Matenda a shuga > Matenda a shuga

Matenda a shuga - kusintha kwapatsiku kwakumitsempha yama impso komwe kumachitika mu mitundu iwiri ya matenda a shuga ndikubweretsa glomerulossteosis, kuchepa kwa kusefedwa kwa impso komanso kukula kwa aimpso kulephera (CRF). Matenda a shuga a nephropathy amawonetsedwa mwapang'onopang'ono ndi microalbuminuria ndi proteinuria, ochepa matenda oopsa, nephrotic syndrome, zizindikiro za uremia ndi kulephera kwa aimpso. Kuzindikirika kwa matenda a shuga a nephropathy kumadalira mtundu wa albumin mkodzo, kutsimikizika kwa endin native creatinine, mapuloteni ndi lipid mawonekedwe a magazi, zambiri kuchokera ku ultrasound impso, ultrasound yamitsempha yama impso. Mankhwalawa matenda a shuga, nephropathy, zakudya, kukonza chakudya, mapuloteni, mafuta kagayidwe, kutenga ACE ndi ARA zoletsa, detoxification mankhwala, ndipo ngati pakufunika, hemodialysis, kupatsirana kwa impso akuwonetsedwa.

Zambiri

Matenda a diabetes ndi nephropathy amachedwa mtundu wa shuga 1 komanso mtundu wachiwiri wa shuga ndipo amodzi mwa omwe amafa odwala matendawa. Kuwonongeka kwa mitsempha yayikulu komanso yaying'ono yamitsempha yamagazi yomwe imayamba panthawi ya matenda ashuga (matenda ashuga macroangiopathy ndi microangiopathy) imathandizira kugonjetsedwa kwa ziwalo zonse ndi machitidwe, makamaka impso, maso, ndi dongosolo lamanjenje.

Matenda a shuga a nephropathy amawonetsedwa mu 10-20% ya odwala omwe ali ndi matenda osokoneza bongo, nthawi zambiri nephropathy imapangitsa mtundu wa matenda omwe amadalira insulin. Matenda a diabetes a nephropathy amapezeka kawirikawiri mwa odwala amuna ndi anthu omwe ali ndi matenda a shuga 1, omwe amayamba kutha msinkhu. Chiwopsezo cha chitukuko cha matenda ashuga nephropathy (siteji CRF) chimawonedwa ndi nthawi yayitali ya zaka 15 mpaka 15.

Zomwe zimayambitsa matenda a shuga a Nephropathy

Matenda a diabetes a nephropathy amachitika chifukwa cha kusintha kwa ma pathological m'mitsempha yama impso ndi glomeruli ya capillary malupu (glomeruli) yomwe imagwiritsa ntchito kusefera. Ngakhale malingaliro osiyanasiyana a pathogenesis a matenda ashuga nephropathy omwe amawaganizira mu endocrinology, chinthu chachikulu komanso chiyambi cholumikizira chitukuko chake ndi hyperglycemia. Matenda a diabetes a nephropathy amachitika chifukwa chosakhalitsa chokwanira cha zovuta za carbohydrate metabolism.

Malinga ndi chiphunzitso cha matenda a diabetesic nephropathy, nthawi zonse hyperglycemia imatsogolera pang'onopang'ono kusintha kwa zochita zamankhwala am'thupi: zosagwiritsa ntchito enzymatic glycosylation ya mapuloteni am'minyewa a minyewa komanso kuchepa kwa ntchito yawo, kusokonezeka kwa madzi osakanikirana a homeostasis, kagayidwe ka mafuta acids, kuchepa kwa mphamvu ya glucose. minyewa, impso.

Chiphunzitso cha hememnamic pakukula kwa matenda ashuga nephropathy amatenga gawo lalikulu la kuthamanga kwa magazi komanso kuthamanga kwa magazi mkati: kusalinganika pamvekedwe yabweretsedwe ndi ma arterioles komanso kuwonjezeka kwa magazi mkati mwa glomeruli. Kutalika kwa magazi kwa nthawi yayitali kumabweretsa kusintha kwamachitidwe mu glomeruli: choyamba, kuchepa kwamitsempha ndi kuthamanga kwamkodzo mkatikati ndikumasulidwa kwa mapuloteni, kenako ndikusinthanso minyewa yaimpso yothandizirana ndi glomerular occlusion, kuchepa kwa mphamvu yawo yochita kusefa komanso kukula kwa kufinya kwakanthawi.

Malingaliro amtunduwu amakhazikitsidwa ndi kukhalapo kwa wodwala yemwe ali ndi matenda ashuga nephropathy malinga ndi matenda a hemodynamic. Mu pathogenesis ya matenda ashuga nephropathy, njira zonse zitatu za chitukuko zimagwira ndi kulumikizana kwambiri.

Zomwe zimayambitsa matenda osokoneza bongo a nephropathy ndi matenda oopsa oopsa, kuchuluka kwa hyperglycemia, matenda a kwamikodzo, kuthina kwamafuta komanso kunenepa kwambiri, umuna, kusuta, komanso kugwiritsa ntchito mankhwala a nephrotoxic.

Zizindikiro za matenda ashuga a shuga

Matenda a shuga ndi nephropathy omwe akudwala pang'onopang'ono, chithunzi chake cham'chipatala chimadalira gawo la kusintha kwa matenda. Pakupanga kwa matenda a shuga, nephropathy, magawo a microalbuminuria, proteinuria ndi gawo lothana ndi matenda a impso kulephera amadziwika.

Kwa nthawi yayitali, matenda a shuga a nephropathy ndi asymptomatic, popanda mawonekedwe akunja. Pa gawo loyambirira la matenda a shuga, nephropathy, kuchuluka kwa impso (hyperfunctional hypertrophy), kuchuluka kwa magazi aimpso komanso kuchuluka kwa kusefukira kwa glomerular (GFR) kumadziwika. Zaka zingapo pambuyo pa kuwonongeka kwa matenda ashuga, kusintha koyambirira kwazomwe zimapangidwira mu impso kumawonedwa. Kuchuluka kwa kusefukira kwakunyanja kumatsalira; kutulutsa kwa albumin mu mkodzo sikupitilira zoyenera (

Kuyambika kwa matenda ashuga nephropathy amapanga zaka zopitilira 5 atayambika matendawa ndipo amawonetsedwa ndi microalbuminuria wokhazikika (> 30-300 mg / tsiku kapena 20-200 mg / ml mumkodzo wam'mawa). Kuwonjezeka kwa magazi kwa nthawi ndi nthawi kumatha kudziwika, makamaka pakulimbitsa thupi. Kuzindikira kwa odwala omwe ali ndi matenda ashuga nephropathy amawonekera pokhapokha matendawa atadwala.

Odwala matenda a shuga a nephropathy amatuluka pambuyo pa zaka 15 mpaka 20 ndi matenda a shuga 1 ndipo amadziwika ndi proteinuria (protein ya urine> 300 mg / tsiku), zomwe zikuwonetsa kusasintha kwa chotupa. Kutuluka kwa magazi ndi magazi a magazi ndi magazi zimachepetsedwa, matenda oopsa oopsa amakhala osasintha ndipo zimavuta kuwongolera. Nephrotic syndrome imayamba, yowonetsedwa ndi hypoalbuminemia, hypercholesterolemia, zotumphukira ndi patsekeke. Magazi a creatinine ndi urea wamagazi amakhala abwinobwino kapena okwera pang'ono.

Pa siteji yodwala matenda ashuga nephropathy, pali kuchepa kochedwa kusefedwa ndi ntchito ya impso: kukula kwa proteinuria, GFR yochepa, kuchuluka kwakukulu kwa urea ndi creatinine m'magazi, kukula kwa kuchepa kwa magazi, kuchepa kwa magazi. Pakadali pano, hyperglycemia, glucosuria, excretion wa kwamkati insulin, komanso kufunikira kwa insulin yakunja kungachepetse kwambiri. Nephrotic syndrome imapita, kuthamanga kwa magazi kumafikira kwambiri, kufooka kwa matumbo, uremia ndi kulephera kwaimpso kumayamba ndi zizindikiro zakudziyipitsa kwa thupi pogwiritsa ntchito zinthu za metabolic komanso kuwonongeka kwa ziwalo zosiyanasiyana.

Matenda a matenda ashuga nephropathy

Kuzindikira koyambirira kwa matenda ashuga nephropathy ndi ntchito yovuta. Pofuna kukhazikitsa matenda a diabetesic nephropathy, kuyesa kwa magazi ndi zamankhwala ambiri, kusanthula kwamkodzo komanso kuchuluka kwa mkodzo, kuyesa kwa Rehberg, kuyesa kwa Zimnitsky, ndi ma ultrasound a mitsempha ya impso.

Zizindikiro zikuluzikulu za matenda ashuga nephropathy ndi microalbuminuria ndi glomerular kusefera kwamphamvu. Ndi kuwunika kwa pachaka kwa odwala omwe ali ndi matenda a shuga, njira ya tsiku ndi tsiku ya albin mkodzo kapena kuchuluka kwa albumin / creatinine kumawerengedwa.

Kusintha kwa matenda ashuga nephropathy kukhala gawo la proteinuria kumatsimikiziridwa ndi kupezeka kwa mapuloteni pakuwunika mkodzo kapena kuwonetsa kwa albumin ndi mkodzo pamwamba pa 300 mg / tsiku. Pali kuchuluka kwa kuthamanga kwa magazi, zizindikiro za nephrotic syndrome. Gawo lomaliza la matenda ashuga nephropathy silovuta kuzindikira: kuchuluka kwa proteinuria ndi kuchepa kwa GFR (osachepera 30 - 15 ml / min), kuchuluka kwa magazi mu metabolinine ndi urea (azotemia), kuchepa kwa magazi, acidosis, hypocalcemia, hyperphosphatemia, hyperlipidemia ndi thupi lonse.

Ndikofunika kuperekera matenda osiyanasiyana a shuga ndi matenda ena a impso: matenda a pyelonephritis, chifuwa chachikulu, chifuwa chachikulu cha glomerulonephritis. Pachifukwachi, kuyesa kwa mkodzo wa microflora, ma impso, impology imatha kuchitika.Nthawi zina (ndi puloteni yokhazikika komanso yowonjezereka, kusintha kwachilendo kwa nephrotic, hematuria), kupindika bwino kwa singano kumathandiza kumveketsa bwino matendawa.

Chithandizo cha odwala matenda ashuga a Nephropathy

Cholinga chachikulu cha chithandizo cha matenda ashuga nephropathy ndikuletsa ndikuchepetsa kupitilira kwa matendawa mpaka matenda a impso, kuchepetsa chiopsezo chokhala ndi vuto la mtima (IHD, myocardial infarction, stroke). Odwala mankhwalawa osiyanasiyana magawo a matenda ashuga nephropathy ndi okhazikika kuwongolera magazi, kuthamanga kwa magazi, kubwezeretsa kwa mavuto a mchere, chakudya, mapuloteni ndi lipid kagayidwe.

Mankhwala oyamba posankha diabetesic nephropathy ndi angiotensin-converting enzyme (ACE) zoletsa: enalapril, ramipril, trandolapril ndi angiotensin receptor antagonists (ARA): irbesartan, valsartan, losartan, normalization systemic and intraocular dyspepsia. Mankhwala amatengedwa ngakhale ndi magazi abwinobwino Mlingo womwe sungamveketse kukula kwa hypotension.

Kuyambira ndi gawo la microalbuminuria, zakudya zochepa zomanga thupi, zopanda mchere zimasonyezedwa: Kuchepetsa kudya kwa mapuloteni a nyama, potaziyamu, phosphorous ndi mchere. Kuchepetsa chiopsezo cha matenda a mtima, kukonza dyslipidemia chifukwa chakudya m'mafuta ochepa komanso kumwa mankhwala osokoneza bongo omwe amapangitsa kuti magazi akhale ndi magazi a lipid.

Pa gawo lomaliza la matenda a shuga, netiopathy, matenda opatsirana, kusintha kwa matenda a shuga, kugwiritsa ntchito ma sorbents, anti-azotemic othandizira, matenda a hemoglobin, komanso kupewa osteodystrophy pamafunika. Ndi kuwonongeka kwakuthwa mu impso, funso likubwera pochita hemodialysis, mosalekeza peritoneal dialysis, kapena opaleshoni yamankhwala opatsirana impso.

Kuneneratu komanso kupewa matenda ashuga a nephropathy

Microalbuminuria yovomerezeka panthawi yokhayo ndiye gawo lokhalo lomwe lingayambitse matenda a shuga. Pa nthawi ya proteinuria, n`zotheka kupewa kupitirira kwa matenda aakulu aimpso kulephera, pomwe mukufika kumapeto kwa matenda a shuga a nephropathy kumabweretsa chikhalidwe chosagwirizana ndi moyo.

Pakadali pano, matenda a shuga a nephropathy ndi CRF omwe akupanga chifukwa cha izi ndi omwe akuwonetsa kusintha kwa mankhwala - hemodialysis kapena kupatsirana kwa impso. CRF chifukwa cha matenda ashuga nephropathy amachititsa 15% ya imfa zonse pakati pa odwala omwe ali ndi matenda a 1 a shuga osakwana zaka 50.

Kupewa kwa matenda ashuga nephropathy imakhala mu kupenyetsetsa kwa odwala omwe ali ndi matenda osokoneza bongo a endocrinologist-diabetesologist, kuwongolera kwakanthawi kwamankhwala, kuyang'anira kuwunika kwamankhwala a glycemia, kutsatira malangizo a dokotala.

Magawo a matenda ashuga nephropathy. Kuyesa ndi kufufuza matenda

Nthawi zosiyanasiyana, madokotala amagwiritsa ntchito magulu osiyanasiyana a nephropathy. M'mabuku akale a sayansi ndi zolembedwedwa, zonena zaiwo zidatsalira; Ma nephrologists amakono pazomwe amachita tsiku ndi tsiku amagwiritsa ntchito magawano aposachedwa kwambiri poyerekeza ndi kuchuluka kwa kusefera kwa madzi. Kugawika m'magawo kumaphatikizapo zinthu zotsatirazi:

Gawo I - magawo abwino a impso amatenga gawo lofanana ndi ma nephrons omwe afa, chifukwa chake matenda oopsa amawonekera. Potengera maziko awa, kuthamanga kwa magazi mu ma capillaries a glomeruli kumawonjezeka ndipo kusefukira mwamphamvu kumawonjezeka,
Gawo II - mu pathophysiology imatchedwa gawo losalankhula. Ino ndi nthawi ya kusintha kwakukuru kwa zomwenso. Chipinda chapansi panthaka cha ma nephrons, chomwe magazi amasefedwa, kumakulirakulira. Palibe mawonetseredwe azachipatala.Mu mkodzo wokha ndiomwe amatha kulemba zochulukirapo nthawi zonse. Monga lamulo, zaka pafupifupi 5 mpaka 10 zimadutsa albinuria yayikulu,
Gawo III amatchedwanso gawo la microalbuminuria, ndipo oposa theka la odwala ali ndi mawonekedwe osakhalitsa. Njira yotereyi ya nephropathy imatha kukhala zaka 10-15,
Gawo IV amatchedwa gawo la nephropathy yayikulu, momwe macroalbuminuria amawonedwa kale. Pathogenesis yamatenda apa nthawi ino imadziwika ndi kuchepa kwapang'onopang'ono mu kuchuluka kwa kusefera kwa ma nephrons. Poona izi, odwala matenda ashuga ambiri amatha kuonetsa matenda oopsa,
Gawo V ndi malo opumira. Matenda a shuga a nephropathy amatchulidwa, zomwe zimayimira uremia wamphamvu. Impso sizitha kuthana ndi kutuluka kwa nayitrogeni m'thupi ndi zinthu zina za metabolic. Mlingo wosefera umachepetsedwa kwambiri. Odwala omwe ali ndi nephropathy a gawo lino amafunikira mwachangu hemodialysis komanso kufulumira kwa othandizira impso.

Mkulu aliyense, wachinyamata, kapena mwana yemwe wapezeka ndi matenda amtundu wa 2 kapena mtundu wa 2 amayenera kukayezetsa, kuyezetsa magazi ndi kuyesa kwamatenda amkodzo pafupipafupi. Zizindikiro izi zimagwira ntchito ya impso ndipo, ngati zapezeka zovuta, lolani kuyambitsa kwa nephropathy nthawi yake yoyambira. Izi zokha ndizomwe zitha kuthandizira kuchedwetsa kuyambika kwa zizindikiro za matendawa ndikuthandizira wodwalayo kukhala ndi moyo wonse popanda dialysis.

Kuzindikira kwa matenda am'mimba kumaphatikizapo kuyesa komanso kuchuluka kwa madandaulo. Komanso chidziwitso chokhudza matenda omwe wodwalayo amakhala nacho ndikofunikira kwambiri kwa dokotala. Podziwa iye, azitha kuyambitsa matenda osiyanasiyana a impso, makamaka ndi matenda a pyelonephritis, glomerulonephritis ndi chifuwa chachikulu cha kwamikodzo. Njira yodziwitsa matenda opatsirana ndi njira yodziwira bwino ya impso ndi dopplerography ya mitsempha ya impso. Zimakupatsani mwayi wofufuza kapangidwe, kukula kwa ziwalo komanso kusintha kwachiwiri kwa magazi ake. Muzochitika zazikulu, akatswiri amapanga biopsy ndikuwerenga mtundu wa minofu pansi pa microscope ndikukhazikitsa ndendende kuchuluka kwa ma nephrons athanzi kwa owonongeka.

Tcherani khutu! Nephropathy mu matenda a shuga amadziwika ndi mitundu yambiri yazizindikiro zodziwitsa, zomwe zimaphatikizapo matenda oopsa, proteinuria ndi kuchepa kwa GFR.

Kuti dokotala azindikire molondola, molingana ndi code ya ICD, wodwalayo amayenera kuyesedwa ndi mayeso ngati nephropathy ikukayikira ngati ali ndi matenda a shuga. Chithandizo, chomwe chimagwira ntchito, chimawunikiranso pogwiritsa ntchito zotsatira za mkodzo ndi magazi. Mndandanda wazotsatira zoyenera zikuphatikiza:

mayeso a mkodzo wamba komanso tsiku ndi tsiku kuti ayese albuminuria,
kubzala mkodzo pazinthu zamafuta michere kuti muzindikire tizilombo toyambitsa matenda,
kuwerengetsa kuchuluka kwa kusefedwa kwa glomerular,
seramu biochemistry ya kutsimikiza kwa urea, zotsalira za nayitrogeni ndi creatinine.

Zakudya za matenda a impso a shuga

Mu magawo oyamba a matenda a pathology, kusintha kokha mwa chizolowezi chazakudya kungachepetse kupita patsogolo kwa nephropathy ndikuchepetsa kukula kwa mawonekedwe ake azachipatala. Choyamba, ndikofunikira kuchepetsa mchere wambiri mpaka magalamu atatu patsiku. Izi sizikugwira ntchito kokha mchere wopanda, komanso zinthu zomwe zimaphatikizidwa. Izi zimaphatikizapo mitundu yonse ya msuzi wa mafakitale, zakudya zamzitini, masoseji, ma pickles.

Nephrologists ndi urologist amalimbikitsanso zakudya zama protein ochepa. Ndikofunikira kudya nyama yocheperako, ngakhale ndibwino kupatsa chidwi ndi mitundu yazakudya: nkhuku, nyama ya kalulu. Kuphatikiza apo, onse odwala matenda ashuga amachepetsa kwambiri chakudya, zakudya za shuga ndi mafuta.Zakudya ndizosamalitsa, komabe, akatswiri azakudya amatha kuthandizira kupanga menyu yosiyanasiyana komanso yoyenera mothandizidwa ndi zonunkhira ndi zitsamba zonunkhira.

Momwe mavuto a impso amakhudzira chisamaliro cha matenda a shuga

Ngati wodwala yemwe ali ndi matenda ashuga akapezekanso ndi nephropathy, ndiye kuti njira yochizira nthawi zambiri imasintha. Mlingo wamankhwala ambiri umayenera kuchepetsedwa kapena kutsirizidwa kwathunthu chifukwa cha mphamvu ya nephrotoxicity. Chiwerengero cha zigawo za insulin zomwe zimayendetsedwa ziyenera kuchepetsedwa, chifukwa impso zowonongeka zimachotsa pang'onopang'ono, ndipo zimakhala m'magazi kwa nthawi yayitali. Ngati njira yolakwika ya Metformin yakhazikitsidwa kwa nephropathy, vuto lalikulu lotchedwa lactic acidosis limatha kuchitika ndipo limafunikira chithandizo muchipatala cholimbitsa kwambiri.

Hemodialysis ndi peritoneal dialysis

Njira zowonjezera zimakhazikitsidwa ndi kufunsira kwa akatswiri. Ikani pa gawo lotsiriza kuti muchotse, chotsani potaziyamu yambiri, nayitrogeni ndi urea m'magazi. Chotsatira cha njirazi ndi mulingo wapamwamba woposa 500 μmol l.

Asanafike hemodialysis, amaika catheter yapadera yamkati, yomwe imalumikizidwa ndi chida chapadera chomwe chimatenga magazi, kenako ndikuyeretsa ndipo nthawi yomweyo amabwerera pakama. Njirayi iyenera kuchitidwa kangapo pa sabata komanso pokhazikitsa matenda, popeza imakhala ndi chiopsezo cha zovuta komanso matenda oopsa.

Chizindikiro cha peritoneal dialysis ndikuti peritoneum imagwira ntchito yosefera, kotero catheter imayikidwa m'mimba. Kenako, madzi amadzilowetsa kukapanda kuleka, kenako ndikamayendayenda modutsa timachubu. Mwakutero, zinthu zapoizoni zochuluka zimachotsedwa.

Pofuna kupewa kutukuka kwa CKD, kupititsa patsogolo matendawa ndikukhalanso ndi moyo wabwino, ndikofunikira kuti mumayesedwe pafupipafupi, kuyang'anira mayeso a glucose tsiku lililonse ndikugwiritsa ntchito mankhwala othandizira omwe adanenedwa ndi adotolo.

Kodi matenda a shuga ndi nephropathy ndi ati

Chimodzi mwazinthu zovuta zowopsa za matenda a shuga ndi nephropathy, komwe ndiko kuphwanya kapena kutaya kwathunthu kwa ntchito ya impso. The pathogenesis yamatenda imatsimikiziridwa pazinthu zingapo:

Hyperglycemia - pali kuphwanya kapangidwe ka mapuloteni m'matumbo a impso, kutsegula kwa ma radicals omasuka okhala ndi cytotoxic.
Hyperlipidemia - ofanana ndi atherosulinosis, mapangidwe a zolengeza amapezeka m'mitsempha ya impso, yomwe imatha kupangitsa kuti blockage.
Intraperitoneal hypertension - yowonetsedwa ndi hyperfiltration, ndiye kuti kuchepa kwa ntchito yotsuka impso, kuchuluka kwa minofu yolumikizana kumawonjezeka.

Nephropathy yakuchokera kwa odwala matenda ashuga m'mbiri ya achipatala amawonetsedwa ngati matenda a impso akuwonetsa chizindikiro. Malinga ndi ICD-10, matendawa ali ndi nambala zotsatirazi:

ndi mtundu wa matenda a shuga omwe amadalira insulin - E 10,2,
ndi kulephera kwa aimpso komanso kudalira insulini - E 11.2,
ngati mu matenda a shuga mulibe thanzi lokwanira, impso zomwe zakhudzidwa - E 12.2,
ndi matenda a nephropathic kumbuyo kwa mtundu wanthendowo - E 13.2,
ndi mawonekedwe osadziwika a shuga omwe amawonongeka ndi impso - E 14.2.

Mawonetseredwe azachipatala amatengera gawo la matendawa. Pa gawo loyamba, zizindikiro zopanda pake zimachitika:

kuchepa kwa magwiridwe antchito, kunenepa kwambiri,
kupezeka kwa kufooka wamba,
kulekerera zolimbitsa thupi,
chizungulire, nthawi zina,
maonekedwe akumutu wopanda kanthu.

Pamene matenda a Kimmelstil Wilson akupita patsogolo, mawonetseredwe akufalikira. Zizindikiro zotsatirazi zamatenda zimawonedwa:

Maonekedwe a kutupa m'mawa,
kukodza pafupipafupi komanso zopweteka,
kupweteka m'dera lumbar,
ludzu losalekeza
kuthamanga kwa magazi
kukokana mu minofu ya ng'ombe, zowawa, zamatumbo,
nseru ndi kuwonda.

Mkulu wa plasma glucose ndiye chifukwa chachikulu cha chitukuko cha matenda ashuga. Chuma cha zinthu pakhoma la mtima chimapangitsa kusintha kwachilengedwe.

Local edema ndi kapangidwe kake kakonzedwe kamitsempha yamagazi kamene kamapangika kamapanga kagayidwe kazinthu kakang'ono ka impso, kamene kamadziunjikira mkati mwake.
Hypomerular matenda oopsa ndikutukuka kopitilira kukakamiza kwa ma nephrons.
Zovuta za ntchito za podocytes zomwe zimapereka kusefera njira mu matupi a impso
Kukhazikitsa kwa renin-angiotensin dongosolo, lomwe lakonzedwa kuti muchepetse kuchuluka kwa magazi.
Matenda ashuga a m'mimba - zotumphukira zomwe zimakhudzidwa ndi zotumphukira zamitsempha zimasinthidwa kukhala minofu yochepa, motero pali zovuta zaimpso.

Ndikofunikira kuti odwala matenda ashuga azisamalira thanzi lawo nthawi zonse. Pali zinthu zingapo zoopsa zomwe zimatsogolera pakupanga kwa nephropathy:

osakwanira kuchuluka kwa glycemic,
kusuta (chiopsezo chachikulu chimachitika mukamamwa ndudu zoposa 30 / tsiku),
chitukuko cha matenda a shuga
kuchuluka kwokhazikika kwa kuthamanga kwa magazi,
kukhalapo kwa zomwe zikukulitsa mbanja,
hypercholesterolemia,
kuchepa magazi

Epidemiology ya matenda ashuga a shuga

Kukula kwa matenda amisamba kumasungidwa pamilandu ya 10-20 kwa anthu mamiliyoni onse obadwa. Kuwerengera kwa amuna ndi akazi mokomera zakale ndi 2 mpaka 1. Mtundu 1 wa matenda osokoneza bongo kapena matenda a shuga amatengera 30% ya anthu odwala matenda ashuga. Type 2 shuga mellitus - 20%. Mitundu ingapo, monga amwenye aku America ndi anthu aku Africa, atha kukhala, makamaka chifukwa cha majini.

Gawo 1 - Preclinical

M'malo mwake, ngati mupita kutsatanetsatane, mutha kupeza polyuria (kuchulukitsidwa kwa mkodzo wambiri), kupezeka kwa shuga mkodzo ndikuwonjezereka kwa kusefera kwa glomerular. Kutalika kwa gawo ili la matendawa kumatengera kuti mutha kuwongolera kuchuluka kwa shuga m'magazi: kulamulidwa kwabwinoko, nthawi yayitali kwambiri.

Gawo 4 - Nephropathy

Amadziwika ndi zizindikiro zotsatirazi:

Macroalbuminuria wokhala ndi mitengo yoposa 200 mcg pamphindi.
Matenda oopsa.
Kupindika kwapang'onopang'ono mu ntchito ya impso ndi kuwonjezeka kwa creatinine.
Kutsika kwapang'onopang'ono mu kusefuka kwa impso, mtengo womwe umatsika kuchoka pa mamililita 130 pamphindi mpaka 30-10 ml / min.

Gawo 5 - uremia

Gawo lodetsa matenda. Ntchito ya impso imawonongeka mopanda chiyembekezo. Mitengo ya kusefa ya glomerular pansi pa 20 ml / min, mankhwala okhala ndi nayitrogeni amasonkhana m'magazi. Pakadali pano, dialysis kapena kupatsidwa chiwalo ndikofunikira.

Matendawa amatha kukhala modabwitsa, kutengera mtundu wa matenda a shuga, omwe ndi:

ndi matenda a shuga 1 magawo omwe adayamba kuphulika kwathunthu a nephropathy kuyambira 1 mpaka 2, ndipo gawo la matendawa limatulutsa mofulumira kwambiri mu hyperuricemia - kuyambira 2 mpaka 5 zaka.
ndi matenda a shuga a 2 mchitidwewu ndiwosasimbika, macroalbuminuria amawonekera osachepera zaka 20 kapena kupitilira kuchokera pachiwopsezo cha matenda ashuga.

Chifukwa chiyani matenda ashuga nephropathy amakula?

Sayansi yamakono yamankhwala satha kutchula zifukwa zenizeni zomwe zimayambitsa matenda a matenda ashuga. Komabe, pali zifukwa zokwanira zosonyeza kuchuluka zinthu zomwe zimathandizira kukula kwake.

Izi ndi izi:

Makamaka. Pali kudziwiratu kwamunthu komwe kumadwala.Kukonzekereratu nthawi zambiri kumachitika chifukwa cha zinthu ziwiri: banja komanso mitundu. Mitundu ina (Amwenye ndi Afirika) nthawi zambiri amakumana ndi nephropathy.
Hyperglycemia. Kuwongolera shuga ndimagazi ndikofunikira kudziwa. Kukhazikitsidwa poyesa kuti kuwongolera bwino kwamwazi wama glucose m'mitundu yonse iwiri ya shuga kumakulitsa nthawi yomwe imadutsa pakati pa kuyambika kwa matenda ashuga komanso kuyambika kwa albuminuria.
Matenda oopsa. Kuthamanga kwa magazi kumapangitsa kuti matendawa atukuke. Izi ndi zowona kwa matenda amtundu 1 komanso matenda ashuga amtundu 2. Chifukwa chake, mwa odwala matenda ashuga, chithandizo cha matenda oopsa kwambiri.
Proteinuria. Proteinuria imatha kukhala chifukwa cha matenda ashuga komanso chifukwa chake. Inde, proteinuria imazindikira kutupa kwamkati, komwe kumapangitsa kuti microsis (ikhale m'malo mwa minyewa yachilendo yomwe ilibe matupi ofunikira). Zotsatira zake, ntchito ya impso imazimiririka.
Zakudya zomanga thupi kwambiri. Kudya kwakanthawi kwamapuloteni kumapangitsa kuchuluka kwa mapuloteni mumkodzo, motero, mwayi waukulu wokhala ndi matenda a shuga. Mawuwa adanenedwa kuchokera pakuyesa kuchuluka kwa anthu aku Northern Europe, omwe anthu ake amadya mapuloteni ambiri amanyama.
Kusuta ndudu. Osuta omwe ali ndi matenda a shuga amatha kukhala nephropathy kuposa osuta.
Dyslipidemia. Ndiye kuti, lipids yamagazi ambiri motero, cholesterol ndi triglycerides. Amawoneka mu odwala omwe samadwala matenda a shuga ndipo amathandizira kukulitsa ntchito yaimpso.

Kuzindikira kwa Nephropathy: Kuunika kwa Urine ndi Kuyesa kwa Albumin

Pamtima wa matenda a nephropathy Odwala matenda a shuga amanama urinalysis ndi kusaka kwa albumin. Zachidziwikire, ngati muli ndi albinuria kapena microalbuminuria, kuti muwonetsetse kuti muli ndi matenda a shuga, ndikofunikira kupatula zina zonse zomwe zingayambitse vutoli (matenda a kwamkodzo thirakiti kapena kuchita masewera olimbitsa thupi kwa nthawi yayitali).

Kafukufuku wa milingo ya albumin akuperekeka kuwunika kwa glomerular kusefera mtengo ndi serum creatinine. The positivity of yaying'ono / macroalbuminuria imatsimikiziridwa pambuyo osachepera Mayeso awiri abwino kwa miyezi itatu.

Pankhani ya odwala omwe akudwala mtundu 1 shugakuyesa kwa microalbuminuria ziyenera kuchitidwa kamodzi pachakakuyambira kuyambira pomwe matenda a shuga adapezeka.

Pankhani ya odwala omwe akudwala mtundu 2 shuga, kafukufuku wa microalbuminuria uyenera kuchitika panthawi yopezeka ndi matenda ashuga, kenako pachaka.

Chithandizo cha matenda ashuga nephropathy

Chithandizo chabwino kwambiri cha nephropathy ndicho kupewa. Kuti muzindikire, ndikofunikira kuzindikira microalbuminuria munthawi yake ndikuchepetsa kukula kwake.

Kuti muchepetse kupezeka kwa microalbuminuria, muyenera:

Sungani shuga m'magazi anu. Mkhalidwe womwe umapezeka ndi zakudya zoyenera, kumwa mankhwala osokoneza bongo komanso kuchita masewera olimbitsa thupi nthawi zonse.
Yang'anirani kuthamanga kwa magazi. Kuti muchite izi, ndikofunikira kuthana ndi kulemera kwa thupi, kutsatira zakudya zochepa mu sodium komanso zambiri mu potaziyamu, ndikugwiritsa ntchito antihypertensive mankhwala.
Tsatirani zakudya zochepa zama protein. Kudya kwa protein tsiku ndi tsiku kumayenera kukhala pakati pa 0,6 ndi 0,9 magalamu pa kilogalamu ya thupi.
Sungani cholesterol ya LDL pansi pa 130 mg pa desilita imodzi ya magazi.

Matendawa akamakula, amayamba kudwala matenda a hemodialysis kapena impso.Odwala omwe ali ndi matenda amtundu woyamba 1, omwe ma cell a pancreatic satsekera insulin, impso ndi kapamba ndizovomerezeka.

Chakudya chothandiza popewa nephropathy

Monga taonera, mapuloteni ambiri ndi sodium ndi gawo lofunikira pachiwopsezo. Chifukwa chake, kuti muchepetse kupitirira kwa matenda, njira yotsika ya protein ndi sodium iyenera kutsatiridwa.

Zakudya zamapuloteni ziyenera kukhala pakati pa 0,6 ndi 1 g pa kilogalamu ya thupi.

Ma calories okhala pakati pa 30 ndi 35 kcal pa kilogalamu yakulemera thupi.

Kwa wodwala wolemera pafupifupi makilogalamu 70, chakudyacho chizikhala ndi zopatsa mphamvu 1600-2000, zomwe 15% ndi mapuloteni.

Zoyambira Kuchita ndi matenda a shuga a Nabetes

Mfundo zofunika kupewa ndi kuchiza matenda ashuga nephropathy pamagawo I-III ndi monga:

glycemic control
kuwongolera kuthamanga kwa magazi (kuthamanga kwa magazi kuyenera kukhala 2.6 mmol / l, TG> 1.7 mmol / l); kukonza Hyperlipidemia (lipid-kuchepetsa zakudya) kumafunika, koma osakwanira - mankhwala a lipid-kuchepetsa.

Ndi LDL> 3 mmol / L, kuchuluka kwa ma statins kumasonyezedwa:

Atorvastatin - mkati 5-20 mg kamodzi patsiku, kutalika kwa mankhwala kumatsimikiziridwa payekha kapena
Lovastatin mkati 10-40 mg kamodzi patsiku, kutalika kwa mankhwala kumatsimikiziridwa payekha kapena
Simvastatin mkati 10-20 mg kamodzi patsiku, nthawi ya mankhwala imatsimikiziridwa payekhapayekha.
Mlingo wa ma statins amawongoleredwa kuti akwaniritse chandamale cha LDL cha 6.8 mmol / L) ndipo GFR yofananira ikuwonetsa ma fiber:
Oral fenofibrate 200 mg kamodzi patsiku, kutalika mtima payekha kapena
Waprofibrate mkati mwa 100-200 mg / tsiku, kutalika kwa mankhwala kumatsimikiziridwa payekhapayekha.

Kubwezeretsanso kwa intracubular hemodynamics pamlingo wa microalbuminuria kutha kupezeka ndikuchepetsa kumwa kwa mapuloteni a nyama 1 g / kg / tsiku.

Kuwongolera kwa kusokonezeka kwa metabolic ndi electrolyte mu kuperewera kwaimpso

Pomwe proteinuria imawonekera, zakudya zama protein ochepa ndi mchere wochepa zimayikidwa, kuletsa kudya mapuloteni a nyama mpaka 0,6-0.7 g / kg pa thupi (pafupifupi mpaka 40 g protein) ndimankhwala okwanira a caloric (35-50 kcal / kg / tsiku), kuchepetsa mchere mpaka 3-5 g / tsiku.

Pachipatala cha creatinine cha 120-500 μmol / L, chodabwitsa cha kulephera kwaimpso chimachitika, kuphatikizapo chithandizo cha kuchepa kwa impso, osteodystrophy, hyperkalemia, hyperphosphatemia, hypocalcemia, ndi zina zambiri. Ndi kukula kwa aimpso kulephera, pali zovuta zomwe zimadziwika pakuwongolera kagayidwe kazakudya komwe kamakhudzana ndi kusintha kwa insulin. Kuwongolera uku ndikovuta kwambiri ndipo kuyenera kuchitidwa payekhapayekha.

Ndi hyperkalemia (> 5.5 meq / l), odwala amalembedwa:

Hydrochrothiazide pakamwa 25-50 mg m'mawa wopanda kanthu kapena
Furosemide mkati 40-160 mg m'mawa pamimba yopanda kanthu katatu pa sabata.

Sodium polystyrenesulfonate pakamwa 15 ga 4 pa tsiku mpaka kufikira ndikusunga mulingo wa potaziyamu m'magazi osaposa 5.3 meq / l.

Pambuyo pakufika pamlingo wa potaziyamu m'magazi a 14 meq / l, mankhwala amatha kuyimitsidwa.

Pankhani ya ndende ya potaziyamu m'magazi opitilira 14 meq / l ndi / kapena zizindikiro za Hyperkalemia yayitali pa ECG (kutalika kwa nthawi ya PQ, kukulira kwa zovuta za QRS, kusalala kwa mafunde a P), zotsatirazi zimaperekedwa mwachangu poyang'anira ECG:

Calcium gluconate, 10% yankho, 10 ml yolowa mkati kwa mphindi 2-5 kamodzi, pakalibe kusintha mu ECG, kubwereza jakisoni ndikotheka.
Soluble insulin (yaumunthu kapena nkhumba) yochepa yogwira 10-20 IU mu glucose solution (25-50 g glucose) kudzera mu mnofu wa celloglycemia, ndi hyperglycemia kokha insulin imayendetsedwa molingana ndi msinkhu wa glycemia.
Sodium bicarbonate, 7.5% yankho, 50 ml kudzera m'mitsempha, kwa mphindi 5 (ngati concomitant acidosis), pakalibe kusintha, bwerezaninso pambuyo pa mphindi 10-15.

Ngati izi sizothandiza, hemodialysis imachitidwa.

Odwala azotemia, enterosorbents amagwiritsidwa ntchito:

Yoyendetsedwa kaboni mkati 1-2 g masiku 3-4, nthawi ya mankhwala imatsimikiziridwa payekha kapena
Povidone, ufa, mkati mwa 5 g (kusungunuka mu 100 ml ya madzi) katatu patsiku, nthawi yamankhwala imatsimikiziridwa payekhapayekha.

Ngati kuphwanya phosphorous-calcium metabolism (nthawi zambiri hyperphosphatemia ndi hypocalcemia), zakudya zimayikidwa, kuletsedwa kwa phosphate mu chakudya mpaka 0.6-0.9 g / tsiku, ndi kusagwira kwake, kukonzekera kwa calcium kumagwiritsidwa ntchito. Mulingo woyenera wa phosphorous m'magazi ndi 4.5-6 mg%, calcium - 10,5-11 mg%. Pankhaniyi, chiwopsezo cha ectopic calcation ndi chochepa. Kugwiritsa ntchito ma aluminium phosphate omangira ma aluminium kuyenera kukhala ochepa chifukwa choopsa kwambiri cha kuledzera. Kuletsa kwa endo native synthesis wa 1,25-dihydroxyvitamin D ndi mafupa kukana parathyroid timadzi timatulutsa hypocalcemia, kuthana ndi omwe metabolites a vitamini D amauza.

Odwala ndi hyperphosphatemia ndi hypocalcemia ndi mankhwala:

Calcium calcium, mu koyamba mlingo wa 0,5-1 g wa calcium yoyambira mkati katatu pa tsiku ndi chakudya, ngati kuli kotheka, onjezani mlingo uliwonse pakadutsa masabata 2 mpaka 3 mpaka 3 katatu pa tsiku mpaka phosphorous m'magazi 4, 5-6 mg%, calcium - 10,5-11 mg%.

Calcitriol 0,25-2 mcg pakamwa 1 nthawi patsiku akuyang'aniridwa ndi seramu calcium kawiri pa sabata. Pamaso aimpso magazi ndi matenda mawonetseredwe kapena concomitant zamtima matenda.
Epoetin-beta subcutaneously 100-150 U / kg kamodzi pa sabata mpaka hematocrit ifike 33-36%, hemoglobin level 110-120 g / l.
Iron sulfate mkati mwa 100 mg (potengera chitsulo chosazidwa) 1-2 pa tsiku kwa ola limodzi la chakudya, kwa nthawi yayitali kapena
Iron (III) hydroxide sucrose tata (yankho la 20 mg / ml) 50-200 mg (2,5-10 ml) isanadze kulowetsedwa, kuchepetsa 0,9% mu sodium mankhwala enaake (1 ml ya mankhwala 20 ml ya njira), kudzera m'mitsempha kutumikiridwa pa mlingo wa 100 ml kwa mphindi 15 katatu pa sabata, kutalika kwa mankhwala kumatsimikiziridwa payekha kapena
Iron (III) hydroxide sucrose tata (yankho la 20 mg / ml) 50-200 mg (2.5-10 ml) kudzera mu liwiro la 1 ml / mphindi 2-3 kamodzi pa sabata, kutalika kwa mankhwala kumatsimikiziridwa payekhapayekha.

Zotsatira za extracorporeal chithandizo cha matenda aimpso kulephera mu shuga amatsimikiza kale kuposa odwala omwe ali ndi aimpso osiyanasiyana, popeza mu shuga amasungidwe amadzimadzi, utsi wamphamvu wa nayitrogeni komanso electrolyte umakhala ndi mfundo zapamwamba za GFR. Ndi kuchepa kwa GFR kosakwana 15 ml / mphindi ndikuwonjezereka kwa creatinine mpaka 600 μmol / l, ndikofunikira kuyesa zomwe zikuwonetsa ndi zotsutsana ndikugwiritsira ntchito njira zochiritsira zosowa m'malo: hemodialysis, peritoneal dialysis ndi kupatsirana kwa impso.

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Chithandizo cha uremia

Kuwonjezeka kwa seramu creatinine pamtunda kuchokera pa 120 mpaka 500 μmol / L kumawonekera kwambiri pazomwe zimalepheretsa impso kulephera. Pakadali pano, chithandizo chamankhwala chimachitika ndikufuna kuthetsa kuledzera, kuimitsa matenda oopsa, ndikukonzanso zosokoneza zamagetsi. Makhalidwe apamwamba a serum creatinine (500 μmol / L ndi apamwamba) ndi hyperkalemia (kupitirira 6.5-7.0 mmol / L) amawonetsa kuyambika kwa gawo lothana ndi kulephera kwa aimpso, komwe kumafunikira njira zakunja kwa dialysis.

Chithandizo cha odwala omwe ali ndi matenda osokoneza bongo nthawi ino amachitika palimodzi ndi ma endocrinologists ndi nephrologists. Odwala omwe akudwala matenda a impso amalephera kuchipatala m'madipatimenti apadera a nephrology omwe amakhala ndi makina a dialysis.

Chithandizo cha matenda a shuga ndi nephropathy mu mawonekedwe a mawonekedwe a aimpso kulephera

Odwala omwe ali ndi matenda amtundu wa 1 komanso mtundu wa 2 wodwala omwe ali pa insulin mankhwala, kupitilira kwa matenda aimpso kulephera nthawi zambiri kumadziwika ndi kukula kwa matenda a hypoglycemic omwe amafunikira kuchepetsa kuchuluka kwa insulin (Zabrody phenomenon).Kukula kwa matenda amtunduwu kumachitika chifukwa chakuti kuwonongeka kwambiri kwaimpso parenchyma, ntchito ya aimpso insulinase yomwe ikugwira nawo ntchito yoyipa ya insulin imachepa. Chifukwa chake, insulini yoyendetsedwa bwino imapangidwa pang'onopang'ono, imazungulira m'magazi kwa nthawi yayitali, ndikupangitsa hypoglycemia. Nthawi zina, kufunika kwa insulini kumachepetsedwa kwambiri kwakuti madokotala amakakamizidwa kuletsa jakisoni wa insulin kwakanthawi. Kusintha konse kwa insulin kuyenera kuchitidwa pokhapokha ngati chiwopsezo cha glycemia chikuyenera. Odwala omwe ali ndi matenda a shuga a mtundu wachiwiri omwe adalandira mankhwala a hypoglycemic, omwe ali ndi vuto lofooka la impso, ayenera kusinthidwa kupita ku insulin. Izi ndichifukwa choti ndi chitukuko cha matenda aimpso osalephera, chimbudzi cha kukonzekera konse kwa sulfonylurea (kupatula glyclazide ndi glycidone) ndi mankhwala ochokera ku gulu la Biguanide amatsika kwambiri, zomwe zimapangitsa kuti chiwopsezo chawo m'magazi chiwonjezeke.

Kukonzekera kuthamanga kwa magazi kukukhala njira yayikulu yochizira matenda a impso, omwe amachepetsa kuyambika kwa kulephera kwa impso. Cholinga cha antihypertensive tiba, komanso gawo la proteinuric la nephropathy, ndikukhala kuthamanga kwa magazi pamlingo wosaposa 130/85 mm Hg. ACE inhibitors amaonedwa ngati mankhwala osankha oyamba, monga mwa magawo ena a matenda ashuga a nephropathy. Nthawi yomweyo, munthu azikumbukira kufunika kogwiritsa ntchito mankhwalawa mosamala ndi kulephera kwa impso (serum creatinine level of more 300 μmol / L) chifukwa cha kufupika kwakanthawi kwa ntchito ya kusefukira kwa impso komanso kukula kwa vuto la Hyperkalemia. Mu gawo la kufooka kwa impso, monga lamulo, monotherapy sakhazikika pamlingo wamagazi, chifukwa chake, tikulimbikitsidwa kuchita mankhwala ophatikiza antihypertensive omwe ali m'magulu osiyanasiyana (ACE inhibitors + loop diuretics + calcium channel blockers + kusankha beta-blockers + pakati zochita mankhwala) . Nthawi zambiri, njira yokhayi yothandizira mankhwalawa 4 yothandizira matenda oopsa aimpso kulephera imakupatsani mwayi wolingana ndi kuthamanga kwa magazi.

Mfundo yofunika yochizira nephrotic syndrome ndikuchotsa hypoalbuminemia. Ndi kuchepa kwa serum albumin ndende ya osakwana 25 g / l, kulowetsedwa kwa njira za Albin ndikulimbikitsidwa. Nthawi yomweyo, ma loop diuretics amagwiritsidwa ntchito, ndipo mlingo wa furosemide womwe umayendetsedwa (mwachitsanzo, lasix) umatha kufika 600-800 ndipo ngakhale 1000 mg / tsiku. Potazium-spure diuretics (spironolactone, triamteren) mu gawo la kufooka kwa impso sikugwiritsidwa ntchito chifukwa choopsa cha hyperkalemia. Liazide diuretics imaphatikizidwanso pakulephera kwa impso, chifukwa zimathandizira kuchepa kwa kusefedwa kwa impso. Ngakhale kutayika kwakukulu kwa mapuloteni mu mkodzo ndi nephrotic syndrome, ndikofunikira kupitiliza kutsatira mfundo yotsika ya mapuloteni otsika, momwe mapuloteni omwe amapezeka ndi nyama sayenera kupitirira 0,8 g pa 1 kg ya kulemera kwa thupi. Nephrotic syndrome imadziwika ndi hypercholesterolemia, chifukwa chake njira yothandizira mankhwalawa imaphatikizapo mankhwala ochepetsa lipid (mankhwala othandiza kwambiri ochokera ku gulu la statins). Kukula kwa odwala omwe ali ndi matenda osokoneza bongo omwe ali ndi matenda ashuga nephropathy mu gawo la matenda aimpso kulephera komanso nephrotic syndrome ndi osavomerezeka. Odwala otere ayenera kukhala okonzekera mwachangu chithandizo chowonjezera cha impso.

Odwala omwe ali pachiwopsezo cha aimpso kulephera, pamene serum creatinine imaposa 300 μmol / l, amafunikira malire a protein yanyama (mpaka 0,6 g pa 1 kg ya kulemera kwa thupi). Pokhapokha ngati kuphatikizidwa kwa matenda aimpso kulephera komanso nephrotic syndrome ndikololedwa kudya mapuloteni ochuluka mwa 0,8 g pa kg iliyonse ya thupi.

Ngati mukufunikira kutsatira kwa moyo wanu wonse zakudya zama protein ochepa omwe ali ndi odwala omwe ali ndi chakudya chochepa, mavuto omwe amabwera chifukwa cha kupatsirana kwa mapuloteni awoawo kumatha. Pachifukwa ichi, tikulimbikitsidwa kugwiritsa ntchito ketone analogues ya amino acid (mwachitsanzo, ketrateil ya mankhwala). Mankhwalawa ndi mankhwalawa, ndikofunikira kuwongolera kuchuluka kwa calcium m'magazi, chifukwa nthawi zambiri hypercalcemia imayamba.

Matendawa, omwe nthawi zambiri amapezeka mwa odwala omwe amalephera kupweteka aimpso, nthawi zambiri amagwirizanitsidwa ndi kuphatikizika kwa aimpso erythropoietin - mahomoni omwe amapereka erythropoiesis. Pofuna kubwezeretsa mankhwala, ntchito erythropoietin (epoetin alpha, epoetin beta) imagwiritsidwa ntchito. Poyerekeza ndi zamankhwala, kuperewera kwachuma cha seramu kumakulirakulira, chifukwa chake, pakakhala chithandizo chokwanira, mankhwala a erythropoietin akulangizidwa kuti aphatikizidwe ndi kugwiritsa ntchito mankhwala okhala ndi chitsulo. Pakati pa zovuta za erythropoietin mankhwala, kukula kwa ochepa ochepa matenda oopsa, hyperkalemia, ndi chiopsezo chachikulu cha thrombosis. Mavuto onsewa ndiosavuta kuwawongolera ngati wodwala ali ndi chithandizo cha hemodialysis. Chifukwa chake, ndi 7-10% yokha ya odwala omwe amalandira chithandizo cha erythropoietin mu pre-dialysis siteji ya aimpso kulephera, ndipo pafupifupi 80% amayamba mankhwalawa akaperekedwa ku dialysis. Ndi magazi osasinthika oopsa komanso matenda oopsa a mtima, chithandizo cha erythropoietin chimatsutsana.

Kukula kwa aimpso kulephera amadziwika ndi hyperkalemia (oposa 5.3 mmol / L) chifukwa kuchepa kwa aimpso excretion wa potaziyamu. Pachifukwa ichi, odwala amalangizidwa kuti asatenge zakudya zomwe zili ndi potaziyamu (nthochi, maapricots owuma, zipatso za zipatso, zipatso zouma, mbatata). Milandu pomwe hyperkalemia imafika pazomwe zimawopseza kumangidwa kwamtima (kupitirira 7.0 mmol / l), wogwirizira wa potaziyamu, 10% calcium gluconate solution, amathandizidwa kudzera m'mitsempha. Ma resin a Ion amagwiritsidwanso ntchito pochotsa potaziyamu m'thupi.

Mavuto a phosphorous-calcium metabolism osalephera aimpso amadziwika chifukwa cha hyperphosphatemia ndi hypocalcemia. Kuwongolera hyperphosphatemia, kuletsa kudya zakudya zomwe zimakhala ndi phosphorous (nsomba, zolimba komanso zosinthidwa tchizi, nokunye) ndikuyambitsa mankhwala omwe amamangira phosphorous m'matumbo (calcium calciumate kapena calcium acetate) amagwiritsidwa ntchito. Kuwongolera hypocalcemia, kukonzekera kwa calcium, colecalciferol ndi mankhwala. Ngati ndi kotheka, chitani opaleshoni yochotsa ziwopsezo za parathyroid.

Enterosorbents ndi zinthu zomwe zimatha kumangirira zinthu zopweteka m'matumbo ndikuzichotsa m'thupi. Kuchita kwa ma enterosorbents mu kuperewera kwa impso kumalingidwa, kumbali imodzi, kupangitsa kuti kulowererapo kwa poizoni wa uremic kuchokera m'magazi, ndi mbali inayo, kuchepetsa kuchepa kwa sumu zam'mimba kuchokera m'matumbo kulowa m'magazi. Monga enterosorbents, mutha kugwiritsa ntchito kaboni yokhazikitsidwa, povidone (mwachitsanzo, ma postodeis), minisorb, ma resin a ion-exchange. Enterosorbents iyenera kumwedwa pakati pa chakudya, maola 1.5-2 mutamwa mankhwalawa. Pochiza ma sorbents, ndikofunikira kuwunika pafupipafupi ntchito zamatumbo, ngati pakufunika kutero, mupeze mankhwala othandizira mankhwala othandizira kapena othandizira enemas.

Mfundo zachithandizo

Chithandizo cha matenda ashuga nephropathy ali ndi njira zingapo:

Matenda a shuga mthupi,
kuthamanga kwa magazi
kubwezeretsa mafuta kagayidwe,
Kuchotsa kapena kutha kwa chitukuko cha matenda a impso.

Therapy ndizokhazikitsidwa:

mankhwala
chakudya
maphikidwe a mankhwala azikhalidwe.

Woopsa kuwonongeka impso, aimpso m'malo.

Komanso, wodwala ayenera:

Kuchuluka zolimbitsa thupi
lekani zizolowezi zoyipa (kusuta, mowa),
sinthani malingaliro am'maganizo, pewani kupsinjika,
kukhala ndi thupi lokwanira.

Ndipo ngati magawo oyamba a mankhwala adapangidwira njira zodzitetezera, milandu yonyalanyazidwa imapereka njira yoopsa.

Zochizira matenda a shuga, nephropathy, njira zonse zothetsera matenda zimayikidwa ndi adokotala.

Sintha shuga

Matenda a shuga m'thupi amabwera pochizira nephropathy ndi mndandanda wama shuga omwe amachititsa kuti matendawa azikula.

Kafukufuku wachipatala adakhazikitsa: ngati kwa nthawi yayitali index ya glycemic hemoglobin sapitirira 6.9%, ndizotheka kupewa chitukuko cha nephropathy.

Akatswiri amavomereza mfundo za glycated hemoglobin yopitilira 7% pachiwopsezo chachikulu cha dera la hypoglycemic, komanso mwa odwala omwe ali ndi matenda am'mtima.

Pofuna kukonza mankhwala a insulini ndikofunikira: kuwunikiranso mankhwala omwe agwiritsidwa ntchito, njira yawo komanso Mlingo.

Monga lamulo, dongosolo lotsatirali limagwiritsidwa ntchito: insulin yayitali imaperekedwa nthawi 1-2 patsiku, mankhwala osokoneza bongo - musanadye.

Kusankha kwa mankhwala ochepetsa shuga a matenda a impso ndi ochepa. Kugwiritsa ntchito mankhwala, kuchotseka komwe kumachitika kudzera mu impso, komanso kukhala ndi vuto losafunikira m'thupi, ndikosayenera.

Ndi matenda a impso, ntchito:

biguanides omwe ungapangitse lactic acidosis kuti ikomoke,
thiazolinedione, zomwe zimapangitsa kuti madzi azisungidwa mthupi,
glibenclamide chifukwa chakuchepa kwambiri kwa shuga wamagazi.

Kwa odwala matenda ashuga amtundu wa 2, kugwiritsa ntchito mankhwala otetezeka kwambiri pakamwa, omwe ali ndi zotsika kwambiri kudzera mu impso, akulimbikitsidwa:

Ngati sizotheka kupeza chindapusa chokwanira chifukwa chakumwa mapiritsi a mtundu wa 2 odwala ashuga, akatswiri amapanga chithandizo chophatikiza pogwiritsa ntchito insulin yayitali. Zinthu zitafika povuta kwambiri, wodwalayo amasamukira ku insulin.

Kuphatikizika kwa impso ndi kapamba

Lingaliro la kuphatikiza kotereku ndiloyenera chifukwa chokwanira kuti wodwalayo athe kukonzanso, popeza kufalikira kwa ziwalo zimaphatikizapo kuthetseratu mawonetseredwe a kulephera kwa impso ndi matenda a shuga mellitus omwe, omwe adayambitsa matenda a impso. Nthawi yomweyo, kuchuluka kwa odwala omwe ali ndi matenda a shuga komanso kumuika pambuyo pochita izi ndi kotsika kuposa ndikumayendetsa impso kwayekha. Ichi ndichifukwa cha zovuta zambiri zaluso pochita opareshoni. Komabe, podzafika kumapeto kwa chaka cha 2000, zinthu zoposa 1,000 zophatikizidwa pamodzi za impso ndi kapamba zidachitidwa ku United States of America. Kupulumuka kwa zaka zitatu kwa odwala kunali 97%. Kusintha kwakukulu muumoyo wa odwala, kuyimitsidwa kwa kuwonjezereka kwa kuwonongeka kwa ziwalo zomwe zikuyang'aniridwa mu matenda a shuga, komanso kudziyimira pawokha kwa insulin kwapezeka mu 60-92% ya odwala. Pamene matekinoloje atsopano akupitilira patsogolo pamankhwala, ndizotheka kuti m'zaka zikubwerazi mtundu wamtunduwu wogwirizira udzakhala patsogolo.

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Kubwezeretsa kwa glomerular chapansi chapamwamba

Amadziwika kuti gawo lofunikira pakukweza kwa matenda ashuga nephropathy imaseweredwa ndi kuphatikizika kwa glycosaminoglycan heparan sulfate, yomwe ndi gawo la membrane wa glomerular basrane ndipo imapereka chida chosankha fungo.Kubwezeretsanso komwe kusungidwa kwa phula ili mu minyewa yam'mimba kumatha kubwezeretsanso kuperewera kwa membrane ndikuchepetsa kuwonongeka kwa mapuloteni mu mkodzo. Kuyesera koyamba kugwiritsa ntchito glycosaminoglycans pochiza matenda a shuga a nephropathy anapangidwa ndi G. Gambaro et al. (1992) mu makoswe omwe ali ndi matenda a shuga a streptozotocin. Zinakhazikitsidwa kuti kuikidwa kwake koyambirira - pakuwonekera kwa matenda a shuga - kumalepheretsa kusintha kwa kusintha kwa morphological mu minofu ya impso komanso mawonekedwe a albuminuria. Kuchita bwino kwa mayeso kwatilola kupitabe ku mayesero azachipatala a mankhwala omwe ali ndi glycosaminoglycans popewa komanso kuchiza matenda a shuga. Posachedwa, mankhwala a glycosaminoglycans ochokera ku Alfa Wassermann (Italy) Veselential F (INN - sulodexide) adapezeka pamsika wama Russia waku Russia. Mankhwala ali ndi glycosaminoglycans - ochepa maselo kulemera heparin (80%) ndi dermatan (20%).

Asayansi amafufuza za nephroprotective ya mankhwalawa odwala omwe ali ndi matenda a shuga 1 omwe amakhala ndi magawo osiyanasiyana a matenda ashuga. Odwala omwe ali ndi microalbuminuria, kwamikodzo albumin excretion amachepetsa sabata 1 pambuyo poyambira mankhwalawa ndikukhazikika pamiyezi itatu ya miyezi 99 atachotsedwa ntchito. Odwala ndi proteinuria, kwamikodzo mapuloteni excretion kwambiri amachepetsa masabata 3-4 pambuyo pa kuyamba chithandizo. The zinatheka zotsatira anapitiliza atasiya mankhwala. Palibe zovuta zamankhwala zomwe zidadziwika.

Chifukwa chake, mankhwala ochokera ku gulu la glycosaminoglycans (makamaka, sulodexide) akhoza kuwonedwa ngati othandiza, opanda zotsatira zoyipa za heparin, komanso osavuta pakugwiritsa ntchito njira ya pathogenetic ya matenda ashuga a nephropathy.

Matenda a kuthamanga kwa magazi

Kusintha kwamatenda a impso kumachitika, ndikofunikira kwambiri kusintha zizindikiro zamagazi ndikuchotsa ngakhale owonjezera omwe ali nawo.

Kupsinjika kwa magazi, chizolowezi choyenera kwambiri, chimakupatsani mwayi kuti muchepetse kukula kwa njira za impso.

Posankha mankhwala, ndikofunikira kulingalira momwe zimakhudzira gawo lomwe lakhudzidwa. Monga lamulo, akatswiri amatembenukira ku magulu otsatirawa a mankhwalawa:

ACE inhibitors (Lisinopril, Enalapril). Mankhwala amagwiritsidwa ntchito nthawi zonse za matenda. Ndikofunikira kuti nthawi yawo yowonekera isapitirire maola 10-12. Mankhwala a ACE inhibitors, ndikofunikira kuchepetsa kugwiritsa ntchito mchere wa tebulo mpaka 5 g patsiku ndi mankhwala okhala ndi potaziyamu.
Angiotensin receptor blockers (Irbesartan, Lozartan, Eprosartup, Olmesartan). Mankhwalawa amathandizira kuchepetsa kukakamiza konse mu impso.
Saluretikam (Furosemide, Indapamide).
Ma calcium blockers (Verapamil, etc.). Mankhwala amaletsa kulowa kwa calcium m'maselo a thupi. Izi zimathandizira kukulitsa ziwiya zama mtima, kukonza magazi mu minofu ya mtima, chifukwa, zimachotsa matenda oopsa.

Lipid kagayidwe kachakudya

Ndi kuwonongeka kwa impso, mafuta a cholesterol sayenera kupitirira 4.6 mmol / L, triglycerides - 2.6 mmol / L. Chosiyana ndi matenda a mtima, momwe mulingo wa triglycerides uyenera kukhala wochepera 1.7 mmol / L.

Kuti tichotse izi, tiyenera kugwiritsa ntchito magulu otsatirawa:

Staninov (Lovastatin, Fluvastatin, Atorvastatin). Mankhwala amachepetsa kupanga ma enzyme omwe amaphatikizidwa ndi kuphatikiza kwa cholesterol.
Fibrate (Fenofibrate, Clofibrate, Cyprofibrate). Mankhwala amachepetsa mafuta a plasma poyambitsa lipid metabolism.

Kuthetsa Matenda a Renal

Anemal magazi amawonedwa mu 50% ya odwala omwe ali ndi vuto la impso ndipo amapezeka pa gawo la proteinuria.Mwanjira imeneyi, hemoglobin sapitirira 120 g / l mwa akazi ndi 130 g / l mwa oyimira theka lamphamvu la anthu.

Kupezeka kwa njirayi kumapangitsa kuti pakhale kusakwanira kwa mahomoni (erythropoietin), omwe amachititsa kuti hematopoiesis wamba. Kuchepa kwa magazi m'thupi kumachitika nthawi zambiri limodzi ndi kuperewera kwa chitsulo.

Mphamvu ya wodwalayo yakuthupi ndi yam'maganizo imachepa, kugonana kumachepa mphamvu, chilakolako cha kugona ndikugona.

Kuphatikiza apo, kuchepa magazi kumapangitsa kuti nephropathy ipite patsogolo kwambiri.

Kubwezeretsanso mulingo wa chitsulo, Venofer, Ferrumleck, etc. amathandizira kudzera m'mitsempha.

Zotsatira zama protein a non-enzymatic glycosylated

Mapuloteni osachita enzymatic glycosylated a protein of the glomerular basement membrane pansi pa zochitika za hyperglycemia amatsogolera kuphwanya kwawo kukhazikika ndi kutayika kwa kusankha kosavomerezeka kwa mapuloteni. Njira yodalirika pakuthandizira matenda a mtima wamatenda a shuga ndi kusaka mankhwala omwe angasokoneze zomwe sizikuchitika mu enzymatic glycosylation. Chosangalatsa choyeseza chinali kuthekera kwakapezeka kwa acetylsalicylic acid kochepetsa mapuloteni a glycosylated. Komabe, kuikidwa kwake ngati glycosylation inhibitor sikunapeze kufalitsa kachipatala kokwanira, popeza Mlingo womwe mankhwalawo umathandizira uyenera kukhala wokulirapo, womwe umakhala wofukidwa ndi kukulitsa zovuta.

Kusokoneza zomwe sizimapanga enzymatic glycosylation m'maphunziro oyesera kuyambira zaka za m'ma 80 zapitazo, mankhwala aminoguanidine agwiritsidwa ntchito bwino, omwe amakanika ndi magulu a carboxyl a zinthu zomwe zimasinthidwa glycosylation, kuimitsa njirayi. Posachedwa, choletsa chokhazikika cha mapangidwe a pyridoxamine glycosylation end apangidwa.

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Zotsatira zamatenda a polyol glucose

Kuchulukitsidwa kwa glucose metabolism panjira ya polyol mothandizidwa ndi aldose reductase enzyme kumabweretsa kudzikundikira kwa sorbitol (chinthu chosagwira ntchito) pazinthu zosadalira insulini, zomwe zimathandizanso kukulitsa zovuta za shuga. Kusokoneza njirayi, chipatalachi chimagwiritsa ntchito mankhwala ochokera ku gulu la aldose reductase inhibitors (tolrestat, statil). Kafukufuku angapo adawonetsa kuchepa kwa albuminuria mwa odwala omwe ali ndi matenda amtundu wa 1 omwe adalandira aldose reductase inhibitors. Komabe, chithandizo chachipatala cha mankhwalawa chimatchulidwa pochiza matenda a shuga kapena retinopathy, komanso kuchepera kwa matenda a shuga. Mwina izi zimachitika chifukwa chakuti njira ya polyol ya kagayidwe kachakudya imagwira ntchito yocheperako pathogenesis ya kuwonongeka kwa impso ya matenda ashuga kuposa ziwiya zina zama cell zomwe sizimadalira insulini.

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Zotsatira pa endothelial cell zochita

M'maphunziro oyesera komanso azachipatala, gawo la endothelin-1 monga mkhalapakati wa kupitirira kwa matenda ashuga nephropathy adakhazikitsidwa momveka. Chifukwa chake, chidwi chamakampani ambiri opanga mankhwala atembenukira ku kaphatikizidwe kamankhwala omwe angalepheretse kuchulukitsidwa kwa chinthuchi. Pakadali pano, mayesero oyeserera a mankhwala omwe amateteza ma receptor a endothelin-1. Zotsatira zoyambirira zikuwonetsa kuchepa mphamvu kwa mankhwalawa poyerekeza ndi ACE inhibitors.

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Kuunikira kwa chithandizo chamankhwala

Njira zothandizira kupewa ndi kuchiza matenda ashuga nephropathy zimaphatikizanso njira zina zochizira matenda ashuga, komanso kupewa matenda osakanikirana a shuga ndi kuchepa kwapang'onopang'ono kwa kuchepa kwa impso.

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Electrolyte bwino

Kuthekera kwa mankhwala a enterosorbent kuyamwa zinthu zovulaza kuchokera m'matumbo am'mimba kumathandizira kuchepetsa kwambiri kuledzera kwa thupi komwe kumayambitsa vuto laimpso ndi mankhwala omwe amagwiritsidwa ntchito.

Enterosorbents (makala ophatikizidwa, Enterodeum, ndi zina) amalembedwa ndi dokotala payekhapayekha ndipo amatengedwa ola limodzi ndi theka mpaka maola awiri asanadye ndi mankhwala.

Miyezi yambiri ya potaziyamu m'thupi (hyperkalemia) imachotsedwa mothandizidwa ndi oyambitsa potaziyamu, yankho la calcium gluconate, insulini yokhala ndi shuga. Ndi chithandizo cha mankhwala, hemodialysis ndiyotheka.

Chotsani Albuminuria

Kuwonongeka kwa impso glomeruli, ngakhale kwambiri ndi nephropathy, kumapangitsa kukhalapo kwa mapuloteni mu mkodzo.

Renal glomerular permeability imabwezeretsedwa mothandizidwa ndi nephroprotective Sulodexide.

Nthawi zina, akatswiri amapereka Pentoxifylline ndi Fenofibrate kuti athetse albinuria. Mankhwalawa ali ndi zotsatira zabwino, koma kuchuluka kwa chiwopsezo cha zotsatira zoyipa pazabwino zogwiritsidwa ntchito ndi akatswiri sizinadziwike bwino.

Dialysis - kuyeretsa magazi kudzera mu zida zapadera kapena kudzera mu peritoneum. Ndi njira iyi, ndizosatheka kuchiritsa impso. Cholinga chake ndikusintha chiwalo. Mchitidwewu suyambitsa kupweteka ndipo nthawi zambiri umaloledwa ndi odwala.

Pa hemodialysis, chipangizo chapadera chimagwiritsidwa ntchito - dialyzer. Kulowa mu zida, magazi amachotsa zinthu zapoizoni ndi madzi ochulukirapo, omwe amathandizira kuti pakhale zamagetsi zamagetsi zamchere komanso zamchere.

Mchitidwewu umachitika katatu pa sabata ndipo umakhala pafupifupi maola 4-5 mumankhwala ndipo ungayambitse:

kusanza ndi kusanza
kutsitsa magazi,
mkwiyo pakhungu,
kutopa kwambiri
kupuma movutikira
kukanika kwa mtima,
kuchepa magazi
amyloidosis, momwe mapuloteni amadziunjikira m'malumikizidwe ndi tendon.

Nthawi zina, peraloneal dialysis amachitidwa, zomwe zikuwonetsa kuti ndi kusatheka kwa hemodialysis:

magazi akutaya
kulephera kupeza zofunikira zombo (zochepetsedwa kapena ana),
mtima matenda
kufunitsitsa kwa wodwala.

Ndi peritoneal dialysis, magazi amayeretsedwa kudzera mu peritoneum, pomwe pamenepa ndi dialyzer.

Ndondomeko zitha kuchitidwa onse kuchipatala komanso kunyumba kawiri kapena kupitilira tsiku.

Chifukwa cha peritoneal dialysis, zotsatirazi zingaoneke:

bakiteriya kutupa kwa peritoneum (peritonitis),
kukhetsa mkodzo
chophukacho.

Kutsegula sikunachitike ndi:

mavuto amisala
matenda oncological
khansa
myocardial infaration kuphatikiza ndi zina mtima
kulephera kwa chiwindi
matenda ammbuyo.

Ngati njirayi yakanidwa, katswiriyo ayenera kulimbikitsa lingaliro lake.

Kupatsirana kwa impso

Njira yokhayo yophatikizira thupira ndi gawo la matenda a matenda ashuga nephropathy.

Kuchita opaleshoni yopambana kumatha kukulitsa thanzi la wodwalayo.

Opaleshoni sikuchitidwa ndi zotsatirazi zotsutsana:

kusagwirizana kwa thupi la wodwalayo komanso ziwalo za woperekayo,
zotupa zatsopano zamavuto,
matenda a mtima pachimake,
matenda aakulu
kunyalanyaza zochitika zam'maganizo zomwe zingasokoneze kusintha kwa postoperative kwa wodwala (psychosis, uchidakwa, kugwiritsa ntchito mankhwala osokoneza bongo),
matenda opatsirana (chifuwa chachikulu, HIV).

Kuthekera kochita opaleshoni yamatenda a metabolic, komanso matenda osiyanasiyana a impso: membrous proliferative glomerulonephritis, hemolytic uremic syndrome ndi matenda ena, amasankhidwa payekhapayekha ndi katswiri aliyense.

Zakudya za anthu odwala matenda ashuga nephropathy ndi imodzi mwanjira zovuta kwambiri.

Mfundo zomwe zimayambitsa kudya ndi izi:

Kuchepetsa kudya kwa mapuloteni tsiku ndi tsiku kumathandizira kuchepetsa kuchuluka kwa zinyalala za nayitrogeni m'thupi. Kugwiritsa ntchito nyama komanso nsomba zimakololedwa ndikusintha kwamapuloteni azamasamba.
Nthawi zina, kuchepetsa mchere wambiri mpaka 5 g pa tsiku ndikulimbikitsidwa. Kuphatikizidwa kwa phwetekere ndi mandimu, adyo, anyezi, ndi tsinde la udzu winawake muzakudya kungakuthandizeni kusintha kuzolowera zakudya zopanda mchere.
Kutengera zotsatira za mayesowo, katswiriyo amawona kuthekera kowonjezera kapena kuchepetsa kugwiritsa ntchito zakudya zomwe zili ndi potaziyamu.
Ma regimen omwera amatha kutha pokhapokha ngati pali kutupa kwambiri.
Chakudya chizikhala chovundira kapena chophika.

Mndandanda wazakudya zovomerezeka ndi zoletsedwa zimapangidwa ndi dokotala ndipo zimatengera gawo la matendawa.

Zithandizo za anthu

Chithandizo cha matenda ashuga nephropathy n`chotheka pogwiritsa ntchito wowerengeka azitsamba pa siteji ya kuchira kapena koyambirira matenda.

Kubwezeretsa ntchito ya impso, decoctions ndi teti kuchokera ku lingonberries, sitiroberi, chamomiles, cranberries, zipatso za rowan, m'chiuno cha rose, ndi plantain amagwiritsidwa ntchito.

Nyemba zouma (50 g), zophika m'madzi otentha (1 l), zimathandizira pa ntchito ya impso komanso kutsitsa shuga mthupi. Pambuyo kukakamira kwa maola atatu, chakumwacho chimamwa mu ½ chikho cha mwezi umodzi.

Kuti muchepetse cholesterol, ndikofunikira kuwonjezera mafuta a azitona kapena a fulakesi ku chakudya - 1 tsp. 2 kawiri tsiku lonse.

Mabulosi a Birch (2 tbsp), atasefukira ndi madzi (300 ml) ndikubwera chithupsa, amathandizira kuti impso ntchito. Kuumirira mu thermos kwa mphindi 30. Idyani zakudya zotentha za 50 ml mpaka 4 pa tsiku musanadye kwa masiku 14.

Kupitilira magazi kosalekeza kumathandizira kuthetsa kulowetsedwa kwa phula, kutengedwa katatu patsiku, 20 kutsika ndi kotala ola limodzi asanadye.

Ndikulimbikitsidwanso kukonzekera decoctions pogwiritsa ntchito chivwende ndi peels kapena kudya chipatsocho musanalandire chithandizo.

Ngati matenda a shuga apezeka, wodwalayo ayenera kumvetsera kwambiri thupi lakelo. Njira yodziwika bwino ya matenda ashuga nephropathy ndi chinsinsi cha chithandizo chake.

Matenda a shuga: onani zonse zomwe mukufuna. Pansipa, zizindikiritso zake ndi kuzindikira kwake zikufotokozedwa mwatsatanetsatane pogwiritsa ntchito mayeso a magazi ndi mkodzo, komanso ultrasound ya impso. Chinthu chachikulu chimauzidwa za njira zabwino zakuchiritsira zomwe zimakulolani kuti mukhale ndi shuga m'magazi 3.9-5.5 mmol / l khola maola 24 patsiku, monga mwa anthu athanzi. Dongosolo Lachiwiri la Dr. 2 ndi mtundu wopewa matenda a shuga a Type 1 amathandiza kuchiritsa impso ngati nephropathy sinapite patali. Dziwani chomwe microalbuminuria ndi proteinuria ndi, choti muchite ngati impso zanu zilonda, ndi momwe mungapangire matenda a magazi ndi kupangainine m'magazi.

Matenda a shuga ndi nephropathy ndi kuwonongeka kwa impso chifukwa cha shuga wamagazi ambiri. Komanso kusuta fodya ndi matenda oopsa zimawononga impso. Kwa zaka 15-25 wodwala matenda ashuga, ziwalo zonsezi zimalephera, ndipo dialysis kapena kumuika ndikofunikira. Tsambali likufotokozera mwatsatanetsatane za wowerengeka azitsamba ndi chithandizo chamankhwala pofuna kupewa kulephera kwa impso kapena osachepetsa kukula kwake. Malangizo amaperekedwa, kukhazikitsa komwe sikumateteza impso zokha, komanso kumachepetsa chiopsezo cha kugunda kwamtima ndi sitiroko.

A Nephropathy a Matenda A shuga: Nkhani Yatsatanetsatane

Dziwani momwe matenda a shuga amakhudzira impso zanu, zizindikiro, ndi algorithm yodziwitsa matenda a matenda a shuga. Mvetsetsani zomwe kuyezetsa kuyenera kudutsidwa, momwe mungawerengere zotsatira zawo, ndizothandiza bwanji kwa impso. Werengani za chithandizo chamankhwala, zakudya, mankhwala azikhalidwe komanso kusintha kwa moyo wathanzi. Malingaliro a chithandizo cha impso mwa odwala omwe ali ndi matenda a shuga a 2 akufotokozedwa. Zambiri zimaperekedwa za mapiritsi omwe amachepetsa shuga ya magazi ndi kuthamanga kwa magazi.Kuphatikiza pa iwo, ma statin a cholesterol, aspirin, ndi mankhwala a anemia angafunike.

Kodi matenda ashuga amakhudza bwanji impso?
Kodi pali kusiyana kotani pakati pamavuto a impso mu mtundu 2 ndi mtundu woyamba wa shuga?
Zizindikiro ndi matenda a matenda ashuga nephropathy
Chimachitika ndi chiyani ngati impso zaleka kugwira ntchito?
Chifukwa chiyani shuga amachepetsedwa panthawi ya matenda ashuga nephropathy?
Ndi magazi ati ndi mkodzo womwe amayesedwa? Mungamve bwanji zotsatira zawo?
Kodi microalbuminuria ndi chiyani?
Kodi proteinuria ndi chiyani?
Kodi cholesterol imakhudza bwanji zovuta za impso?
Kodi ndi anthu angati omwe anthu odwala matenda ashuga amafunika kuchita nthawi zambiri kuti awonetsetse impso?
Kodi zizindikiro za matenda ashuga nephropathy pa ultrasound ndi ziti?
Diabetes nephropathy: magawo
Zoyenera kuchita ngati impso zikupweteka?
Kodi matenda a shuga amawachiritsa bwanji kuti ateteze impso?
Ndi mapiritsi ati ochepetsa shuga omwe amayatsidwa?
Ndi mankhwalawa ati omwe ndimayenera kumwa?
Momwe mungalandiridwire ngati mwapezeka kuti muli ndi Diabetesic Nephropathy ndipo pali mapuloteni ambiri mumkodzo wanu?
Kodi wodwala yemwe ali ndi matenda ashuga nephropathy ndi kuthamanga kwa magazi ayenera kuchita chiyani?
Kodi ndi njira zina ziti zothandiza zomwe mungagwiritse ntchito pochiza matenda a impso?
Momwe mungachepetse magazi kulenga mu shuga?
Kodi ndikotheka kubwezeretsa kuchuluka kwa impso?
Ndi zakudya ziti zomwe ziyenera kutsatiridwa chifukwa cha matenda ashuga a nephropathy?
Kodi anthu odwala matenda ashuga amakhala nthawi yayitali bwanji?
Kupatsirana kwa impso: zabwino ndi zoyipa
Kodi chinthu chothira impso chimatha kukhalako mpaka liti?

Chikhulupiriro: Zofunikira Pang'ono

Impso zimakhudzana ndi kusefa zinyalala m'magazi ndikuziwachotsa ndi mkodzo. Amatulutsanso mahomoni a erythropoietin, omwe amachititsa kuti maselo ofiira a magazi - maselo ofiira a m'magazi.

Magazi nthawi ndi nthawi amadutsa impso, zomwe zimachotsa zinyalala kuchokera pamenepo. Mwazi wotsukidwa umazungulira mowonjezereka. Zoizoni ndi zinthu za metabolic, komanso mchere wambiri, wosungunuka m'madzi ambiri, amapanga mkodzo. Imayenda ndikuyenda mu chikhodzodzo, pomwe imasungidwa kwakanthawi.

Thupi limayang'anira bwino kuchuluka kwa madzi ndi mchere mu mkodzo, komanso kuchuluka kwa zomwe zimatsala m'magazi kuti magazi ake azithamanga komanso azikhala ndi ma electrolyte.

Impso iliyonse imakhala ndi zosefera pafupifupi miliyoni miliyoni zomwe zimatchedwa nephrons. Glomerulus yamitsempha yamagazi (ma capillaries) ndi imodzi mwazinthu za nephron. Kuchuluka kwa kusefera kwa glomerular ndichizindikiro chofunikira chomwe chimazindikira momwe impso zilili. Amawerengeredwa potengera zomwe zili mu creatinine m'magazi.

Designinine ndi imodzi mwazinthu zomwe zimawonongeka. Pakulephera kwa impso, amadziunjikira m'magazi pamodzi ndi zinthu zina zonyansa, ndipo wodwalayo amamva zoledzeretsa. Mavuto a impso amatha chifukwa cha matenda ashuga, matenda, kapena zifukwa zina. Mulingo uliwonse mwa izi, kuchuluka kwa kusefedwa kwa glomerular kumayesedwa kuti muwone kuwopsa kwa matendawa.

Kodi matenda ashuga amakhudza bwanji impso?

Kuchuluka kwa shuga m'mwazi kumawononga zinthu zomwe zimasefa impso. Popita nthawi, zimazimiririka ndipo zimasinthidwa ndi minyewa, yomwe singayeretse magazi a zinyalala. Zosefera zochepa zomwe zatsalira, ndipamenenso impso zimagwira. Mapeto ake, amasiya kuthana ndi kuchotsedwa kwa zinyalala ndi kuledzera kwa thupi kumachitika. Pakadali pano, wodwalayo amafunika chithandizo chamankhwala kuti asafe - dialysis kapena kupatsirana kwa impso.

Asanafe kwathunthu, zosefera zimakhala "zotayidwa", zimayamba "kutaya". Amapereka mapuloteni mumkodzo, womwe suyenera kukhalapo. Mwakutero, albumin yomwe ili ndi ndende zambiri.

Microalbuminuria ndiye chimbudzi cha albumin mkodzo wambiri 30-300 mg patsiku. Proteinuria - Albumin imapezeka mumkodzo mumtunda wopitilira 300 mg patsiku. Microalbuminuria imatha kuyima ngati chithandizo chitha bwino. Proteinuria ndivuto lalikulu kwambiri. Imawerengedwa ngati yosasinthika komanso zizindikilo kuti wodwalayo adayamba njira ya kulephera kwa impso.

Choyipa chachikulu chomwe chikuwongolera matenda a shuga, chimakhala chowopsa kwambiri chakulephera kwa impso ndipo chimatha kuchitika mwachangu. Mwayi wokumana ndi kulephera kwathunthu kwa impso mu odwala matenda ashuga kwenikweni siwokwera kwambiri. Chifukwa ambiri a iwo amafa ndi vuto la mtima kapena matenda opha ziwalo asanafunike chithandizo chakubwezeretsa kwina. Komabe, chiwopsezocho chikuwonjezereka kwa odwala omwe shuga imaphatikizidwa ndi kusuta kapena matenda operewera kwamkodzo.

Kuphatikiza pa matenda a shuga a nephropathy, pakhoza kukhalanso aimpso a stenosis. Uku ndikutulutsa kwa mapangidwe a atherosulinotic ammodzi kapena onse a mitsempha yomwe imadyetsa impso. Nthawi yomweyo, kuthamanga kwa magazi kumakwera kwambiri. Mankhwala othandizira matenda oopsa samathandiza, ngakhale mutamwa mitundu ingapo yamapiritsi amphamvu nthawi imodzi.

Mitsempha ya minyewa ya m'mimba nthawi zambiri imafuna opaleshoni. Matenda a shuga amawonjezera chiwopsezo cha matendawa, chifukwa amachititsa kuti matendawa azidwala, kuphatikizapo ziwiya zomwe zimadyetsa impso.

Mtundu wachiwiri wa impso

Nthawi zambiri, mtundu wachiwiri wa matenda ashuga umabisala kwa zaka zingapo mpaka utapezeka ndi kuthandizidwa. Zaka zonsezi, zovuta zimayamba kuwononga thupi la wodwalayo. Samapitilira impso.

Malinga ndi malo omwe amalankhula Chingerezi, pa nthawi yomwe amadziwika kuti ali ndi vutoli, 12% ya odwala omwe ali ndi matenda a shuga a 2 ali kale ndi microalbuminuria, ndipo 2% ali ndi proteinuria. Mwa odwala olankhula Chirasha, izi ndizowonjezera nthawi zingapo. Chifukwa chakuti azungu amakhala ndi chizolowezi chotsatira mayeso azachipatala. Chifukwa cha izi, amatha kupeza matenda osachiritsika.

Matenda a 2 a shuga amatha kuphatikizidwa ndi zinthu zina zomwe zingayambitse matenda opatsirana a impso:

kuthamanga kwa magazi
cholesterol yayikulu magazi,
panali milandu ya matenda a impso abale ake,
pakhala zochitika za kugunda kwamtima koyambirira kapena kupweteka m'banjamo,
kusuta
kunenepa
ukalamba.

Kodi pali kusiyana kotani pakati pamavuto a impso mu mtundu 2 ndi mtundu woyamba wa shuga?

Mtundu woyamba wa matenda ashuga, zovuta za impso nthawi zambiri zimayamba zaka 5 mpaka 5 matenda atayamba. Mu mtundu 2 wa matenda ashuga, zovuta izi zimadziwika nthawi yomweyo mukazindikira. Chifukwa matenda amtundu wa 2 matenda a shuga amakhala nthawi yayitali kwa zaka zambiri wodwala asanakumane ndi zomwe akuganiza komanso akuyerekeza kuti awone ngati ali ndi shuga. Mpaka pomwe matenda atapangidwa ndikuthandizidwa, mankhwalawa amawononga impso ndi thupi lonse.

Matenda a 2 a shuga ndi matenda oopsa kuposa matenda ashuga 1. Komabe, zimachitika kangapo konse. Odwala a shuga a Type 2 ndi gulu lalikulu kwambiri la odwala omwe amaperekedwa ndi malo opangira dialysis ndi akatswiri othandizira impso. Mliri wa matenda ashuga a 2 ukuwonjezereka padziko lonse lapansi komanso m'maiko olankhula Chirasha. Izi zimawonjezera kuntchito ya akatswiri omwe amachiza matenda a impso.

Mtundu woyamba wa matenda ashuga, odwala omwe ali ndi matendawa kuubwana komanso unyamata nthawi zambiri amakhala ndi nephropathy. Kwa anthu omwe ali ndi matenda ashuga a mtundu woyamba akamakula, chiopsezo cha mavuto a impso sichikulirapo.

Zizindikiro ndi Kudziwitsa

M'miyezi yoyambirira komanso zaka, matenda ashuga nephropathy ndi microalbuminuria samayambitsa chilichonse. Odwala amazindikira mavuto pokhapokha njira yothetsera matenda a impso ili pafupi. Poyamba, zizindikirazo sizowoneka bwino, zikufanana ndi kutopa kapena kuzizira.

Zizindikiro zoyambirira za matenda a shuga:

kufooka, kutopa,
kuganiza kopusa
kutupa kwa miyendo
kuthamanga kwa magazi
kukodza pafupipafupi,
kufunikira kofikira kulowa kuchimbudzi usiku,
kuchepetsa mlingo wa insulin ndi mapiritsi ochepetsa shuga,
kufooka, kuchepa kwa magazi ndi kuchepa magazi,
pakhungu, zotupa.

Odwala ochepa amatha kukayikira kuti zizindikirozi zimayamba chifukwa cha kuwonongeka kwa impso.

Chimachitika ndi chiyani ngati impso zileka kugwira ntchito ndi matenda ashuga?

Anthu odwala matenda ashuga omwe amakhala ndi ulesi kuti azimwa magazi ndi mkodzo pafupipafupi amatha kukhala osadziwa mpaka gawo lotsiriza, kulephera kwa aimpso kulephera. Komabe, pamapeto pake, zizindikiro zakuledzera zomwe zimayambitsidwa ndi matenda a impso zimadziwika:

kusadya bwino, kuchepa thupi,
Khungu limawuma ndipo limayenderera mosalekeza,
kutupa kwambiri, kukokana kwa minofu,
kutupa ndi matumba pansi pa maso,
kusanza ndi kusanza
chikumbumtima.

Chifukwa chiyani shuga amachepetsedwa panthawi ya matenda ashuga nephropathy?

Inde, ndi matenda ashuga a nephropathy omaliza omaliza aimpso, magazi a shuga amatha. Mwanjira ina, kufunika kwa insulin kumachepa. Ndikofunikira kuchepetsa mlingo wake kuti pasakhale hypoglycemia.

Chifukwa chiyani izi zikuchitika? Insulin imawonongedwa m'chiwindi ndi impso. Impso zikawonongeka kwambiri, zimalephera kupanga insulin. Hormon iyi imakhala m'magazi motalikirapo ndipo imathandizira ma cell kuti ayamwa glucose.

Kulephera kwa impso ndi tsoka kwa ashuga. Kuchepetsa mlingo wa insulin ndikungotonthoza pang'ono.

Ndi mayeso ati omwe amafunikira kudutsidwa? Momwe mungawerengere zotsatirazo?

Kuti mudziwe bwino ndikusankha chithandizocho, muyenera kuchita mayeso:

protein (albumin) mumkodzo,
kuchuluka kwa albumin ndi creatinine mu mkodzo,
magazi creatinine.

Creatinine ndi chimodzi mwazinthu zomwe zasokoneza mapuloteni omwe impso zimagwira. Kudziwa mulingo wa creatinine m'magazi, komanso zaka ndi jini la munthu, mutha kuwerengetsa kuchuluka kwa kusefedwa kwa glomerular. Ichi ndi chisonyezo chofunikira, pamaziko omwe gawo la matenda ashuga nephropathy limatsimikiziridwa ndi kulandira mankhwala. Dokotala amathanso kukulemberani mayeso ena.

Pansipa 3.5 (azimayi)

Pokonzekera magazi ndi mkodzo mayeso omwe atchulidwa pamwambapa, muyenera kupewa kuchita masewera olimbitsa thupi komanso kumwa kwambiri kwa masiku atatu. Kupanda kutero, zotsatira zake zimakhala zoipa kuposa momwe zilili.

Kodi kuchuluka kwa kusefukira kwa impso kumatanthauza chiyani?

Pa mawonekedwe a zotsatira za kuyezetsa magazi a creatinine, mulingo woyenera uyenera kuganiziridwa mutaganizira zausinkhu wanu komanso zaka, ndipo kuchuluka kwa impso kuyenera kuwerengeka. Kukwera kwake kumakhala kwabwino.

Kodi microalbuminuria ndi chiyani?

Microalbuminuria ndi mawonekedwe a puloteni (albumin) mumkodzo m'miyeso yaying'ono. Ndi chizindikiro choyambirira cha kuwonongeka kwa impso. Amawerengedwa ngati chiopsezo cha matenda a mtima ndi sitiroko. Microalbuminuria imawonedwa ngati yosinthika. Kumwa mankhwala, kuyendetsa bwino shuga komanso kuthamanga kwa magazi kumatha kuchepetsa kuchuluka kwa albumin mu mkodzo kuti ikhale yofanana kwa zaka zingapo.

Kodi proteinuria ndi chiyani?

Proteinuria ndi kukhalapo kwa mapuloteni mumkodzo wambiri. Chizindikiro choyipa kwambiri. Zimatanthawuza kuti vuto la mtima, kugunda, kapena kufooka kwa impso kungokhala pakona. Pamafunika chithandizo champhamvu. Komanso, zitha kuchitika kuti nthawi yothandizidwa moyenera idasowa kale.

Ngati mukupeza microalbuminuria kapena proteinuria, muyenera kufunsa dokotala yemwe amathandiza impso. Katswiriyu amatchedwa nephrologist, kuti asasokonezedwe ndi katswiri wamitsempha. Onetsetsani kuti chifukwa cha mapuloteni mumkodzo si matenda opatsirana kapena kuvulala kwa impso.

Zitha kuzindikirika kuti chifukwa choyambitsa kusawerengeka kolakwika chidadzaza kwambiri. Potere, kusanthula mobwerezabwereza patatha masiku angapo kumapereka tanthauzo labwino.

Kodi cholesterol yamagazi imakhudza bwanji zovuta za impso?

Amakhulupirira kuti ma cholesterol okwera amathandizira kukulira kwa malo a atherosulinotic. Atherosulinosis imodzimodzi imakhudza mitsempha yambiri, kuphatikizapo yomwe magazi amayenda impso. Zikumveka kuti odwala matenda ashuga ayenera kutenga ma statins a cholesterol, ndipo achedwetsa kukula kwa impso.

Komabe, malingaliro a chitetezo chamatumbo a impso ndiwotsutsana. Ndipo zovuta zoyipa za mankhwalawa ndizodziwika bwino. Kutenga ma statins ndikumvetsetsa kuti musakhale ndi vuto lachiwiri la mtima ngati muli nalo kale. Zachidziwikire, kupewa wodalirika ku matenda amtima wapamtima kuyenera kuphatikizapo zinthu zina zambiri, kuwonjezera pa kumwa mapiritsi a cholesterol. Sikoyenera kumwa ma statins ngati simunakhale ndi vuto la mtima.

Kusintha ku chakudya chamafuta ochepa nthawi zambiri kumapangitsa kuchuluka kwa cholesterol “chabwino” komanso “yoyipa” m'magazi. Osati kuchuluka kwa glucose kokha komwe kumapangidwira, komanso kuthamanga kwa magazi. Chifukwa cha izi, chitukuko cha matenda a shuga ndi nephropathy. Kuti zotsatira za mayeso a magazi a shuga ndi cholesterol zikondweretsere inu ndi anzanu, muyenera kutsata zakudya zamafuta ochepa. Muyenera kusiyiratu zinthu zoletsedwa.

Kodi ndi anthu angati omwe anthu odwala matenda ashuga amafunika kuchita nthawi zambiri kuti awonetsetse impso?

Kupanga kwa impso kumapangitsa kuti muwoneke ngati pali mchenga ndi miyala mu ziwalo izi. Komanso, mothandizidwa ndi mayeso, chotupa cha impso (cysts) chitha kupezeka.

Chithandizo cha matenda a impso a shuga: kubwereza

Komabe, kuwunika kwa ultrasound sikungathandize pa vuto la matenda ashuga komanso kuwunika momwe mankhwalawo alili. Ndikofunikira kwambiri kumatenga nthawi zonse kuyesa magazi ndi mkodzo, omwe akufotokozedwa mwatsatanetsatane.

Zoyenera kuchita ngati impso ikuvulala ndi matenda ashuga?

Choyamba, muyenera kuonetsetsa kuti zimapweteka impso. Mwina mulibe vuto la impso, koma osteochondrosis, rheumatism, kapamba, kapena matenda ena omwe amayambanso ndi vuto lofananalo. Muyenera kuwona dokotala kuti mudziwe chomwe chimayambitsa kupwetekaku. Sizingatheke kuzichita nokha.

Kudzichitira nokha mankhwala kungavulaze kwambiri. Mavuto a shuga a impso nthawi zambiri sayambitsa kupweteka, koma zizindikiro za kuledzera zomwe zalembedwa pamwambapa. Miyala ya impso, colic re impso ndi kutupa nthawi zambiri sizigwirizana mwachindunji ndi kusokonekera kwa glucose metabolism.

Mankhwalawa a matenda a shuga a nephropathy amayesetsa kupewa kapena kuchedwetsa kuyambika kwa kuleka kwa gawo la impso, komwe kukufunika dialysis kapena kufalikira kwa ziwalo. Amakhala ndikukhala ndi shuga komanso magazi.

Ndikofunikira kuyang'anira kuchuluka kwa creatinine m'magazi ndi mapuloteni (albin) mumkodzo. Komanso, mankhwala a boma amalimbikitsa kuwunikira cholesterol m'magazi ndikuyesera kuchepetsa. Koma akatswiri ambiri amakayikira kuti ndi yothandiza kwambiri. Njira zochizira matenda oteteza impso zimachepetsa chiopsezo cha kugunda kwa mtima ndi sitiroko.

Kodi muyenera kumwa chiyani kuti mupulumutse impso zanu?

Inde, ndikofunikira kumwa mapiritsi kuti muchepetse zovuta za impso. Anthu odwala matenda ashuga nthawi zambiri amapatsidwa mankhwala angapo:

Mapiritsi opanikizika makamaka ndi ACE inhibitors ndi angiotensin-II receptor blockers.
Aspirin ndi ma antiplatelet othandizira ena.
Matenda a cholesterol.
Zithandizo za kuchepa kwa magazi m'thupi zomwe kulephera kwa impso zimatha kuyambitsa.

Mankhwalawa onsewa akufotokozedwa mwatsatanetsatane pansipa. Komabe, kupatsa thanzi kumatenga gawo lalikulu. Kumwa mankhwala kumakhala kovuta nthawi zambiri kuposa zakudya zomwe wodwala matenda ashuga amawonera. Chinthu chachikulu chomwe muyenera kuchita ndikusankha kusintha kwa zakudya zamafuta ochepa. Werengani zambiri pansipa.

Osadalira wowerengeka azitsamba ngati mukufuna kudziteteza ku matenda ashuga a nephropathy. Ma tiyi a chomera, ma infusions ndi ma decoctions ndizothandiza monga gwero lamadzi popewa komanso kuchizira kwamadzi. Sakhala ndi vuto loteteza impso.

Kodi kuchitira impso matenda ashuga?

Choyamba, amagwiritsa ntchito jakisoni wazakudya ndi insulin kuti shuga azikhala pafupi ndi nthawi yayitali. Kusunga hemoglobin ya glycated HbA1C pansipa 7% kumachepetsa chiopsezo cha proteinuria ndi kulephera kwa aimpso ndi 30-40%.

Kugwiritsa ntchito njira za Dr. Bernstein kumakuthandizani kuti muchepetse shuga mwachizolowezi, monga momwe mumakhalira athanzi, komanso hemoglobin yotsika 5.5%. Zizindikiro izi zitha kuchepetsa chiwopsezo cha zovuta kwambiri za impso kufika pa zero, ngakhale izi sizinatsimikizidwe ndi maphunziro ovomerezeka.

Pali umboni kuti ndi shuga wokhazikika m'magazi, impso zomwe zimakhudzidwa ndi matenda a shuga zimachiritsidwa ndikuchira. Komabe, uku ndikutheka pang'ono. Pa magawo 4 ndi 5 a shuga a nephropathy, nthawi zambiri zimakhala zosatheka.

Mapuloteni ndi mafuta amanyama ndizovomerezeka. Kuyenera kugwiritsa ntchito zakudya zamafuta ochepa kumakambidwa pansipa. Ndi mfundo zabwinobwino za kuthamanga kwa magazi, kuthira mchere kumayenera kuchepetsedwa ndi 5-6 g patsiku, ndipo pamlingo wokwera, mpaka 3 g patsiku. M'malo mwake, izi sizochepa kwambiri.

Siyani kusuta.
Werengani nkhani ya “Mowa wa Matenda a shuga” ndipo musamamwe zoposa zomwe zasonyezedwa pamenepo.
Ngati simumamwa mowa, ndiye kuti musayambe.
Yesetsani kuchepetsa thupi ndipo musamalemere kwambiri.
Lankhulani ndi dotolo wanu za zomwe mungachite zolimbitsa thupi, komanso zolimbitsa thupi.
Khalani ndi polojekiti ya kuthamanga kwa magazi kunyumba ndipo mumayezera magazi anu pafupipafupi.

Palibe mapiritsi amatsenga, ma tinctures, ndipo makamaka wowerengeka azitsamba omwe amatha kubwezeretsa impso mwachangu komanso mosavuta.

Tiyi wokhala ndi mkaka suthandizira, koma m'malo mwake umavulaza, chifukwa mkaka umadzutsa shuga wamagazi. Karkade ndi chakumwa chotchuka cha tiyi chomwe chimathandizanso kuposa kumwa madzi oyera. Bola osayesa konse wowerengeka azitsamba, ndikuyembekeza kuchiritsa impso. Kudzipatsa mankhwala a ziwalo zosefera ndi kowopsa kwambiri.

Ndi mankhwala ati omwe amakupatsani?

Odwala omwe apeza matenda a diabetes a nephropathy nthawi imodzi nthawi zina amagwiritsa ntchito mankhwala angapo nthawi imodzi:

mapiritsi a matenda oopsa - mitundu 2-4,
cholesterol statins
antiplatelet agents - ma aspirin ndi dipyridamole,
Mankhwala omwe amamanga phosphorous m'thupi,
mwina yankho lina la kuchepa magazi m'thupi.

Kumwa mapiritsi ambiri ndichinthu chophweka chomwe mungachite kuti muchepetse kapena kuchedwetsa kulephera kwa impso. Onani dongosolo la 2 la 2 la matenda a shuga kapena mtundu wa matenda a shuga. Tsatirani mosamala malangizowo. Kusintha kwa moyo wathanzi kumafuna kuyeserera kwambiri. Komabe, ziyenera kukhazikitsidwa. Sizingathandize kuthana ndi mankhwala ngati mukufuna kuteteza impso zanu ndikukhala ndi moyo wautali.

Ndi mapiritsi ati ochepetsa shuga a shuga omwe ali ndi vuto la matenda a shuga?

Tsoka ilo, mankhwala omwe amadziwika kwambiri metformin (Siofor, Glucofage) ayenera kuyikidwa pambali kale pa matenda a matenda ashuga. Sizingatengedwe ngati wodwalayo ali ndi kusefukira kwama 60 ml / min, ngakhale pang'ono. Izi zikufanana ndi magazi a creatinine:

kwa amuna - pamwambapa 133 μmol / l
kwa akazi - pamwambapa 124 micromol / l

Kumbukirani kuti kukwera kwa creatinine, ndikoipa kwambiri komwe impso zimagwira ndikuchepetsa kuchuluka kwa kusefera kwake. Kale kumayambiriro kwa zovuta za impso za matenda ashuga, metformin iyenera kusiyidwa ku njira yochizira matenda kuti mupewe ngozi lactic acidosis.

Kwa boma, odwala matenda ashuga retinopathy amaloledwa kumwa mankhwala omwe amachititsa kuti kapamba apange insulin yambiri. Mwachitsanzo, a Diabeteson MV, Amaryl, Maninil ndi iwo omwe ali ndi fanizo. Komabe, mankhwalawa ali pamndandanda wamapiritsi owopsa a shuga 2. Amachepetsa kapamba ndipo samachepetsa kufa kwa odwala, komanso amachulukitsa. Ndi bwino osazigwiritsa ntchito. Anthu odwala matenda ashuga omwe amakhala ndi vuto la impso amayenera kulowetsanso mapiritsi ochepetsa shuga ndi jakisoni wa insulin.

Mankhwala ena a shuga amatha kumwa, koma mosamala, monga momwe adavomerezera ndi dokotala.Monga lamulo, sangapereke chiwongola dzanja mokwanira komanso samapereka mwayi wokana jakisoni wa insulin.

Mapiritsi opsinjika omwe ndiyenera kumwa?

Mapiritsi oopsa ndiofunika kwambiri, omwe ali m'magulu a ACE inhibitor kapena angiotensin-II receptor blockers. Samangokhala kutsitsa magazi, komanso amatetezanso impso. Kumwa mankhwalawa kumathandizira kuchepa kwa mathero a impso.

Yesani kusunga kuthamanga kwa magazi anu pansipa 130/80 mm Hg. Art. Pa izi, nthawi zambiri mumayenera kugwiritsa ntchito mitundu ingapo ya mankhwala. Yambani ndi ACE inhibitors kapena angiotensin-II receptor blockers. Amathandizidwanso ndi mankhwala ochokera m'magulu ena - beta-blockers, diuretics (diuretics), calcium block blockers. Funsani adotolo kuti akupatseni mapiritsi osakanikirana omwe amakhala ndi zinthu ziwiri zomwe zimagwira munthawi imodzi.

ACE inhibitors kapena angiotensin-II receptor blockers kumayambiriro kwa mankhwalawa amatha kuwonjezera milingo ya creatinine. Lankhulani ndi dotolo wanu za momwe izi ziliri zowopsa. Mwambiri, simudzayenera kusiya mankhwalawo. Komanso, mankhwalawa amatha kuwonjezera kuchuluka kwa potaziyamu m'magazi, makamaka ngati mumawaphatikiza ndi ena kapena mankhwala a diuretic.

A potaziyamu wambiri amatha kupangitsa kuti mtima wamangidwa. Kuti mupewe izi, simuyenera kuphatikiza ACE inhibitors ndi angiotensin-II receptor blockers, komanso mankhwala omwe amatchedwa potaziyamu-yosungila diuretics. Kuyesedwa kwa magazi kwa creatinine ndi potaziyamu, komanso mkodzo wa protein (albin) uyenera kutengedwa kamodzi pamwezi. Osakhala aulesi kuchita izi.

Musagwiritse ntchito zomwe muli nazo ma cholesterol, aspirin ndi othandizira ena am'magazi, mankhwala osokoneza bongo komanso othandizira magazi. Mapiritsi onsewa amatha kuyambitsa mavuto. Lankhulani ndi dokotala wanu za kufunika kokutenga. Komanso, adotolo ayenera kuthana ndi kusankha kwa mankhwalawa kwa matenda oopsa.

Ntchito ya wodwala si kukhala waulesi kuti azichita mayeso pafupipafupi ndipo ngati kuli koyenera, funsani dokotala kuti akonze dongosolo la chithandizo. Chida chanu chachikulu pakupanga shuga wabwino wamagazi ndi insulin, osati mapiritsi a shuga.

Kodi wodwala yemwe ali ndi matenda ashuga nephropathy ndi kuthamanga kwa magazi ayenera kuchita chiyani?

Kusinthana ndi zakudya zama carb ochepa sikungokhala shuga wamagazi, komanso cholesterol ndi kuthamanga kwa magazi. Nawonso, kuphatikiza shuga ndi kuthamanga kwa magazi kumalepheretsa kukula kwa matenda a shuga.

Komabe, ngati kulephera kwa impso kwakula bwino, ndikachedwa kwambiri kusinthana ndi zakudya zamafuta ochepa. Zimangotenga mapiritsi okhawo omwe adokotala adawauza. Mwayi weniweni wa chipulumutso ungaperekedwe ndi kumuyika impso. Izi zikufotokozedwa mwatsatanetsatane pansipa.

Mwa mankhwala onse a matenda oopsa, ACE inhibitors ndi angiotensin-II receptor blockers ndiye oteteza impso kwambiri. Muyenera kumwa kamodzi mwa mankhwalawa, sangathe kuphatikizidwa. Komabe, ikhoza kuphatikizidwa ndi kugwiritsa ntchito beta-blockers, mankhwala okodzetsa kapena oletsa njira za calcium. Nthawi zambiri, mapiritsi osakanikirana osavuta amayikidwa, omwe amakhala ndi zinthu 2-3 zogwira pansi pa chipolopolo chimodzi.

Kodi ndi njira zina ziti zothandiza zomwe mungagwiritsire ntchito matenda a impso?

Kuwerengera mankhwala azitsamba ndi mankhwala ena aanthu ndizovuta kwambiri zomwe mungachite. Mankhwala achikhalidwe samathandiza konse kuchokera ku matenda ashuga a nephropathy. Pewani kutali ndi charlatans omwe amakutsimikizirani kuti mudzachita zina.

Mafano azithandizo wowerengeka amwalira mwachangu chifukwa cha zovuta za matenda ashuga. Ena mwa iwo amafa mosavuta chifukwa cha vuto la mtima kapena sitiroko. Ena asanafe amakumana ndi mavuto ndi impso, miyendo kapena kuwola.

Pakati pa wowerengeka azitsamba a matenda ashuga nephropathy ndi lingonberries, sitiroberi, chamomile, kiranberi, zipatso zamizere, m'chiuno, nthano, masamba a birch ndi masamba owuma nyemba. Kuchokera pazomwe zalembedwa azitsamba, tiyi ndi decoctions zakonzedwa. Tikubwerezanso kuti alibe zoteteza ku impso.

Khalani ndi chidwi ndi zakudya zamagulu owonjezera magazi. Izi ndiye, choyambirira, magnesium wokhala ndi vitamini B6, komanso taurine, coenzyme Q10 ndi arginine. Amabweretsa zabwino. Amatha kumwedwa kuwonjezera pa mankhwala, koma osati m'malo mwake. Mu magawo akulu a matenda ashuga nephropathy, izi zowonjezera zitha kuperekedwa. Lankhulani ndi dokotala wanu za izi.

Momwe mungachepetse magazi kulenga mu shuga?

Creatinine ndi mtundu wa zinyalala zomwe impso zimachotsa m'thupi. Kupezeka pafupi ndi magazi abwinobwino, impso zimagwira ntchito bwino. Impso zodwala sizitha kuthana ndi zotuluka za creatinine, chifukwa chake zimadziunjikira m'magazi. Kutengera ndi zotsatira za kusanthula kwa creatinine, kuchuluka kwa kusefedwa kwa glomerular kumawerengeredwa.

Kuteteza impso, anthu odwala matenda ashuga nthawi zambiri amapatsidwa mapiritsi otchedwa ACE inhibitors kapena angiotensin-II receptor blockers. Nthawi yoyamba mukayamba kumwa mankhwalawa, kuchuluka kwa magazi anu amatha kuchuluka. Komabe, pambuyo pake zitha kuchepa. Ngati mulingo wanu wa creatinine wakwera, lankhulanani ndi dokotala za momwe izi ziliri zowopsa.

Kodi ndikotheka kubwezeretsa kuchuluka kwa impso?

Amakhulupilira kuti kuchuluka kwa kusefedwa kwa glomerular sikungakulire pambuyo poti kuchepa kwambiri. Komabe, zikuwoneka kuti ntchito ya impso mu odwala matenda ashuga imatha kubwezeretsedwanso. Kuti muchite izi, muyenera kukhala ndi shuga wokhazikika monga magazi mwa anthu athanzi.

Kuti mukwaniritse izi, mutha kugwiritsa ntchito njira zotsatirira za mtundu 2 za shuga kapena mtundu wa 1 wodwala matenda a shuga. Komabe, izi ndizovuta, makamaka ngati zovuta za impso za matenda ashuga zayamba kale. Wodwala amafunika kukhala ndi chilimbikitso chambiri komanso kuwongolera kutsatira tsiku ndi tsiku.

Chonde dziwani kuti ngati chitukuko cha matenda ashuga nephropathy chatha osabweranso, ndiye kuti kwachedwa kwambiri kusinthira ku chakudya chamoto chochepa. Zomwe sizibwerera ndizomwe zimasinthana ndi kusefukira kwa 40-45 ml / min.

Zambiri kuchokera kwa Dr. Bernstein

Zonse zomwe zatchulidwa pansipa ndizomwe amachita a Dr. Bernstein, osathandizidwa ndi kafukufuku wadzaoneni. Mwa anthu omwe ali ndi impso zathanzi, kuchuluka kwa kusefedwa kwa madzi ndi 60-120 ml / min. Mafuta ochulukirapo a m'magazi amawononga pang'onopang'ono zosefera. Chifukwa cha izi, kuchuluka kwa kusefedwa kwa glomerular kumachepa. Ikatsika mpaka 15 ml / min ndipo pansipa, wodwalayo amafunikira dialysis kapena kupatsirana kwa impso kuti asafe.

Dr. Bernstein amakhulupirira kuti zakudya zamafuta ochepa zitha kutumikiridwa ngati kuchuluka kwa kusefedwa kwa glomerular kukwera kuposa 40 ml / min. Cholinga ndikuchepetsa shuga kukhala yabwinobwino ndikuwasunga bwino 3.9-5.5 mmol / L, monga mwa anthu athanzi.

Kuti mukwaniritse izi, simuyenera kutsatira zakudya zokha, koma gwiritsani ntchito njira zonse zothandizira odwala matenda ashuga amtundu wa 2 kapena pulogalamu ya matenda a shuga 1. Zochita zosiyanasiyana zimaphatikizapo zakudya zama carb otsika, komanso jakisoni wa insulin yotsika, kumwa mapiritsi ndi kuchita zolimbitsa thupi.

Odwala omwe akwanitsa kuchuluka kwa shuga m'magazi, impso zimayamba kuchira, ndipo matenda a shuga amatha kuzimiririka. Komabe, izi ndizotheka pokhapokha ngati zovuta zomwe zili m'mavuto sizinapite patali kwambiri. Mlingo wosefera wama glomerular 40 ml / min ndi mtengo wapang'onopang'ono. Ngati zimatheka, wodwalayo amangotsatira zakudya zoletsedwa ndi mapuloteni. Chifukwa chakudya chochepa kwambiri cha carb chimathandizira kukulitsa kulephera kwa impso.

Tikubwerezanso kuti mugwiritse ntchito izi pangozi yanu.Mwina zakudya zamafuta ochepa zimapweteketsa impsozo komanso kuzitsuka kwambiri kosachepera 40 ml / min. Kafukufuku wokhazikika wa chitetezo chake kwa odwala matenda ashuga sanachitike.

Musadzichepetse pakudya, koma gwiritsani ntchito njira zosiyanasiyana kuti magazi anu azikhala athanzi komanso abwinobwino. Makamaka, pezani momwe mungapangire shuga m'mimba pamimba yopanda kanthu. Kuyesa kwa magazi ndi mkodzo kuti ayang'anire ntchito ya impso sikuyenera kumwedwa pambuyo pakuchita zolimbitsa thupi kwambiri kapena kumwa. Yembekezerani masiku 2-3, apo ayi zotsatira zake zimakhala zoipa kuposa momwe zilili.

Kodi anthu odwala matenda ashuga amakhala nthawi yayitali bwanji?

Onani zinthu ziwiri izi:

Kuchuluka kwa kusefukira kwa impso sikunachepetsedwebe kwambiri.
Impso sizikugwiranso ntchito, wodwalayo amathandizidwa ndi dialysis.

Poyambirira, mutha kuyesa kukhala ndi shuga m'magazi anu monga momwe ziliri ndi anthu athanzi. Kuti mumve zambiri, onani njira 2 yothetsera matenda a shuga kapena mtundu wa njira 1 yolerera matenda ashuga. Kugwiritsa ntchito bwino mosamala malangizowa kungathandize kuti matenda ashuga a nephropathy azikhala ndi zovuta zina, komanso kubwezeretsa magwiridwe oyenera a impso.

Kutalika kwa moyo wa munthu wodwala matenda ashuga kumatha kukhala chimodzimodzi kwa anthu athanzi. Zimadalira kwambiri chidwi cha wodwalayo. Kutsatira malingaliro a Dr. Bernstein pakuchiritsa tsiku ndi tsiku kumafunikira kulangidwa kwakukulu. Komabe, palibe chosatheka mu izi. Njira zowongolera matenda a shuga zimatenga mphindi 10-15 patsiku.

Kutalika kwa moyo wa anthu odwala matenda ashuga omwe amathandizidwa ndi dialysis zimatengera ngati ali ndi chiyembekezo chodikirira kubereketsa impso. Kupezeka kwa odwala omwe akupita dialysis kumakhala kowawa kwambiri. Chifukwa amakhala ndi thanzi komanso matenda ofooka. Komanso, kukhala ndi ndandanda yotsuka yoyeretsa kumawalepheretsa kukhala ndi moyo wabwinobwino.

Olemba magwero ku America akuti 20% ya odwala omwe akudwala dialysis pachaka amakana njira zina. Chifukwa chake, amadzipha chifukwa chazovuta kwambiri pamoyo wawo. Anthu omwe ali ndi vuto loti-a impso amatha kutsatira ngati ali ndi chiyembekezo chodzaberekera impso. Kapenanso ngati akufuna kumaliza bizinesi ina.

Kupatsirana kwa impso: zabwino ndi zoyipa

Kuika impso kumawathandiza odwala kukhala ndi moyo wabwino komanso wautali kuposa kuyimba. Chachikulu ndichakuti kulumikizidwa ndi malo ndi nthawi ya dialysis njira zimatha. Chifukwa cha izi, odwala ali ndi mwayi wogwira ntchito komanso kuyenda. Pambuyo pakuwongolera bwino kwa impso, zoletsa zopatsa thanzi zimatha kubwezeretsedwanso, ngakhale chakudya chikuyenera kukhalabe chathanzi.

Zoyipa zosinthika poyerekeza ndi dialysis ndizovuta kuchitidwa, komanso kufunika kotenga mankhwala a immunosuppressant omwe ali ndi zotsatira zoyipa. Sizingatheke kuneneratu pasadakhale kuti zaka zochulukirazi zidzakhala zaka zingati. Ngakhale pali zoperewerazi, odwala ambiri amasankha opaleshoni m'malo modukitsa khungu ngati ali ndi mwayi wolandila impso.

Kuika impso nthawi zambiri kumakhala kwabwino kuposa dialysis.

Nthawi yocheperako yomwe wodwala amakhala pa dialysis musanaikidwe, ndiye kuti vutoli limakula. Poyenera, opareshoni iyenera kuchitidwa isanayesedwe pakufunika. Kuika impso kumachitika kwa odwala omwe alibe khansa komanso matenda opatsirana. Opaleshoni imatha pafupifupi maola anayi. Munthawi imeneyi, ziwalo za wodwalayo sizichotsedwa. Impso yaopereka imayikidwa pamimba yotsika, monga akuwonetsera.

Kodi ndi ziti zomwe zikuwonetsa nthawi ya postoperative?

Pambuyo pa opareshoni, mayeso okhazikika ndi kukambirana ndi akatswiri amafunikira, makamaka chaka chatha. M'miyezi yoyamba, kuyezetsa magazi kumachitika kangapo pa sabata. Kupitilira apo, kuchuluka kwawo kumacheperachepera, koma kupita pafupipafupi ku chipatala kungakhale kofunikira.

Kukanidwa kwa impso komwe kumachitika kumatha kuchitika ngakhale mutagwiritsa ntchito mankhwala a immunosuppression. Zizindikiro zake: kutentha thupi, kuchepa kwa mkodzo, kutupa, kupweteka kwa impso. Ndikofunika kuchitapo kanthu panthawi yake, kuti musaphonye mphindi, funsani dokotala mwachangu.

Ndikothekanso kubwerera kuntchito pafupifupi masabata 8. Koma wodwala aliyense ali ndi vuto lakelo komanso kuthamanga kwake pambuyo pochita opareshoni. Ndikulimbikitsidwa kutsatira zakudya zomwe zimaletsedwa ndi mchere komanso mafuta. Imwani zamadzi zambiri.

Amuna ndi akazi omwe akukhala ndi impso yodalitsika nthawi zambiri amatha kubereka ana. Amayi akulimbikitsidwa kutenga pakati pasanathe chaka chimodzi atachitidwa opareshoni.

Kodi chinthu chothira impso chimatha kukhalako mpaka liti?

Kunena zowonjezera, kupambana kwa impso kumakulitsa moyo wa wodwala matenda ashuga wazaka zisanu ndi zinayi. Yankho lolondola la funsoli limatengera zinthu zambiri. 80% ya anthu odwala matenda ashuga atatha kubereka akhala zaka zosachepera zisanu. 35% ya odwala amatha kukhala ndi moyo zaka 10 kapena kupitilira. Monga mukuwonera, mwayi wopambana pantchitoyi ndiwofunikira.

Zowopsa zokhala ndi moyo wochepera:

Wodwala matenda a shuga adadikira nthawi yayitali kuti awonjezeke impso, adathandizidwa ndi dialysis kwa zaka zitatu kapena kupitilira.
Zaka za wodwalayo panthawi ya opaleshoni zimakhala zaka zoposa 45.
Zochitika za matenda amtundu wa 1 wazaka 25 kapena kupitirira.

Impso zochokera kwa wopereka wamoyo zili bwino kuposa cadaver. Nthawi zina, kuphatikiza ndi impso ya cadaveric, kapamba amathanso kuwaika. Lumikizanani ndi akatswiri zokhuza zabwino ndi zovuta za opaleshoni iyi poyerekeza ndi kupatsirana kwa impso.

Pambuyo pake kuti impso yowetsedwa ikazike mizu, mutha kuyipeza mwakachetechete ndi chiopsezo, kusinthira ku chakudya chamafuta ochepa. Chifukwa ndi njira yokhayo yobwezeretsanso shuga kuti ikhale yokhazikika komanso kuti ikhale yokhazikika komanso yabwinobwino. Mpaka pano, palibe dokotala amene angavomereze izi. Komabe, ngati mutsatira zakudya zabwino, glucose wanu wamagazi adzakhala wokwera ndikutsika. Ndi chiwalo chovekedwa, chinthu chomwecho chitha kuchitika mwachangu zomwe zachitika kale ku impso zanu.

Tikubwerezanso kuti mutha kusintha zakudya zamafuta ochepa pambuyo pothana ndi impso kokha pachiwopsezo chanu komanso pachiwopsezo. Choyamba onetsetsani kuti muli ndi mawerengero abwino a magazi a creatinine ndi glomerular filtration mitengo yomwe ili pamwamba pa mulingo.

Zakudya zamafuta ochepa kwambiri za anthu odwala matenda ashuga okhala ndi impso yowazidwa sizivomerezeka. Palibe kafukufuku yemwe adachitapo pankhaniyi. Komabe, pamasamba olankhula Chingerezi mutha kupeza nkhani za anthu omwe adapeza mwayi ndikupeza zotsatira zabwino. Amasangalala ndi shuga wabwinobwino, cholesterol yabwino komanso kuthamanga kwa magazi.

Zaka khumi zomaliza zimadziwika ndi kuwonjezeka-2 kwa chiwerengero cha odwala matenda ashuga padziko lapansi. Chimodzi mwazomwe zimayambitsa kufa ndi matenda "okoma" ndi matenda a shuga. Chaka chilichonse, pafupifupi 400,000 odwala amakhala ndi vuto lochedwa la impso, lomwe limafunikira hemodialysis ndi kupatsirana kwa impso.

Kupanikizika ndi njira yopitira pang'onopang'ono komanso yosasinthika (pa proteinuria), yomwe imafunikira kulowererapo ndikuwongolera komwe matenda ashuga. Chithandizo cha nephropathy mu shuga chikufotokozedwa m'nkhaniyi.

Zochitika Pang'onopang'ono Zakuwala

Miyezi yambiri ya shuga yomwe imadziwika ndi odwala ndi yomwe imapangitsa kuti pakhale zovuta. Ndi hyperglycemia yomwe imayambitsa zinthu zina:

intracranial matenda oopsa (kuchuluka kwapanthawi mkati mwa impso),
zokhudza zonse ochepa matenda oopsa (kuchuluka magazi okwanira),
hyperlipidemia (kuchuluka kwamafuta m'magazi).

Ndi machitidwe awa omwe amatsogolera kuwonongeka kwa mawonekedwe a impso pamaselo a ma cell.Kugwiritsa ntchito zakudya zamapuloteni ambiri (omwe ali ndi nephropathy, kotero kuchuluka kwamapuloteni mumkodzo, komwe kumapangitsa kupitilira kwamphamvu kwa matenda) ndi kuchepa kwa magazi m'thupi kumawerengedwa kuti ndi zinthu zina zowonjezera.

Gulu

Gawoli lamakono la matenda a impso motsutsana ndi matenda ashuga lili ndi magawo asanu, awiri oyamba amawonedwa ngati anzeru, ndipo ena onse ndi azachipatala. Kuwonetsera kwamtsogolo ndi kusintha mwachindunji mu impso, palibe zodziwika bwino za matenda.

Katswiri angathe kudziwa:

kuchepa kwa impso,
makulidwe apansi a glomerular basement,
Kukula kwa masangial matrix.

M'magawo awa, palibe kusintha pakumveka kwamkodzo, kuthamanga kwa magazi kumakhala kwabwinobwino, palibe kusintha komwe kumatchulidwa m'matumbo a fundus. Kuchitapo kanthu kwakanthaŵi ndi kuikidwa kwa chithandizo kungabwezeretse thanzi la wodwalayo. Magawo awa amawonedwa ngati osinthika.

kuyamba matenda ashuga nephropathy,
kwambiri matenda ashuga nephropathy,
uremia.

Pre-dialysis chithandizo

Therapy imakhala ndikutsatira zakudya, kukonza kagayidwe kazinthu, kuchepetsa magazi, komanso kubwezeretsa mafuta kagayidwe. Chofunikira ndichakuti mukwaniritse chiphuphu cha matenda ashuga pogwiritsa ntchito mankhwala a insulin kapena kugwiritsa ntchito mankhwala ochepetsa shuga.

Mankhwala osagwiritsa ntchito mankhwala atengedwa motere:

zolimbitsa thupi, koma pamlingo woyenera,
kusiya kusuta ndi kumwa mowa,
kuchepetsa mavuto obwera chifukwa chovuta,
kusintha kwa malingaliro am'maganizo.

Zakudya zamankhwala

Kuwongolera kwa zakudya sikungokhala kukanidwa kwa chakudya cham'mimba chochepa kwambiri, chomwe chimakonda matenda a shuga, komanso motsatira mfundo za tebulo No. 7. Ndikulimbikitsidwa kudya zakudya zamagulu ochepa zam'kati, zomwe zimatha kukhutitsa thupi la wodwalayo ndizofunikira, mavitamini, ndi zinthu zina.

Kuchuluka kwa mapuloteni omwe amalandilidwa m'thupi sayenera kupitilira 1 g pa kilogalamu imodzi ya kulemera kwa thupi patsiku, ndikofunikira kutsitsa milomo ya lipids kuti ikhale bwino m'mitsempha yamagazi, pochotsa cholesterol "yoyipa". Zotsatirazi ziyenera kukhala zochepa:

buledi ndi pasitala
chakudya zamzitini
marinade
ankasuta nyama
mchere
madzi (mpaka lita imodzi patsiku),
misuzi
nyama, mazira, mafuta.

Zakudya zotere zimapangidwa panthawi yobala mwana, ndimatenda amtundu wa matenda opatsirana, ali mwana.

Kukonza shuga kwamwazi

Popeza ndi glycemia wokwera kwambiri yomwe imawoneka kuti ndiyomwe imayambitsa kukula kwa matenda a shuga, ndikofunikira kuchita chilichonse kuti zitsimikizidwe kuti shuga ali mgulu lololedwa.

Chizindikiro pamwambapa 7% chololedwa kwa odwala omwe ali pachiwopsezo chachikulu chotenga matenda a hypoglycemic, komanso kwa odwala omwe ali ndi matenda amtima komanso chiyembekezo chamoyo chawo chikuyembekezeka kukhala chochepa.

Ndi mankhwala a insulin, kukonza kwa vutoli kumachitika ndi kuwunika kwa mankhwalawa omwe amagwiritsidwa ntchito, kayendetsedwe kake komanso mitundu ya mankhwala. Njira yabwino kwambiri imawonetsedwa kuti ndi jakisoni wa insulin yotalika 1-2 patsiku komanso mankhwala "achidule" musanadye chilichonse mthupi.

Mankhwala ochepetsa shuga a mankhwalawa odwala matenda ashuga nephropathy nawonso amagwiritsidwa ntchito. Mukamasankha, ndikofunikira kulingalira njira zochotsera zinthu zogwira ntchito m'thupi la wodwalayo ndi pharmacodynamics ya mankhwala.

Mfundo zofunika

Malangizo amakono a akatswiri:

Biguanides sagwiritsidwa ntchito chifukwa cha kulephera kwa impso chifukwa choika lactic acidosis chikomokere.
Thiazolinediones sinafotokozedwe chifukwa zimapangitsa kuti madzi azisungika m'thupi.
Glibenclamide ingayambitse kuchepa kwakukulu kwa shuga m'magazi chifukwa cha matenda a impso.
Ndi yankho lachilendo la thupi, Repaglinide, Gliclazide amaloledwa.Pakutha kugwira ntchito, mankhwala a insulin amasonyezedwa.

Kuwongolera kwa magazi

Kugwira bwino ntchito sikuchepera 140/85 mm Hg. Art., Komabe, manambala ndi ochepera 120/70 mm RT. Art. Tiyeneranso kupewa. Choyamba, magulu otsatirawa a mankhwalawa ndi omwe amamuyimira amagwiritsidwa ntchito pochiza:

Zoletsa za ACE - Lisinopril, enalapril,
angiotensin receptor blockers - losartan, olmesartan,
saluretics - Furosemide, Indapamide,
calcium blockers - Verapamil.

Zofunika! Magulu awiri oyambawo amatha kusintha wina ndi mzake pamaso pa anthu ochita kupanga Hypersensitivity kuti azigwira ntchito.

Malangizo a metabolism yamafuta

Odwala omwe ali ndi matenda a shuga, matenda a impso ndi dyslipidemia amakhala ndi chiopsezo chachikulu cha matenda a mtima ndi mitsempha yamagazi. Ichi ndichifukwa chake akatswiri amalimbikitsa kukonza zizindikiritso zamafuta m'mwazi omwe ali ndi matenda "okoma".

cholesterol - ochepera 4.6 mmol / l,
kwa triglycerides - osachepera 2.6 mmol / l, ndipo ngati matenda a mtima ndi mitsempha ya magazi - osakwana 1.7 mmol / l.

Mankhwalawa amagwiritsa ntchito magulu awiri akuluakulu a mankhwalawa: ma statins ndi ma fibrate. Chithandizo cha Statin chimayamba pomwe ma cholesterol afika 3,6 mmol / l (malinga ngati palibe matenda m'thupi). Ngati pali ma concomitant pathologies, mankhwalawa amayenera kuyamba ndi mafuta aliwonse a cholesterol.

Amaphatikizapo mibadwo ingapo yamankhwala (Lovastatin, Fluvastatin, Atorvastatin, Rosuvastatin). Mankhwala osokoneza bongo amatha kuchotsa cholesterol yowonjezereka m'thupi, kuchepetsa LDL.

Statins amalepheretsa ma enzyme enaake omwe amayambitsa kupanga cholesterol m'chiwindi. Komanso, mankhwalawa amachulukitsa kuchuluka kwa maselo otsika a lipoprotein m'maselo, zomwe zimabweretsa kutulutsa kwakukulu kwa thupi.

Gulu la mankhwalawa lili ndi njira zingapo zochitira. Zinthu zomwe zimagwira zimatha kusintha kayendedwe ka cholesterol pamtundu wa gene. Oimira:

Kukonzanso kwa Filter Permeability

Umboni wamankhwala umati kusinthidwa kwa shuga wamagazi ndi kusamalidwa kwambiri sikungalepheretse nthawi zonse chitukuko cha albinuria (mkhalidwe womwe mapuloteni amawonekera mumkodzo, omwe sayenera kukhala).

Monga lamulo, nephroprotector Sulodexide ndi mankhwala. Mankhwala amagwiritsidwa ntchito kubwezeretsa impso glomerular, zomwe zimapangitsa kuchepa kwa mapuloteni obwera kuchokera mthupi. Mankhwala a Sulodexide amasonyezedwa kamodzi pa miyezi isanu ndi umodzi.

Electrolyte bwino kuchira

Njira zotsatirazi zochizira zimagwiritsidwa ntchito:

Menyani potaziyamu yayikulu m'magazi. Gwiritsani ntchito yankho la calcium gluconate, insulin yokhala ndi glucose, yankho la sodium bicarbonate. Kusakwanira kwa mankhwala ndi chizindikiro cha hemodialysis.
Kuthetsa azotemia (kuchuluka kwa zinthu za nayitrogeni m'magazi). Enterosorbents (mpweya wothandizidwa, Povidone, Enterodeum) ndi omwe amapatsidwa.
Kuwongolera milingo yayikulu ya phosphate ndi kuchuluka kwa calcium. Yankho la calcium carbonate, iron sulfate, Epoetin-beta limayambitsidwa.

Chithandizo cha odwala siteji ya nephropathy

Mankhwala amakono amapereka njira zitatu zazikulu zochizira mu gawo lomaliza la kulephera kwa impso, komwe kungatalikitse moyo wa wodwalayo. Izi zimaphatikizapo hemodialysis, peritoneal dialysis ndi kupatsirana kwa impso.

Njira imapangidwa poyeretsa magazi pamagazi. Pachifukwa ichi, adotolo amakonzekeretsa mwayi wamitsempha womwe magazi amatengedwa. Kenako imalowa mu zida za "impso ya", pomwe imatsukidwa, kupatsidwa zinthu zofunikira, ndipo imabwereranso m'thupi.

Ubwino wa njirayi ndikukusowa kwa kufunika kwa zochitika za tsiku ndi tsiku (nthawi zambiri kawiri pa sabata), wodwalayo amakhala akuyang'aniridwa ndi achipatala nthawi zonse. Njirayi imapezeka ngakhale kwa odwala omwe sangathe kudzipulumutsa.

nkovuta kupereka ma venous, chifukwa zombozi ndizofooka kwambiri,
zovuta kuthana ndi magazi
kuwonongeka kwa mtima ndi mitsempha yamagazi kumapita patsogolo mwachangu,
ndizovuta kuchepetsa shuga
wodwalayo amaphatikizidwa kuchipatala kwamuyaya.

Peritoneal dialysis

Njira zamtunduwu zitha kuchitidwa ndi wodwala. Catheter imayikidwa mu pelvis yaying'ono kudzera khoma lamkati lakunja, lomwe limasiyidwa kwa nthawi yayitali. Kudzera mu catheter iyi, kulowetsedwa ndikutulutsa yankho linalake kumachitika, yomwe imafanana ndi plasma ya magazi.

Zoyipa ndizofunikira pakuwonetsera kwatsiku ndi tsiku, kulephera kuchita bwino ndi kuchepa kwakanema kwa zithunzi zowoneka bwino, komanso ngozi yomwe ingayambike chifukwa cha kutupa kwa peritoneum.

Njira za nephropathy mu matenda ashuga, matenda ake ndi chithandizo