Matenda a impso a shuga monga concomitant pathology

Matenda a shuga ndi matenda osachiritsika omwe amayamba chifukwa cha kusakwanira kwathunthu kapena kocheperako kwa timadzi ta pancreatic - insulin. Awa ndi matenda oyipa omwe akhudza anthu ambiri, kuchuluka kwa matenda a zam'mimba kwambiri, ndipo posachedwapa akhala ndi chizolowezi chowonjezera. Mukapezeka ndi matenda a shuga, ndikofunikira kuwunika kuwerengera magazi ndikupewa zovuta zomwe zingachitike.

Zovuta za matenda ashuga: tikulimbana ndi chiyani?

Mavuto a shuga ndi zinthu zoyambirira kusamala nazo, ndipo amatha kukhala owawa, i.e. kupita patsogolo msanga kapena kutuluka patapita nthawi zambiri, monga momwe madokotala amanenera. Mavuto onse a shuga ali ndi chifukwa chimodzi chachikulu - Kusintha kwa kuchuluka kwa shuga m'magazi.

Matenda a impso, maso, ndi dongosolo lamanjenje ndi zina mwazovuta zazikulu komanso zovuta za matenda ashuga. Monga lamulo, zovuta zosagwirizana ndi matenda ashuga zimayamba mkati mwa zaka 5 mpaka 10 pambuyo popezeka ndi matenda a shuga.

Nthawi zina kumakhala kuyambitsa kwa kuwonongeka kwa impso, maso, ndi mantha, makamaka mu tandem, komwe kumapangitsa madokotala kuganiza kuti wodwalayo ali ndi matenda amtundu wa 2, ndipo pokhapokha kuwunika magaziwo kumatsimikiziridwa.

Kodi matenda ashuga amakhudza bwanji impso?

Pokhala fayilo "yamoyo", amatsuka magazi ndikuchotsa zinthu zopweteka zamankhwala am'thupi - michere - m'thupi.

Ntchito yawo ina ndikuwongolera kuchuluka kwamchere wamchere m'thupi.

Mu shuga, magazi amakhala ndi shuga wambiri.

Katundu pa impso umachuluka, chifukwa glucose amathandiza kuchotsa madzi ambiri. Kuchokera pa izi, m'mayambiriro a shuga, kuchuluka kwa kusefa kumawonjezeka ndipo kuthamanga kwa impso kumawuka.

Zomanga za glomerular za limba kwambiri patakhala kuzunguliridwa ndi membrane wapansi. Mu shuga, imakhuthala, komanso minofu yoyandikana nayo, yomwe imayambitsa kusintha kowononga m'makutu ndi mavuto ndi kuyeretsa magazi.

Zotsatira zake, ntchito ya impso imasokonezeka kwambiri mpaka kulephera kwa impso. Zimadziwulula:

• kutsika kwa mawu amthupi ambiri,
• mutu
• matenda am'mimba dongosolo - kusanza, kutsegula m'mimba,
• Khungu
• mawonekedwe amkamwa achitsulo,
• fungo la mkodzo kuchokera mkamwa
• kupuma movutikira, komwe kumamveka chifukwa chokhala ndi mphamvu yayitali komanso osapuma,
• spasms ndi kukokana kumadera akumunsi, nthawi zambiri kumachitika madzulo komanso usiku.

Zizindikirozi sizimawoneka nthawi yomweyo, koma patatha zaka zopitilira 15 kuchokera pomwe njira zam'magazi zimayenderana ndi matenda a shuga. Popita nthawi, zinthu za nayitrogeni zimadziunjikira m'magazi, zomwe impso sizingathenso kutuluka. Izi zimayambitsa mavuto atsopano.

Matenda a shuga

Matenda a diabetes nephropathy amatanthauza zochitika zambiri zomwe zimatchulidwa kuti ndizovuta za impso.

Tikuyankhula za kugonjetsedwa kwa zomangira ndi ziwiya zomwe zimawadyetsa.

Kuphwanya thanzi kumeneku ndikowopsa chifukwa cha kukanika kwa impso komwe kumapitilira, komwe kumawopseza kutha kumapeto kwa matenda - mkhalidwe wowopsa.

Muzochitika zotere, yankho limatha kuyendetsa impso kapena kufalitsa impso.

Dialysis - kuyeretsa magazi kwapadera pogwiritsa ntchito zida zapadera - amalembera ma pathologies osiyanasiyana, koma mwa omwe amafunikira njirayi, ambiri ndi omwe akudwala matenda a shuga II.

Monga tanena kale, kugonjetsedwa kwa ziwalo zazikuluzikulu zamkodzo mwa anthu omwe ali ndi vuto la "shuga" kumayamba zaka zambiri, osadziwonetsa yekha kumayambiriro.

Kusokonezeka kwa impso komwe kumapangidwa magawo oyamba, ndikupita patsogolo, kumadutsa mwakuya, komwe ndi matenda a shuga. Njira yake, akatswiri azachipatala amagawidwa m'magawo angapo:

• kukulitsa kwa njira zopatsirana zomwe zimayambitsa kuthamanga kwa magazi ndipo, chifukwa chake, kuchuluka kwa impso,
• kuchuluka pang'ono kwa albumin mu mkodzo (microalbuminuria),
• kuwonjezeka kopita patsogolo kwa kuchuluka kwa mapuloteni a albumin mu mkodzo (macroalbuminuria), komwe kumachitika motsutsana ndi maziko a kuthamanga kwa magazi,
• mawonekedwe a nephrotic syndrome, omwe akuwonetsa kuchepa kwakukulu kwa ntchito zamafayidi amisala.

Pyelonephritis

Pyelonephritis ndi njira yachilendo yotupa mu impso yomwe imachokera ku bakiteriya, momwe zida zamkodzo lanu amakhudzidwa.

Mkhalidwe wofananawo ukhoza kukhalapo ngati matenda osiyana, koma nthawi zambiri zimachitika chifukwa cha zovuta zina zaumoyo, monga:

• urolithiasis,
• zotupa zoyipa za njira yobereka,
• matenda ashuga.

Ponena za chomaliza, zimayambitsa pyelonephritis nthawi zambiri. Poterepa, kutupa kwa impso sikupweteka.

Kuti mumvetsetse zifukwa, ndikofunikira kumvetsetsa kuti, mosasamala kanthu za momwe matenda amtunduwu amapatsira, palibe tizilombo toyambitsa matenda. Nthawi zambiri, kutupa kumachitika chifukwa cha kuyanika kwa coccal tizilombo ndi bowa.

Vutoli limasokonekera chifukwa chakuti njira ya matenda ashuga imayendera limodzi ndi kufooka kwa chitetezo chathupi.

Glucose mumkodzo amapanga malo abwino operekera tizilombo toyambitsa matenda.

Zida zoteteza thupi sizitha kugwira ntchito zawo, chifukwa chake pyelonephritis imayamba.

Tizilombo tating'onoting'ono tomwe timakhudza kusefukira kwa impso, zomwe zimayambitsa mapangidwe a magazi a bakiteriya ozunguliridwa ndi leukocyte kulowetsedwa.

Kukula kwa pyelonephritis kwa nthawi yayitali kumatha kukhala kozizira komanso kooneka bwino, koma kenako kuwonongeka ndikuwoneka bwino:

• kwamikodzo ntchito. Kuchuluka kwa mkodzo tsiku ndi tsiku kumachepa, pamakhala mavuto pokodza,
• munthu amadandaula za ululu wopweteka m'dera lumbar. Amatha kukhala amodzi mbali imodzi kapena awiriawiri, amakula mosayang'ana mayendedwe ake komanso zolimbitsa thupi.

Miyala yamiyendo

Kupangidwe kwa miyala ya impso kumachitika pazifukwa zosiyanasiyana, koma njira imodzi nthawi zonse imakhudzana ndi kusokonezeka kwa metabolic.

Kupangidwe kwa oxalates kumatheka chifukwa chophatikiza oxalic acid ndi calcium.

Zomanga zotere zimaphatikizidwa ndimipanda yolimba komanso yopanda mawonekedwe, yomwe imatha kuvulaza epithelium yamkati mwa impso.

Miyala ya impso ndizofala kwambiri mwa anthu odwala matenda ashuga. Vomerezani zonse - njira zowonongeka mthupi ndipo, makamaka, impso. Pathology imasokoneza kayendedwe ka magazi, kupangitsa kuti ikhale yoperewera. Trophic zakudya za zimakhala. Zotsatira zake, impso ndizosakwanira mumadzi, zomwe zimayambitsa ntchito ya mayamwa. Izi zimabweretsa mapangidwe a oxalate malo.

Hormone ya aldosterone, yopangidwa mu ma grenal adrenal komanso yofunikira pakukhazikitsa kuchuluka kwa potaziyamu ndi calcium m'thupi, ilibe mphamvu yomwe mukufuna. Chifukwa cha kuchepa kwa chiwopsezo chake, mchere umadziunjikira impso. Vuto lomwe madokotala amalitcha urolithiasis limakula.

Matenda a shuga Cystitis

Cystitis ndi, tsoka, chinthu chofala.

Amadziwika bwino ndi ambiri monga kutupa kwa chikhodzodzo.

Komabe, ndi anthu ochepa omwe amadziwa kuti matenda a shuga ndi omwe amayambitsa izi.

Izi zikufotokozedwa ndi:

• zotupa za atherosrance
• zolakwika mu chitetezo cha m'thupi, zomwe zimachepetsa kwambiri kuteteza kwa chikhodzodzo. Chiwalochi chimayamba kusokonezedwa ndi zomwe zimachitika pathogenic maluwa.

Maonekedwe a cystitis ndiosatheka kuzindikira. Amadzipangitsa kumva:

• mavuto ndi kutuluka kwa mkodzo. Njirayi imakhala yovuta komanso yopweteka,
• kupweteka m'munsi pamimba, kukumbukira za contractions. Amayambitsa kuvutika kwambiri poyesa kukodza,
• magazi mkodzo
• Zizindikiro za kuledzera, chimodzi chomwe ndi kuwonjezeka kwa kutentha kwa thupi motsutsana ndi maziko wamba a khungu.

Chizindikiro cha matenda amkodzo mu shuga mellitus ndikuti ziyenera kuphatikizidwa ndi magawo a zomwe zimayambitsa matenda.

Izi zikutanthauza kuti kusankha kwa mankhwala ndi kuchuluka kwake kuyenera kuvomerezedwa ndi dokotala.

Chifukwa chake, mukazindikira nephropathy, maupangiri amachitidwe osokoneza bongo amasintha. Pakufunika kuletsa mankhwala ena kapena kuchepetsa kumwa.

Ngati kusefukira kwa mankhwalawa kumavutika, mlingo wa insulin umasinthidwa kutsikira. Izi ndichifukwa choti impso zofowoka sizitha kuzichotsa mthupi moyenera komanso munthawi yoyenera.

Chithandizo cha chotupa cha chikhodzodzo (cystitis) mu shuga mellitus chimaphatikizapo:

• kumwa Furadonin kanayi pa tsiku, maola 6 aliwonse. Kapenanso, Trimethoprim imatha kutumikiridwa (kawiri pa tsiku, mosiyanasiyana) kapena Cotrimoxazole,
• Kukhazikitsidwa kwa mankhwala a antibacterial (Doxycycline kapena Amoxicillin) kwa masiku atatu mpaka sabata limodzi ndi theka, kutengera mawonekedwe ndi kuuma kwa matenda.
• kumwa antispasmodics.

Chofunikira ndi njira yolimbikitsira kumwa panthawi yomwe mukumwa mankhwala, komanso kugwiritsa ntchito njira zaukhondo mosamala.

Miyala yaying'ono nthawi zina imatha kutulutsidwa mwanjira yachilengedwe, ndipo miyala yayikulu imagwira bwino ntchito. Chifukwa chake madokotala amalangiza. Izi zimakhala choncho makamaka ngati kusanthula kwa ultrasound kukuwonetsa kuti oxalate ndi yopatsa chidwi ndikuyika moyo pachiwopsezo ngati itasuntha ndikutseka chitsekocho.

Chimodzi mwazinthu izi ndi njira yomwe imakulolani kuti muwononge mapangidwe mwachindunji pamtunda wa chimbudzi.

Kuvulala pakhungu ndi kocheperako, ndipo nthawi yake yochira ndiyifupi kwambiri kuposa kuchitira opaleshoni wamba.

Kukhala m'chipatala ndi masiku awiri, ndipo njira yayikulu yopewa kuyambiranso ikutsatira malamulo okhudzana ndi zakudya omwe adokotala adawakhazikitsa.

Chifukwa chake, mavuto ndi kwamikodzo mu shuga, mwatsoka, ndi osapeweka. Komabe, izi sizitanthauza kuti sangamenyedwe. Khama lofunsira thanzi la munthu, kulandira chithandizo chanthawi yake kwa dokotala ndikukwaniritsa zomwe walangizidwa zimathandizira kusintha kosasangalatsa, kukhazikika kwazinthuzo komanso kupewa zovuta zazikulu.

Unyolo wamatenda

Zomwe zimayambitsa matenda a shuga padziko lonse lapansi zimatchedwa kunenepa kwambiri komanso kumangokhala. Komabe, mdziko lathu, kupsinjika kosalekeza mwa anthu kumawonjezeredwa pazinthu izi. Izi zikuwoneka mu mawerengero apadziko lonse: ngati ku Europe ambiri odwala matenda ashuga ndi okalamba, ndiye kuti matenda athu amakhudza anthu kuyambira zaka 33 mpaka 55. Mwambiri, akatswiri a WHO amatcha matenda ashuga "vuto la mibadwo yonse ndi mayiko onse."

Amadziwika kuti chithandizo cha matenda aliwonse mwa wodwala yemwe ali ndi matenda ashuga (mu 90% ya matenda a shuga) amafunika chisamaliro chapadera komanso chidziwitso chochuluka. Kuphatikiza apo, nthawi zambiri vutoli limayenderana kwambiri ndikudziwonetsa kokhumudwitsa ndipo ndizotsatira zake mwachindunji. Matenda a shuga a Mtundu Wachiwiri amatsogolera kuwonongeka kosasintha kwa ziwalo zonse ndi machitidwe. Zotsatira zake, odwala matenda ashuga amatha kupatsidwanso stroko katatu, akudwala matenda a shuga a nephropathy, retinopathymitsempha. Chifukwa chake, funso ndikuti: momwe mungatetezere kuti asawonongeke ndikulemala koyambirira?

Migwirizano ndi matanthauzidwe

Matenda a impso a matenda ashuga (DBP) - kuwonongeka kwapang'onopang'ono kwa impso mu shuga, limodzi ndi kupangika kwa ma nodular kapena kupukusa glomerulossteosis, zomwe zimapangitsa kuti pakhale kulephera kwa matenda a impso (ESR) ndi kufunika kogwiritsa ntchito mankhwalawa obwezeretsanso matenda a impso (RRT): hemodialysis (HD)

Mavuto ochepera komanso mafupa m'matumbo a impso (MKN-CKD) - lingaliro la kusokonezeka kwa mchere wa mineral ndi mafupa ndikupanga kwachiwiri hyperparathyroidism, hyperphosphatemia, hypocalcemia, kuchepa kwa kupanga kwa calcitriol motsutsana ndi maziko a kuchepa kwa unyinji wogwira minyewa ya impso.

Kuphatikizika kwa impso ndi kapamba (STPiPZh) - kuperekera munthawi yomweyo impso ndi kapamba kwa anthu odwala matenda ashuga komanso kulephera kwa impso.

Matenda a nephrocardial syndrome (mtundu 4) - mapangidwe apadera a pathophysiological phenomenena akuwonetsa kuyambitsa kwa matenda a impso matenda ochepetsa mphamvu ya m'magazi, kupanga hypertrophy yamanzere yamitsempha ndikuwonjezera chiopsezo cha zochitika zazikulu zamtima kudzera mu hemodynamic, neurohormonal komanso immuno-biochemical feedbacks.

Zotsatira za matenda a shuga pantchito ya impso

Impso - fyuluta yomwe thupi la munthu limachotsera zinthu zopweteka za metabolic. Impso iliyonse imakhala ndi mitundu yambiri ya glomeruli, cholinga chake chachikulu ndikuyeretsa magazi. Imadutsa glomeruli yolumikizidwa ndi tubules.

Magazi nthawi yomweyo amatenga zinthu zambiri zamadzimadzi ndi michere kenako zimafalikira thupi lonse. Zinyalala zomwe zimapezeka ndi magazi zimakhalabe m'mapangidwe a impso, pambuyo pake zimatumizidwa ku chikhodzodzo ndikuchotsa m'thupi.

M'magawo oyamba a matenda a shuga, impso imagwira ntchito mopitilira muyeso, yomwe imalumikizidwa ndi kuwonjezeka kwa shuga m'magazi. Imodzi mwa luso lake ndi kukopa kwamadzimadzi, kotero odwala matenda a shuga ali ndi ludzu lochulukirapo. Kutulutsa kwambiri mkati mwa glomeruli kumawonjezera kukakamiza mwa iwo, ndipo amayamba kugwira ntchito mwadzidzidzi - kuchuluka kwa kusefedwa kwa glomerular kumawonjezeka. Chifukwa chake, odwala matenda a shuga nthawi zambiri amathamangira kuchimbudzi.

Pazigawo zoyambirira za kukhazikitsidwa kwa matenda ashuga, timatumbo tambiri timeneti timakhuthala, chifukwa chake ma capillaries amayamba kukakamizidwa kulowa mu glomeruli, chifukwa chake, sangathe kuyeretsa magazi konse. Inde, makina owerengera ntchito amagwira ntchito. Koma shuga wokhala ndi nthawi yayitali akuyamba kukhala chitsimikizo cha kulephera kwa impso.

Kulephera kwamkati kumakhala kowopsa kwambiri, ndipo vuto lake lalikulu limakhala poizoni wambiri m'thupi. M'magazi mumapezeka zochuluka kwambiri za mankhwala oopsa a nayitrogeni.

Mu matenda ashuga, kuopsa kwa matenda a impso ndikosayenera, mwa odwala ena ndi okwera, ena otsika. Izi zimadalira kwambiri phindu la kuthamanga kwa magazi. Amadziwika kuti odwala oopsa omwe ali ndi matenda a shuga amadwala matenda a pathology nthawi zambiri.

Mphepo zakufa

Njira zothandiza. 1 - ochepa matenda oopsa ndi zotulukapo zake (ischemia, stroke, vuto la mtima).

Kafukufuku waposachedwa akuwonetsa kuti chiopsezo chotsika kwambiri ku thanzi la anthu chimakhala ndi kuthamanga kwa magazi kwa 115/75. Ngakhale wodwala yemwe ali ndi matenda ashuga akuchulukirachulukira pang'ono (mwachitsanzo, 139 / 8-9) ndipo osatha kuthandizidwa malinga ndi malingaliro a mtima, amagwera m'gulu lomweli lofanana ndi wodwala yemwe ali ndi mavuto oposa 170/95. Kuthekera kwa kufa pamilandu iyi kuli osachepera 20%.

Matenda oopsa a arterial (AH) ndi matenda ashuga nthawi zambiri amakhala mbali imodzi. Oposa 40% ya odwala onse amtima ali ndi insulin kukana. Ziwerengero zosayenerera - pafupifupi 90% ya odwala omwe ali ndi matenda a shuga II amadziwika kuti ali ndi matenda oopsa.

Izi zikuwonetsa kuti pathogenesis yamatenda onse awiriwa ali ndi chinthu chofanana, chomwe chimawalola kuti azindikire momwe amapezeka ndi duet lakufa, amalimbikitsa zotsatira za mnzake ndikuwonjezera kufa.

The pathogenesis of hypertension ili ndi zigawo khumi ndi ziwiri.Koma ngakhale imodzi mwa izo - kukana insulini - imayambitsa kutsegulidwa kwa CNS chifukwa chakuti mutatha kudya, nthawi zonse pamakhala kuwonjezeka kwa zochitika za mtima wa dongosolo la chisoni. Izi ndizofunikira kuti mphamvu zomwe zimagwiritsidwa ntchito zigwiritsidwe ntchito mwachangu komanso mwachuma. Pansi pa zochitika za insulin kukana, pamakhala kukwiya kwakutali kwa mawonekedwe amtunduwu, zomwe zotsatira zake zimakhala vasoconstriction, kuchuluka kwakutulutsa, ndi kupweteka kwa impso kuchokera kumbali ya impso. Koma koposa zonse, wodwala wodwala matenda a shuga amadzayamba aimpso hypersympathicotonia, amene amachepetsa mphamvu yoipa ya matenda oopsa.

Zinthu za matenda oopsa kwa odwala matenda ashuga ndi matenda oopsa mu supine udindo ndi orthostatic hypotension. Chifukwa chake, kwa wodwala wodwala matenda a shuga, kuwunika kuthamanga kwa magazi (tsiku ndi tsiku) kumafunika. Komanso, mwa odwala awa pali kusiyana kwakukulu kwamankhwala othamanga magazi, zomwe zimawopsa chifukwa cha matenda a ziwongo. Matenda oletsa kukana amayamba msanga ndipo ziwalo zomwe zakukhudzidwa zimakhudzidwa.

Zotsatira za kuwunika kwa meta kunawonetsa kuti odwala omwe ali ndi matenda ashuga komanso matenda oopsa, kutsika kwa systolic kwa 6 mm, ndi kupsinjika kwa diastolic ndi 5.4 mm, mosasamala kuti ndi mankhwala ati omwe amagwiritsidwa ntchito pamenepa, kumabweretsa kuchepa kwa chiopsezo cha kufa kwa wachibale ndi 30%. Chifukwa chake, tikakhala ndi njira yothandizira, cholinga chachikulu chizikhala kuchepetsa kufinya.

Ndikofunikira kuti musangoyang'ana zokhazokha, komanso kuthamanga kwa magazi, chifukwa si mankhwala onse omwe amachepetsa - choyamba, zimakhudza beta-blockers.

Kuzindikiritsidwa kwa chiwopsezo chachikulu cha matenda otere kumabweretsa zolinga zolimba kwambiri za antihypertensive chithandizo, chomwe ndichofunika kuyamba ndi mankhwala ophatikiza. Kupsinjika kwa odwala onse, mosasamala za kuchuluka kwa chiwopsezo, ndi 130 / 80. Malingana ndi miyezo yachipatala yaku Europe, palibe chifukwa chofotokozera mankhwala kwa odwala omwe ali ndi matenda ashuga kapena matenda a mtima omwe amakhala ndi kuthamanga kwambiri komanso akamachepetsa m'munsimu. Zimatsimikiziridwa kuti kukwaniritsa ziwerengero zochepa sikuyenda ndi kusintha kwakukulu, komanso zimayambitsa chiopsezo chokhala ndi ischemia.

Tsoka la zachinyengo pamtima

Kulephera kwamtima kosalekeza, komwe kumapanganiza kwambiri njira ya matenda ashuga, kumayenderana kwambiri ndi matenda oopsa.

Chiwopsezo cha matenda ashuga pankhani ya kupita patsogolo kwa kulephera kwa mtima chimawonjezeka kasanu. Ngakhale kukhazikitsidwa kwa njira zatsopano zamankhwala, kupha anthu chifukwa cha kuphatikiza kwa mitundu iwiriyi, mwatsoka, sikuchepetsedwa. Pankhani ya vuto la mtima losalephera, kusokonezeka kwa metabolic ndi ischemia nthawi zonse kumawonedwa. Matenda a shuga a Type II amathandizira kwambiri kusokonezeka kwa metabolic mwa odwala. Kuphatikiza apo, ndi matenda ashuga, nthawi zambiri pamakhala "chete" myocardial ischemia yowunikira ECG tsiku lililonse.

Malinga ndi kafukufuku wa Framingham, kuyambira pomwe amadziwika kuti ali ndi vuto la kulephera kwamtima kwakakhazikitsidwa, azimayi amakhala ndi chiyembekezo cha zaka 3.17 ndi amuna zaka 1.66. Ngati kufa kwakuthupi m'masiku 90 oyambirira sikumachotsedwa, ndiye kuti chizindikiro mwa akazi chizikhala pafupifupi zaka 5.17, mwa amuna - zaka 3.25.

Kuchita bwino kwa chithandizo chododometsa cha kulephera kwa mtima ndi matenda a shuga sikufikira cholinga. Chifukwa chake, lingaliro la metabolic cytoprotection, kutengera kukonzanso kwa kagayidwe kachakudya m'dera la ischemic, tsopano likukula.

M'mabuku azachipatala amalemba kuti azindikire polyneuropathy, wodwalayo ayenera kubwera ndi madandaulo a dzanzi komanso kufooka kwa zala. Uku ndiye njira yolakwika. Tiyenera kumvetsetsa kuti wodwala yemwe ali ndi matenda ashuga, matenda am'mtima, komanso "gulu" lina la ma concomitant pathologies samadandaula ndi kuzika pang'ono. Chifukwa chake, simuyenera kudalira chizindikiro ichi. Dotolo ayenera kuchenjezedwa za kuwonjezeka kwa kugunda kwa mtima kapena kukhalapo kwa matenda oopsa - awa ndi "ma foni" oyamba a chitukuko mitsempha.

Mfundo zoyambira kuchitira ululu wa neuropathic:

1. etiological Therapy (matenda a shuga) - kalasi I, mulingo wa umboni A,
2. mankhwala a pathogenetic - antioxidants, antihypoxants, metabolic mankhwala - kalasi II A, mulingo wa umboni B,
3. dalili mankhwala - kuchepetsa ululu matenda - kalasi II A, mulingo wa umboni B,
4. kukonzanso - mavitamini, mankhwala a neurotrophic kanthu, mankhwala a anticholinesterase, kalasi II A, mulingo wa umboni B,
5. angioprotectors - kalasi II B, mulingo wa umboni C,
6. olimbitsa thupi.

Kuyiwalika zovuta

Mwa mitundu yonse ya polyneuropathy ya matenda ashuga, chidwi chochepa chimaperekedwa kwa autonomic neuropathy. Mpaka pano, palibe chidziwitso chodziwika bwino pakupezeka kwake (zimasiyana 10 mpaka 100%).

Odwala omwe ali ndi matenda ashuga autonomic neuropathy, chiwerengero chaimfa chimachulukitsidwa kwambiri. The pathogenesis ya matendawa ndi ovuta, koma tinganene motsimikiza kuti munthu akamakhala ndi matenda ashuga, ndiye kuti masinthidwe osautsa kwambiri omwe amachitika m'mitsempha yamatsenga. Mwa izi, matenda ashuga cholecystopathy amayenera chisamaliro chapadera, komwe ndi matenda osokoneza bongo a biliary thirakiti, kuphatikizapo matendawo omwe amayamba chifukwa cha kukoka kwa minyewa ya toni ya ndulu, ndulu za bile ndi ma sphincters awo. Pankhani yowunika kwambiri, wodwalayo amayambitsa "kukumbukira kwa metabolic" ndi kupitirira kwa neuropathy kumakhala bwino.

Chithandizo cha matenda a gallbladder mu vuto la hypomotor matenda akuphatikiza kugwiritsa ntchito cholecystokinetics, monga prophylaxis ya matenda a ndulu, akatswiri akuti ursodeoxycholic acid. Anticholinergic ndi myotropic antispasmodics amagwiritsidwa ntchito pothandiza kuchepetsa ululu.

Kukhumudwa ngati chinthu

Mwa kuchuluka kwa anthu, kuchuluka kwa kukhumudwa kumakhala pafupifupi 8%, pomwe pakuyang'anira ma endocrinologist chizindikirochi chimafika 35% (ndiye kuti, nthawi pafupifupi 4). Pafupifupi anthu mamiliyoni 150 ali ndi vuto lakukhumudwa padziko lapansi, pomwe 25% okha ndi omwe amatha kulandira chithandizo chokwanira. Chifukwa chake, titha kunena kuti nchimodzi mwa matenda omwe sanadziwike bwino. Kukhumudwa kumabweretsa kuwonongeka kwa ntchito kwa wodwala, kuchuluka kwa madandaulo, kuyendera dokotala, mankhwala osankhidwa, komanso kuwonjezereka kwa zipatala.

Pankhani ya matenda a shuga mellitus motsutsana ndi kumbuyo kwa kupsinjika, chiwopsezo chikuwonjezeka ndi 2,5 - kuphatikizika kwa macrovas, 11 zina - zovuta zam'magazi, kupha kwambiri maulendo asanu, komanso kuperewera kwa metabolic kumawonjezeka.

Malingaliro ake, chisamaliro chikuyenera kuyang'ana pa kuthekera kwa mankhwala azitsamba, chifukwa kuchepetsa zovuta ndizofunikira kwambiri kwa endocrinological odwala.

Makhalidwe amuyaya

Zowonadi, ili ndi gawo laling'ono chabe la zovuta zomwe matenda ashuga amatsogolera. Koma akwanira kuyamikira chithunzi chonse chokhumudwitsachi. Matendawa ali ndi "oyandikana" omwe ndi ovuta kuwachotsa, ndipo chithandizo chake chofunikira chimafunikira maluso ambiri kuchokera kwa dokotala. Panthawi yakuchuluka kwa mabungwe azachipatala omwe ali ndi ma que osatha, ndizosatheka kupeza nthawi yochiritsira wodwala wokhala ndi "maluwa" a shuga. Chifukwa chake, ziribe kanthu momwe angayang'anire malingaliro a WHO kwa anthu kuti aziyang'anira thupi ndikuyenda kwambiri angayang'ane, lero ndikulimbikitsa kokha kwa mankhwala komwe kungathetsere vuto la matenda ashuga.

Zolemba zam'mbuyomu: Gulu la shuga ndi matenda ena okhudzana nawo

• Kutaya mano

Pakati pa mitundu yonse ya matenda a mano, nthawi zambiri anthu amakumana ndi vuto la mano. Malinga ndi ziwerengero, munthu aliyense wachitatu ...

Njira zamakono zochizira matenda osokoneza bongo

Fissure wautali, kapena kukomoka kwa anus ndikuwonongeka kwakutali (kupitirira miyezi itatu) kuwonongeka kosachiritsa ku nembanemba ya mucous ...

Matenda oopsa komanso matenda ashuga

Popeza chiwopsezo chachikulu chotenga zovuta zazikulu ndi kuphatikiza kwa matenda oopsa ndi matenda oopsa a shuga, ndikofunikira kuyamba chithandizo cha kuthamanga kwa magazi ...

Kufalikira - zomwe zimayambitsa matendawa

Kuphulika pazaka zilizonse ndi chinthu chosasangalatsa. Zimapereka zovuta zambiri ndi zovuta, zosokoneza kuchokera ku moyo wotanganidwa komanso ...

Mtima tachycardia

Matendawa ndi amodzi mwa mitundu ya ma arrhythmias apamwamba, ndipo ali ndi kugunda kwamtima. Nthawi zambiri, munthu ku ...

Zokhudza matenda a shuga pantchito ya impso

Impso - chiwalo chophatikizidwa kuti chichotse poizoni, poizoni ndi zinthu zowola m'thupi la munthu. Kuphatikiza apo, amasunga mchere wamchere ndi mchere mthupi. Impso zimagwira nawo gawo la kuwonongeka kwa mapuloteni ndi zakudya, pakupanga mahomoni ena ndi zinthu zofunika kwambiri zachilengedwe zomwe zimachepetsa kuthamanga kwa magazi.

Matenda a shuga ndi impso ndi magawo awiri omwe amapezeka kawiri kawiri. Zowonongeka za impso mu mtundu wa shuga wa shuga zimapezeka pamitundu itatu iliyonse, ndipo mwa 5% ya milandu - mu mawonekedwe odziyimira pawokha a insulin. Vuto lofananalo limatchedwa - diabetesic nephropathy, yomwe imakhudza mitsempha yamagazi, capillaries ndi tubules, ndipo chifukwa cha kunyalanyaza kumabweretsa kulephera kwa impso ndi matenda ena owopsa. Matenda a kwamikodzo zida zanu amapezekanso pazifukwa zina:

• onenepa kwambiri
• chibadwa
• kuthamanga kwa magazi
• cholesterol yayikulu magazi, etc.

Impso ndi gawo lovuta, lopangidwa ndi zigawo zingapo zazikulu. Cortex ndiye gawo lakunja, ndipo medulla ndiye wamkati. Gawo lalikulu lothandizira lomwe limatsimikizira ntchito yawo ndi nephron. Kapangidwe kameneka kamagwira ntchito yayikulu pokodza. Mu thupi lililonse - alipo opitilila miliyoni.

Gawo lalikulu la nephrons limapezeka mu cortical chinthu ndipo ndi 15% yokha yomwe ili pakatipa pakati pa cortical ndi medulla. Nephron imakhala ndi tubules yomwe imadutsa wina ndi mnzake, Shumlyansky-Bowman kapu ndi tsango la malo abwino kwambiri, ndikupanga zomwe zimatchedwa myelin glomeruli, zomwe zimagwira ngatiosefa.

Zoyenera, zimatha kusungunuka kwa myelin glomeruli ndikulola madzi ndi zinthu za metabolic kusungunuka mkati mwake kuti zithe kulowa m'magazi. Zosafunika zofunika kuwola zimayikidwa mkodzo. Matenda a shuga ndi vuto lomwe limachitika pakakhala kuchuluka kwa shuga m'magazi. Izi zimabweretsa kuwonongeka kwa zimagwirira za glomerular komanso kuwonjezeka kwa kuthamanga kwa magazi.

Mafuta akakwezedwa, impso zimafunika kusefa magazi ochulukirapo. Kuchuluka kwambiri kumabweretsa kutsekeka kwa nephrons, kuwonongeka kwawo ndi kulephera. Pamene glomeruli italephera kutulutsa, zinthu zowola zimayamba kudziunjikira mthupi. Zoyenera, zimayenera kuchotsedwa m'thupi, ndipo mapuloteni ofunikira amasungidwa. Mu matenda ashuga - chilichonse chimachitika mwanjira ina. Pathology imagawidwa m'magulu atatu:

1. Angiopathy - kuwonongeka kwa mitsempha yaying'ono komanso yayikulu. Chochita chachikulu chitukuko ndi chithandizo chabwino cha matenda ashuga komanso kulephera kutsatira malamulo oyang'anira kuchuluka kwa shuga m'magazi. Ndi angiopathy, pali kuphwanya chakudya, mapuloteni ndi metabolism yamafuta. Mphamvu ya okosijeni yokhala ndi minyewa imachuluka ndipo magazi amatuluka m'matumbo ang'onoang'ono amayamba kufooka, mitundu ya atherosulinosis.

1. Autonomous diabetesic nephropathy. Kukula kwa matenda amtunduwu mu 70% ya milandu kumachitika chifukwa cha kupezeka kwa matenda ashuga. Amakula ndikukula limodzi ndi matendawa. Amadziwika ndi kuwonongeka kwa ziwiya zazing'ono ndi zazing'ono, makulidwe a makoma awo, komanso zimayambitsa kusintha kwamaselo komanso kusintha kwa minyewa yake yolumikizidwa ndi mafuta. Mu diabetesic nephropathy, pali kuphwanya lamulo la kukakamiza mu myelin glomeruli ndipo, chifukwa chake, dongosolo lonse losefera.

1. Zilonda zopatsirana. Mu matenda a shuga, kugonjetsedwa kwa mtima wathunthu kumawonedwa makamaka. Zotsatira zake, zolephera mu ntchito ya ziwalo zotsala zimapezeka. Izi mosazungulira zimabweretsa kuchepa kwa chitetezo chokwanira. Ofooka komanso osatha kukana matenda opatsirana kwathunthu, thupi limakhala pachiwopsezo cha microflora ya pathogenic. Izi zimapangitsa kuti pakhale zovuta zingapo mu mawonekedwe a kutupa ndi mawonekedwe a matenda opatsirana, mwachitsanzo, pyelonephritis.

Zizindikiro

Munthu samaphunzira nthawi yomweyo za kuphwanya ntchito ya impso. Matendawa asanayambe kudziwonekera, monga lamulo, zoposa chaka chimodzi zimadutsa. Matendawa amatha kukhala asymptomatic kwazaka zambiri. Zizindikiro zakulephera kugwira ntchito kumawonetsedwa nthawi zambiri kuwonongeka kukafika 80%. Nthawi zambiri matendawa amawonekera motere:

• kutupa
• kufooka
• kusowa kwa chakudya
• kuthamanga kwa magazi
• kukodza kwambiri,
• ludzu lalikulu.

Chifukwa cha kuwonongeka kwa ziwiya zapamadzi poyerekeza ndi 85%, amalankhula za kulephera kwa impso. Kupanga kudziwa izi kumaphatikizapo dialysis kuti muchepetse katundu ndikukhalanso ndi thanzi lamthupi. Ngati izi sizinabweretse zotsatira zomwe zikuyembekezeka, ndiye kuti chomaliza ndi kupatsirana kwa impso.

Kuyesa kwa mavuto a impso

Wodwala akapezeka ndi matenda a shuga, ayenera kuyang'anitsitsa thanzi lake. Kwa moyo wabwinobwino, wodwalayo sayenera kungoyang'anira kuchuluka kwa shuga, komanso kukhudzidwa ndi ziwalo zamkati. Izi zimakhudza mamembala omwe ali pachiwopsezo chambiri ndipo nthawi zambiri amatha kugwidwa ndi matenda mu matenda. Ziwalo izi zimaphatikizapo impso.

Pali njira zingapo zofunika zodziwikitsa zovuta zamagulu oyambira m'magawo oyambira. Njira zoyambirira:

• Pimani mayeso a albumin - mayesowa ndi omwe amawonetsa mapuloteni am'maselo ochepa. Mapuloteni awa amapangidwa m'chiwindi. Malinga ndi zomwe zili mumkodzo, madokotala amatha kuzindikira momwe magawo awonongera osati impso, komanso chiwindi. Zotsatira za kuyesedwa kwa ma labotale zimakhudzidwa ndi mimba, kusowa kwa chakudya kapena kutopa. Kuti mupeze zidziwitso zatsatanetsatane, akatswiri amalangizidwa kuti ayendetsereni pamodzi ndi kuyesa kwa kupanga.

• Imani mayeso a kupanga magazi. Creatine ndiye chinthu chomaliza chosinthana ndi mapuloteni okhala ndi ma amino acid. Izi zimapangidwa m'chiwindi ndipo zimatenga gawo mu mphamvu ya metabolism pafupifupi minofu yonse. Amayamwa limodzi ndi mkodzo ndipo ndiye chofunikira kwambiri chothandizira cha impso. Kupitilira muyeso wamomwewo wa zinthu kumawonetsa kukhalapo kwa kulephera kwa impso, kungawonetse zotsatira za matenda a radiation, ndi zina zambiri.

Pambuyo pazaka zisanu zamatendawa, tikulimbikitsidwa kubwereza mayeso a labotale mapuloteni (albin) ndi zinthu zawo za metabolic (creatine) miyezi isanu ndi umodzi iliyonse.

• Kuwonetsa kumbuyo kwako ndi kuyesa kwa X-ray komwe kumathandizira kuwunika mawonekedwe a mawonekedwe a impso. Imachitika pobweretsa chosemphana mthupi, mothandizidwa ndi chithunzi cha x-ray chimagwiritsidwa ntchito kuti apeze chithunzi cha ziwalo ndi mkodzo. Kutsutsana ndi njirayi ndi hypersensitivity kusiyanitsa othandizira, odwala amatenga Glucofage ndi mitundu ina ya matenda, mwachitsanzo, kulephera kwaimpso.

• Ultrasound ndi mtundu wa ultrasound womwe umatha kudziwa kukhalapo kwa ma neoplasms osiyanasiyana, omwe ndi: calculi kapena miyala. Mwanjira ina, kuzindikira zizindikiro zoyambira za urolithiasis, komanso kudziwa mawonekedwe a khansa mwanjira yotupa.

Kupatula urology ndi ultrasound amagwiritsidwa ntchito, ngati lamulo, kuti azindikire tsatanetsatane wa mbiri yakale yomwe ilipo. Kutumizidwa ngati pakufunika kuti mupatsidwe matenda ena ndi kusankha njira yoyenera yothandizira.

Chithandizo ndi kupewa

Mphamvu ya chithandizo iyenera kukhala yogwirizana ndi chidziwitso chomaliza. Monga lamulo, onse othandizira amathandizira kuchepetsa katundu pa impso. Kuti tichite izi, ndikofunikira kukhazikika kwa magazi komanso kuchepetsa shuga. Mwa izi, mankhwala omwe amalimbitsa magazi ndi shuga wamagazi amagwiritsidwa ntchito. Ndi zovuta zomwe zimachitika, monga njira yotupa, mankhwala oletsa kupweteka omwe amagwiritsidwa ntchito.

Muzochitika zovuta kwambiri, pamene mankhwala osokoneza bongo samabweretsa zotsatira zoyenera, amatengera njira ya dialysis kuyeretsa magazi. Ngati thupi silichita ntchito zake, zimasinthana.

Chithandizo cha impso ndi matenda a shuga ndi njira yayitali komanso yowawa. Chifukwa chake, njira yayikulu komanso yoyenera ndi kupewa matenda. Moyo wathanzi umatha kuchedwetsa kapena kuletsa kuwoneka kwa ma pathologies a ziwalozi. Kukhala ndi moyo wathanzi kumatanthauza:

• Kuyang'anira kuthamanga kwa magazi.
• Kuyang'anira cholesterol ndi shuga wamagazi.
• Moyo wokangalika.
• Kusungabe zolimbitsa thupi.
• Zakudya zoyenera.

Matenda omwe apezeka ndi nthawi yake ndiye njira yothetsera vutoli ndi 50%. Osadzilimbitsa, ndipo pakukayikira koyamba kwa vuto laimpso, pitani kuchipatala msanga. Kumbukirani kuti matenda ashuga ndi zotulukapo zake sindiwo chiganizo chamankhwala oyenera komanso a panthawi yake.

1.1 Tanthauzo

Matenda A Impso a Impso (CKD) - lingaliro la nadnosological lomwe limalongosola mwachidule kuwonongeka kwa impso kapena kuchepa kwa kufinya kwa glomerular (GFR) yochepera 60 ml / min / 1.73 m2, kulimbikira kwa miyezi yopitilira itatu, ngakhale atazindikira kuti anali oyamba. Mawu akuti CKD ndi ofunika makamaka kwa odwala matenda a shuga (DM), atapatsidwa kufunikira komanso kufunika kophatikiza njira zodziwikirazi, kuchiza komanso kupewa matenda a impso, makamaka povuta kwambiri komanso zovuta kukhazikitsa mtundu wamatendawa. Osiyanasiyana a aimpso matenda a shuga (makamaka diabetesic glomerulosulinosis, kwamikodzo matenda matenda, glomerulonephritis, mankhwala nephritis, atherosranceotic stenosis a renal artery, tubulointerstitial fibrosis, etc.), kukhala ndi njira zosiyanasiyana za chitukuko, kusuntha kwa mphamvu, njira zamankhwala, ndizovuta zina kwa odwala omwe ali ndi matenda ashuga. popeza kuphatikiza kwawo pafupipafupi kumakulitsa.

1.2 Etiology ndi pathogeneis

Diabetesic nephropathy (kapena diabetesic impso matenda) (ND) ndizotsatira za zotsatira za metabolic ndi hemodynamic pazotsatira zamkati, zomwe zimasinthidwa ndi majini.

• Hyperglycemia - waukulu woyambitsa kagayidwe kachakudya ka matenda a shuga, omwe amapezeka mu njira zotsatirazi:

- sanali enzymatic glycosylation wa mapuloteni a impso, kuphwanya kapangidwe kake ndi ntchito,

- mwachindunji glucotoxic zotsatira zimagwidwa ndi puloteni kinase C enzyme, amene amawongolera mtima kupezeka, contractility, cell kuchuluka, ntchito minofu kukula,

- kutsegulira kwamapangidwe opanga ma free radicals ndi cytotoxic zotsatira,

- kusokonekera kapangidwe kofunika kwambiri kamangidwe kake ka glycosaminoglycan wa membrane wa glomerulus wa impso - heparan sulfate. Kutsika kwa zomwe zili heparan sulfate kumayambitsa kutayika kwa ntchito yofunika kwambiri yam'mimba yosungirako - kuyesa kosankha, komwe kumayendetsedwa ndi mawonekedwe a microalbuminuria, ndipo pambuyo pake, ndi kupitirira kwa njirayo, ndi proteinuria.

• Hyperlipidemia - China china champhamvu champhamvu. Malinga ndi malingaliro amakono, kukula kwa nephrosulinosis mu machitidwe a hyperlipidemia ndi ofanana ndi kapangidwe ka maselo atherosulinosis (mawonekedwe ofanana ndi maselo a mesangial ndi maselo osalala a minyewa, chotengera cholandirira cha LDL, zida za oxidized LDL muzochitika zonsezi.

• Proteinuria - Chofunikira kwambiri chopanda hemodynamic cha kupita patsogolo kwa DN. Poyang'anitsitsa kapangidwe ka mafiyilo amadzimadzi, mapuloteni opanga ma cell akuluakulu amakumana ndi mesangium ndi ma cell a renal tubules, omwe amachititsa kuwonongeka kwa maselo a mesangial, kuthamanga kwa sclerosis ya glomeruli, komanso kukula kwa njira yotupa mkati mwa minofu yapakati. Kuwonongeka kwa tubular reabsorption ndiye gawo lalikulu la kupita patsogolo kwa albuminuria.

• Matenda oopsa (AH) mwa odwala matenda a shuga 1 amayamba kachiwiri chifukwa cha matenda a impso a ashuga. Odwala omwe ali ndi matenda a shuga a 2, matenda oopsa oopsa mu 80% ya milandu isanachitike chitukuko cha matenda ashuga. Komabe, mulimonsemo, imakhala chinthu champhamvu kwambiri pakukula kwa matenda a impso, yoposa zinthu za metabolic pakufunika kwake. Makhalidwe a patathophysiological a maphunziro a shuga ndi kuphwanya mzere wamagazi wamagazi ndi kufooka kwa kuchepa kwake kwa thupi usiku ndi orthostatic hypotension.

• Intracubular matenda oopsa - Chomwe chimatsogolera hemodynamic pakupanga ndi kufalikira kwa matenda ashuga nephropathy, kuwonetsera komwe kumayambiriro kwake ndi kuchepa mtima. Kuzindikira kwa izi kunali "bwino" pakumvetsetsa pathogenesis ya DN. Limagwirira imayendetsedwa ndi matenda a hyperglycemia, woyamba amachititsa kusintha kwa impso, zomwe zimayambitsa kuwonekera kwa albuminuria. Kuwonetsedwa kwanthawi yayitali kwa makina azamphamvu a hydraulic kumayambitsa kukwiya kwamayendedwe oyandikana ndi glomerulus, zomwe zimapangitsa kuti collagen ikhale yochulukirapo komanso kuchuluka kwake m'dera la mesangium (njira yoyambirira ya sclerotic). Chidziwitso china chofunikira chinali kutsimikiza kwa ntchito ya ultrahigh ya renin-angiotensin-aldosterone system (RAAS) mu shuga. Kuchuluka kwa aimpso kwakomweko kwa angiotensin II (AII) kumakhala kochulukirapo ka 1000 kuposa zomwe zili m'madzi am'madzi. Njira za pathogenic zochita za AII mu shuga zimayambitsidwa osati ndi mphamvu yamphamvu ya vasoconstrictor, komanso chifukwa cha proliferative, prooxidant ndi prothrombotic. Mu impso, AII imayambitsa matenda oopsa a intracranial, amathandizira ku sclerosis ndi fibrosis ya minyewa yaimpso kudzera kumasulidwa kwa ma cytokines ndi kukula kwa zinthu.

• Anemia - chinthu chofunikira kwambiri pakukula kwa DN, kumabweretsa impso hypoxia, yomwe imakulitsa michere ya interstitial, yomwe imagwirizana kwambiri ndi kuchepa kwa impso. Kumbali ina, DN yowopsa imabweretsa kukula kwa magazi m'thupi.

• Kusuta monga kudziyimira pawokha pachiwopsezo cha kukulitsa ndi kupitilira kwa DN panthawi yachangu yowonekera kumayambitsa kutseguka kwa mtima wamanjenje, kumakhudza kuthamanga kwa magazi ndi aimpso hemodynamics. Kuwonekera kwambiri kwa chikonga kumayambitsa kusokonekera kwa endothelial, komanso mtima wokwanira cell hyperplasia.

Kuopsa kopezeka ndi DN kumatsimikiziridwa ndi ma genetic. 30-45% yokha ya odwala omwe ali ndi matenda ashuga 1 ndi mtundu 2 wa shuga ndi omwe amapanga izi. Zinthu zokhudzana ndi majini zimatha kuchita mwachindunji komanso / kapena limodzi ndi majini omwe amakhudza matenda amtima, kudziwa kuchuluka kwa chiwopsezo cha gawo lachiwopsezo pazotsatira za metabolic ndi hemodynamic factor. Kafukufukuyu akuchitika pofuna kutsimikizira zolakwika zamtundu zomwe zimafotokozera za mapangidwe a impso, komanso kuwerenga majini omwe amaika ntchito yama enzymes osiyanasiyana, ma receptor, mapuloteni oyang'anira omwe akukhudzidwa ndi DN. Maphunziro a genetic (kuwunika ma genomic ndi kusaka mitundu ya anthu ofuna) matenda ashuga ndi zovuta zake ndizovuta ngakhale kuchuluka.

Zotsatira za ACCOMPLISH, ADVANCE, ROADMAP ndi maphunziro ena angapo zapangitsa kuti azitha kuzindikira CKD ngati njira yodziyimira payokha yopanga matenda amtima (CHVD) komanso kufanana kwa matenda a mtima (CHD) chifukwa cha zovuta. Mu gulu la mtima mtima, mtundu 4 (aakulu nephrocardial syndrome) wapezeka, womwe umawonetsa kuyambika kwa matenda a impso matenda ochepetsa mphamvu ya m'magazi, kukulitsa michere yamanzere yamitsempha yamagazi ndikuwonjezera chiopsezo cha zochitika zazikulu zamtima kudzera mu hemodynamic, neurohormonal komanso immuno-biochemical feedbacks. Ubale uwu umatchulidwa kwambiri ndi DN 2-6.

Zowerengeka za anthu zikuwonetsa chiopsezo chachikulu cha kufa kwa mtima ndi mtima mwa odwala omwe ali ndi HD, mosasamala za msinkhu, wofanana ndi chiwopsezo cha kufa kwa mtima ndi odwala omwe ali ndi zaka 80 kapena kuposerapo. Mpaka 50% mwa odwala omwe ali ndi asymptomatic muhimu myocardial ischemia. Chowonadi chakuchepa kwa ntchito ya impso chifukwa cha kakulidwe ka DN kamathandizira kukula kwa mtima wama mtima, chifukwa chimapereka zotsatira za zinthu zina zomwe sizoyambira chikhalidwe:

1.3 Epidemiology

Matenda a shuga ndi CKD ndi mavuto awiri azachuma komanso azachuma azaka zaposachedwa zomwe dziko lonse lakumana nawo pamlingo wamatenda osachiritsika. Kuchuluka kwa DN kumadalira nthawi yayitali ya matendawa, ndipo chiwopsezo chokwanira kwambiri kuyambira zaka 15 mpaka 20 za matenda ashuga. Malinga ndi State Record of DM, kuchuluka kwa DM pafupifupi 30% kwa matenda amtundu 1 shuga (mtundu 1) ndi mtundu 2 matenda ashuga (mtundu 2). Ku Russia, malinga ndi kulembetsa kwa Russian Dialysis Society ka 2011, odwala matenda ashuga amapatsidwa mabedi a dialysis pokhapokha ndi 12,2%, ngakhale kufunikira kwenikweni ndikofanana ndi m'maiko otukuka (30-40%). Gulu la odwala matenda a shuga omwe ali ndi matenda oyamba ndi aimpso oyambira samadziwikirabe. Amaphunziridwanso, zomwe zimapangitsa kuti zikhale zovuta kuneneratu kuchuluka kwa kufalikira kwa ESRD ndi kufunikira kwa OST. Kuchuluka kwa zaka zisanu kwa odwala omwe ali ndi matenda ashuga omwe adayamba kulandira chithandizo cha HD ndiwotsika kwambiri poyerekeza ndi magulu ena a nosological, omwe amawonetsa gawo lalikulu la hyperglycemia pakupanga kwamphamvu kwa metabolic metabolic amasintha khalidwe la kulephera kwa impso. Ziwerengero zapamwamba zapamwamba za odwala omwe ali ndi matenda a shuga zimaperekedwa ndi kupatsirana kwa impso (makamaka zokhudzana ndi moyo), zomwe zimatipangitsa kuti tilingalire njira iyi ya PST monga yoyenera mdera ili la odwala.

Kukhalapo kwa DN ndi gawo lofunikira lodziyimira pawokha pakupanga matenda a mtima. Kafukufuku wa anthu ku Alberta (Canada), omwe adaphatikizira odwala omwe ali m'magazi okwanira 1,3 miliyoni, omwe adatsatiridwa kwa miyezi 48, adawonetsa kufunikira kwa CKD kuphatikiza ndi matenda a shuga pakukula kwa myocardial infarction (MI), kufananizidwa ndi MI yapitayi. Chiwopsezo cha kufa kwathunthu, kuphatikiza m'masiku 30 atatha kuphulika kwa myocardial, chinali chachikulu kwambiri pagulu la odwala matenda a shuga ndi CKD. Malinga ndi USRDS, pali kusiyana kwakukulu pamafupipafupi a matenda a mtima ndi odwala a CKD komanso opanda CKD, ngakhale atakhala zaka zingati .

1.4 Kulembera malinga ndi ICD-10:

E10.2 - Mellitus wodwala yemwe amadalira insulin ndi kuwonongeka kwa impso

E11.2 - Mellitus wa shuga wosadalira insulini yemwe akuwonongeka impso

E10.7 - Mellitus wodwala yemwe amadalira insulin wokhala ndi zovuta zingapo

E11.7 - Mellitus wa shuga wosadalira insulin wokhala ndi zovuta zingapo

E13.2 - Mitundu ina yanenedwayi yokhala ndi vuto la matenda ashuga komanso kuwonongeka kwa impso

E13.7 - Mitundu ina yanenedwayi yokhala ndi vuto la matenda ashuga lokhala ndi zovuta zingapo

E14.2 - Mellitus wa shuga wosadziwika yemwe ali ndi kuwonongeka kwa maso

E14.7 - Mellitus wa shuga wosadziwika yemwe ali ndi zovuta zingapo

1.5 Gulu

Malinga ndi lingaliro la CKD, kuwunika kwa gawo la matenda a impso kumachitika molingana ndi mtengo wa GFR, womwe umawonetsedwa kwambiri ndikuwonetsa kuchuluka ndi kuchuluka kwa ntchito ya nephrons, kuphatikizapo omwe amagwirizana ndi kugwira ntchito kosagwirizana (tebulo 1).

Gome 1. Magawo a CKD malinga ndi GFR

GFR (ml / mphindi / 1.73m 2)

Wokwera komanso woyenera

Kulephera aimpso

Chulukitsa kwambiri #

# kuphatikizapo nephrotic syndrome (SEA> 2200 mg / 24 ora A / Cr> 2200 mg / g,> 220 mg / mmol)

Kuchulukana kwakale kwa albuminuria: kwabwinobwino (2, kubwereza kuyesedwa pakatha miyezi itatu kapena kale. Chiwerengero cha A / Cr chatsimikizika mu gawo limodzi mosiyanasiyana ngati A / Cr isilinganiso> 30 mg / g (> 3 mg / mmol), bwerezani mayesowo pambuyo pa miyezi itatu kapena kale Ngati GFR 2 ndi / kapena A / Cr ratio> 30 mg / g (> 3 mg / mmol) atapitilira miyezi itatu, CKD imapezeka ndipo chithandizo chikuchitika. bwerezani pachaka.

Magulu oika pachiwopsezo cha DN, omwe akufunika kuyang'anira kuwunika kwa albuminuria ndi GFR, amaperekedwa pagome 3.

Tebulo 3. Magulu oika pachiwopsezo cha DN omwe amafunikira zojambula za albinuria ndi GFR pachaka

Odwala omwe ali ndi matenda amtundu woyamba 1 omwe amadwala adakali achichepere ndi kutha

Zaka 5 atadwala matenda ashuga,

pachaka (IB)

Odwala omwe ali ndi matenda a shuga 1, amadwala atatha msinkhu

Nthawi yomweyo atazindikira

Nthawi yomweyo atazindikira

pachaka (IB)

Amayi oyembekezera omwe ali ndi matenda ashuga kapena

odwala matenda a shuga

1 nthawi pa trimester

2,5 Zidziwitso zina

• Panthawi yamavuto a etiology yodziwitsa a impso komanso / kapena momwe ikukula msanga, kufunsira kwa nephrologist ndikulimbikitsidwa

Mlingo wa kukhulupirika kwa malingaliro B (mulingo wa umboni ndi 1).

Ndemanga:Ngakhale kusintha kwa mbiri yakale mu matenda ashuga glomerulosulinosis nthawi zambiri kumatsimikizika kwa odwala omwe ali ndi matenda amtundu wa 1 ndi DM, odwala omwe ali ndi matenda amtundu wa 2 omwe ali ndi vuto laimpso, kusintha kwa maumbidwe kumakhala kwakukulu. Mndandanda wa biopsies ya impso mwa odwala omwe ali ndi matenda a shuga a 2, ngakhale ndi proteinuria, kusintha kwazomwe zimachitika amapezeka pafupifupi 30% ya milandu. Maganizo a StNotypical a DN amatha kubisa matenda awo osiyanasiyana a impso mu shuga: unilateral kapena bilteral atherosranceotic renal artery stenosis, tubulointerstitial fibrosis, matenda a kwamikodzo matenda, nephritis yapakati, mankhwala a nephritis, etc. Chifukwa chake, kufunsa kwa nephrologist kumasonyezedwa pamavuto.

• Ngati ndi kotheka, limodzi ndi njira zofufuzira zofunika kuzindikiritsa matenda a impso mu matenda ashuga (albuminuria, mkodzo sediment, creatinine, potaziyamu seramu, kuwerengeka kwa GFR), zowonjezera (kubwereza kopitilira muyeso wa impso ndi zotupa za aimpso, angiography ya renal vasthenism. .)

Mlingo wokhulupilika pazotsimikizira B (mulingo wa umboni ndi 2).

• Ndikulimbikitsidwa kuyika matenda a mtima ndi odwala onse omwe ali ndi matenda ashuga ndi DM.

Mlingo wokhulupilika pazotsimikizira B (mulingo wa umboni ndi 2).

Ndemanga:Magulu a GFR ndi a albuminuria amalola odwala omwe akudwala matenda ashuga ndi CKD kukhala pachiwopsezo cha zochitika zamtima komanso kulephera kwa aimpso (Table 4). Monga njira zoyeserera zovomerezeka, ECG, EchoCG, ndi zina zowonjezera zitha kudziwika: Mayeso olimbitsa thupi: kuyesa kozungulira, kuyendetsa njinga

geometry), kuphatikiza kwamtundu umodzi wotulutsa mphamvu yokhala ndi chithunzi chapadera (scintigraphy) cha myocardium yokhala ndi katundu, nkhawa ya echocardiography (yokhala ndi katundu, wokhala ndi dobutamine), MSCT, Coronarography

Gome 4: Kuphatikizidwa kwa vuto la mtima ndi kulephera kwa aimpso kwa odwala omwe ali ndi CKD, kutengera mtundu wa GFR ndi albinuria

Albuminuria ##

Zabwinobwino kapena zowonjezera pang'ono

Magulu a GFR (ml / mphindi / 1.73m 2)

Wokwezeka kapena woyenera

Otsika #

Otsika #

# chiopsezo chochepa - monga momwe zimakhalira kwa anthu ambiri, pakakhala kuti palibe akuwonongeka kwa impso, magulu a GFR C1 kapena C2 sakwaniritsa njira za CKD.

## Albuminuria - Chiwerengero cha albumin / creatinine chimatsimikizika mu gawo limodzi (makamaka m'mawa), GFR imawerengeredwa pogwiritsa ntchito njira ya CKD-EPI.

3.1. Chithandizo cha Conservative

• Ndikulimbikitsidwa kuti pakhale chiphuphu cha carbohydrate metabolism kuti muchepetse chitukuko ndikuchepetsa kupita patsogolo kwa CKD mwa odwala matenda ashuga

Mlingo wa kukhulupirika kwa malingaliro A (mulingo wa umboni ndi 1).

Ndemanga:Udindo wokhutira kubwezeretsa kwa carbohydrate metabolism popewa kukula ndi kupitilira kwa ma NAM kwawonetsedwa motsimikizika mu maphunziro akulu kwambiri: DCCT (Diabetes Control and Complication T kesi), UKPDS (UK Prospective Diabetes Study), ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation ) 10.11.

Kuwongolera kwa glycemic kumakhala kovuta m'magawo ovuta a CKD pazifukwa zingapo. Izi ndiye, choyambirira, chiopsezo cha hypoglycemia chifukwa cha kuchepa kwa aimpso a gluconeogeneis komanso kuchuluka kwa insulin ndi othandizira antiglycemic ndi metabolites awo. Chiwopsezo cha hypoglycemia chitha kupitilira phindu la kayendedwe ka glycemic (mpaka kukula kwa arrhythmias yoopsa).

Kuphatikiza apo, kudalirika kwa glycated hemoglobin (HbA1c) monga chisonyezo cha kubwezeretsanso kwa kagayidwe kazakudya m'zinthu izi za CKD, zomwe nthawi zambiri zimayendetsedwa ndi kuchepa kwa magazi, zimachepa chifukwa cha kuchepa kwa theka la moyo wama cell ofiira a magazi, kusintha kwa zinthu zawo mothandizidwa ndi metabolic ndi ma meological factor, ndi mphamvu ya mankhwalawo. Vutoli limakhala lovuta chifukwa chakuti hyperglycemia yowopsa, kusintha magwiridwe antchito a erythrocyte ndi hemoglobin, ndipo, motero, kutsogoza hypoxia, kuthamangitsa kuwonongeka kwa maselo ofiira amwazi, kutsatira kwawo kwambiri endothelium, palokha kungathandize kuchepetsa theka la moyo wama cell ofiira. Komabe, kufunika koyendetsa glycemia pamagawo onse a CKD kumawonekera mosamala kwambiri pakakulitsa, poganizira chiopsezo cha kufa kwamtima ndi mtima mogwirizana ndi kuuma kwa kupweteka kwa impso. Ndizovuta kwambiri kuyang'anira glycemia mwa odwala matenda a shuga omwe amalandira dialysis mankhwala. Awa ndi odwala omwe ali ndi chipatala chokwanira cha ma micro- and macrovascular complication, chiwopsezo cha ntchito ya autonomic mantha system, chowonetsedwa makamaka ndi kulephera kuzindikira hypoglycemia, komanso chiwopsezo chachikulu cha kufa ndi mtima komanso mtima. Panthawi yovuta yachipatalachi, zikuwoneka kuti ndizoyenera kugwiritsa ntchito ngati njira imodzi yokhayo kuti mudziwe momwe mungagwiritsire ntchito zowongolera za glycemic ndikusankha mankhwala ochepetsa shuga a T2DM, poganizira zoletsa zomwe zilipo.

Malingaliro aposachedwa a KDIGO amawona kuwongolera glycemic monga gawo la njira ya ionti ya multifactorial yolowera kuthana ndi kuthamanga kwa magazi ndi chiwopsezo cha mtima. Malangizo a US National Kidney Fund (NKF KDOQI) amawonetsa kuchuluka kwa HbA1c mwa anthu omwe ali ndi matenda ashuga ndi CKD, poganizira kuopsa kwake:

Ma alpha glucosidase inhibitors ali ndi malire ochepa a hypoglycemic pazotsatira zoyipa (kupanga kwa mpweya, kutsegula m'mimba) zomwe zimachepetsa kugwiritsa ntchito. Mankhwalawa ali osavomerezeka chifukwa cha kuchepa kwaimpso.

Kusaka kwa kayendetsedwe ka kagayidwe kazakudya kamene kamakwaniritsa zofunikira zamakono zogwira ntchito ndi chitetezo mwa anthu omwe ali ndi CKD kumapangitsa chidwi chowonjezereka pakufunika kwa mankhwala othandizira mtundu wa incretin. Amathandizira zida zamagulu azachipatala pakuwongolera ntchito ya beta-cell, kukulitsa chitetezo cha shuga m'magazi olimbitsa thupi ndi chiopsezo chochepa cha hypoglycemia, kupondereza kuchulukitsidwa kwa glucagon, zotsatira zabwino zamtima, komanso kuthekera kolamulira thupi. Awa ndikulonjeza ndikuwalonjeza othandizira kagayidwe kazakudya mu zovuta zovuta za gulu lovuta la odwala omwe ali ndi matenda a shuga a 2 komanso CKD. Mavuto am'mimba (gastroparesis, enteropathy, etc., omwe nthawi zambiri amakula ndi exenatide), omwe amachepetsa moyo, ophatikizira glycemic control, komanso okhudzana ndi zakudya, amayenera kusamalidwa mwapadera pogwiritsa ntchito glucagon-like peptide receptor agonists -1 (? GLP-1) odwala omwe ali ndi CKD . Kugwiritsa ntchito kwa GLP-1 kungakulitse mavutowa chifukwa chokhoza kuchepetsa kuthamanga kwa m'mimba komanso kuyamwa kwa glucose wokhazikika, komanso mankhwala omwe amafunikira kuwongolera mozungulira kwa a (ana a immunosuppressants mwa anthu omwe ali ndi impso yolalidwa). Kuphatikiza kwa angiotensin-kutembenuza enzyme zoletsa komanso okodzetsa - njira yofunikira ya nephroprotective ya CKD mwa odwala matenda a shuga a 2 - amafunika kukhala tcheru makamaka pofotokoza exenatide chifukwa chakuchulukitsa kwa vuto la impso ndi kukula kwa zovuta. Odwala GFR 30-50 ml / mphindi / 1.73 m2, mankhwala mosamala omwe amayang'aniridwa ndi impso amafunikira. Exenatide imatsutsana mwa anthu omwe ali ndi GFR osakwana 30 ml / mphindi / 1.73 m2. Gulu lina la mankhwala? GLP-1 - liraglutide, omwe ndi 85% otupa kwa anthu a GLP-1, akuwonetsa zofanana ndi exenatide yokhala ndi zovuta zoyipa komanso moyo wautali wamasiku omwe amakupatsani mwayi woperekera mankhwalawa nthawi 1 patsiku. Kugwiritsa ntchito liraglutide mwa anthu omwe ali ndi CKD ndi ESRD (pa peritoneal dialysis) sikuwonetsa kuwonjezeka kwakukulu pakuwonekera kwake komanso chiwopsezo cha mavuto. Odwala omwe ali ndi hypoalbuminemia amafunikira chisamaliro chapadera, popeza 98% ya mankhwalawo imamangiriza mapuloteni amwazi. Zochitika ndi liraglutide mwa odwala omwe amalephera kupweteka aimpso zimathabe. Pakali pano, kugwiritsa ntchito mankhwalawa odwala omwe ali ndi vuto laimpso, kuphatikizapo kuphatikiza ndi ESRD, zotsutsana.

Kafukufuku wa LEADER (Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results) akuwonetsa, komanso kuchepa kwa pafupipafupi zochitika zamtima, kuchepa kwa chitukuko ndi kulimbikira kwa macroalbuminuria mwa odwala omwe ali ndi matenda a shuga a 2 komanso chiopsezo cha matenda amtima panthawi ya mankhwalawa ndi liraglutide.

Inhibitors a dipeptidyl peptidase-4 (IDPP-4) atenga malo oyenera pazomangamanga zapadziko lonse lapansi komanso zapakhomo pochiza odwala omwe ali ndi matenda a shuga a 2. Kuchita bwino ndi chitetezo cha othandizira awa kwa anthu omwe ali ndi vuto lofanana laimpso atsimikiza. Poyerekeza ndi othandizira ena a hypoglycemic, IDPP-4 amawonetsa chiopsezo chocheperako cha hypoglycemia komanso zotheka m'matumbo ndi monotherapy, zomwe zimapangitsa kuti azikhala okongola kwambiri pakulamulira kwa glycemic mumikhalidwe yopanga matenda a impso. Kugwiritsa ntchito mankhwalawa kwa matenda aimpso kuwonongeka kumadalira gawo la CKD. Tiyenera kudziwa kuti, kuphatikiza ma insretins, magawo a DPP-4 ndi ma peptides angapo omwe amadziwika ndi zotsatira za mtima - BNP, NPY, PYY, SDF-1alpha, yomwe imatsegula malingaliro atsopano, kuwonjezera pazomwe zimayendera pakulamulira kwa glycemic, komwe kumalumikizidwa ndi cardio ndi katundu wa nephroprotective.

Zotsatira zakusindikiza zikuwonetsa kufunikira ndi chitetezo cha IDPP-4 (sitagliptin **, vildaglptin **, saxagliptin **, linagliptin **) yogwiritsidwa ntchito masiku ano ndi monotherapy ndikumamatira ku chithandizo chatsopano chotsitsa shuga mwa anthu omwe ali ndi GFR yochepetsedwa (kuphatikiza omwe akukodzetsa), Poyerekeza ndi placebo, pafupipafupi zochitika zovuta zomwe zimakhudzana ndi mankhwalawo, komanso ntchito ya impso, mtima ndi pafupipafupi pa hypoglycemia.

Mwa zina mwatsopano zomwe zimapangidwa ndi makampani opanga mankhwala ndi kusankha glucose reabsorption inhibitors (glyphlosins). Kugwiritsa ntchito mankhwalawa kuli ndi kuwonjezeka kwa natriuresis kutsatiridwa ndi kuchepa kwapang'onopang'ono kwa kuthamanga kwa magazi pokhudzana ndi renin-angiotensin-aldosterone dongosolo (mwina ndikuwonjezera mphamvu yotseka njirayi) ndikuchepetsa kulemera kwa thupi ndi glucosuria wowonjezereka. Kuphatikiza pa zotsatira zotchedwa kutsitsa shuga, malinga ndi zotsatira za kafukufuku, akuwonetsa zoyipa zingapo zomwe zimapangitsa kuti azigwiritsa ntchito, makamaka matenda amkodzo ndi ziwalo, omwe ndi osayenera kwambiri mwa anthu odwala matenda ashuga komanso impso. Nthawi yomweyo, kafukufuku wa EMPA-REG OUTCOME, omwe anaphatikiza odwala omwe ali ndi vuto lalikulu la CVD, adawonetsa mwayi woperekera chithandizo chokwanira poyerekeza ndi placebo pofika kumapeto kophatikizira (kufa kwa mtima, infarction ya nonfatal myocardial, inffatalalfalalal. Ndikofunikira kuti zotsatirazi sizinali zogwirizana ndi impso - 25% ya omwe anali ndi GFR ya osaposa 60 ml / min, ndi 28% ndi 11%, motsatana, a MAU ndi proteinuria. Pamodzi ndi zotsatira zabwino za CVS, odwala omwe ali m'gulu la empagliflozin adawonetsa kuchepa kwa albuminuria.

Malangizo ogwiritsira ntchito mankhwala ochepetsa shuga malinga ndi gawo la CKD aperekedwa. 9 ..

Gome 9. Mankhwala ochepetsa shuga omwe ali ovomerezeka kugwiritsidwa ntchito m'magawo osiyanasiyana a CKD.

Kodi matenda a impso amawonetsedwa bwanji mu shuga?

Matenda a shuga ndi nephropathy ndi amodzi mwa zovuta kwambiri za matenda ashuga. Chizindikiro chake chachikulu chidzakhala albuminuria - puloteni mu mkodzo. Nthawi zambiri, Albin yaying'ono imatulutsidwa mkodzo, womwe impso zimachoka m'magazi. Ndi matenda ashuga, kuchuluka kwa albumin mu mkodzo kumachuluka kwambiri.

Mwambiri, thanzi la odwala limakhalabe labwino, ndipo kugwiritsa ntchito chimbudzi pafupipafupi kumayenderana ndi ludzu lochulukirapo. Koma pokhapokha pakuwunika momwe matendawa akulira ndikukula, zovuta za matenda a shuga sizitenga nthawi yayitali.

Matenda a impso ndi kukula kwa aimpso kulephera

Ndi matenda osokoneza bongo osayang'aniridwa bwino mu impso, njira za pathological zimayamba - minangial minofu imakula pakati pa capillaries a impso. Njirayi imapangitsa minyewa ya glomerular kuonda. Chizindikiro chodziwika bwino cha kuwonongeka kwa impso pang'ono ndi pang'ono chimapanga - tinamwino ta Kimmelstil-Wilson. Pamene matenda akukulira, impso zimatha kusefa magazi ochepa komanso ang'onoang'ono.

Kulephera kwamanja kumadziwika ndi zojambulajambula, ndipo madokotala azindikira njira. Panthaŵi yodziwika bwino ya matenda ashuga odwala ambiri, kuchuluka kwa kusefedwa kwamphamvu kumalembedwa. Pambuyo pazaka zochepa, ndipo ngati matenda ashuga sawayendetsa bwino, ndiye kuti chaka chokwanira, pali kukula kwa membrane wa glomerular, kukula kwa mesangium. Izi zimatsatiridwa ndi nthawi yopepuka ya zaka 5 mpaka 10, momwe mulibe zizindikiro zakuwonongeka kwa impso.

Pambuyo pa nthawi iyi, kupenda magazi, kuwulula kusintha kwakukulu m'magazi ndi mkodzo. Pokhapokha ngati pakuchitika zinthu zomwe zingachitike kapena ngati sizikuyenda bwino patatha zaka makumi angapo, odwala matenda ashuga amafunikira dialysis ndi kupatsirana kwa impso.

Magazi, kupanikizika, cholowa

Kuphatikiza pakuchuluka kwa shuga m'magazi, zinthu zina zimathandizira kuwonongeka kwa impso. Choyamba, matenda oopsa. Kuphatikiza apo, chinthuchi chimapatsidwa mtengo wofanana ndi kudumphira kwa shuga m'magazi. Kuyang'anira kuthamanga kwa magazi kumachitika ndi mankhwala, omwe amateteza kwambiri impso kuti zisawonongeke.

Kukonzekereratu kwa matenda ashuga nephropathy kungatengedwe, monga matenda a shuga.

Kuphatikiza apo, kafukufuku waposachedwa wasonyeza kuti kuwonjezeka kwa mafuta m'magazi kumathandizira kukula kwa mesangium ndikuwonjezereka mwachangu kwa kulephera kwa impso.

Zolinga zochizira matenda ashuga nephropathy

Chithandizo cha matenda a impso mu shuga chimapangidwa multifaceted, chifukwa ndikofunikira kuchita pamagulu onse a matenda. Choyamba, muyenera kukopa kuchuluka kwa shuga m'magazi. Pali umboni wokwanira kuti iyi ndiyo njira yayikulu yothandizira komanso kupewa. Ndikofunikanso kuwongolera manambala omwe akukakamizidwa mwa kukonza zakudya, kumwa mankhwala.

Cholinga cha zakudya zapadera, kuwongolera kuchuluka kwa cholesterol yoyipa ndi kuchuluka kwake, sizingolepheretsa zovuta za mtima zokha, komanso kuteteza impso.

Mu matenda a shuga, chifukwa cha kuchepa kwa chitetezo cha mthupi, matenda opatsirana a genitourinary amapangidwa nthawi zambiri, omwe pambuyo pake amatha ndi matenda a impso. Chifukwa chake, odwala ayenera kusamala kwambiri za thanzi lawo ndipo nthawi yomweyo ayenera kuchitapo kanthu pochiza matenda.