Ku-mellitus yesifo sikashukela, ukukhiqizwa kwe-insulin kuyaphazamiseka noma ukumelana nezicubu kukhula. I-glucose ayikwazi ukungena kwizitho zomzimba futhi ijikeleze egazini.
Ukuntuleka kwe-glucose, njengenye yezinto zokwakha zamandla, kuholela ekuphazamisweni kokusebenza kwezitho nezinhlelo emzimbeni, futhi ukweqisa kwayo egazini kulimaza imithambo yegazi, imicu yezinzwa, isibindi nezinso.
Ukulimala kwezinso kusifo sikashukela kuyizinga eliphakeme kakhulu lezinkinga eziyingozi, ukwehluleka kokusebenza kwazo kuholela kwisidingo se-hemodialysis kanye nokufakelwa kwezinso. Lokhu kuphela okungasindisa izimpilo zeziguli.
Zilimala kanjani izinso kushukela?
Ukuhlanzwa kwegazi kudoti kwenzeka ngokusebenzisa isihlungi esikhethekile sezinso.
Indima yayo yenziwa yi-renal glomeruli.
Igazi elivela emithanjeni ezungeze i-glomeruli lidlula ngaphansi kwengcindezi.
Iningi loketshezi kanye nezakhamzimba ziyabuyiswa, kuthi imikhiqizo yemetabolic ngokusebenzisa ama-ureters kanye nesinye isuke idedelwe.
Ngaphezu kokuhlanza igazi, izinso zenza imisebenzi ebalulekile:
- Ukukhiqizwa kwe-erythropoietin, okuthinta ukwakheka kwegazi.
- I-synthesis ye-renin, elawula umfutho wegazi.
- Ukulawulwa kokushintshaniswa kwe-calcium ne-phosphorus, okufakiwe ekwakhekeni kwezicubu zamathambo.
Ushukela wegazi ubangela i-glycation yamaprotheni. Kubo, ama-antibodies aqala ukukhiqizwa emzimbeni. Ngaphezu kwalokho, ngokuphendula okunjalo, ukubalwa kweplatelet kuyakhuphuka egazini kanye namafomu amancane egazi.
Amaprotein asefomu le-glycated angavuza izinso, futhi ingcindezi eyandayo iyasheshisa le nqubo. Amaprotheni anqwabelana ezindongeni zama-capillaries naphakathi kwawo ezicutshini zezinso. Konke lokhu kuthinta ukuvama kwama-capillaries.
Egazini leziguli ezinesifo sikashukela kuneglucose eyeqile, okuthi, uma idlula ku-glomerulus, ithathe uketshezi oluningi ngayo. Lokhu kwandisa ingcindezi ngaphakathi kwe-glomerulus. Izinga lokuhlunga le-glomerular liyanda. Esigabeni sokuqala sikashukela, kuyanda, bese kancane kancane siqala ukuwa.
Ngokuzayo, ngenxa yomthwalo oqhubekayo ezingweni ezinesifo sikashukela, ingxenye ye-glomeruli ayimelani nokugcwala ngokweqile futhi iyafa. Lokhu kuholela ekunciphiseni kokuhlanzwa kwegazi nokukhula kwezimpawu zokuhluleka kwe-renal.
Izinso zinesibalo esikhulu se-glomeruli, ngakho-ke le nqubo ihamba kancane, futhi izimpawu zokuqala zokulimala kwezinso kushukela zivame ukutholakala kungakapheli iminyaka emihlanu kusukela ekuqaleni kwalesi sifo. Lokhu kufaka phakathi:
- Ubuthakathaka obujwayelekile, ukushesha komoya ekusetshenzisweni okuncane.
- I-Lethargy ne-ukozela.
- Ukuqina okuqhubekayo kwemilenze nangaphansi kwamehlo.
- Umfutho wegazi ophakeme.
- Ukwehla ushukela wegazi.
- Isicanucanu, ukuhlanza.
- Isihlalo esingazinzile ngokushintshana kokugomela kanye nesifo sohudo.
- Imisipha yamathole ibuhlungu, imilenze iminyene, ikakhulukazi kusihlwa.
- Ukulunywa kwesikhumba.
- Ukunambitha kwensimbi emlonyeni.
- Kungenzeka kube nephunga lomchamo eliphuma emlonyeni.
Isikhumba siphuzi, sibe nombala ophuzi noma womhlaba.
Ukuxilongwa kwelebhu ukulimala kwezinso
Ukunqunywa kwezinga lokuhlunga le-glomerular (ukuhlolwa kweReberg). Ukubona ubungako bomchamo obukhishwe ngomzuzu, bekuqoqwa umchamo wansuku zonke. Kuyadingeka ukwazi kahle isikhathi lapho umchamo uqoqwe khona. Ngemuva kwalokho, izinga lokuhlunga libalwa kusetshenziswa amafomula.
Inkomba ejwayelekile yokusebenza kwezinso ingaphezu kwe-90 ml ngomzuzu, ifike ku-60 ml - umsebenzi umi kancane, ufike kuma-30 - ukulimala kwezinso okulinganiselwe. Uma ijubane lehla laya ku-15, lapho-ke kutholakala ukuthi kutholakala ukuhluleka kwe-renal okungamahlalakhona.
Ukuhlaziywa kwe-urine kwe-albhamuin. I-Albumin yincane kunawo wonke ama-protein omchamo. Ngakho-ke, ukutholwa kwe-microalbuminuria kumchamo kusho ukuthi izinso zilimele. I-Albuminuria iba ne-nephropathy kwiziguli ezinesifo sikashukela i-mellitus, izibonakalisa nangosongo lokuqalwa kwe-myocardial infarction kanye nesifo sohlangothi.
Imvamisa ye-albhamuin kumchamo ingafika kuma-20 mg / l, aze afike ku-200 mg / l atholakala ene-microalbuminuria, ngaphezulu kwama-200 - macroalbuminuria kanye nokulimala kwezinso okunzima.
Ngaphezu kwalokho, i-albhamuinuria ingenzeka ngokungabekezelelani kokuzala kwe-glucose, izifo ze-autoimmune, umfutho wegazi ophakeme. Kungadala ukuvuvukala, amatshe ezinso, i-cysts, i-glomerulonephritis engapheli.
Ukuthola izinga lokulimala kwezinso kushukela, udinga ukwenza isifundo:
- Ukuhlolwa kwegazi kwe-biochemical for creatinine.
- Ukunqunywa kwezinga lokuhlunga le-glomerular.
- Ukuhlaziywa kwe-urine kwe-albhamuin.
- I-Urinalysis ye-creatinine.
- Ukuhlolwa kwegazi kwe-creatinine. Umkhiqizo wokugcina we-protein metabolism yi-creatinine. Amazinga weCreatinine angakhuphuka ngokuncipha kokusebenza kwezinso nokuhlanzwa kwegazi okunganele. Ngokwesifo sezinso, i-creatinine ingakhula ngokuzikhandla okukhulu ngokomzimba, ubukhulu bokudla kwenyama ekudleni, ukomisa, kanye nokusebenzisa umuthi olimaza izinso.
Amanani ajwayelekile kwabesifazane aqhamuka kuma-microsol / l angama-53 kuya kwangama-106, emadodeni kusuka kuma-71 kuye kwangama-115 micromol / l.
4. Ukuhlaziywa kwe-urine ye-creatinine. I-Creatinine esegazini ikhishwa yizinso. Uma kwenzeka umsebenzi wezinso ongasebenzi kahle, ngokuzikhandla okukhulu ngokomzimba, izifo, ukudla ikakhulukazi imikhiqizo yenyama, izifo ze-endocrine, amazinga e-creatinine akhuphuka.
Okujwayelekile kuma-mmol ngosuku kwabesifazane ngu-5.3-15.9; kwabesilisa 7.1 - 17.7.
Ukuhlolwa kwedatha evela kulezi cwaningo kwenza ukuthi sikwazi ukwenza izibikezelo: kungenzeka kanjani ukuthi izinso zehluleke futhi yisiphi isikhathi yisiphi isifo sezinso esingamahlalakhona (CKD). Ukuxilongwa okunjalo kuyadingeka ngoba izimpawu ezinzima zomtholampilo ziqala ukuvela esiteji lapho izinguquko ezinso sezinso sezivele zingaphenduki.
I-Albuminuria ivela esiteji sokuqala, ngakho-ke uma uqala ukwelashwa, khona-ke ukwehluleka kwe-renal okungamahlalakhona kungavinjelwa.
Ukuvimbela ukulimala kwezinso kushukela
Amaqembu asengozini yokuthola isifo sezinso kusifo sikashukela afaka iziguli zohlobo lokuqala nolwesibili sikashukela, kanye nesifo sikashukela sokukhulelwa ngesikhathi sokukhulelwa. Ngakho-ke, kuzo zonke izigaba, ukuhlolwa okuphathelene nezinso kungeniswa okungenani kanye ngonyaka, bese izinso ezikhulelwe zihlolwa njalo ezinyangeni ezintathu.
Izinga eliphakeme lokucindezela ezigulini ezinesifo sikashukela sohlobo lokuqala zingavela nezinkinga zezinso, futhi isifo sikashukela sohlobo 2, umfutho wegazi ophakeme njengolunye lwezimpawu zingatholakala ngaphambi kwesifo sikashukela kanye nesifo sikashukela.
Ukuhlanganiswa komfutho wegazi ophakeme nesifo sikashukela kuyingozi, ngoba ndawonye konakalisa izinso, imithambo yegazi, inhliziyo, amehlo nobuchopho. Uma isiguli sinokuthambekela komfutho wegazi ophakeme, khona-ke kuyadingeka ukushiya usawoti, ikhofi, itiye elinamandla. Udinga ukulawula izinga lokucindezela nsuku zonke ekuseni nakusihlwa.
Ngokuvimbela isifo sikashukela, ukulimala kwezinso kudinga izindlela ezilandelayo zokuvikela:
- Gcina ushukela wegazi ezingeni elinconyiwe.
- Uma i-pathology yezinso isolwa ekudleni, usawoti kanye ne-protein yezilwane kufanele kube nomkhawulo.
- Gada umfutho wegazi, ungavumeli ukwanda okungaphezulu kwe-130/80.
- Izinkomba zokuhlola imetabolism yamafutha, i-cholesterol yegazi.
- Thatha izidakamizwa ezinqunyiwe
- Ukuzivocavoca, ubunzima bokuzivocavoca.
- Khipha utshwala nokubhema.
- Uma kwenzeka izifo ezibangelwa ukuvuvukala, ngamatshe ezinso, ukwelashwa okuthile kufanele kwenziwe, ukuhlaziywa kufanele kubhekwe okungenani kanye ezinyangeni ezintathu.
Izindlela zokunxephezela isifo sikashukela, lapho izinso zivikelwe khona ekubhujisweni: ushukela osheshayo ongu-5-6.5 mmol / l; amahora amabili ngemuva kokudla 7.5-9.0 mmol / l; ngesikhathi sokulala, i-6-7.5 mmol / l, i-hemoglobin ye-glycated kusuka ku-6 kuye ku-7%.
Uma kwenzeka ukungasebenzi kahle kwama-metabolism, kanye nokubekwa kwe-cholesterol nokwakheka kwezigcawu ze-atherosclerotic, kukhona ukubhujiswa kwezicubu zezinso. Ucwaningo lwephrofayili ye-lipid lwenziwa okungenani kanye ngonyaka. Ukwenza lula isifundo sikashukela, ikakhulukazi ngohlobo lwesibili, kuyadingeka ukwenqaba ukudla inyama enamafutha, isibindi, imayonesi, amasoseji anamafutha.
Uma kusolwa isifo sezinso, uhlobo 2 sikashukela kufaneleelashwe ngemithi engenabungozi ezinso kakhulu. Lokhu kufaka phakathi iMetformin, i-Glyurenorm, i-Aktos, iNovoNorm, iJanuvia, i-Onglisa.
Esigabeni sokwehluleka kwezinso, isilinganiso sezidakamizwa zokulungiswa kwesifo sikashukela, kufaka phakathi i-insulin, kumele sincishiswe.
Ukwelashwa kwezinso ngeSifo Sikashukela
Izinso ziphathwa kahle isifo sikashukela esiteji lapho i-albhamuinuria ingadluli kuma-200 mg / l.
Ukwelashwa okuyinhloko ukunxephezela isifo sikashukela, kugcinwe izinga elinconyelwe i-glycemia. Ngaphezu kwalokho, izidakamizwa ezivela eqenjini le-eniotensin-converting enzymes zinqunyelwe. Inhloso yabo ikhonjiswa ngisho nasezingeni elijwayelekile lokucindezela.
Ukuthatha imithamo emincane yemithi enjalo kunganciphisa amaprotheni emchameni, kuvikele ukubhujiswa kwe-renal glomeruli. Imvamisa, udokotela obonayo unquma izidakamizwa ezinjalo:
- Kapoten.
- Qeda.
- Prestarium.
- Tarka.
- Monopril.
Isigaba proteinuria sidinga ukunqunyelwa kwamaprotheni ezilwane ekudleni. Lokhu akusebenzi ezinganeni nakwabesifazane abakhulelwe. Wonke umuntu welulekwa ukuthi anikele imikhiqizo yenyama, inhlanzi, ushizi we-cottage shizi noshizi.
Ngomfutho wegazi ophakeme, ukudla okunosawoti kufanele kugwenywe, kunconywa ukuthi kungadli okungaphezulu kuka-3 g kasawoti wethebula ngosuku. Ungasebenzisa ujusi kalamula namakhambi ukwengeza ukunambitheka.
Ukwehlisa ingcindezi kulesi sigaba, izidakamizwa zivame ukusetshenziswa:
- UMikardis.
- I-Cozaar.
- I-Aprovel.
Uma kwenzeka umelana nokulwa, ama-diuretics axhunyaniswa nawo noma kusetshenziswa umuthi ohlangene.
Uma isifo sikashukela nezinso kungazange kwelashwa isikhathi eside, khona-ke lokhu kuholela ekuthuthukisweni kokwehluleka kwezinso okungapheli. Ngokuhamba kwesikhathi, i-glomeruli esezicubu zezinso iba mbalwa futhi izinso ziqale ukwehluleka.
Lesi simo sidinga ukuqashwa kaningi kwamazinga kashukela usuku lonke, ngoba ukunxephezela isifo sikashukela kungavimbela ukukhula kwe-coma nezifo ezivame ukuhambisana noshukela kulesi sigaba.
Uma amaphilisi enganiki umphumela, iziguli ezinjalo zidluliselwa ekwelashweni kwe-insulin. Ukwehla okukhulu kwezinga likashukela, ukuvuselelwa okuphuthumayo kuyadingeka emtholampilo.
I-nephropathy yesifo sikashukela esigabeni sokuhluleka kokuqina kwe-renal kudinga ushintsho ekudleni. Ukuvinjelwa okujwayelekile kwama-carbohydrate alula ngalesi sigaba akusizi. Ngaphezu kwalokho, imithetho enjalo yethulwa ekudleni:
- Kulesi sigaba, amaprotheni ezilwane akhawulelwe noma akhishwe ngokuphelele.
- Ngaphezu kwalokho, kunengozi yokwanda kwe-potassium egazini. Ukudla okuphezulu kwe-potassium akufakiwe ekudleni: amazambane, omisiwe, ama-prunes, ama-apricots omisiwe, izinsuku nama-currants amnyama.
- Esikhathini ekudleni, kuyadingeka futhi nokunciphisa umkhawulo wokudla ngokuqukethwe okuphezulu kwe-phosphorus (inhlanzi, ushizi, i-buckwheat), faka i-calcium ephuma kuziphuzo zobisi ezigcotshisiwe, i-sesame, isilimo esidliwayo esinamagatsha anamanzi kwimenyu.
Isimo esibalulekile esigabeni sokuhluleka kwe-renal ukuphathwa kwengcindezi kanye ne-potassium excretion ngosizo lwe-diuretics - Furosemide, Uregit. Ukuqapha okuphoqelekile kwamanzi adakiwe futhi ahoxisiwe, kunciphisa i-edema.
I-anemia ekulimaleni kwezinso idinga ukusetshenziswa kwe-erythropoietin nemithi equkethe i-iron. Ukubopha ubuthi emathunjini, kusetshenziswa ama-sorbents: i-Enterodeis, i-carbon eyenziwe yasebenza, i-Polysorb.
Ngokuqhubeka okuqhubekayo kokwehluleka kwezinso, iziguli zixhunywe kuhlelo lokuhlanza igazi. Isibonakaliso se-dialysis yisilinganiso se-creatinine ngaphezulu kwe-600 600mol / L. Amaseshini anjalo aqhutshwa ngaphansi kokulawulwa ngamapharamitha we-biochemical futhi ukuphela kwendlela yokugcina umsebenzi obalulekile.
I-Hemodialysis noma i-peritoneal dialysis iyenziwa. Futhi ngokuzayo, iziguli ezinjalo zikhonjiswa ukufakelwa kwezinso, ezingabuyisela amandla okusebenza nomsebenzi weziguli.
Kwividiyo ekulesi sihloko, isihloko sesiifo sezinso kushukela siyaqhubeka.
