusanza sikum'patsa mpumulo wodwala,
• kukodza kumasokonezeka - kukakamira kumachitika pafupipafupi, koma panthawi imodzimodziyo kumatha kumveka kuperewera kwa chikhodzodzo,
• kutupa kwamiyendo ndi manja, kutupira pambuyo pake kumatha kuchitika mbali zina za thupi, kuphatikizanso kumaso,
• m'magawo omaliza a chitukuko, kuthamanga kwa magazi kumatha kufika povuta,
• kudzikundikira kwamadzi mumimba yam'mimba (ascites), yomwe ndiowopsa kwambiri moyo,
• kufooka okula
• pafupifupi ludzu losalekeza
• kupuma pang'ono, kupweteka mtima,
• mutu ndi chizungulire,
• Azimayi amatha kukumana ndi mavuto azisamba - kusamba kapena kusakhalapo kwanthawi yayitali.

Chifukwa chakuti magawo atatu oyamba azomwe amapanga chipangidwe cha matenda a zam'mimba ali ngati asymptomatic, kudziwika kwakanthawi ndi chithandizo chake ndizosowa.

Morphology

Maziko a diabetesic nephropathy ndi aimpso glomerular nephroangiosulinosis, omwe nthawi zambiri amasokoneza, samakonda kupweteka (ngakhale nodular glomerulossteosis idayamba kufotokozedwa ndi Kimmelstil ndi Wilson mu 1936 monga chiwonetsero cha matenda ashuga). Ma pathogenesis a matenda ashuga nephropathy ndi ovuta, malingaliro angapo a chitukuko chake amapangidwa, atatu mwa iwo ndi omwe amaphunziridwa kwambiri:

• kagayidwe
• hemodynamic
• chibadwa.

Zikhulupiriro zamatabolic ndi hemodynamic zimapangitsa gawo la hyperglycemia, komanso chibadwa - kukhalapo kwa chibadwa.

Sinthani ya Morphology |Epidemiology

Malinga ndi International Diabetes Federation, odwala onse omwe ali ndi matenda ashuga ndi 387 miliyoni. 40% ya iwo imayamba kukhala ndi matenda a impso, zomwe zimabweretsa kulephera kwa impso.

Kupezeka kwa matenda ashuga nephropathy amatsimikizika pazinthu zambiri ndipo ndiwosiyana kwambiri m'maiko aku Europe. Zomwe zimachitika pakati pa odwala ku Germany omwe amalandila chithandizo cha impso zimaposa kuchuluka kwa United States ndi Russia. Ku Heidelberg (kumwera chakumadzulo kwa Germany), 59% ya odwala omwe adatsuka magazi chifukwa cha kulephera kwa impso mu 1995 anali ndi matenda a shuga, ndipo 90% ya milandu yachiwiri.

Kafukufuku waku Dutch adawona kuti kufalikira kwa matenda ashuga nephropathy sikuperewera. Panthawi ya zitsanzo za minofu ya impso pa autopsy, akatswiri adatha kuzindikira mu 106 mwa 168 odwala kusintha kwa histopathological komwe kumayenderana ndi matenda a impso a matenda ashuga. Komabe, 20 mwa 106 odwala sanakumanepo ndi matendawo pazakuwonekera.

Zizindikiro za matenda a shuga a Nephropathy

Matendawa amadziwika ndi kusapezeka kwa matendawa m'magawo oyamba a matendawa. Mu magawo omaliza, pamene matendawa akuwonetsa kusapeza bwino, mutha kuwonetsa zizindikiro za matenda ashuga:

• Kutupa
• Kuthamanga kwa magazi
• Kupweteka mtima
• Kupuma pang'ono
• Kuchepetsa mseru
• W ludzu
• Anachepetsa chilako
• Kuchepetsa thupi
• Kugona.

Pa gawo lomaliza la matendawa, mayesowo apeza mkokomo wa phokoso ("uremic maliro").

Stage Diabetesic Nephropathy

Potukula matendawa, magawo 5 amasiyanitsidwa.

Magawo oyamba a shuga nephropathy (1 - 3) amasintha: kubwezeretsa kwathunthu ntchito ya impso ndikotheka. Bwino insulin mankhwala zimayambitsa matenda a impso.

Magawo omaliza a diabetesic nephropathy (4-5) pakali pano sanachiritsidwe. Chithandizo chomwe chikugwiritsidwa ntchito chiyenera kulepheretsa wodwalayo kuti achepetse matenda ake.

Chithandizo cha odwala matenda ashuga a Nephropathy

Chitsimikizo cha kuchita bwino ndikuyamba kulandira chithandizo mukangoyamba kuwonongeka kwa impso. Potengera zakudya zomwe zidaperekedwa, mankhwala akumwa amachitika kuti musinthe:

• shuga m'magazi
• kuthamanga kwa magazi
• zikuonetsa lipid kagayidwe,
• intrarenal hemodynamics.

Kugwiritsa ntchito bwino matenda a shuga a nephropathy kumatheka pokhapokha ngati ali ndi matenda abwinobwino komanso osakhazikika. Kukonzekera konse kofunikira kudzasankhidwa ndi adokotala.

Pankhani ya matenda a impso, kugwiritsa ntchito ma enterosorbents, mwachitsanzo, kuyambitsa kaboni, kumasonyezedwa. Amachotsa poizoni wa uremic m'magazi ndikuwachotsa m'matumbo.

Beta-blockers kuti achepetse kuthamanga kwa magazi ndi thiazide diuretics sayenera kugwiritsidwa ntchito kwa odwala matenda ashuga omwe akuwonongeka impso.

Ku United States, ngati matenda ashuga a nephropathy apezedwa gawo lotsiriza, kuyika kwina kwa impso + kwachitika. Momwe matendawa amatengera ziwalo ziwiri zomwe zakhudzidwa nthawi imodzi ndiabwino kwambiri.

Momwe mavuto a impso amakhudzira chisamaliro cha matenda a shuga

Kuzindikira kwa matenda a shuga a nephropathy akukakamiza kuwunikiranso njira zamankhwala zochizira matenda ashuga.

• Odwala omwe ali ndi matenda a shuga a mtundu woyamba 1 ndi mtundu wa 2 omwe amagwiritsa ntchito mankhwala a insulin amafunika kuchepetsa mlingo wa insulin. Impso zakhudzidwa zimachepetsa kagayidwe ka insulin, mlingo wokhazikika ungayambitse hypoglycemia.

Mutha kusintha mlingo pokhapokha ngati mukufunsidwa ndi dokotala wovomerezeka ndi glycemia.

• Odwala omwe ali ndi matenda a shuga a mtundu wachiwiri omwe amatenga mapiritsi ochepetsa shuga amasinthidwa kupita ku insulin. Impso zodwala sizingachotse thupi la mankhwala oopsa a sulfonylurea.
• Anthu odwala matenda ashuga omwe ali ndi vuto la impso sanalangizidwe kuti asinthe zakudya zamafuta ochepa.

Hemodialysis ndi peritoneal dialysis

Njira yothandizira mankhwalawa, hemodialysis, imathandizira kutalikitsa kwa odwala omwe ali ndi matenda ashuga omaliza. Amawonetsera zisonyezo zotsatirazi:

• GFR yatsikira mpaka 15 ml / min
• Mulingo wa Creatinine (kuyesa kwa magazi)> 600 μmol / L

Hemodialysis - njira ya "kuyeretsa" magazi, kuthetsa kugwiritsa ntchito impso. Magazi akudutsa nembanemba wokhala ndi katundu wapadera amamasulidwa ku poizoni.

Pali hemodialysis omwe amagwiritsa ntchito "impso ya kupanga" ndi peritoneal dialysis. Pa hemodialysis pogwiritsa ntchito "impso yochita kupanga", magazi amatulutsidwa kudzera mwa membrane wapadera. Peritoneal dialysis imaphatikizapo kugwiritsa ntchito peritoneum ya wodwalayo monga nembanemba. Potere, njira zapadera zimaponyedwa pamimba yamatumbo.

Kodi hemodialysis yabwino ndi iti:

• Chovomerezeka ndichichita katatu pamlungu,
• Ndondomeko imachitidwa moyang'aniridwa ndi ogwira ntchito zachipatala mothandizidwa ndi iwo.

• Chifukwa cha kusayenda bwino kwa sitima, pamakhala zovuta kubweretsa ma catheters,
• Matenda amtima wapita patsogolo,
• Zosokoneza za Hemodynamic zakula,
• Chovuta kuyendetsa glycemia,
• Ndikovuta kuyendetsa magazi,
• Kufunika kokachezera azachipatala nthawi yonse.

Njira siziwachitikira odwala:

• Kudwala matenda
• Zowawa
• Pambuyo pa vuto la mtima.
• Ndi kulephera kwa mtima:
• Ndi matenda oletsa kupindika m'mapapo,
• Pambuyo pa zaka 70.

Ziwerengero: Chaka cha hemodialysis chimapulumutsa odwala 82%, pafupifupi theka lidzakhalapo zaka zitatu, zitatha zaka 5, 28% ya odwala adzapulumuka chifukwa cha njirayi.

Kodi zabwino peritoneal dialysis:

• Itha kuchitika kunyumba,
• Khola hemodynamics amasungidwa,
• Mlingo wokwera wa kuyeretsa magazi umatheka.
• Mutha kubaya insulini munthawi yake,
• Zombo sizikhudzidwa,
• Wotsika kuposa hemodialysis (katatu).

• Ndondomeko ziyenera kuchitidwa tsiku lililonse maola 6,
• Peritonitis imayamba
• Pofuna kutaya masomphenya, ndizosatheka kuchita ndekha inunso.

• Matenda oyipa pakhungu la pamimba,
• Kunenepa kwambiri
• Adhesions pamimba,
• Kulephera kwa mtima
• Matenda amisala.

Peritoneal dialysis imatha kuchitika yokha pogwiritsa ntchito chipangizo chapadera. Chipangizocho (sutikesi yaying'ono) cholumikizidwa ndi wodwalayo asanagone. Mwazi umatsukidwa usiku, njirayi imatenga pafupifupi maola 10. M'mawa, njira yatsopano imatsanulidwa mu peritoneum kudzera mu catheter ndipo zida zamagetsi zimazimitsidwa.

Peritoneal dialysis imatha kupulumutsa odwala 92% mchaka choyamba chamankhwala, pambuyo pa zaka 2, 76% adzapulumuka, pakatha zaka 5 - 44%.

Kutha kwa kusefa kwa peritoneum kumatha kuwonongeka ndipo pakapita nthawi padzakhala kofunikira kusinthana ndi hemodialysis.

Ndili ndi zaka 47, ndinapezeka kuti ndili ndi matenda ashuga a 2. M'masabata angapo ndinapeza pafupifupi 15 kg. Kutopa nthawi zonse, kugona, kumva kufooka, kuwona kunayamba kukhala pansi.

Nditakwanitsa zaka 55, ndinali nditadzibaya kale ndi insulin, zonse zinali zoipa kwambiri. Matendawa adapitilirabe, kukomoka kwakanthawi kunayamba, ambulansi imandibwezera kuchokera kudziko lina. Nthawi zonse ndimaganiza kuti nthawi ino ikhala yomaliza.

Chilichonse chinasintha mwana wanga wamkazi atandilola kuti ndiwerenge nkhani imodzi pa intaneti. Simungayerekeze m'mene ndimamuyamikirira. Nkhaniyi inandithandiza kuthana ndi matenda ashuga, omwe amati ndi osachiritsika. Zaka 2 zapitazi ndidayamba kusuntha zowonjezereka, nthawi yamasika ndi chilimwe ndimapita kumayiko tsiku lililonse, ndikumalima tomato ndikugulitsa pamsika. Azakhali anga amadabwa ndimomwe ndimapangira chilichonse, komwe ndimapeza mphamvu zambiri, sakhulupirira kuti ndili ndi zaka 66.

Ndani akufuna kukhala ndi moyo wautali, wamphamvu komanso kuiwalako za matenda oyipawa kwamuyaya, tengani mphindi 5 ndikuwerenga nkhaniyi.