Ukuchazwa kwe- "diabetesic nephropathy" kungumqondo ohlanganayo ohlanganisa ubunzima bezifo eziholela ekulimaleni kwemithambo esezinso emhlane ngemuva kwesifo sikashukela esibuhlungu kakhulu.
Imvamisa igama elithi “Kimmelstil-Wilson syndrome” lisetshenziselwa lokhu kugula, ngoba imiqondo ye-nephropathy ne-glomerulosclerosis isetshenziswa njengegama elifanayo.
Kwi-nephropathy yesifo sikashukela ngokwe-ICD 10, kusetshenziswa amakhodi ama-2. Ngakho-ke, ikhodi yesifo sikashukela se-nephropathy ngokusho kwe-ICD 10 ingaba ne-E.10-14.2 (isifo sikashukela ngomonakalo wezinso) kanye ne-N08.3 (izilonda ze-glomerular in sikashukela). Imvamisa, umsebenzi wezinso okhubazekile ubonakala ngokuncika kwe-insulin, uhlobo lokuqala - 40-50%, kanti ohlotsheni lwesibili, ukubonakala kwe-nephropathy kungu-15-30%.
Izizathu zokuthuthuka
Odokotela bane imibono emithathu ebalulekile maqondana nezimbangela ze-nephropathy:
- ukushintshana. Umongo womcabango wokuthi indima eyinhloko yokubhubhisa iboniswa izinga eliphakeme likashukela egazini, ngenxa yokuthi ukuhamba kwegazi kwemithambo kuyaphazamiseka, futhi amafutha afakwa emithanjeni, okuholela ku-nephropathy;
- ufuzo. Okusho ukuthi, isiphetho selifa lesifo. Inshokutsi yemcabango kutsi tindlela tekusetjentiswa kwetfu letifaka tifo letifana nesifo sikashukela kanye nesifo sikashukela ezinganeni;
- hemodynamic. Umbono uthi ngesifo sikashukela kukhona ukwephulwa kwe-hemodynamics, okungukuthi, ukusakazeka kwegazi ezinso, okubangela ukwanda kwezinga le-albhamuin emchameni - amaprotheni abhubhisa imithambo yegazi, ukulimala okukhona kulo isikhumba (sclerosis).
Ngaphezu kwalokho, izizathu zokuthuthukiswa kwe-nephropathy ngokuya nge-ICD 10 zivame ukufaka:
- ukubhema
- ushukela wegazi ophakeme;
- umfutho wegazi ophakeme;
- ama-triglycerides ampofu ne-cholesterol;
- i-anemia
Imvamisa, eqenjini le-nephropathy, kutholakala lezi zifo ezilandelayo:
- isifo sikashukela se-glomerulossteosis;
- i-renal artery atherossteosis;
- i-necrosis yemiselekazi yezinso;
- imali efakwa emiseleni yezinso;
- pyelonephritis.
Izimpawu
Okokuqala, kubalulekile ukusho ukuthi isifo sikashukela singaba nomthelela olimazayo ezinso zeziguli isikhathi eside, futhi isiguli ngeke sibe nemizwa engemnandi.
Imvamisa, izimpawu ze-nephropathy zesifo sikashukela ziqala ukutholwa ngesikhathi lapho ukuhluleka kwe-reso kusungule.
Ngesikhathi sesigaba sokuqala, iziguli zingathola ukwanda kwengcindezi yegazi, i-proteinuria, kanye nokwenyuka kwe-15-25% kosayizi wezinso. Esigabeni esithuthukile, iziguli zine-diuretic-immune nephrotic syndrome, umfutho wegazi ophakeme, kanye nokwehla kwezinga lokuhlunga le-glomerular. Isigaba esilandelayo - isifo sezinso esingamahlalakhona - sibonisa ngokuba khona kwe-azotemia, i-renal steodystrophy, i-hypertension ye-arterial kanye nokuphikelela kwe-edematous syndrome.
Itholakala kanjani?
Ukuthola i-nephropathy, kusetshenziswa umlando wesiguli nokuhlolwa kwelebhu. Indlela ephambili esigabeni sokuqala ukubona ukuthi izinga le-albhamuin lomchamo.
Izindlela ezilandelayo zingasetshenziswa ukuthola isifo sikashukela ngokwe-ICD 10:
- ukuzimisela kwe-GFR kusetshenziswa ukuhlolwa kweReberg.
- i-biopsy yezinso.
- I-Dopplerography yezinso nemithambo ye-peripheral (ultrasound).
Ngaphezu kwalokho, i-ophthalmoscopy izosiza ekuboneni uhlobo kanye nesigaba se-retinopathy, futhi i-electrocardiogram izosiza ukukhomba i-hypertrophy engakwesokunxele ye-ventricular.
Ukwelashwa
Ekwelapheni isifo sezinso, isimo esivelele ukwelashwa okuphoqelekile kwesifo sikashukela. Indima ebalulekile idlalwa yi-normalization ye-lipid metabolism kanye nokuqina kwengcindezi yegazi. I-Nephropathy ilashwa ngemithi evikela izinso nomfutho wegazi ophansi.
Izibonelo zokudla okuqukethe ama-carbohydrate alula
Enye yezindlela zokwelapha ukudla. Ukudla kwe-nephropathy kufanele kube yimikhawulo yokudla ama-carbohydrate alula futhi kuqukethe inani lamaprotheni elifunekayo.
Lapho udla, uketshezi alulinganiselwe, ngaphezu kwalokho, uketshezi kufanele luqukethe i-potassium (ngokwesibonelo, ujusi ongafakiwe). Uma isiguli sinciphisile i-GFR, ukudla okunamaprotheni aphansi, kepha ngasikhathi sinye okudingakalayo inani lamakhalori, kuyanconywa. Uma i-nephropathy yesiguli ihlanganiswa ne-hypertension ye-arterial, kunconywa ukudla okunosawoti omncane.
Ukwelashwa kwe-relio we-Palliative
Uma isiguli sinokwehla kwezinga lokuhlunga kwe-glomerular kuya enkombeni engezansi kwe-15 ml / min / m2, udokotela ohambelayo unquma ukuqala ukwelashwa okubuyiselwe esikhundleni, okungamelwa yi-hemodialysis, i-peritoneal dialysis noma ukufakelwa.
Umongo we-hemodialysis ukuhlanzwa kwegazi ngohlelo lokusebenza "lwezinso". Inqubo kumele yenziwe izikhathi ezi-3 ngesonto, cishe amahora angama-4.
I-Peritoneal dialysis ifaka ukuhlanzwa kwegazi nge-peritoneum. Nsuku zonke, izikhathi ezi-3-5 isiguli sifakwa ngesisombululo se-dialysis ngqo esikhunjeni sesisu. Ngokungafani ne-hemodialysis engenhla, i-peritoneal dialysis ingenziwa ekhaya.
Ukudluliselwa kwezinso kwe-Donor kuyindlela eyeqisayo yokulwa nephropathy. Kulokhu, isiguli kufanele sisebenzise izidakamizwa ezicindezela amasosha omzimba, ukuvimbela ukwenqatshwa.
Izindlela ezintathu zokuvimbela
Indlela ethembeke kakhulu yokuvikela ukuthuthukiswa kwe-nephropathy isinxephezelo esamukelekayo sesifo sikashukela:
- ukuvikela okuyinhloko ukuvikela i-microalbuminuria. Izici ezibalulekile zokuthuthukiswa kwe-microalbuminuria yilezi: isikhathi sesifo sikashukela sisuka eminyakeni engu-1 kuye kwemi-5, ifa, ukubhema, i-retinopathy, i-hyperlipidemia, kanye nokuntuleka kwendawo yokugcina yezinso esebenza ngokusobala;
- Ukuvinjwa kwesibili ukunciphisa ukubhebhetheka kwalesi sifo ezigulini esevele zinciphisile i-GFR noma i-albhamuin kumchamo ophakeme kunokwejwayelekile. Lesi sigaba sokuvimbela sifaka: Ukudla okunamaprotheni aphansi, ukulawulwa kwengcindezi yegazi, ukuqina kwephrofayili ye-lipid egazini, ukulawulwa kwe-glycemic kanye nokujwayelekile kwe-intrarenal hemodynamics;
- ukuvikela okuphezulu kwenziwa esiteji se-proteinuria. Umgomo oyinhloko wesigaba ukunciphisa ubungozi bokuqhubeka kokuhluleka kokuqina kwezinso, okubuye kubonakale: nge-hypertension ye-arterial, isinxephezelo esanele se-carbohydrate metabolism, proteinuria ephezulu kanye ne-hyperlipidemia.
Amavidiyo ahlobene
Mayelana nezimbangela nokwelashwa kwe-nephropathy yesifo sikashukela ku-TV show "Phila unempilo!" no-Elena Malysheva:
Ngaphandle kokuthi phakathi kwayo yonke imiphumela emibi yesifo sikashukela i-mellitus, i-nephropathy ingenye yezindawo eziholayo, ukubhekwa ngokucophelela kwezindlela zokuzivikela kuhlangene nokuxilongwa okufika ngesikhathi nokwelashwa okulungile kuzosiza ukubambezeleka okukhulu ukuthuthukiswa kwalesi sifo.
