Inkambo ende yesifo sikashukela iholela ezinkingeni ezihambisana nokukhuphuka kweglucose egazini elijikelezayo. Umonakalo wezinso uba khona ngenxa yokubhujiswa kwezinto zokuhlunga, okubandakanya ama-glomeruli kanye nama-tubules, kanye nemikhumbi ebondla.
I-nephropathy enkulu yesifo sikashukela iholela ekusebenzeni okunganele kwezinso kanye nesidingo sokuhlanza igazi usebenzisa i-hemodialysis. Ukudluliselwa kwezinso kuphela okungasiza iziguli ezikulesi sigaba.
Izinga le-nephropathy kusifo sikashukela linqunywa ukuthi ikunxephezela kanjani ukwanda koshukela wegazi kanye nomfutho wegazi ozinzile.
Izimbangela zokulimala kwezinso kushukela
Isici esiyinhloko esiholela ku-nephropathy yesifo sikashukela ukuphathwa kabi kwethoni ye-reter glomerular arterioles engenayo naphumayo. Esimweni esijwayelekile, i-arteriole iphindwe kabili ngokulingana ne-efferent, okudala ingcindezi ngaphakathi kwe-glomerulus, ekhuthaza ukungcola kwegazi ngokwenziwa komchamo oyinhloko.
Izinkinga zokushintshana kwesifo sikashukela i-mellitus (hyperglycemia) zinomthelela ekulahlekelweni yimithambo yegazi amandla nokuqina. Futhi, izinga eliphakeme likashukela egazini libangela ukugeleza okungapheli kwezicubu ukungena egazini, okuholela ekunwetshisweni kwemithambo yokulethwa, futhi labo abakwenzayo bagcina ubukhulu babo noma bube mncane.
Ngaphakathi kwe-glomerulus, ingcindezi iyakha, okuholela ekugcineni ekubhujisweni kokusebenza kwe-renal glomeruli kanye nokubuyiselwa kwabo ngezicubu ezixhunyiwe. Ingcindezi ephakeme ikhuthaza ukudlula ngokusebenzisa i-glomeruli of compounds okuvame ukungavunyelwe kuzo: amaprotheni, ama-lipid, amaseli egazi.
I-nephropathy yesifo sikashukela isekela umfutho wegazi ophakeme. Ngokucindezela okwanda njalo, izimpawu ze-proteinuria ziyanda kanye nokufayiliswa ngaphakathi kwezinso kunciphisa, okuholela ekuqhubekeni kokuhluleka kwe-renal.
Enye yezizathu ezibangela i-nephropathy kusifo sikashukela Ukudla okunokuqukethwe okunamaprotheni amaningi ekudleni. Kulokhu, izinqubo ezilandelayo ze-pathological zikhula emzimbeni:
- E-glomeruli, ingcindezi iyanda futhi ku-filtration kuyanda.
- Ukwanda kwamaprotheni e-Urinary kanye nokubekwa kwamaprotheni kuzicubu zezinso kuyanda.
- Isibuko se-lipid segazi siyashintsha.
- I-Acidosis iba ngenxa yokwanda kokuhlanganiswa kwezakhi ze-nitrogenous.
- Umsebenzi wezinto zokukhula usheshisa i-glomerulossteosis uyanda.
I-nephritis yesifo sikashukela iba nemvelaphi yeshukela likashukela eliphakeme. I-Hyperglycemia ayisho nje kuphela ekulimaleni okwedlulele emithanjeni yegazi ngama-radicals mahhala, kepha futhi inciphisa izakhiwo zokuvikela ngenxa ye-glycation yamaprotheni e-antioxidant.
Kulokhu, izinso zingezitho zezitho ezinokuzwela okwengeziwe kokucindezelwa kwe-oxidative.
Izimpawu ze-Nephropathy
Ukubonakaliswa komtholampilo kwe-nephropathy yesifo sikashukela kanye nokuhlukaniswa kwesigaba kukhombisa ukuqhubekela phambili kokubhujiswa kwezicubu zezinso kanye nokwehla kwamandla abo okususa izinto ezinobuthi egazini.
Isigaba sokuqala sivezwa ngokwanda kokusebenza kwezinso - izinga lokuhlunga komchamo landa ngo-20- 40% futhi lenyuka nokunikezwa kwegazi ezinso. Azikho izimpawu zomtholampilo kulesi sigaba se-nephropathy yesifo sikashukela, futhi ushintsho ezinso lubuyele kabusha ngokujwayelekile kwe-glycemia esondele kokujwayelekile.
Esigabeni sesibili, izinguquko ezihlelekile kwizicubu zezinso ziqala: ulwelwesi olungaphansi lwe-glomerular basement bese lukhula luvuleke kumamolekyuli amancane kakhulu amaprotheni. Azikho izimpawu zesifo, ukuhlolwa komchamo kuyinto eyejwayelekile, umfutho wegazi awuguquki.
I-nephropathy yesifo sikashukela sesigaba se-microalbuminuria ibonakaliswa ngokukhishwa kwe-albhamuin ngenani lezinsuku ezingama-30 kuye kwangama-300 mg. Ngohlobo 1 sikashukela, kwenzeka eminyakeni engama-3-5 ngemuva kokuqala kwesifo, kanti i-nephritis yohlobo 2 lwesifo sikashukela ingahambisana nokuvela kwamaprotheni omchamo kusukela ekuqaleni.
Ukuqina okukhona kwe-glomeruli yezinso zamaprotheni kuhlobene nezimo ezinjalo:
- Isinxephezelo sesifo sikashukela esibi.
- Umfutho wegazi ophakeme.
- I-cholesterol ephezulu yegazi.
- Ama-Micro and macroangiopathies.
Uma kulesi sigaba ukulungiswa okuzinzile kwezinkomba eziqondiwe ze-glycemia kanye nomfutho wegazi kutholakala, khona-ke isimo se-renal hemodynamics nokuqina kwemithambo kusengabuyiselwa kokujwayelekile.
Isigaba sesine yi-proteinuria engaphezulu kwama-300 mg ngosuku. Kwenzeka ezigulini ezinesifo sikashukela ngemuva kweminyaka engu-15 zokugula. Ukuhlunga kwe-glomerular kuyancipha njalo ngenyanga, okuholela ekwehlulekeni kwe-renal esibulala emva kweminyaka engama-5-7. Izimpawu ze-nephropathy zesifo sikashukela kulesi sigaba zihambisana nomfutho wegazi ophakeme kanye nokulimala kwemithambo.
Ukuxilongwa okuhlukile kwe-nephropathy yesifo sikashukela nephritis, imvelaphi yokulwa nezifo noma amagciwane kususelwa eqinisweni lokuthi i-nephritis kwenzeka ngokuvela kwe-leukocytes kanye ne-erythrocyte emchameni, kanye nephropathy yesifo sikashukela kuphela nge-albhamuinuria.
Ukuxilongwa kwe-nephrotic syndrome futhi kuthola ukwehla kwamaprotheni egazi kanye ne-cholesterol ephezulu, i-lipoproteins ephansi kwabantu.
I-Edema ku-nephropathy yesifo sikashukela iyamelana ne-diuretics. Baqala ukubonakala kuphela ebusweni nasemlenzeni ophansi, bese benwebela esiswini nasesifubeni, kanye ne-pericardial sac. Iziguli ziya ngokuya buthakathaka, isicanucanu, ukuphefumula, ukuhluleka kwenhliziyo kuyajoyina.
Njengomthetho, i-nephropathy yesifo sikashukela ihlangana ngokuhlangana ne-retinopathy, i-polyneuropathy kanye nesifo senhliziyo. I-Autonomic neuropathy iholela esimweni esibuhlungu se-infyoction ye-myocardial, i-atony yesinye, i-orthostatic hypotension kanye ne-erectile dysfunction. Lesi sigaba sithathwa njengento engenakuphikwa, ngoba ama-glomeruli angaphezu kwama-50% abhujisiwe.
Ukuhlukaniswa kwe-nephropathy yesifo sikashukela kuhlukanisa isigaba sesihlanu sokugcina njenge-uremic. Ukwehluleka kwezinhlungu okungamahlalakhona kubonakaliswa ngokwanda kwegazi lezinhlanganisela ezinobuthi ze-nitrogenous - i-creatinine ne-urea, ukwehla kwe-potassium kanye nokwanda kwe-serum phosphates, ukwehla kwezinga lokuhlunga le-glomerular.
Izimpawu ezilandelayo ziimpawu ze-nephropathy zesifo sikashukela esisezingeni lokwehluleka kwezinso:
- I-hypertension ye-arterial ethuthukayo.
- Isifo se-edematous syndrome.
- Ukuphefumula, i-tachycardia.
- Izimpawu ze-pulmonary edema.
- Ukuphazamiseka kwemizwa okuqinile kwesifo sikashukela i-mellitus.
- I-Osteoporosis
Uma ukuhlunga kwe-glomerular kwehla kuze kufike ku-7-10 ml / min, khona-ke ukulunywa, ukugabha nokuphefumula okunomsindo kungaba yizimpawu zokudakwa.
Ukuzimisela komsindo wokuqhekeka kwengqondo kuwuphawu lwesigaba esibulalayo futhi kudinga ukuxhumeka kwesiguli ngokushesha kwizixhobo ze-dialysis kanye nokufakelwa kwezinso.
Izindlela zokuthola i-nephropathy kushukela
Ukuxilongwa kwe-nephropathy kwenziwa ngesikhathi sokuchama kwe-glomerular filtration rate, ukuba khona kwamaprotheni, amaseli amhlophe egazi namaseli abomvu egazi, kanye ne-creatinine ne-urea egazini.
Izimpawu ze-nephropathy zesifo sikashukela zinganqunywa ngokuqhekeka kweReberg-Tareev ngokuqukethwe kwe-creatinine kumchamo wansuku zonke. Esikhathini sokuqala, ukuhlunga kukhuphuka amahlandla ama-2-3 kuye kuma-200-300 ml / min, bese kwehla okuphindwe kayishumi lapho lesi sifo siqhubeka.
Ukubona i-nephropathy yesifo sikashukela enezimpawu zayo ezingakakhombisi, kutholakala ukuthi i-microalbuminuria iyatholakala. I-Urinalysis yenziwa ngokumelene nesizinda sesinxephezelo se-hyperglycemia, amaprotheni alinganiselwe ekudleni, ama-diuretics kanye nokuzivocavoca komzimba awafakiwe.
Ukuvela kwe-proteinuria ephikelelayo kuwubufakazi bokufa kwama-50-70% we-glomeruli yezinso. Isibonakaliso esinjalo singadala i-nephropathy yesifo sikashukela kuphela, kodwa futhi nephritis yemvelaphi yokuvuvukala noma ye-autoimmune. Ezimweni ezingabazisayo, i-percutaneous biopsy iyenziwa.
Ukuthola izinga lokuhluleka kwe-renal, i-urea yegazi ne-creatinine iyahlolwa. Ukunyuka kwabo kukhombisa ukuqala kokwehluleka kwezinso okungamahlalakhona.
Izindlela zokuvimbela nokwelashwa kwe-nephropathy
Ukuvimbela i-nephropathy kungabantu abanesifo sikashukela abanobungozi obukhulu bokulimala kwezinso. Lokhu kufaka phakathi iziguli ezine-hyperglycemia, isifo esihlala isikhathi esingaphezu kweminyaka emi-5, ukulimala kwe-retina, i-cholesterol ephezulu, uma esikhathini esidlule isiguli sasiba nephritis noma kutholakale ukuthi sine-hyperfiltration yezinso.
Uhlobo lwe-1 yesifo sikashukela, i-nephropathy yesifo sikashukela ivinjelwa ukwelashwa kwe-insulin okuqinisiwe. Kufakazelwa ukuthi ukugcinwa okunjalo kwe-hemoglobin ye-glycated, njengezinga elingaphansi kuka-7%, kunciphisa ubungozi bomonakalo emithanjeni yezinso ngamaphesenti angama-27-34. Kuhlobo 2 sikashukela mellitus, uma umphumela onjalo ungeke utholakale ngamaphilisi, iziguli zidluliselwa kwi-insulin.
Ukwelashwa kwe-nephropathy yesifo sikashukela esiteji se-microalbuminuria nakho kwenziwa ngesinxephezelo esifanele esifanele sesifo se-carbohydrate metabolism. Lesi sigaba esokugcina lapho unganciphisa khona kwesinye isikhathi futhi ngesinye isikhathi izimpawu eziphikisayo nokwelashwa kuletha umphumela oqondile obonakalayo.
Izikhombisi-ndlela eziphambili zokwelapha:
- Ukwelashwa kwe-insulin noma ukwelashwa okuhlanganisa ne-insulin namathebulethi. Isikhombisi yi-glycated hemoglobin engaphansi kuka-7%.
- Ama-inhibitors we-eniotensin-converting enzyme: ekucindezelweni okujwayelekile - imithamo ephansi, enokwelashwa okuphakathi okuphezulu.
- Ukuhlelwa ngokweqile kwe-cholesterol yegazi.
- Ukunciphisa amaprotheni ekudleni ku-1g / kg.
Uma ukuxilongwa kukhombisa isigaba se-proteinuria, khona-ke i-nephropathy yesifo sikashukela, ukwelashwa kufanele kususelwe ekuvimbeleni ukukhula kwehluleki lwezinso okungamahlalakhona. Lokhu, ohlotsheni lokuqala lwesifo sikashukela, ukwelashwa kwe-insulin okunamandla kuyaqhubeka, futhi nokukhethwa kwamacwecwe ukunciphisa ushukela, umphumela wawo we-nephrotoxic kumele ungafakwa. Kokuqokwa okuphephe kakhulu kweGlurenorm neDiabetes. Futhi, ngokusho kwezinkomba, ngesifo sikashukela sohlobo 2, ama-insulin anqunywa ngaphezu kokwelashwa noma adluliselwa ngokuphelele ku-insulin.
Ukucindezela kunconywa ukuthi kugcinwe ku-130/85 mm Hg. Ubuciko. Ngaphandle kokufinyelela izinga elijwayelekile lomfutho wegazi, isinxephezelo se-glycemia nama-lipid egazini akulethi umphumela ongafuneki, futhi akunakwenzeka ukumisa ukuqhubeka kwe-nephropathy.
Umsebenzi omkhulu wokwelapha kanye nomphumela we-nephroprotective wabonwa kuma-inhibitors we-angiotensin-converting. Bahlanganiswe nama-diuretics nama-beta-blockers.
Amazinga we-cholesterol yegazi ancishiswa ngokudla, ukwenqaba utshwala, ukwanda komsebenzi womzimba. Uma kungakapheli izinyanga ezi-3 ama-lipids egazi engajwayelekile, khona-ke ama-fibrate nama-statin anqunyelwe. Okuqukethwe ngamaprotheni ezilwane ekudleni kuncishiselwa ku-0,7 g / kg. Lokhu kukhawulelwa kusiza ukunciphisa umthwalo ezinso futhi kunciphise nephrotic syndrome.
Esigabeni lapho i -umbeinine yegazi iphakanyiselwe ku-120 nangaphezulu i-μmol / L, ukwelashwa okubonakalayo kokudakwa, umfutho wegazi ophakeme, kanye nokwephulwa kokuqukethwe kwe-electrolyte esegazini kwenziwa. Kumanani angenhla kwama-500 μmol / L, isigaba sokuntuleka okungapheli sithathwa njenge-ukuphela, esidinga ukuxhunyaniswa kwezinso okwenziwe into esetshenziswayo.
Izindlela ezintsha zokuvimbela ukukhula kwe-nephropathy yesifo sikashukela zifaka ukusetshenziswa komuthi ovimbela ukubhujiswa kwe-glomeruli yezinso, okuthinta ukuqina kolwelwesi olungaphansi. Igama lalesi sidakamizwa ngu-Wessel Douet F. Ukusetshenziswa kwalo kuvunyelwe ukunciphisa ukuphuma kwe-protein emchameni futhi umphumela waqhubeka izinyanga ezi-3 ngemuva kokukhanselwa.
Ukutholwa kwekhono le-aspirin lokunciphisa i-protein glycation kuholele ekufuneni izidakamizwa ezintsha ezinomphumela ofanayo, kepha zilahlekelwe yimiphumela ecasulayo kulwelwesi lwama-mucous. Lokhu kufaka i-aminoguanidine ne-vithamini B6. Imininingwane nge-nephropathy yesifo sikashukela inikezwe kuvidiyo ekulesi sihloko.
