Ngeshwa, isifo sikashukela sivame ukudala izinkinga zezinso, futhi ziyingozi kakhulu. Ukulimala kwezinso ngesifo sikashukela kunikeza isiguli izinkinga ezinkulu. Ngoba ekwelapheni ukwehluleka kwe-renal, izinqubo ze-dialysis kufanele zenziwe njalo. Uma unenhlanhla ngokwanele yokuthola onikelayo, khona-ke enza umsebenzi wokuhambisa izinso. Isifo sezinso kusifo sikashukela kwesinye isikhathi sibangela ukufa kweziguli.
Uma isifo sikashukela sihle ngokulawula ushukela wegazi, khona-ke izingqinamba zezinso zingagwenywa.
Izindaba ezimnandi ukuthi, uma ugcina ushukela wegazi lakho usondele kokujwayelekile, cishe ungakuvikela ukulimala kwezinso. Ukuze wenze lokhu, udinga ukuzibandakanya ngamandla empilweni yakho.
Futhi uzokujabulela ukuthi izindlela zokuvikela isifo sezinso ziyasiza ukuvikela ezinye izinkinga zesifo sikashukela.
Isifo sikashukela sidala kanjani ukulimala kwezinso
Enganeni ngayinye, umuntu unamakhulu ezinkulungwane ezibizwa nge- “glomeruli”. Lezi izihlungi ezihlanza igazi lokungcola kanye nobuthi. Igazi lidlula ngaphansi kwengcindezi ngama-capillaries amancane e-glomeruli bese liyahlungwa. Ubuningi boketshezi nezakhi zegazi ezijwayelekile zibuyela emzimbeni. Futhi imfucuza, kanye nenani elincane lamanzi, kudlula kusuka ezinsweni kuya kwesinye. Ngemuva kwalokho asuswa ngaphandle ngokusebenzisa i-urethra.
Esikhathini sikashukela, igazi elinokuqukethwe okunoshukela omningi kudlula ezinso. I-glucose idonsa uketshezi oluningi, olubangela ingcindezi eyandayo ngaphakathi kwe-glomerulus ngayinye. Ngakho-ke, isilinganiso sokuhlunga kwe-glomerular - lokhu kuyinkomba ebalulekile yekhwalithi yezinso - kuvame ukwanda ezigabeni zokuqala zesifo sikashukela. I-glomerulus izungezwe isicubu esibizwa nge- “glomerular basement membrane”. Futhi lo membrane uqina ngokungananazi, njengamanye izicubu ezisondelene nawo. Ngenxa yalokhu, ama-capillaries ngaphakathi kwe-glomeruli adonswa kancane kancane. I-glomeruli engasebenzi kancane ihlala isebenza, okubi kakhulu kwizinso ukuhlunga igazi. Njengoba izinso zomuntu zinesibalo esikhulu se-glomeruli, inqubo yokuhlanzwa kwegazi iyaqhubeka.
Ekugcineni, izinso zichithekile kangangokuba zivele Izimpawu zokuhluleka kwezinso:
- ubuqili;
- ikhanda
- ukuhlanza
- isifo sohudo
- isikhumba;
- ukunambitheka kwensimbi emlonyeni;
- ukuphefumula okubi, ukukhumbuza iphunga lomchamo;
- ukuphefumula, ngisho nokuzivocavoca umzimba okuncane kanye nesimo sokuphumula;
- ukugoba nokuguguleka emilenzeni, ikakhulukazi kusihlwa, ngaphambi kokulala;
- ukulahlekelwa ukwazi.
Lokhu kwenzeka, njengomthetho, ngemuva kweminyaka engu-15- 20 yesifo sikashukela, uma ushukela wegazi ugcinwe waphakanyiswa, isb. Isifo sikashukela saphathwa kabi. I-Uricemia iyenzeka - ukunqwabelana kokungcola kwe-nitrogen egazini lapho izinso ezithintekile zingasakwazi ukuhlunga.
Ukuhlaziywa nokuhlolwa kwezinso kusifo sikashukela
Ukubheka izinso zakho ngesifo sikashukela, udinga ukuthatha lezi zivivinyo ezilandelayo
- ukuhlolwa kwegazi kwe-creatinine;
- ukuhlaziywa komchamo we-albhamuin noma i-microalbumin;
- i-urinalysis ye-creatinine.
Ukwazi izinga le-creatinine egazini, ungbala isilinganiso sokuhlunga kwe-glomerular yezinso. Babuye bathola ukuthi ngabe kukhona i-microalbuminuria noma cha, futhi isilinganiso se-albhamuin sokwenza i-creatinine emchini siyabalwa. Ukuthola imininingwane eminingi ngazo zonke lezi zivivinyo nezinkomba zomsebenzi wezinso, funda okuthi "Yiziphi izivivinyo okufanele uzenze ukuze uhlole izinso" (kuvula ewindini elihlukile).
Isibonakaliso sokuqala kwezinkinga zezinso kusifo sikashukela yi-microalbuminuria. I-Albumin yiprotheni enamamolekyuli amancane ububanzi. Izinso ezinempilo zedlulisela inani elincanyana kakhulu emchameni. Lapho nje umsebenzi wabo usiba mubi ngisho nangaphezulu, kune-albhamuin engaphezulu yomchamo.
Izinkomba zokuxilonga ze-albhamuinuria
| I-Albuminuria kumchamo wasekuseni, mcg / min | I-Albuminuria ngosuku, mg | Ukuhlushwa kwe-albhamuin kumchamo, mg / l | Isilinganiso se-albhamuin / umchamo we-creatinine, mg / mol | |
|---|---|---|---|---|
| I-Normoalbuminuria | < 20 | < 30 | < 20 | I-2,5 yabesilisa ne <3.5 yabesifazane |
| I-Microalbuminuria | 20-199 | 30-299 | 20-199 | I-2.5-25.0 yamadoda ne-3.5-25.0 yabesifazane |
| Macroalbuminuria | >= 200 | >= 300 | >= 200 | > 25 |
Kufanele wazi ukuthi inani elandayo le-albhamuin kumchamo kungenzeka lingabangelwa ukulimala kwezinso kuphela. Uma izolo bekukhona umsebenzi obalulekile womzimba, namuhla i-albhamuinuria ingaba phezulu kunokwejwayelekile. Lokhu kumele kubhekwe lapho uhlela usuku lokuhlaziywa. I-Albuminuria nayo iyanda: ukudla okunamaprotheni amaningi, umkhuhlane, izifo ezithinta umchamo, ukuhluleka kwenhliziyo, ukukhulelwa. Isilinganiso se-albhamuin edalwe wumchamo womchamo uyinkomba ethembeke kakhulu yezinkinga zezinso. Funda kabanzi ngakho lapha (kuvula ngewindi elihlukile)
Uma isiguli esinesifo sikashukela sitholakala futhi siqinisekiswa kaninginingi nge-microalbuminuria, lokhu kusho ukuthi unengozi eyengeziwe yokungahluleki kwezinso kuphela, kodwa nesifo senhliziyo. Uma kungenakwelashwa, lapho kamuva umthamo wezinso uhlunga kakhulu, futhi amanye amaphrotheni osayizi omkhulu aqhamuka umchamo. Lokhu kubizwa ngokuthi yi-proteinuria.
Okubi lapho ukusebenza kwezinso kusebenza, khona lapho i-creatinine inqwabelana egazini. Ngemuva kokubala inani lokuhlunga le-glomerular, kungenzeka ukunquma ukuthi ukulimala kwezinso kweziguli kuyinto ngasiphi isigaba.
Izigaba zesifo sezinso esingamahlalakhona, kuya ngesilinganiso se-glomerular filtration rate
Isigaba sokulimala kwezinso | Izinga lokuhlunga le-glomerular (GFR), ml / min / 1.73 m2 |
|---|---|
Norm | > 90 |
1 | > 90, ngezivivinyo ezibonisa ubufakazi bezinkinga zezinso |
2 | 60-90 - ukulimazeka okuncane kwezinso |
3-A | I-45-59 - ukulimala kwezinso okulinganiselwe |
3-in | I-30-44 - ukulimala kwezinso okulinganiselwe |
4 | 15-16 - ukulimazeka okukhulu kwe-reso |
5 | <15 noma i-dialysis - Ukwehluleka kwezinhlungu okungamahlalakhona |
Amanothi etafuleni. Ubufakazi bezinkinga zezinso obukhombisa ukuhlolwa nokuhlolwa. Kungaba:
- i-microalbuminuria;
- i-proteinuria (ukuba khona kwamamolekyuli amakhulu kumchamo);
- igazi kumchamo (ngemuva kokuba sekukhishwe zonke ezinye izimbangela);
- ukuhlukunyezwa kwesakhiwo, okukhombisa i-ultrasound yezinso;
- glomerulonephritis, eyaqinisekiswa yi-biopsy yezinso.
Njengomthetho, izimpawu ziqala ukuvela kuphela esigabeni sesi-4 sesifo sezinso esingamahlalakhona. Futhi zonke izigaba zangaphambili ziyaqhubeka ngaphandle kokuboniswa kwangaphandle. Uma kuvela ukuthi uthola izinkinga zezinso zisencane futhi aqale ukwelashwa ngesikhathi, lapho-ke ukukhula kokuhluleka kwe-renal kuvame ukuvinjelwa. Futhi, sincoma ngokuqinile ukuthi uthathe izivivinyo zakho njalo okungenani ngonyaka, njengoba kuchazwe esigabeni esithi "Yiziphi izivivinyo okufanele uzithathe ukuze uhlole izinso zakho." Ngaso leso sikhathi, ungabheka namazinga e-urea ne-uric acid egazini.
Thayipha izibhebhe zesifo sikashukela ezi-2 ezivunyelwe ukuthi zisetshenziswe ezigabeni ezahlukahlukene zesifo sezinso
| Izidakamizwa | Izigaba zokulimala kwezinso, okuvunyelwe kuzo ukuthi zisebenze |
|---|---|
| I-Metformin (Siofor, Glucofage) | 1-3a |
| I-Glibenclamide, kufaka phakathi i-micronized (Maninyl) | 1-2 |
| I-Gliclazide ne-Gliclazide MV (Glidiab, Actos) | 1-4* |
| I-Glimepiride (Amaryl) | 1-3* |
| I-Glycvidone (Glurenorm) | 1-4 |
| I-Glipizide, kufaka phakathi isikhathi eside (i-Movogleken, i-Glibens retard) | 1-4 |
| I-Repaglinide (NovoNorm, Diagninid) | 1-4 |
| I-Nateglinide (Starlix) | 1-3* |
| I-pioglitazone (Aactos) | 1-4 |
| I-Sitagliptin (Januvius) | 1-5* |
| I-Vildagliptin (Galvus) | 1-5* |
| I-Saxagliptin (Onglisa) | 1-5* |
| I-Linagliptin (Trazhenta) | 1-5 |
| I-Exenatide (Baeta) | 1-3 |
| I-Liraglutid (Victoza) | 1-3 |
| I-Acarbose (Glucobai) | 1-3 |
| Insulin | 1-5* |
Qaphela etafuleni.
* Emazingeni ama-4-5 wokulimala kwezinso, udinga ukulungisa umthamo womuthi. Futhi, njengoba isifo sezinso siqhubeka, ukwehlukana kwe-insulin emzimbeni kuncipha. Lokhu kwandisa ubungozi be-hypoglycemia. Ngakho-ke, imithamo ye-insulin idinga ukulungiswa ibheke phansi.
Iziguli ezisengozini yokuthola ukwehluleka kwezinso.
| Izinhlobo zeziguli | Kufanele ihlolwe kangaki |
|---|---|
| Thayipha iziguli ezinesifo sikashukela ezi-1 ezigula zisencane noma ngemuva kokuthomba | Eminyakeni engu-5 ngemuva kokuqala kwesifo sikashukela, bese kuba njalo ngonyaka |
| Thayipha iziguli ezinesifo sikashukela ezi-1 ezigula ngesikhathi sokuthomba | Ngokushesha phezu kokuxilongwa, bese kuba njalo ngonyaka |
| Uhlobo lweziguli zesifo sikashukela sohlobo 2 | Ngokushesha phezu kokuxilongwa, bese kuba njalo ngonyaka |
| Abesifazane abakhulelwe abanesifo sikashukela noma sikashukela sokukhulelwa | Isikhathi esingu-1 kwi-trimester |
Ukuvimbela ukulimala kwezinso kushukela
Isifo sezinso esingamahlalakhona siba cishe e-1/3 yeziguli ezinesifo sohlobo 1 nohlobo 2, okungukuthi, kude kakhulu nazo zonke. Ukuthi uzithola kanjani izimpawu zokuhluleka kwezinso kuya ngemiphumela yokuhlolwa esikuchazile esigabeni esedlule. Thatha izivivinyo bese uxoxa ngemiphumela yabo nodokotela wakho.
Ongakwenza ukuvikela ukulimala kwezinso kushukela:
- gcina ushukela wegazi usondele kokujwayelekile - lento ebaluleke kakhulu
- funda isihloko esithi “Ukudla kwezinso ezinesifo sikashukela”;
- ukukala njalo umfutho wegazi ekhaya nge-tonometer (ukuthi ungayenza kanjani ngendlela efanele ukuze umphumela unembe);
- umfutho wegazi lakho kufanele ube ojwayelekile, ngaphansi kuka-130/80;
- thatha izivivinyo ezihlola umsebenzi wezinso okungenani isikhathi esisodwa ngonyaka;
- yenza konke okudingekile ukulawula ushukela, umfutho wegazi, i-cholesterol namafutha egazi, kubandakanya nokuthatha imithi enqunywe ngudokotela wakho;
- bambelela ekudleni okulungile kwesifo sikashukela (kule ndaba, izincomo ze- "ezisemthethweni" zihluke kakhulu kwezethu, funda ngezansi kulesi sihloko);
- ukuzibandakanya ekwelashweni okujwayelekile kokuzivocavoca, zama ukuzivocavoca kwasekhaya ngama-dumbbells akhanyayo, aphephile ngokuphelele ezinso;
- phuza utshwala “ngokomfanekiso,” ungalokothi udakwe;
- yekela ukubhema;
- thola udokotela omuhle ozohola "ushukela wakho", bese uya kuye njalo.
Ucwaningo lufakazele ngokukholisayo ukuthi ukubhema ngokwako kuyisici esibalulekile esandisa ingozi yokuthola ukwehluleka kwezinso kushukela. Ukuyeka ukubhema akusona isincomo esisemthethweni, kepha yisidingo esiphuthumayo.
Ukwelashwa kwesifo sezinso
Udokotela unquma ukwelashwa kwezinso ngesifo sikashukela, kuya ngokuthi yisigaba sini isigaba sabo. Umthwalo wemfanelo oyinhloko wokwenza ukuqokwa kulele nesiguli. Okuthile futhi kuncike kumalungu omndeni wakhe.
Sibala izindawo eziphambili zokwelapha izifo zezinso kushukela:
- ukulawula okukhulu ushukela wegazi;
- kwehlise umfutho wegazi kufinyelela ezingeni lokuhlosiwe le-130/80 mm RT. Ubuciko. nangaphansi;
- Ukugcina ukudla okwanele kwezinkinga zezinso ezinesifo sikashukela;
- Ukulawulwa kwe-cholesterol ne-triglycerides (amafutha) egazini;
- ukuhlohla;
- ukufakelwa kwezinso.
Isihloko esithi "Diabetesic Nephropathy" sikhuluma ngokwelashwa kwezifo zezinso sikashukela ngemininingwane eminingi. Bheka futhi "Ukudla ngezinso ezinesifo sikashukela."
Isifo sikashukela nezinso: okudingeka ukukhumbule
Uma kunezinkinga nezinso, khona-ke ukuhlolwa kwegazi kwe-creatinine nomchamo we-microalbuminuria kungazithola kusenesikhathi. Uma ukwelashwa kuqalwa ngesikhathi, lokhu kwandisa kakhulu amathuba okuphumelela. Ngakho-ke, izivivinyo ezichazwe lapha (zivula ewindini elihlukile) kufanele zilethwe njalo ngonyaka. Cabanga ukusebenzisa ukudla okune-carbohydrate ephakeme ukwenza ushukela wakho wegazi ube ngokujwayelekile. Funda kabanzi esihlokweni esithi "Ukudla ngezinso ezinesifo sikashukela."
Kwabanesifo sikashukela abaningi abanomfutho wegazi ophakeme, ngaphezu kwemithi, ukukhawulela usawoti ekudleni kwabo kuyasiza. Zama ukunciphisa ukudonsa kwakho kwe-sodium chloride, isb. Usawoti wethebula, futhi uhlole ukuthi yimiphi imiphumela oyitholayo. Umuntu ngamunye unomuzwa wakhe ngamunye kasawoti.
Enye inkinga, i-neuropathy yesifo sikashukela, ingalimaza izinzwa ezilawula isinye. Kulesi simo, umsebenzi wokukhipha ibhethri uphazamisekile. Umchamo, ohlala ngaso sonke isikhathi, ukutheleleka okulimaza izinso kunganda. Ngasikhathi sinye, kubantu abanesifo sikashukela abakwazi ukuguqula ushukela wegazi labo, i-neuropathy imvamisa ibuye ibuyele emuva, i.e., idlula ngokuphelele.
Uma unenkinga yokuchama noma ezinye izimpawu zokutheleleka kwe-umchamo, bheka udokotela wakho ngokushesha. Lezi zinkinga zingasheshisa kakhulu ukuthuthukiswa kwezinkinga zezinso ezinesifo sikashukela.
