I-Diabetes nephropathy yisifo lapho kwenzeka khona umonakalo emithanjeni yezinso, imbangela yaso isifo sikashukela. Kulokhu, imikhumbi eshintshiwe ithathelwa indawo izicubu ezixineneyo, ezibandakanya i-sclerosis kanye nokuvela kokwehluleka kwe-renal.
Izimbangela ze-nephropathy yesifo sikashukela
Isifo sikashukela i-mellitus yiqembu lonke lezifo ezivela ngenxa yokwephulwa kokubumba noma isenzo se-insulin ye-hormone. Zonke lezi zifo zihambisana nokwanda okuqinile kweglucose yegazi. Kulokhu, izinhlobo ezimbili zikashukela ziyahlukaniswa:
- kuncike ku-insulin (uhlobo I lwesifo sikashukela mellitus;
- okungathembeli kwe-insulin (uhlobo II sikashukela mellitus.
Uma imithambo nezicubu zemizwa kuvezwa ukuvezwa isikhathi eside kwamazinga aphezulu kashukela, kanye noshukela wegazi ojwayelekile kubalulekile lapha, ngaphandle kwalokho izinguquko ze-pathological ezithweni ezinobunzima besifo sikashukela zenzeka emzimbeni.
Enye yalezi zinkinga i-nephropathy yesifo sikashukela. Ukufa kweziguli ngenxa yokwehluleka kwe-renal isifo esifana nohlobo I sikashukela mellitus kwenzeka kuqala. Ngohlobo lwesifo sikashukela sohlobo II, indawo ehamba phambili enanini lokufa kuthathwa izifo ezihlotshaniswa nohlelo lwenhliziyo, futhi ukwehluleka kwezintso kuyazilandela.
Ekuthuthukiseni i-nephropathy, indima ebalulekile idlalwa ngokwanda kweglucose yegazi. Ngaphezu kweqiniso lokuthi i-glucose isebenza kumaseli we-vascular njenge-toxin, ibuye isebenze nezinqubo ezibangela ukucekelwa phansi kwezindonga zemithambo yegazi futhi zibenze bavunyelwe.
Isifo sezinzwa esise-naral sikashukela
Ukuthuthukiswa kwe-nephropathy yesifo sikashukela kunomthelela ekwandeni kwengcindezi emikhunjini ye-renal. Ungavela ngenxa yomthetho ongafanele womonakalo ohlelweni lwezinzwa obangelwa yisifo sikashukela i-mellitus (isifo sikashukela se-diabetes).
Ekugcineni, amafomu izicubu ezithambile endaweni yemikhumbi eyonakele, okuholela ekuphazamiseni okukhulu kwezinso.
Izimpawu ze-Diabetesic Nephropathy
Lesi sifo sikhula ngezigaba eziningana:
Ngiya esiteji Kuboniswa ngokuhlangana kwezinso, futhi kwenzeka kanye ekuqaleni kwesifo sikashukela, sinezimpawu zaso. Amaseli wemithambo ye-renal akhuphuka kancane, inani lomchamo nokuhlunga kwalo kuyanda. Ngalesi sikhathi, amaprotheni omchamo awakalungiswa. Azikho izimpawu zangaphandle.
Isigaba II kuboniswe ekuqaleni kwezinguquko ezihlelekile:
- Ngemuva kokuthi isiguli sitholakale sinesifo sikashukela, cishe eminyakeni emibili kamuva lesi sigaba senzeka.
- Kusukela kulo mzuzu, izindonga zemikhumbi yezinso ziqala ukuqina.
- Njengasesimweni esidlule, amaprotheni omchamo awakatholakali futhi umsebenzi wokukhipha izinso awukhubazekile.
- Izimpawu zesifo asikatholakali.
Isigaba III - Lokhu ukuqala kwesifo sikashukela. Kwenzeka, njengomthetho, iminyaka emihlanu ngemuva kokuxilongwa kwesiguli esinesifo sikashukela. Imvamisa, esimeni sokuthola ezinye izifo noma ngesikhathi sokuhlolwa okujwayelekile, inani elincane lamaprotheni (kusuka ku-30 kuye kwangama-300 mg / ngosuku) litholakala umchamo. Isimo esifanayo sibizwa ngokuthi yi-microalbuminuria. Iqiniso lokuthi amaprotheni avela kumchamo akhombisa ukulimala okukhulu emithanjeni yezinso.
- Kulesi sigaba, izinga lokuhlunga le-glomerular liyashintsha.
- Le nkomba inquma izinga lokushiswa kwamanzi nezinto ezinobunzima besisindo samangqamuzana esidlula kusihlungi se-renal.
- Esigabeni sokuqala se-nephropathy yesifo sikashukela, le nkomba ingaba ejwayelekile noma iphakanyisiwe kancane.
- Izimpawu zangaphandle nezimpawu zesifo azikho.
Izigaba ezintathu zokuqala zibizwa ngokuthi ama-preclinical, ngoba azikho izikhalazo zesiguli, futhi izinguquko ze-pathological ezinso zinqunywa kuphela ngezindlela zaselebhu. Noma kunjalo, kubaluleke kakhulu ukuthola lesi sifo ngezigaba ezintathu zokuqala. Okwamanje, kusenokwenzeka ukulungisa lesi simo futhi siguqise lesi sifo.
Isigaba se-IV - kwenzeka eminyakeni eyi-10-15 ngemuva kokuba isiguli satholakala nesifo sikashukela i-mellitus.
- Le yi-nephropathy ekhulunyiwe yesifo sikashukela, ebonakala ngokubonakaliswa kwezimpawu ezicacile.
- Lesi simo sibizwa nge- proteinuria.
- Kuwo umchamo, kutholakala inani elikhulu lamaprotheni, ukugxilisa kwalo egazini, kunalokho, kuyancipha.
- Ukuqina kokuqina komzimba kuyabonakala.
Uma i-proteinuria incane, khona-ke imilenze nobuso buyadumba. Njengoba lesi sifo siqhubeka, i-edema isakazeka emzimbeni wonke. Lapho ushintsho lwe-pathological ezinso luthatha umlingiswa ophimisiwe, ukusetshenziswa kwama-diuretics kuba okungenakwenzeka, ngoba akusizi. Esimweni esifanayo, kukhishwa uketshezi olusuka ezinhlafunweni kukhishwe (ukubhoboza).
Ukuze kugcinwe ukulingana kwamaprotheni egazini, umzimba wephula amaprotheni akhe. Iziguli ziqala ukunciphisa umzimba ngendlela ephakeme. Ezinye izinkomba zifaka:
- ukoma
- isicanucanu
- ukozela
- ukulahleka kwesifiso
- ukukhathala.
Cishe ngaso sonke isikhathi kulesi sigaba kunokwanda kwengcindezi yegazi, imvamisa inani laso liphezulu kakhulu, yingakho ukuphefumula, ikhanda elibuhlungu, izinhlungu enhliziyweni.
Isigaba se-V ibizwa ngokuthi isigaba esibulalayo sokwehluleka kwezinso futhi ukuphela kokukhubazeka kwesifo sikashukela. I-sclerosis ephelele yemikhumbi yezinso yenzeka, iyeka ukufeza umsebenzi we-excretory.
Izimpawu zesigaba esedlule zigcinwe, kulapho kuphela esevele ezisongela impilo. Kuphela yi-hemodialysis, i-peritoneal dialysis, noma ukufakelwa kwezinso, noma ngisho nenkimbinkimbi yonke, i-pancreas-fig.
Izindlela zanamuhla zokuxilongwa kwe-nephropathy yesifo sikashukela
Ukuhlolwa okujwayelekile akunikezeli ulwazi mayelana nezigaba zokugula. Ngakho-ke, ezigulini ezinesifo sikashukela kunokuxilongwa okukhethekile komchamo.
Uma amazinga e-albhamuin esebangeni lama-30 kuye kwangama-300 mg / ngosuku, sikhuluma nge-microalbuminuria, futhi lokhu kukhombisa ukukhula kwe-nephropathy yesifo sikashukela emzimbeni. Ukwanda kwesilinganiso sokuhlunga kwe-glomerular futhi kukhombisa isifo sikashukela.
Ukuthuthukiswa kwe-arterial hypertension, ukukhuphuka okukhulu kwesilinganiso samaprotheni kumchamo, umsebenzi obonakalayo ongaboni kahle kanye nokwehla okuphikelelayo kwesilinganiso sokuhlunga kwe-glomerular yilezo zimpawu ezibonisa isigaba sokwelashwa lapho kudlula khona isifo sikashukela. Izinga lokuhlunga le-glomerular lehlela ezingeni le-10 ml / min nangaphansi.
I-nephropathy yesifo sikashukela, ukwelashwa
Zonke izinqubo ezihambisana nokwelashwa kwalesi sifo zihlukaniswe izigaba ezintathu.
Ukuvimbela ushintsho lwe-pathological emikhunjini ye-renal ku-mellitus yesifo sikashukela. Kuqukethe ekugcineni amazinga kashukela egazini ezingeni elifanele. Kulokhu, izidakamizwa ezinciphisa ushukela ziyasetshenziswa.
Uma i-microalbuminuria isivele ikhona, ngakho-ke ngaphezu kokugcina amazinga kashukela, isiguli sinqunyelwe ukwelashwa kwe-hypertension ye-arterial. Ama-angiotensin aguqula ama-enzyme inhibitors akhonjisiwe lapha. Kungaba i-enalapril ngemithamo emincane. Ngaphezu kwalokho, isiguli kufanele silandele indlela ekhethekile yokudla kwamaprotheni.
Ngama-proteinuria, okokuqala ngqa ukuvimbela ukuncipha okusheshayo kokusebenza kwezinso nokuvinjwa kokwehluleka kokubulala izinso. Ukudla kungumkhawulo oqinile kokuqukethwe kwamaprotheni ekudleni: 0.7-0.8 g nge-1 kg yesisindo somzimba. Uma izinga lamaprotheni liphansi kakhulu, umzimba uzoqala ukudiliza namaprotheni akhe.
Ukuvimbela lesi simo, i-ketone analogues yama-amino acid ibekelwe isiguli. Ukuhlala kufanelekile kugcina izinga elifanele likashukela egazini nokunciphisa umfutho wegazi ophakeme. Ngokwengeziwe kuma-inhibitors e-ACE, kunqunywa i-amlodipine, evimba iziteshi ze-calcium ne-bisoprolol, i-beta-blocker.
I-Diuretics (indapamide, furosemide) ichazwa uma isiguli sine-edema. Ngaphezu kwalokho, nciphisa ukungena koketshezi (1000 ml ngosuku), noma kunjalo, uma kukhona i-insipidus yesifo sikashukela, ukumanzana koketshezi kuzofanela kubhekwe nge-prism yalesi sifo.
Uma izinga lokuhlunga le-glomerular lehla laya ku-10 ml / min noma ngaphansi, isiguli sinqunyelwe ukwelashwa okubuyiselwe esikhundleni (i-peritoneal dialysis ne-hemodialysis) noma ukufakelwa kwezitho (ukufakelwa).
Ngokufanelekile, isigaba esibulalayo se-nephropathy yesifo sikashukela siphathwa ngokudluliselwa kwengxubevange yezinso. E-United States, ngokuxilongwa kwe-nephropathy yesifo sikashukela, le nqubo ivame impela, kepha ezweni lethu, ukuthunyelwa okunjalo kusezingeni lokuthuthuka.
