Isihloko esikhulunywa ngokudla kwezinso sikashukela kungenye ebaluleke kakhulu esizeni sethu. Imininingwane oyifunde ngezansi izoba nomthelela omkhulu enkambweni yesifo sikashukela sakho esizayo kanye nezinkinga zayo, kufaka phakathi isifo sikashukela. Ukudla sikashukela esikuphakamisayo ukuthi uzama uzama kwehluke kakhulu ezincomeni zendabuko. Imithi ingabambezela isigaba sokugcina sokwehluleka kwezinso, ukuvuvukala kanye nokufakwa kwezinso iminyaka eminingana. Kepha lokhu akuyona inzuzo enkulu, ikakhulukazi ezigulini ezinesifo sikashukela sohlobo 1 sabantu abasha nabaphakathi. Funda indlela ehlukile futhi ephumelelayo yokudla ekwelapheni ukulimala kwezinso likashukela ngezansi.
Umuthi osemthethweni wesifo sikashukela uncoma ukudla “okulinganiselayo”. Funda ngokuthi yiziphi izivivinyo okudingeka uzenze ukuhlola izinso zakho. Uma lezi zivivinyo zikukhombisa i-microalbuminuria, futhi ikakhulukazi i-proteinuria, udokotela wakho mhlawumbe uzokucebisa ukuthi udle amaphrotheni amancane. Ngoba kukholelwa ukuthi imikhiqizo yamaprotheni iyalayisha kakhulu izinso futhi ngenxa yalokho isheshisa ukuthuthukiswa kokwehluleka kwezinso. Udokotela uzosho futhi abhale ekhadini ukuthi ukudla amaprotheni kufanele kwehliswe ku-0,7-1 amagremu nge-1 kg yesisindo somzimba ngosuku. Uzozama nokudla amafutha amancane ezilwane ngangokunokwenzeka, ngethemba lokwehlisa cholesterol yakho ne-triglycerides egazini. Amafutha asosiwe abhekwa njengezilimaza kakhulu emithanjeni yegazi: ibhotela, amaqanda, isinqe.
Kodwa-ke, isici esiyinhloko esithinta izinso kusifo sikashukela akukhona ukudla ukudla kwamaprotheni, kepha ushukela wegazi ophezulu. Uma umuntu enoshukela ophakeme ngokungamahlalakhona, khona-ke izinguquko zokuqala ze-pathological ezinso zakhe zingabonakala ngemuva kweminyaka engu-2-3. Odokotela batusa ukuthi abantu abanesifo sikashukela banciphise ukusebenzisa kwabo amaprotheni ngoba baphakamisa ukuthi amaprotheni okudla asheshise ukuthuthukiswa kokuhluleka kwezinso. Eqinisweni, imbangela yokuqhamuka kwesifo sikashukela sikashukela siphakanyiswa ushukela wegazi, futhi amaprotheni okudla awanalutho, ngaphandle kwezimo ezinzima kakhulu. Ake sibheke ukuthi izinso zisebenza kanjani ukuqinisekisa lokhu.
Zihlelwe kanjani izinso zomuntu futhi zisebenza kanjani
Izinso zihlunga amanzi, ushukela owedlulele, izidakamizwa, nezinye izinto ezinobuthi ezisegazini, bese imfucuza ikhishwa emchanjeni. Izinso ziyisitho okwakhiwa ngaso umchamo. Imvamisa, izinso ngalinye liqukethe izihlungi ezilingana nesigidi lapho igazi lidlula ngaphansi kwengcindezi. Lezihlungi zibizwa ngokuthi i-glomeruli. Igazi lingena kwi-glomerulus ngokusebenzisa i-arteryole encane ebizwa ngokuthi i-afferent (engenayo) i-arteriole. Le arteriole iphetha ngenqwaba yemikhumbi emincane kakhulu ebizwa ngokuthi ama-capillaries. E-capillaries kunezimbobo ezingama-microscopic (ama-pores) aphethe icala elibi likagesi.
Ukuphela okuphansi kwe-capillary ngayinye kugeleza ku-arteriole ephumelelayo (lapho kuphuma khona), lapho ububanzi buba cishe khona izikhathi ezi-2 kunalezo ezingenayo. Ngenxa yalokhu kuncipha, umfutho owengeziwe wenzeka lapho igazi liphuma ngesixha se-capillaries. Ngaphansi kwethonya lengcindezi eyandayo, ingxenye yamanzi avela egazini ivuza ngokusebenzisa ama-pores. Amanzi avuzayo agelezela ku-kapulet azungeze inqwaba yama-capillaries, futhi ukusuka lapho angena kwishubhu.
Ama-pores kuma-capillaries angobubanzi kangangokuba ama-molecule amancane, njenge-urea kanye noshukela ngokweqile, okwakha umchamo, avuze ephuma egazini engena emanzini ngamanzi. Esimweni esijwayelekile, ama-molecule amakhulu wobukhulu (amaprotheni) awakwazi ukudlula kuma-pores. Amaprotheni amaningi egazi aphethe icala elibi likagesi. Baxoshwa kuma-pores ama-capillaries, ngoba banecala elibi. Ngenxa yalokhu, ngisho namaprotheni amancane kunazo zonke awahlungwanga yizinso futhi awakhishwa emchameni, kodwa abuyiselwa emuva egazini.
I-Glomerular filtration rate (GFR) iyinkomba yokuthi ungakanani umsebenzi wokuhlunga kwegazi izinso ezenza esikhathini esithile esinikeziwe. Kungabalwa ngokudlula isivivinyo segazi se-creatinine (ungakwenza kanjani lokhu, ngokuningiliziwe). Njengoba ukwehluleka kwe-reso kuyaqhubeka, izinga lokuhlunga kwe-glomerular liyancipha. Kepha kubantu abanesifo sikashukela abaye baphakamisa ushukela wegazi ngokungapheli, kuyilapho izinso zisasebenza kahle, okokuqala izinga lokuhlunga kwe-glomerular liyakhuphuka. Ezimweni ezinjalo, iba ngaphezulu kunokujwayelekile. Lokhu kungenxa yokuthi ushukela owedlulele egazini ukhipha amanzi kwizicubu ezizungezile. Ngakho-ke, umthamo wegazi uyakhuphuka, umfutho wegazi kanye nezinga lokuphuma kwegazi ngokusebenzisa izinso likhuphuka. Ezigulini ezinesifo sikashukela, ekuqaleni kwalesi sifo, ngaphambi kokuvela kokulimala kwezinso okungapheli, isilinganiso sokuhlunga kwe-glomerular singaba izikhathi eziphindwe ka-1.5-2 kunokujwayelekile. Emini, abantu abanjalo abanomchamo bakhipha amashumi amaningana amagremu kashukela.
Kungani usongo oluphambili lwezinso ushukela ophezulu
I-glucose ethe xaxa egazini inomphumela onobuthi ezinhlelweni ezahlukahlukene zomzimba, ngoba amangqamuzana kashukela abopha amaprotheni futhi aphazamise umsebenzi wawo. Lokhu kubizwa ngokuthi ukusabela kwe-glycosylation. Ngaphambi kokuba ososayensi bakufunde ngokucophelela lokhu kusabela, bacabanga ukuthi i-hyperfiltration, isb., Ukusheshiswa kokuhlunga kwe-glomerular kanye nokwanda kwengcindezi yezinso, kwakuyimbangela yesifo sikashukela. Ngemuva kokufunda isigaba esedlule sendatshana, manje uyazi ukuthi ukusheshiswa kokuhlunga kwe-glomerular akuyona imbangela, kodwa kube ngumphumela. Isizathu sangempela sokukhula kokwehluleka kwezinso umphumela onobuthi okhuphuke ushukela wegazi kumaseli.
Ngenqubo yokusebenzisa amaprotheni okudla emzimbeni, kukhiqizwa imfucuza - i-urea ne-ammonia, equkethe i-nitrogen. Emuva maphakathi nekhulu lamashumi amabili, ososayensi baphakamisa ukuthi izinga lokuhlunga kwe-glomerular ezinso likhuphuka ngenxa yesidingo sokuhlanzwa kwegazi kusuka e-urea nase-ammonia. Ngakho-ke, iziguli ezinesifo sikashukela zinconyiwe futhi zisancoma ukudla amaphrotheni amancane ukunciphisa umthwalo ezinso. Kepha ucwaningo olwenziwe ososayensi bakwa-Israyeli lubonise ukuthi kubantu abanempilo ngaphandle kwesifo sikashukela, izinga lokuhlunga lezinso elisezinso liyafana ekudleni okuqukethe amaprotheni n ekudleni okwenziwe ngemifino. Kuyo yonke le minyaka, kuye kwatholakala ukuthi izehlakalo zokuhluleka kwezinso kubantu abadla imifino kanye nabadli benyama azihlukile ngokwezibalo. Kubuye kufakazelwe ukuthi inani elikhulayo lokuhlunga le-glomerular alisona isimo esidingekayo noma esanele sokuthuthuka kwe-nephropathy yesifo sikashukela.
Ucwaningo lweHarvard lubonise okulandelayo. Iqembu lamagundane elabhorethri laligcina ushukela wegazi ezingeni cishe 14 mmol / L. I-nephropathy yesifo sikashukela yathuthuka ngokushesha kulo ngalinye lamagundane. Uma ngabe kufakwe amaprotheni amaningi ekudleni kwawo, khona-ke ukuthuthukiswa kokuhluleka kwe-renal kusheshisiwe. Eqenjini elingumakhelwane lamagundane, ushukela wegazi wawungama-5.5 mmol / L. Bonke babehlala ngokujwayelekile. Akekho kubo owathola i-nephropathy yesifo sikashukela, kungakhathalekile ukuthi bawadla ngamaprotheni amangaki. Kuyamangaza futhi ukuthi umsebenzi wezinso wegundwane uphinde walulama ezinyangeni ezimbalwa ngemuva kokuba ushukela wegazi labo wehle uye kwesejwayelekile.
Isifo sikashukela sibhubhisa kanjani izinso: umbono wesimanje
Umbono wesimanje wokuthuthukiswa kwe-nephropathy yesifo sikashukela ukuthi ngasikhathi sinye izinto eziningana zithinta ama-capillaries ku-glomeruli yezinso. Lokhu kugcotshwa kwamaprotheni ngenxa kashukela wegazi ophakeme, nama-antibodies kuma-protein a-glycated, ukugcwala kwamaplanethi egazini nokuqhekeka kwemithambo emincane ngamagazi egazi. Esikhathini sokuqala kokulimala kwezinso ezinesifo sikashukela, amandla wegesi ongemuhle kuma-pores ama-capillaries ayancipha. Njengomphumela walokhu, amaprotheni ashajwe ngokungafanele okuyiwo amancane, ikakhulukazi, i-albhamuin, aqala ukuvuza esuka egazini angene umchamo. Uma i-urinalysis ikhombisa ukuthi iqukethe i-albhamuin, khona-ke lokhu kubizwa ngokuthi yi-microalbuminuria futhi kusho ingozi eyengeziwe yokuhluleka kwe-renal, ukushaya kwenhliziyo nokushaywa unhlangothi.
Amaprotheni ahambisana nokuvuza kwe-glucose ngokusebenzisa ama-pores kuma-capillary wezinso kalula kakhulu kunamaprotheni ajwayelekile. Umfutho wegazi owandayo, kanye nokuxineka okweqile kwe-insulin egazini, kusheshisa ukucolisiswa ezinso, futhi ngaleyo ndlela amaprotheni amaningi angena ngaphakathi kwezihlungi. Amanye ala maprotheni, ahambisana ne-glucose, anamathela kwi-mesangium - lokhu izicubu eziphakathi kwama-capillaries. Amanani aqakathekileko wamaprotheni wama-glycated nama-antibodies kuwo atholakala ku-glomeruli ye-renal yabantu abanesifo sikashukela, ezindongeni zama-capillaries naku-mesangium. Lezi zingqimba ziya ngokuya zikhula kancane kancane, i-mesangium iyaqina bese iqala ukucwilisa ama-capillaries. Ngenxa yalokhu, ubukhulu bama-pores kuma-capillaries banda, futhi amaprotheni wedayidi elandayo ayakwazi ukuphuma egazini ngawo.
Inqubo yokubhujiswa kwezinso iyasheshiswa, ngoba amaprotheni amaningi futhi anama glycated anamathela ku-mesangium, futhi iyaqhubeka nokuqina. Ekugcineni, i-mesangium kanye nama-capillaries athathelwa indawo yizicubu zesikhumba, ngenxa yalokho i-renal glomerulus eyekayo ukusebenza. Ukweswele kwe-mesangium kubonwa ezigulini ezinokulawulwa okungafanele kwesifo sikashukela, ngisho nangaphambi kokuba i-albhamuin namanye amaprotheni aqale ukuvela kumchamo.
Ucwaningo oluningi kubantu luye lwabonisa ukuthi uma ukulawula ushukela wegazi kwenziwa ngcono, khona lapho ezigabeni zokuqala zesifo sikashukela se-nephropathy, izinga lokuhlunga kwe-glomerular lehla liye kwesejwayelekile, futhi ukuqina kwamaprotheni kumchamo nakho kuyehla. Uma ushukela uhlala uphakama ngokuqhubekayo, khona-ke ukulimala kwezinso kuyaqhubeka. Bafundela amagundane esifo sikashukela, ososayensi babona ukuthi uma behlisela ushukela wegazi labo ngokujwayelekile futhi baligcine lisesimweni esijwayelekile, kuvela glomeruli entsha ezinso esikhundleni sezilimele.
Ingabe i-cholesterol iyazithinta izinso?
Ukuqina okukhulayo kwe-cholesterol “embi” ne-triglycerides (amafutha) egazini kukhuthaza ukuqhekeka kwemithambo yegazi ngama-atherosranceotic plaques. Wonke umuntu uyazi ukuthi lokhu kubangela isifo esiyingozi senhliziyo. Kuyavela ukuthi imithambo enikezela ngegazi ezinso ingena kwi-atherosulinosis ngendlela efanayo nemithambo emikhulu. Uma izitsha ezondla izinso zivinjwe ngamathafa e-atherosclerotic, khona-ke indlala ka-oksijini yezinso iyakhula. Lokhu kubizwa ngokuthi i-stenosis (unciphisa) yemithambo yezinso futhi kusho ukuthi ukwehluleka kwezinso kushukela kukhula ngokushesha. Kukhona ezinye izindlela lapho i-cholesterol “embi” ne-triglyceride ngokweqile egazini zilimaza izinso.
Isiphetho ukuthi udinga ukuqapha i-cholesterol yakho ne-triglycerides yakho egazini, okungukuthi, uvivinya njalo isifo sikashukela. Ukuyigcina ingaphansi kwemingcele ejwayelekile, odokotela bebelokhu bemisela izidakamizwa ezivela ekilasini lama-statin amashumishumi eminyaka. Le mishanguzo iyabiza futhi inemiphumela emibi ebalulekile: ikhulisa ukukhathala futhi ingalimaza isibindi. Izindaba ezimnandi: ukudla okune-carbohydrate ephansi ngokwejwayelekile kuvame nje ushukela wegazi, kodwa ne-cholesterol ne-triglycerides. Thatha ama-statins kuphela uma ukuhlolwa okuphindaphindiwe ngemuva kwamasonto ayi-6 kukhombisa ukuthi ukudla okuvinjelwe i-carbohydrate akusizi. Lokhu akunakwenzeka kakhulu uma uyalwa ngokulandela ukudla futhi udle ngokuphelele ukudla okungavunyelwe.
Ukukhetha phakathi kokudla okuphansi kwe-carb nokudla okunamaphrotheni aphansi
Uma uke wafunda uhlelo lokulashwa kwesifo sikashukela sohlobo lwe-1 noma uhlobo lwe-2 yesifo sikashukela futhi wazama ukulandela izincomo, uyazi ukuthi ukudla okune-carbohydrate okuvumela kukuwehlisa ushukela wegazi kube okwejwayelekile futhi ukulondoloze ngokujwayelekile, njengasebantwini abaphilile ngaphandle kwesifo sikashukela. Funda kabanzi ukuthi iyiphi indlela yemithwalo emincane. Uzibonele ngokwakho ukuthi ukudla "okunokulinganisela", kanye nokudla okunama-protein amancane futhi anamandla aphansi, ungavumeli ushukela ukuthi wenze ngokwejwayelekile. Zigcwele ama-carbohydrate, ngakho-ke ushukela wegazi esigulini esinesifo sikashukela nokugxumagxuma kukhula ngokushesha.
Kodwa-ke, odokotela bayaqhubeka nokuncoma ukudla okunamaprotheni aphansi kwabanesifo sikashukela ukunciphisa ijubane lokukhula kokuhluleka kwezinso futhi kubambezele ukuqala kwe-dialysis. Kulokhu kudla, inqwaba yeprotheni yokudla ithathelwa indawo nge-carbohydrate. Kukholelwa ukuthi le ndlela yokondleka yehlisa umthwalo ezinsweni, yize ingevumeli ukuthi isifo sikashukela sigcine ushukela wegazi ojwayelekile. Ungakukhetha kanjani ukudla okufanele kakhulu kwezinso? Yikuphi ukudla okungcono - amaprotheni aphansi noma i-carbohydrate ephansi? Impendulo: kuya ngokuthi yisiphi isifo sakho sikashukela esikulesi sigaba.
Kukhona iphuzu lokuthi akukho ukubuya. Uma uyiwela, i-glomeruli yonakele kangangokuba ukujwayela ushukela egazini akusakuvumeli ukuthi ubuyisele noma uthuthukise ukusebenza kwezinso. UDkt Bernstein uphakamisa ukuthi leli phuzu lokungabuyi izinga lokuhlunga lezinso ezingaba ngu-40 ml / min. Uma izinga lokuhlunga le-glomerular liphansi, khona-ke ukudla okune-carbohydrate ephansi okugcwele ngamaprotheni ngeke kusasiza, kepha kusheshisa kuphela ukuqala kwesigaba esibulalayo sokwehluleka kwezinso. Uma izinga lokuhlunga le-glomerular lifinyelela ku-40-60 ml / min, khona-ke ukujwayezwa kweshukela egazini ngokudla okuphansi kwe-carbohydrate kuzosiza ekuqiniseni ukusebenza kwezinso isikhathi eside. Ekugcineni, uma izinga lokuhlunga le-glomerular lingaphezu kwama-60 ml / min, khona-ke ngaphansi kokudla kokudla okune-carbohydrate eningi, izinso zibuyiselwa ngokuphelele futhi ziyasebenza, njengasebantwini abaphilile. Thola ukuthi ungasibala kanjani isilinganiso sakho sokuhlunga kwe-glomerular lapha.
Khumbula ukuthi ukudla okune-carbohydrate okuphansi akuzithinti ngokuqondile izinso. Ngokungangabazeki, kusiza ukugcina ushukela wegazi ojwayelekile kushukela. Kucatshangelwa ukuthi ngenxa yalokhu, ukusebenza kwezinso kuyabuyiselwa uma iphuzu lokungabuyi lingakaphasiswa. Ukugcina ushukela ojwayelekile ozinzile, noma kukudla okune-carbohydrate ephansi kakhulu, kufanele ulandele umbuso ngokuphelele. Kufanele ube ongabekezeleli ukudla okungekho emthethweni njengoba amaSulumane athembekile ebekezelela ingulube kanye nemimoya. Kala ushukela nge-glucometer okungenani izikhathi ezi-5 ngosuku, uhlala esimweni sokuzithiba ngokuphelele ushukela wegazi. Umzamo okudingeka uwenze uzokhokha kaningi uma uqiniseka ukuthi ushukela uhlala uqinile. Ngemuva kwezinyanga ezimbalwa, izivivinyo zizokhombisa ukuthi ukusebenza kwezinso kuyazinza noma kuyathuthuka. Ezinye izinkinga zesifo sikashukela nazo zizodamba.
Ukudayela Izinso Zokudla Kwesifo Sikashukela
Iziguli ezinesifo sikashukela ezakha ukuhluleka kwe-reso esigabeni sokugcina zisekela izimpilo zazo ngenqubo yoku dialysis. Ngalezi zinqubo, imfucumfucu equkethe i-nitrogen isuswa egazini. I-Dialysis inqubo ebizayo futhi engathandeki, ebeka engcupheni enkulu yokutheleleka. Ukwehlisa imvamisa yayo, iziguli ziyacelwa ukuba zinciphise umthamo wazo wamaprotheni noketshezi. Kulesi sigaba sokwehluleka kwezinso, i-carbohydrate ephansi, ukudla okune-protein eningi ngokwezigaba akulungile. Ezimweni eziningi, amaprotheni adliwayo angena esikhundleni sama-carbohydrate. Ezinye izikhungo ze-dialysis zaseNtshonalanga manje zincoma ukuthi iziguli zazo ezinesifo sikashukela zidle uwoyela womnqumo esikhundleni se-carbohydrate. Inamafutha amaningi aphilile we-monounsaturated.
Iziphetho
Ukusetshenziswa kwamaprotheni ekudleni akuyona imbangela yokuthuthukiswa kokuhluleka kwe-renal, kufaka phakathi ezigulini ezinesifo sikashukela. Kuphela uma iphuzu lokungabuyi selivele lidlulisiwe futhi izinso sezenze umonakalo ongeke ulungiswe, kulokhu kuphela, amaphrotheni okudla angasheshisa ukuthuthukiswa kokwehluleka kwezinso.I-nephropathy yesifo sikashukela ayikhuli uma isiguli sisebenzisa uhlelo lokwelapha isifo sikashukela sohlobo 1 noma uhlelo lokwelapha isifo sikashukela sohlobo 2, siluleka uhlobo lwaso futhi silondoloze ushukela ngokujwayelekile. Ukudla amaprotheni ekudleni akunawo umthelela ezingeni lokuhlunga lezinso le-glomerular. Ushukela osezingeni eliphakeme ubhubhisa ngempela izinso uma isifo sikashukela singalawulwa kahle.
