Isifo sikashukela singumbulali othule, amazinga kashukela aphakama njalo anethonya elincane enhlalakahleni-ke-ke, abanesifo sikashukela abaningi abanaki ngokukhethekile izinombolo ezikhuphuka njalo ngemamitha. Ngenxa yalokhu, impilo yeziguli eziningi ngemuva kweminyaka eyi-10 inyenyezwa ngenxa yemiphumela kashukela omningi. Ngakho-ke, ukulimala kwezinso kanye nokwehla kokusebenza kwabo, isifo sikashukela, kutholakala ema-40% eziguli ezinesifo sikashukela ezithatha i-insulin, naku-20% wamacala - kulabo abaphuza ama-hypoglycemic agents. Lesi sifo njengamanje siyimbangela evamile kakhulu yokukhubazeka kwesifo sikashukela.
Izizathu zokukhula kwe-nephropathy
Izinso zihlunga igazi lethu kusuka kubuthi obudonsa ubusuku nemini, phakathi nosuku kuhlanzwa kaningi. Umthamo ophelele wetshezi olungena ezinso cishe ngamalitha ayizinkulungwane ezimbili. Le nqubo kungenzeka ngenxa yesakhiwo esikhethekile sezinso - zonke zingena ngenethiwekhi yama-microcapillaries, ama-tubules, imithambo yegazi.
Okokuqala, ukuqoqwa kwama-capillaries lapho igazi lingena ngaphakathi kubangelwa ushukela omningi. Babizwa ngokuthi ama-renal glomeruli. Ngaphansi kwethonya le-glucose, imisebenzi yabo iyashintsha, ingcindezi ngaphakathi kwe-glomeruli iyanda. Izinso ziqala ukusebenza ngemodi esheshayo, amaprotheni angenasikhathi sokuhlunga aphuma angena emchamo. Ngemuva kwalokho ama-capillaries abhujiswa, endaweni yawo izicubu ezithintekayo zikhula, i-fibrosis iyenzeka. AbakwaGlomeruli noma bawuyeka ngokuphelele umsebenzi wabo, noma banciphise umkhiqizo wabo. Ukwehluleka kwasemondweni kwenzeka, ukuphuma komchamo kuyancipha, umzimba udakwe.
Isifo sikashukela nokucindezela kuzoba yinto yesikhathi esedlule
- Ukwehlela ushukela -95%
- Ukuqedwa kwe-vein thrombosis - 70%
- Ukuqedwa kokushaya kwenhliziyo okuqinile -90%
- Ukuqeda umfutho wegazi ophakeme - 92%
- Ukwanda kwamandla ngesikhathi sosuku, ngcono ukulala ebusuku -97%
Ngaphezu kwengcindezi eyandayo kanye nokuqothuka kwemithambo ngenxa ye-hyperglycemia, ushukela futhi uthinta izinqubo ze-metabolic, okubangela ukuphazamiseka okuningi kwe-biochemical. Amaprotheni, kufaka phakathi ulwelwesi lwezinso, ayenziwa ngama-glycosylated (asabela nge-glucose, ushukela), umsebenzi wama-enzyme akhulisa ukuqina kwezindonga zemithambo yegazi uyanda, ukwakheka kwama-radicals wamahhala kuyanda. Lezi zinqubo zisheshisa ukuthuthukiswa kwe-nephropathy yesifo sikashukela.
Ngaphezu kwembangela eyinhloko ye-nephropathy - inani ngokweqile likashukela egazini, ososayensi bakhomba ezinye izinto ezithinta amathuba kanye nokushesha kwalesi sifo:
- Isakhi sofuzo. Kukholelwa ukuthi i-nephropathy yesifo sikashukela ivela kuphela kubantu abanesizinda sofuzo. Ezinye iziguli azinalo ushintsho ezinso noma zingahambi isikhathi eside sesinxephezelo sikashukela;
- Umfutho wegazi ophakeme;
- Izifo ezithathelwanayo zomgudu womchamo;
- Ukukhuluphala ngokweqile
- Ubulili besilisa;
- Ukubhema.
Izimpawu ze-DN
I-nephropathy yesifo sikashukela iba kancane kancane, isikhathi eside lesi sifo asithinti impilo yesiguli esinesifo sikashukela. Izimpawu azikho ngokuphelele. Izinguquko ekugomeni kwezinso ziqala kuphela ngemuva kweminyaka embalwa yokuphila nesifo sikashukela. Ukubonakaliswa kokuqala kwe-nephropathy kuhlotshaniswa nokudakwa okuncane: i-lethargy, ukunambitheka okungathandeki emlonyeni, isifiso sokudla esingesihle. Umthamo wansuku zonke womchamo uyanda, ukuchama kuba kaningi, ikakhulukazi ebusuku. Amandla adonsanayo omchamo ancishisiwe, ukuhlolwa kwegazi kukhombisa hemoglobin ephansi, i-creatinine ne-urea ekhuphukile.
Kwisibonakaliso sokuqala, bonana nochwepheshe ukuze ungaqali lesi sifo!
Izimpawu ze-nephropathy zesifo sikashukela zanda njengoba isigaba sesifo sikhuphuka. Ukubonakaliswa okubonakalisiwe, okubonakalisiwe komtholampilo kwenzeka kuphela ngemuva kweminyaka eyi-15 ukuya kwengama-20, lapho izinguquko ezingenakuphikiswa ezinso zifinyelela ezingeni elibucayi. Zivezwa ngomfutho ophakeme, i-edema ebanzi, ukudakwa kakhulu komzimba.
Ukuhlukaniswa kwe-Diabetesic Nephropathy
Isifo sikashukela nesifo sikashukela sibhekisele ezifweni zohlelo lwezitho zofuzo, ikhodi ngokuya nge-ICD-10 N08.3. Kubonakaliswa ukwehluleka kwezinso, lapho isilinganiso se-filtration ku-glomeruli yezinso (GFR) sincipha.
I-GFR yisisekelo sokuhlukaniswa kwe-nephropathy yesifo sikashukela ngokuya ngezigaba zokuthuthuka:
- Nge-hypertrophy yokuqala, i-glomeruli iba nkulu, umthamo wegazi elicwengekileyo uyakhula. Kwesinye isikhathi ukwanda kwesayizi yezinso kungabonakala. Akukho okubonakaliswa kwangaphandle okwamanje. Uvivinyo alukhombisi inani elikhulayo lamaprotheni kumchamo. I-SCF>
- Ukuvela kwezinguquko ezakhiweni ze-glomeruli kuqashelwa eminyakeni eminingana emva kokuqalwa kwesifo sikashukela i-mellitus. Ngalesi sikhathi, ulwelwesi lwamafinyila luyakhula, nebanga phakathi kwama-capillaries liyakhula. Ngemuva kokuzivocavoca kanye nokwanda okukhulu koshukela, amaprotheni omchamo angatholakala. I-GFR yehla ngaphansi kwama-90.
- Ukuqala kwe-nephropathy yesifo sikashukela kubonakaliswa ukulimala okukhulu emithanjeni yezinso, futhi ngenxa yalokho, inani elandayo lamaprotheni kumchamo. Ezigulini, ingcindezi iqala ukwanda, okokuqala kuphela ngemuva kokusebenza ngokomzimba noma ukuvivinya umzimba. I-GFR yehla kakhulu, kwesinye isikhathi iye ku-30 ml / min, okubonisa ukuqala kokwehluleka kwezinso okungamahlalakhona. Ngaphambi kokuqala kwalesi sigaba, okungenani iminyaka emi-5. Sonke lesi sikhathi, izinguquko ezinso zingabuyiselwa emuva ngokuphathwa okufanele nokudla okuqinile.
- Okwaziwa ngokuthi yiMic Clinical kutholakala lapho izinguquko ezinsweni zingaphenduki, kutholakala amaprotheni emchameni kutholakala> 300 mg ngosuku, i-GFR <30. Lesi sigaba sibonisa umfutho wegazi ophakeme, oncishiswa kabi yizidakamizwa, ukuvuvukala komzimba nobuso, ukunqwabelana komzimba emithanjeni yomzimba.
- I-terminal diabetesic nephropathy isigaba sokuqala salesi sifo. I-glomeruli icishe iyeke ukuhlunga umchamo (i-GFR <15), amazinga egazi we-cholesterol, ukwanda kwe-urea, kwehla kwe-hemoglobin. Kuvela i-edema enkulu, kudakwa kakhulu kuqala, okuthinta zonke izitho zomzimba. Ukudayela okujwayelekile noma ukufakelwa kwezinso kuphela okungavimbela ukufa kwesiguli kulesi sigaba se-nephropathy yesifo sikashukela.
Izici ezijwayelekile zezigaba ze-DN
| Isiteji | I-GFR, ml / imizuzu | Amaproteinuria, mg / usuku | Isipiliyoni esimaphakathi sikashukela, iminyaka |
| 1 | > 90 | < 30 | 0 - 2 |
| 2 | < 90 | < 30 | 2 - 5 |
| 3 | < 60 | 30-300 | 5 - 10 |
| 4 | < 30 | > 300 | 10-15 |
| 5 | < 15 | 300-3000 | 15-20 |
Ukuxilongwa kwe-Nephropathy
Into esemqoka ekuhlolweni kwe-nephropathy yesifo sikashukela ukuthola lesi sifo kulezo zigaba lapho umsebenzi wezinso ongasebenzi kahle usubuyela emuva. Ngakho-ke, abanesifo sikashukela ababhaliswe ne-endocrinologist banikezwa izivivinyo kanye ngonyaka ukuthola i-microalbuminuria. Kusetshenziswa lolu cwaningo, kungenzeka ukuthola amaprotheni kumchamo lapho kungakacaci ekuhlaziyeni jikelele. Ukuhlaziywa kunqunywa njalo eminyakeni emi-5 ngemuva kokuqalwa kwesifo sikashukela sohlobo 1 futhi njalo ezinyangeni ezi-6 ngemuva kokutholakala kwesifo sikashukela sohlobo 2.
Uma izinga lamaprotheni liphezulu kunokujwayelekile (30 mg / ngosuku), kwenziwa ukuhlolwa kweReberg. Ngosizo lwayo, kuhlolwa ukuthi ngabe i-renal glomeruli isebenza kahle yini. Ukuhlolwa, wonke umthamo womchamo okhiqize izinso ngehora (njengenketho, ivolumu yansuku zonke) uyabuthwa, negazi nalo lithathwe emthanjeni. Ngokusekelwe kudatha enanini lomchamo, izinga le-creatinine egazini nomchamo, izinga le-GFR libalwa kusetshenziswa ifomula ekhethekile.
Ukuhlukanisa phakathi kwe-nephropathy yesifo sikashukela ne-pyelonephritis engapheli, kusetshenziswa umchamo ojwayelekile nokuhlolwa kwegazi. Ngesifo esithathelwanayo sezinso, kutholakala inani lamaseli egazi amhlophe namagciwane emchameni. Isifo sofuba se-renal sitholakala ngokuba khona kwe-leukocyturia kanye nokungabikho kwamagciwane. I-Glomerulonephritis iyahluka ngesisekelo sokuhlolwa kwe-x-ray - urology.
Ukushintshwa kwezigaba ezilandelayo zesifo sikashukela kunqunywa ngesisekelo sokwanda kwe-albhamuin, ukubonakala kwamaprotheni e-OAM. Ukuthuthuka okuqhubekayo kwalesi sifo kuthinta izinga lokucindezela, kushintsha kakhulu ukubalwa kwegazi.
Uma ushintsho ezinso lwenzeka ngokushesha okukhulu kunamanani aphakathi, amaprotheni akhula ngokuqinile, kuvela igazi emchimbeni, kwenziwa i-biopsy yezinso - isampula yezicubu zezinso ithathwe ngenalithi emincane, okwenza sikwazi ukucacisa uhlobo lwezinguquko ezenzeka kulo.
Lesi sifo siphathwa kanjani?
Ukuthola lesi sifo, ukuhambela odokotela abakhethekile akudingeki; i-nephropathy yesifo sikashukela ivezwa lapho kuhlolwa udokotela wonyaka nodokotela ojwayelekile noma i-endocrinologist. Babeka ukwelashwa. Umgomo ngalesi sigaba ukunciphisa ushukela, i-cholesterol, i-triglycerides esegazini ibe yinto evamile, ukunciphisa umfutho wegazi.
Amazinga Ushukela Oqondisiwe:
- I-4-7 mmol / l - esiswini esingenalutho;
- I-6-8 mmol / l - ngesikhathi sokulala;
- kufika ku-10 mmol / l - ihora ngemuva kokudla.
Kusukela esigabeni 3, ukubonisana nodokotela wezinhlungu kuyadingeka. Ngokuthuthuka okuqhubekayo kwe-nephropathy, isiguli esinesifo sikashukela sibhaliswa nodokotela wamachaphaza futhi simhambela njalo.
Ukuthatha umuthi
Ngokushesha lapho izivivinyo ze-nephropathy zesifo sikashukela ziqala ukuthola amaprotheni emchameni, nikeza izidakamizwa eqenjini le-ACE inhibitors. Banamandla okukhuthaza i-vasodilation futhi bavimbele i-enzyme, ethinta ukuncipha kwabo. Ngakho-ke, ukwehla komfutho wegazi nokuvikelwa kwezinso kuyatholakala. Ama-inhibitors e-ACE abuye anciphise ukuphuma kwe-albhamuin emchameni, anciphise ubungozi besifo senhliziyo nemikhumbi emikhulu. Izidakamizwa ezinjenge-enalapril, Captopril, lisinopril zingamisa ukuthuthukiswa kokulimala kwezinso ngisho nakulezo ziguli ezinesifo sikashukela ezingenawo umfutho wegazi ophakeme. Kulokhu, imithamo yabo iyaguqulwa ukuze kungabikho ukwehla ngokweqile kwengcindezi.
Nge-DN, kuyadingeka ukuthi uqaphe ngokucophelela futhi ngokucophelela ingcindezi
Iqembu lesibili lezidakamizwa lokwelapha i-nephropathy yesifo sikashukela yi-AT1 receptor blockers. Bayakwazi ukunciphisa ithoni ye-vascular kanye nengcindezi kubo. Kwanele ukuthatha le mithi kanye ngosuku, zibekezelelwa kalula futhi zinobuncane be-contraindication. E-Russia, ama-losartan, i-eprosartan, i-valsartan, i-candesartan abhalisiwe. Ukuvikela okungcono kwezinso, ukwelashwa okuyinkimbinkimbi kuvame ukunqunywa nezidakamizwa ezivela kuwo womabili amaqembu.
Kunzima kakhulu ezigulini ezikhulu kakhulu ezinesifo sikashukela se-nephropathy ukwehlisa ingcindezi, ngakho-ke zinikezwe neminye imithi. Inhlanganisela ngayinye ikhethiwe ngokulandelana ukuze ngokuphelele banciphise umfutho ukuya ku-130/80 noma ngisho nokuphansi, ngezinkomba ezinjalo ingozi yokulimala kwezinso incane - Mayelana nomfutho wegazi ophakeme nesifo sikashukela.
Izidakamizwa zokunciphisa umfutho wegazi kushukela
| Iqembu | Ukulungiselela | Isenzo |
| Ama-diuretics | I-Oxodoline, iHydrochlorothiazide, iHypothiazide, iSpirix, iVeroshpiron. | Khuphula inani lomchamo, unciphise ukugcinwa kwamanzi, unciphise ukuvuvukala. |
| Ama-blocker e-Beta | I-Tenonorm, Athexal, Logimax, Tenorik. | Yehlisa ukushaya kanye nenani legazi elidlula enhliziyweni. |
| Abamelene neCalcium | UVerapamil, uVertisin, uCaveril, uTenox. | Yehlisa ukugcwala kwe-calcium, okuholela ku-vasodilation. |
Esigabeni 3, ama-hypoglycemic agents angathathelwa indawo yilawo ongeke aqongelele ezinso. Esigabeni 4, uhlobo 1 sikashukela ngokuvamile ludinga ukulungiswa kwe-insulin. Ngenxa yokusebenza kwezinso okungekuhle, ikhishwa isikhathi eside egazini, ngakho-ke manje kudingeka okungaphansi. Esigabeni sokugcina, ukwelashwa kwe-nephropathy yesifo sikashukela kuhlanganisa ukukhipha umzimba emzimbeni, kwandise izinga le-hemoglobin, kuthathe indawo yemisebenzi yezinso ezingasebenzi nge-hemodialysis. Ngemuva kokuzinza kwalesi simo, umbuzo wokuthi kungenzeka ukuthi kudluliselwe kwesinye isitho esinikelayo uyacatshangelwa.
Nge-nephropathy yesifo sikashukela, izidakamizwa ezilwa nokuvuvukala (i-NSAIDs) kufanele zigwenywe, ngoba, lapho zithathwa njalo, zisebenza kabi kakhulu izinso. Le yimithi ejwayelekile njenge-aspirin, i-diclofenac, ibuprofen neminye. Udokotela kuphela onolwazi nge-nephropathy yesiguli okwazi ukwelapha le mishanguzo.
Kukhona izinto ezithile ezingefani lapho kusetshenziswa imithi elwa namagciwane. Ukwelashwa kwezifo ezibangelwa amagciwane ezinsweni ezine-nephropathy yesifo sikashukela, kusetshenziswa ama-ejenti asebenzayo kakhulu, ukwelashwa kusekude, ngokulawulwa okuphoqelekile kwamazinga we-creatinine.
Ukudla kwesidingo
Ukwelashwa kwe-nephropathy kwezigaba zokuqala kuncike kakhulu kokuqukethwe kwezakhamzimba nosawoti, okungena emzimbeni ngokudla. Ukudla kwe-nephropathy yesifo sikashukela kungukunciphisa ukusetshenziswa kwamaprotheni ezilwane. Amaprotheni ekudleni abalwa ngokuya ngesisindo seziguli ezinesifo sikashukela - kusuka ku-0,7 kuye ku-1 g ngegremu yesisindo. I-International Diabetes Federation incoma ukuthi okuqukethwe kwamakholishi abe yi-10% yenani eliphelele lokudla okunempilo. Kufanelekile futhi ukunciphisa inani lokudla okunamafutha ukuze wehlise i-cholesterol futhi uthuthukise ukusebenza kwemithambo yegazi.
Umsoco we-nephropathy yesifo sikashukela kufanele ube kasithupha ukuze ama-carbohydrate namaprotheni avela ekudleni kokudla angene emzimbeni ngokulinganayo.
Imikhiqizo evunyelwe:
- Imifino - isisekelo sokudla, kufanele okungenani ibe yingxenye yako.
- Amajikijolo aphansi we-GI nezithelo kutholakala kuphela ibhulakufesi.
- Kuma-okusanhlamvu, i-buckwheat, ibhali, iqanda nelayisi elinsundu kuyathandwa. Zifakwa ezitsheni zokuqala futhi zisetshenziswe njengengxenye yezitsha eziseceleni ezinemifino.
- Ubisi nemikhiqizo yobisi. Amafutha, ukhilimu omuncu, ama-yogurts amnandi nama-curds ahlanganisiwe.
- Iqanda elilodwa ngosuku.
- I-Legumes njengendishi eseceleni nakumasobho ngenani elilinganiselwe. Iprotheni yemifino iphephe kakhulu nge-nephropathy yokudla kune-protein yezilwane.
- Inyama enamafutha amancane nenhlanzi, okungcono isikhathi esingu-1 ngosuku.
Kusukela esigabeni 4, futhi uma kukhona umfutho wegazi ophakeme, khona-ke ngaphambili, kunconywa usawoti. Ukudla kuyayeka ukufaka, kungafakwanga imifino enosawoti futhi ekhethiwe, amanzi amaminerali. Izifundo zemitholampilo zikhombisile ukuthi ngokwehla kokudla usawoti ukuya ku-2 g ngosuku (isigamu sesipuni), ingcindezi nokuncipha kokuwohloka kwehla. Ukufeza lokhu kuncishiswa, awudingi nje ususe usawoti ekhishini lakho, kodwa futhi uyeke ukuthenga imikhiqizo eyenziwe ngomumo eyenziwe kwaphela nemikhiqizo yesinkwa.
Kuzoba wusizo ukufunda:
- Ushukela ophakeme uyimbangela enkulu yokubhujiswa kwemithambo yegazi yomzimba, ngakho-ke kubalulekile ukwazi ukuthi ungasinciphisa kanjani ushukela wegazi ngokushesha.
- Izimbangela zesifo sikashukela i-mellitus - uma zonke zifundwa futhi ziqedwa, khona-ke ukubukeka kwezinkinga ezahlukahlukene kungahlehliswa isikhathi eside.
