Isifo sikashukela igama elijwayelekile ezinkingeni eziningi zesifo sikashukela. Leli gama lichaza izilonda zesifo sikashukela zezinto zokuhlunga zezinso (glomeruli kanye ne-tubules), kanye nemikhumbi ebondla ngayo.
I-nephropathy yesifo sikashukela iyingozi ngoba ingaholela esigabeni sokugcina (esibulalayo) sokwehluleka kwezinso. Kulokhu, isiguli sizodinga ukuhlolwa noma ukushintshwa kwezinso.
Isifo sikashukela esingesinye sezimbangela ezivamile zokufa kokuqala nokukhubazeka ezigulini. Isifo sikashukela sikude kakhulu kwembangela yezinkinga zezinso. Kepha phakathi kwalabo abahlolwa ngokuhlinzwa bese bemile emgqeni wezinyo elinikelayo ngokufakelwa, onesifo sikashukela kunazo zonke. Isizathu esisodwa salokhu ukwanda okukhulu kwezigameko zesifo sikashukela sohlobo 2.
Izizathu zokuthuthukiswa kwe-nephropathy yesifo sikashukela:
- ushukela wegazi ophakeme esigulini;
- cholesterol ompofu kanye triglycerides egazini;
- umfutho wegazi ophakeme (funda indawo yethu "kadadewethu" nge-hypertension);
- i-anemia, ngisho “imnene” (hemoglobin esegazini <13.0 g / lit);
- ukubhema (!).
Izimpawu ze-Diabetesic Nephropathy
Isifo sikashukela singaba nomphumela olimazayo ezinso isikhathi eside kakhulu, size sifike eminyakeni engama-20, ngaphandle kokubanga imizwa engemihle esigulini. Izimpawu ze-nephropathy zesifo sikashukela zenzeka lapho ukwehluleka kwezinso sekuvele. Uma isiguli sinezimpawu zokuhluleka kwe-renal, khona-ke lokhu kusho ukuthi imfucumfucu ye-metabolic inqwabelana egazini. Ngoba izinso ezithintekile azikwazi ukubhekana nokuhlungwa kwazo.
Isigaba sikashukela nephropathy. Ukuhlolwa nokuxilongwa
Cishe bonke abanesifo sikashukela badinga ukuhlolwa minyaka yonke ukuqapha ukusebenza kwezinso. Uma i-nephropathy yesifo sikashukela iba khona, khona-ke kubaluleke kakhulu ukuyithola lapho isekuqaleni, ngenkathi isiguli singazizwa izimpawu. Ukwelashwa kwangaphambili kwe-nephropathy yesifo sikashukela kuqala, kukhulu ithuba lokuphumelela, okuwukuthi, isiguli sizokwazi ukuphila ngaphandle kokuhlinza noma ukufakelwa kwezinso.
Ngo-2000, uMnyango Wezempilo waseRussia Federation wavuma ukuhlukaniswa kwe-nephropathy yesifo sikashukela ngezigaba. Kufaka nokwakhiwa okulandelayo:
- isigaba microalbuminuria;
- isiteji se-proteinuria enokugcinwa kwe-nitrogen-exreting renal function;
- isigaba sokwehluleka kwezinso okungapheli (ukwelashwa nge-dialysis noma ukufakelwa kwezinso).
Kamuva, ochwepheshe baqala ukusebenzisa ukuhlukaniswa okuningana okuningana kwezinkinga zezinso zesifo sikashukela. Kuyo, hhayi i-3, kepha izigaba ezi-5 ze-nephropathy zesifo sikashukela ziyahlukaniswa. Bona izigaba zesifo sezinso esingamahlalakhona ukuthola imininingwane engaphezulu. Isiphi isigaba se-nephropathy yesifo sikashukela esigulini esithile sincike esilinganisweni sakhe se-glomerular filtration rate (kuchazwa ngokuningiliziwe ukuthi kunqunywa kanjani). Lesi yisinkomba esibaluleke kakhulu esibonisa ukuthi umsebenzi wezinso ulondolozwe kahle kangakanani.
Esigabeni sokuthola i-nephropathy yesifo sikashukela, kubalulekile ukuthi udokotela aqonde ukuthi uma ukulimala kwezinso kudalwa yisifo sikashukela noma ezinye izimbangela. Ukuxilongwa okuhlukile kwe-nephropathy yesifo sikashukela nezinye izifo zezinso kufanele kwenziwe:
- i-pyelonephritis engapheli (ukuvuvukala kokutheleleka kwezinso);
- isifo sofuba sezinso;
- glomerulonephritis oyingozi futhi engamahlalakhona.
Izimpawu ze-pyelonephritis engapheli:
- Izimpawu zokudakwa (ubuthakathaka, ukoma, isicanucanu, ukuhlanza, ikhanda);
- ubuhlungu emhlane ongezansi nesisu ohlangothini lwezinso ezithintekile;
- ukwanda kwengcindezi yegazi;
- ezigulini ezingama-⅓ - ukuchama okusheshayo, nobuhlungu;
- ukuhlolwa kukhombisa ukuba khona kwamangqamuzana amhlophe egazi namagciwane emchameni;
- isithombe esibonakalayo nge-ultrasound yezinso.
Izici zesifo sofuba sezinso:
- emchameni - i-leukocytes nesifo sofuba se-mycobacterium;
- nge-urography e-excretory (x-ray yezinso ngokuphathwa kwe-intravenous kwesipikili esiphakathi) - isithombe esibonisa.
Ukudla kwezinkinga zezinso zesifo sikashukela
Ezimweni eziningi ezinezinkinga zezinso ezinesifo sikashukela, ukunciphisa umunyu usawoti kusiza ukwehlisa umfutho wegazi, kunciphise ukuvuvukala, futhi kubambezele phambili ukuqina kwesifo sikashukela. Uma umfutho wegazi lakho uvamile, ungadli ngaphezu kwama-5-6 amagremu kasawoti ngosuku. Uma usuvele unayo i-hypertension, bese ubeka umkhawulo wokudla usawoti ongama-gramu ayi-2-3 ngosuku.
Manje into ebaluleke kakhulu. Umuthi osemthethweni utusa "ukudla okulinganiselayo" kwesifo sikashukela, futhi nokudla okuncane kakhulu kwamaprotheni esifo sikashukela. Siphakamisa ukuthi ucabangele ukusebenzisa ukudla okune-carbohydrate ephansi ukwehlisa ushukela wegazi wakho ngokujwayelekile. Lokhu kungenziwa ngesilinganiso sokuhlunga kwe-glomerular ngenhla kwe-40-60 ml / min / 1.73 m2. Esihlokweni esithi “Ukudla kwezinso ezinesifo sikashukela,” lesi sihloko esibalulekile sichazwa ngokuningiliziwe.
Ukwelashwa Kwe-Diabetesic Nephropathy
Indlela enkulu yokuvikela nokwelapha i-nephropathy yesifo sikashukela ukwehlisa ushukela wegazi, bese uligcina liseduze nokujwayelekile kubantu abaphilile. Ngaphezulu, ufunde ukuthi ungakwenza kanjani lokhu ngokudla okuphansi kwe-carb. Uma izinga likashukela wegazi lesiguli liphakanyiswa ngokungagodli noma sonke isikhathi sisukela phezulu kuya ku-hypoglycemia, khona-ke yonke eminye imisebenzi izosetshenziswa kancane.
Imithi yokwelapha isifo sikashukela nephropathy
Ukulawulwa kwe-hypertension ye-arterial, kanye ne-hypertension ye-intracranial ezinso, izinso sikashukela zivame ukubekelwa izidakamizwa - inhibitors ze-ACE. Le mishanguzo ayigcini nje ngokunciphisa umfutho wegazi, kodwa futhi ivikela izinso nenhliziyo. Ukusetshenziswa kwabo kunciphisa ingozi yokuhluleka kwe-renal renal. Ngokunokwenzeka, ama-inhibitors asebenza isikhathi eside asebenza kangcono kune-Captopril, okufanele athathwe izikhathi ezingama-3-4 ngosuku.
Uma isiguli sakha ukukhwehlela okuomile ngenxa yokuthatha isidakamizwa eqenjini le-ACE inhibitors, khona-ke umuthi ubuyiselwa nge-angiotensin-II receptor blocker. Izidakamizwa ezikuleli qembu zibiza kakhulu kunama-inhibitors e-ACE, kepha mancane kakhulu amathuba okuba nemiphumela emibi. Vikela izinso nenhliziyo ngokusebenza okufanayo.
Izinga lomfutho wegazi eliqondiwe ezigulini ezinesifo sikashukela liyi-130/80 nangaphansi. Ngokuvamile, ezigulini ezinesifo sikashukela sohlobo 2, singatholakala kuphela ngokusebenzisa inhlanganisela yezidakamizwa. Kungaba ne-ACE inhibitor nezidakamizwa “kusuka ekucindezelweni” kwamanye amaqembu: ama-diuretics, ama-beta-blockers, abamelene ne-calcium antagonists. Ama-inhibitors e-ACE nama-angiotensin receptor blockers ndawonye awanconywa. Ungafunda ngemithi yokuhlanganisa yehypertension, enconyelwe ukusetshenziswa kushukela, lapha. Isinqumo sokugcina, amaphilisi okufanele sinikezwe, senziwa udokotela kuphela.
Izinkinga zezinso zithinta kanjani ukunakekelwa kwesifo sikashukela
Uma isiguli sitholakala sinesifo sikashukela, khona-ke izindlela zokwelapha isifo sikashukela zishintshwa kakhulu. Ngoba izidakamizwa eziningi zidinga ukukhanselwa noma isilinganiso sazo sincishiswe. Uma izinga lokuhlunga le-glomerular lehliswa kakhulu, khona-ke imithamo ye-insulin kufanele incishiswe, ngoba izinso ezibuthakathaka zilifaka kancane kancane.
Uyacelwa ukuthi uqaphele ukuthi umuthi odumile we-Type 2 sikashukela metformin (siofor, glucophage) ungasetshenziswa kuphela ngamanani wokuhlunga we-glomerular ngenhla kwe-60 ml / min / 1.73 m2. Uma umsebenzi wezinso wesiguli untekenteke, khona-ke ubungozi be-lactic acidosis buyinkinga enkulu. Ezimweni ezinjalo, i-metformin iyakhanselwa.
Uma ukuhlaziya kwesiguli kukhombisa ukuthi une-anemia, khona-ke kudingeka ukwelashwa, futhi lokhu kuzonciphisa ukuthuthukiswa kwe-nephropathy yesifo sikashukela. Isiguli sinqunyelwe izidakamizwa ezikhuthaza i-erythropoiesis, isb., Ukukhiqizwa kwamangqamuzana egazi abomvu kumongo wethambo. Lokhu akugcini nje ukwehlisa ingozi yokuhluleka kwezinso, kepha futhi ngokuvamile kuthuthukisa ikhwalithi yempilo jikelele. Uma onesifo sikashukela engakabi dialysis, izinsimbi zensimbi nazo zingabekwa.
Uma ukwelashwa kwe-prophylactic kwe-nephropathy yesifo sikashukela kungasizi, khona-ke ukwehluleka kwezinso kuba khona. Kulesi simo, isiguli kufanele sihlole i-dialysis, futhi uma kungenzeka, bese siyifaka kwenye indawo ukufakelwa kwezinso. Sine-athikili ehlukile yokufakelwa kwezinso, futhi sizoxoxa kafushane nge-hemodialysis kanye ne-peritoneal dialysis ngezansi.
I-Hemodialysis kanye ne-peritoneal dialysis
Ngesikhathi senqubo ye-hemodialysis, i-catheter ifakwa emthanjeni wesiguli. Ixhumeke kudivayisi yokuhlunga yangaphandle ehlanza igazi esikhundleni sezinso. Ngemuva kokuhlanza, igazi libuyiselwa egazini lesiguli. I-Hemodialysis ingenziwa kuphela esimweni sesibhedlela. Kungadala ukwehla kwengcindezi yegazi noma ukutheleleka.
I-Peritoneal dialysis kulapho ithubhu ingafakiwe khona emthanjeni, kepha ifakwe esiswini sesisu. Lapho-ke isamba esikhulu solo sinikezwa kuyo ngendlela yokudonsa. Lolu ketshezi olukhethekile oludonsa imfucuza. Ziyasuswa njengamanzi okuphuma emgodini. I-Peritoneal dialysis kumele yenziwe nsuku zonke. Ithwala ingozi yokutheleleka ezindaweni lapho ishubhu lingena khona esiswini sesisu.
Kwi-mellitus yesifo sikashukela, ukugcinwa kwe-fluid, ukuphazamiseka ku-nitrogen ne-electrolyte ibhalansi kukhula ngamanani aphezulu wokuhlunga kwama-glomerular. Lokhu kusho ukuthi iziguli ezinesifo sikashukela kufanele zishintshelwe ku-dialysis ngaphambili kuneziguli ezinamanye ama-renal pathologies. Ukukhethwa kwendlela ye-dialysis kuncike ekuthandweni kukadokotela, kodwa ezigulini akukho mehluko omkhulu.
Ungaqala nini ukwelashwa esikhundleni se-renal (i-dialysis noma ukufakelwa kwezinso) ezigulini ezinesifo sikashukela:
- Isilinganiso sokuhlunga se-glomerular <15 ml / min / 1.73 m2;
- Amazinga aphakanyisiwe we-potassium esegazini (> 6.5 mmol / L), angenakuncishiswa ngezindlela zokwelashwa ezilondolozayo;
- Ukugcinwa koketshezi oluningi emzimbeni ngengozi ye-pulmonary edema;
- Izimpawu ezisobala zokungondleki kahle kwamaprotheni.
Amasu okuhlolwa kwegazi kwiziguli ezinesifo sikashukela eziphathwa nge-dialysis:
- I-hemoglobin ye-Glycated - ngaphansi kwama-8%;
- I-hemoglobin yegazi - 110-120 g / l;
- I-Parathyroid hormone - 150-300 pg / ml;
- Iphosphorus - 1.13-1.78 mmol / L;
- I-calcium ephelele - 2.10-2.37 mmol / l;
- Umkhiqizo Ca × P = Ngaphansi kuka-4.44 mmol2 / l2.
Uma i-renal anemia ikhula ezigulini zikashukela ezinesifo sikashukela, kuvuselelwa izihluthulelo ze-erythropoiesis (epoetin-alpha, epoetin-beta, methoxypolyethylene glycol, epoetin-beta, epoetin-omega, darbepoetin-alpha), kanye namaphilisi wensimbi noma imijovo. Bazama ukugcina umfutho wegazi ngaphansi kwe-140/90 mm Hg. I-Art., I-ACE inhibitors ne-angiotensin-II receptor blockers ihlala izidakamizwa ezikhethayo ekwelapheni umfutho wegazi ophakeme. Funda isihloko esithi “Hypertension in Type 1 and Type 2 Diabetes” ngemininingwane ethe xaxa.
I-Hemodialysis noma i-peritoneal dialysis kufanele ibhekwe njengesinyathelo sesikhashana nje sokulungiselela ukufakelwa kwezinso. Ngemuva kokufakelwa kwezinso isikhathi sokusebenza kokufakelwa, isiguli selashwa ngokuphelele sesehluleki sezinso. I-nephropathy yesifo sikashukela iyaqina, ukusinda kweziguli kuyanda.
Lapho uhlela ukufakelwa kwezinso kushukela, odokotela bazama ukuhlola ukuthi kungenzeka kanjani ukuthi isiguli sibe nengozi yemithambo yegazi (isifo senhliziyo noma unhlangothi) ngesikhathi noma ngemuva kokuhlinzwa. Ukuze lokhu kwenzeke, isiguli sibhekana nokuhlolwa okuhlukahlukene, kufaka phakathi i-ECG enomthwalo.
Imvamisa imiphumela yalezi zivivinyo iveza ukuthi izikebhe ezondla inhliziyo kanye / noma ubuchopho zithinteka kakhulu yi-atherossteosis. Bheka isihloko esithi "iRenal Artery Stenosis" ngemininingwane. Kulokhu, ngaphambi kokufakelwa kwezinso kunconywa ukuthi kubuyiselwe ngokwengeziwe i-patency yale mikhumbi.
