Kuyini ukutholakala kwe- "Diabetesic nephropathy" enjalo - incazelo nezindlela zokwelapha i-pathology

Imbangela yokufa okuphezulu noma ukukhubazeka kubantu abanesifo sikashukela, kungakhathalekile ukuthi hlobo luni lwesifo, yi-nephropathy yesifo sikashukela ehamba kancane.

Lo mbhalo unikezwe ukuthi lesi sifo esiyingozi sikhula kanjani nokuthi sikhula kanjani.

I-nephropathy yesifo sikashukela: kuyini?

Isifo sikashukela i-nephropathy (DN) siyindlela yokusebenza kwezinso eye yathuthuka njengomphumela wesifo sikashukela sekwephuzile. Ngenxa ye-DN, amandla wokuhlunga wezinso ayancipha, okuholela ku-nephrotic syndrome, futhi kamuva ekwehlulekeni kwezintso.

Impilo yezinso enempilo nesifo sikashukela

Lokhu kokugcina kumacala angama-80% kuyabulala. Isizathu salokhu i-pathology ye-glomeruli, tubules. Lesi sifo senzeka cishe kubantu abangama-20% abanesifo sikashukela.

Ngaphezu kwalokho, amadoda kanye nabashukela abethembele nge-insulin kungenzeka kakhulu kunalabo abahlushwa isifo sikashukela esingaxhomekeki ku-insulin. Inani eliphakeme lokukhula kwalesi sifo ukuguqulelwa kwalo esigabeni sokwehluleka kweziinso okungamahlalakhona (i-CRF), okuvame ukwenzeka iminyaka eyi-15 kuya kwengamashumi amathathu yesifo sikashukela.

Izizathu

Ukhuluma ngembangela yokuqalwa kokukhula kwesifo sikashukela, i-hyperglycemia engapheli, ehlangene ne-hypertension ye-arterial, kuvame ukushiwo. Eqinisweni, lesi sifo asihlali njalo singumphumela wesifo sikashukela.

Njengemibono eyinhloko edala lesi sifo, cabanga ngalokhu:

• umzimba. Ukwehla okuphezulu kweshukela kuphumela ekulimaleni kwe-pathological kwezicubu zezinso, okubangela ukungasebenzi kahle kwezinso;
• hemodynamic. Ngokwalo mbono, ukuhamba kwegazi lokungena ngaphakathi kubangelwa ukuphazamiseka kwegazi isikhathi eside, okuholela kokuqala kokuqina emzimbeni, futhi njengoba izicubu ezithintekayo zikhula, ekunciphiseni okukhulu kwezinga lokuhlunga.
• ufuzokuphakamisa ukwenziwa kwezinto kwezakhi zofuzo kushukela.

Ezinye izinto ezivusa ukubangela ukuthuthukiswa kwe-DN zifaka phakathi i-dyslipidemia nokubhema.

Iziqu

I-DN ikhula kancane, idlula ezigabeni eziningana;

1. isigaba sokuqala senzeka ekuqaleni kwesifo sikashukela futhi sihambisana ne-renal hyperfunction. Kulesi simo, amaseli wezicubu ze-renal eba mikhulu, kukhona ukwanda kokuhlunga kanye nokuphuma komchamo. Lesi simo asihambisani nokuboniswa kwangaphandle;
2. imvamisa ngonyaka wesithathu wesifo sikashukela, kukhona ukuguquka kusuka esigabeni sokuqala kuye kwesesibili. Ngalesi sikhathi, ushintsho oluhlelekile luqala ukwenzeka kumaseli wezicubu zezinso, okuholela ekuxhumaneni kwezindonga zemithambo. Ukubonakaliswa kwangaphandle kwe-pathology akubonwa;
3. ngokwesilinganiso, ngemuva kweminyaka emi-5, ukukhula kwesigaba sesithathu kuyaqala, okubizwa ngokuthi yi-ukuqala sikashukela nephropathy. Kutholakala ukuthi luhleliwe noma luhlobo luni lokuhlolwa. Ukugula kubonakaliswa ngokuvela kwamaprotheni emchameni, okukhombisa ukulimala okukhulu emithanjeni yezinso, okuholele ekushintsheni kwe-GFR. Lesi simo sibizwa ngokuthi yi-microalbuminuria;
4. emva kweminye iminyaka engama-5 ukuya kwengama-10, lapho kungekho ukwelashwa okwanele, ukuqala kwe-nephropathy yesifo sikashukela kudlulela esigabeni esimisiwe, kuhambisana nezimpawu ezicacile zomtholampilo. Lesi sigaba sibizwa nge- proteinuria. Isigaba sesine se-DN sikhonjiswa ngokwehla okukhulu kwamaprotheni egazini kanye nokuthuthuka kokuvuvukala okukhulu. Ngezindlela ezibucayi ze-proteinuria, ukuthatha i-diuretics kuba yize, futhi kufanele usebenzise irekhodi ukuze ukhiphe uketshezi oluningi. Ukushoda kwamaprotheni egazini kuholela eqinisweni lokuthi umzimba uqala ukudiliza amaprotheni awo uqobo, okuholela ekulahlekelweni kwesisindo okukhulu kwesiguli nokubonakala kwezimpawu ezithile, kufaka phakathi ukwanda okukhulu komfutho wegazi;
5. Isigaba sesihlanu, sokugcina sesi sifo sibizwa ngokuthi isigaba se-uremic noma esibulalayo sokwehluleka kweziinso okungapheli. Kulesi sigaba, izinso azikwazi ukubhekana nokuvikeleka, ngoba imithambo yazo ihlolwe ngokuphelele, futhi izinga lokuhlunga lincipha laya ku-10 ml / min futhi liphansi, izimpawu zangaphandle ziyanda, ukuthola umlingiswa osongela impilo.

Izimpawu

Isici salesi sifo esingelapheki ukuthi, ukukhula kancane kancane eminyakeni eminingi, kuyindlela esibonakalisayo ekuqaleni - kokuqala - esiteji, kuhambisana nokungabikho ngokuphelele kwezimpawu zangaphandle.

Izingcingo zokuqala ezingabonisi ngokungaqondile isifo sikashukela yilezi:

• umfutho wegazi ophakeme
• ukukhathala;
• umlomo owomile;
• ukuchama njalo ebusuku;
• polyuria.

Ngasikhathi sinye, imiphumela yokuhlolwa kwemitholampilo ingabonisa amandla ancishisiwe we-umchamo othize, bonisa ukuthuthukiswa kwe-anemia kanye nezinguquko ekulinganisweni kwe-lipid, i-creatinine ephezulu kanye ne-urea yegazi.

Kamuva, lapho ifika ibanga le-4-5th ekukhuleni kwayo, lesi sifo siveza isimo se-nausea, ukubukeka kokuhlanza, ukulahleka kwesifiso sokudla, okuhambisana nokuvuvukala, ukuphefumula, ukulunywa, ukuqwasha.

Ukuxilonga

Ukuhlolwa okudingekayo ukuze kutholakale isifo kwenziwa nge-endocrinologist-diabetesologist noma Therapist. Kubandakanya ukuhlolwa okujwayelekile kokuhlolwa komchamo kwe-albhamuin ne-proteinuria, nokuhlolwa kwegazi kwe-creatinine ne-urea. Lezi zifundo zisivumela ukuthi sikhombe ama-MD kusesekuqaleni futhi sivikele ukuqhubeka kwawo.

Imvamisa yokuhlaziya enconyiwe:

• njalo ezinyangeni ezi-6 - kwiziguli ezinesifo sikashukela sohlobo I iminyaka engaphezu kwengu-5;
• njalo ngonyaka - kulabo abanesifo sikashukela sohlobo II iminyaka engaphezu kwemi-5.

Njengendlela ekhanyayo yokuhlonza i-microalbuminuria, amaphilisi wokufaka kanye nemichilo yokuhlola yomchamo nakho kungasetshenziswa, ukuvumela imizuzu engu-5 ukunquma ngokunembile ukuba khona kwe-albhamuin kanye nezinga layo le-microconcentration.

Ukuthuthukiswa kwe-nephropathy yesifo sikashukela kuboniswa ukutholwa kwe-albhamuin emchameni - 30-300 mg / ngosuku, kanye ne-glomerular hyperfiltration. Iprotheni noma i-albhamuin etholakele ekuhlaziyeni umchamo ojwayelekile ekuqoqweni okungaphezu kwama-300 mg / ngosuku ikhombisa ukuguqulwa kwesifo sikashukela kuyi-proteinuria.

Lesi simo sihambisana nomfutho wegazi ophakeme kanye nokuvela kwezimpawu zesifo se-nephrotic, esidinga ukuboniswa nokubhekwa okukhethekile yi-nephrologist.Izigaba zakamuva ze-DN zihambisana ne-proteinuria ekhuphukile, i-SFC ephansi - 30-15 ml / min kanye nephansi, i-creatinine ekhulayo, ukubonakaliswa kwe-azotemia, anemia, acidosis, hyperlipidemia, i-hypocalcemia, i-hyperphosphatemia.

Ngaphezu kwezindlela zetanki lokuhlola umchamo, i-urret ye-excretory kanye ne-ultrasound yezinso, ukuxilongwa okwengeziwe kwe-DN nge-pyelonephritis, glomerulonephritis, kanye nesifo sofuba nakho kuyenziwa.

Izindlela zokwelapha

Ukuvimbela kanye nebanga eliphakeme lokuthi kungenzeka ukuqhubekela phambili kwe-DN ekuhlulekeni kwe-renal okungapheli kuyinjongo eyinhloko yokwelashwa okunqunyelwe.

Izindlela zokwelapha ezisetshenzisiwe zingahlukaniswa izigaba eziningana:

1. ekuhlolweni kwe-microalbuminuria, ukwesekwa kweglucose kuhlala kungaphakathi kobubanzi obujwayelekile. Ngokuhambisana nalokhu, ukubonakaliswa kwezimpawu zomfutho wegazi ophakeme kuvame ukubonwa. Ukulungiswa kwengcindezi yegazi ephakeme, kusetshenziswa ama-inhibitors e-ACE: Delapril, Enapril, Irumed, Captopril, Ramipril nabanye. Ukuzijwayeza kwabo kuholela ekunciphiseni kwengcindezi yegazi, kunciphise ukuqhubeka kwe-DN. Ukwelashwa kwe-antihypertensive kuyangezelelwa ngokuqokwa kwama-diuretics, ama-statins nama-calcium antagonists - uVerapamil, uNifedipine, uDiltiazem, kanye nokudla okukhethekile okuthatha isilinganiso samaprotheni nsuku zonke esifinyelela ku-1 g / kg. Umthamo we-ACE inhibitors ngezinhloso zokuvimbela wenziwa noma kukhona umfutho wegazi ojwayelekile. Uma ukusetshenziswa kwe-inhibitors kubangela ukuthuthukiswa komkhwehlela, ama-blocker e-AR II angabekwa esikhundleni;
2. i-prophylaxis, efaka ukuqokwa kwemithi yokwehlisa ushukela ukuze kuqinisekiswe ushukela wegazi ofanele nokuqapha okuhleliwe komfutho wegazi;
3. phambi kwe-proteinuria, ukwelashwa okuyinhloko kuhloselwe ukuvimbela ukungasebenzi kwezinso - isigaba esibulalayo sokwehluleka kwezinso okungamahlalakhona. Lokhu kudinga ukusekelwa kwamazinga kashukela egazini, ukulungiswa kwengcindezi yegazi, ukunqunyelwa kwamaprotheni ekudleni kuya ku-0,8 g / kg nokulawulwa kokudonswa kwamanzi. Ama-inhibitors e-ACE afakelwe i-Amplodipine (i-calcium blocker blocker), i-Bisoprolol (β-blocker), umuthi wokugaya ukudla - iFurosemide noma i-Indapamide. Esigabeni esibulalayo sesi sifo, ukwelashwa kwe-detoxification, ukusetshenziswa kwama-sorbents, nezidakamizwa ukuze kugcinwe i-hemoglobin nokuvimbela i-azotemia ne-osteodystrophy kuzodingeka.

Ukwelashwa okungaphansi kwe-hemodialysis noma i-peritoneal dialysis kuchazwe ngokuncipha kwesilinganiso sokuhlunga ngaphansi kwe-10 ml / min. Futhi ekusetshenzisweni kwezokwelapha okwenziwa emazweni angaphandle ekwelapheni ukwehluleka kwezinhlungu okungamahlalakhona, ukusetshenziswa kwezitho zomzimba kusetshenziswa.

Amavidiyo ahlobene

Mayelana nokwelashwa kwe-nephropathy yesifo sikashukela kuvidiyo:

Ukuqokwa okufika ngesikhathi kokwelashwa esigabeni se-microalbuminuria kanye nokusebenza kwayo okwanele kuyithuba elihle kakhulu lokuvimbela ukuwohloka ku-nephropathy yesifo sikashukela futhi kuqalise inqubo yokubuyela emuva. Ngama-proteinuria, enza ukwelashwa okufanele, ungavimba ukuqhubeka kwesimo esibucayi kakhulu - i-CRF.