Ishumi leminyaka lokugcina libonakaliswa ukwanda okungama-2 inani leziguli ezinesifo sikashukela emhlabeni. Enye yezimbangela eziholela ekufeni kwesifo "esimnandi" isifo sikashukela. Njalo ngonyaka, cishe iziguli eziyizinkulungwane ezingama-400 ziba nesigaba sekwephuzile sokuhluleka kwezinso okungamahlalakhona, okudinga ukuthi i-hemodialysis kanye nokufakelwa kwezinso.
I-complication inqubo eqhubekayo futhi engenakuphikwa (esigabeni se-proteinuria), edinga ukungenelela okufanelekile nokulungiswa kwesimo sikashukela. Ukwelashwa kwe-nephropathy kushukela kubhekwe esihlokweni.
Izici Zokuqubuka Kwesifo
Amazinga kashukela aphezulu abonakala ezigulini yiwo obangela ukwanda kwezinkinga. I-hyperglycemia eyenza ezinye izici:
- umfutho wegazi we-intracranial (ingcindezi eyandisiwe ngaphakathi kwe-glomeruli yezinso);
- i-systemic arterial hypertension (ukukhuphuka kwengcindezi yegazi eliphelele);
- i-hyperlipidemia (amazinga aphezulu wamafutha egazini).
Yilezi zinqubo eziholela kumonakalo kwizakhiwo ze-renal ezingeni lamaselula. Ukusetshenziswa kokudla okunamaprotheni amaningi (nge-nephropathy, ngakho-ke inani elithile lezinto zamaprotheni emchameni, okuholela ekuqhubekeni phambili ngokwengeziwe kwe-pathology) kanye ne-anemia kubhekwa njengezici ezengeziwe zokuthuthuka.
Ukuvela kwamaprotheni emchameni kuwuphawu oluholayo lwe-nephropathy kushukela
Ukuhlukaniswa
Ukuhlukaniswa kwanamuhla kwe-pathology yezinso ngokumelene nesizinda sesifo sikashukela kunezigaba ezi-5, ezimbili zokuqala zithathwa njengezingenangqondo, kanti ezinye zingumtholampilo. Ukubonakaliswa okungafani nalutho yizinguquko ngqo ezinso, akukho zimpawu ezisobala ze-pathology.
Uchwepheshe angabona:
- isixhumanisi sezinso;
- ukuqina kwe-glomerular basement membrane;
- ukunwetshwa kwe-matrix matrix.
Ngalezi zigaba, azikho izinguquko ekuhlaziyeni umchamo ojwayelekile, umfutho wegazi uvame ukwenzeka okujwayelekile, akukho zinguquko ezishiwo emikhunjini ye-fundus. Ukungenelela ngesikhathi kanye nokuqokwa kokwelashwa kungabuyisela impilo yesiguli. Lezi zigaba zithathwa njengezibuyela emuva.
Izigaba zemitholampilo:
- ukuqala kwe-nephropathy yesifo sikashukela;
- isifo sikashukela esibi;
- uremia.
Ukwelashwa kwangaphambili
Ukwelashwa kuqukethe ukulandela ukudla, ukulungisa i-carbohydrate metabolism, ukwehlisa umfutho wegazi, nokubuyisa umzimba we-metabolism. Iphuzu elibalulekile ukuthola isinxephezelo sikashukela ngokusebenzisa ukwelashwa kwe-insulin noma ukusetshenziswa kwezidakamizwa ezinciphisa ushukela.
I-Nephrologist - uchwepheshe obhekana nezinkinga zezinso ezigulini ezinesifo sikashukela
Ukwelashwa okungeyona yezidakamizwa kususelwa kula maphuzu alandelayo:
- ukwanda kokuzivocavoca umzimba, kepha kungakapheli umkhawulo ofanele;
- ukwenqaba ukubhema nokuphuza utshwala;
- ukunciphisa umthelela wezimo ezicindezelayo;
- ukuthuthukiswa kwesizinda se-psycho-ngokomzwelo.
Ukwelashwa kokudla
Ukulungiswa kokudla okunempilo akukhona kuphela ukwenqatshwa kwama-carbohydrate ashesha ukugaya, ajwayelekile kwisifo sikashukela, kepha futhi kuhambisana nemigomo yetafula Nombolo 7. Ukudla okulinganiselwe kwe-carb ephansi kuyanconywa, okungagcwalisa umzimba wesiguli ngezakhi ezidingekayo, amavithamini nezinto zokulandela umkhondo.
Inani lamaprotheni atholwe emzimbeni akumele lidlule ku-1 g ngekhilogremu yesisindo somzimba ngosuku, kubalulekile futhi ukwehlisa izinga lama-lipids ukuze kuthuthukiswe isimo semithambo yegazi, kususwe "cholesterol" embi ". Imikhiqizo elandelayo kufanele ibe nomkhawulo:
- isinkwa nepasta;
- ukudla okusemathinini;
- ama-marinade;
- ukubhema inyama;
- usawoti;
- uketshezi (kufika ku-1 litre ngosuku);
- amasoseji;
- inyama, amaqanda, amafutha.
Ukulandela ukudla okunamaphrotheni amancane kuyisisekelo sokwelapha i-nephropathy
Ukudla okunjalo kuphikisiwe ngesikhathi sokuzala kwengane, ngama-pathologies ashubile wesimo esithathelwanayo, ebuntwaneni.
Ukulungiswa kweshukela
Njengoba i-glycemia ephezulu ebhekwa njengeyisisusa ekwakhiweni kwe-nephropathy yesifo sikashukela, kuyadingeka ukwenza wonke umzamo wokuqinisekisa ukuthi amazinga kashukela angaphakathi kwebanga elivunyelwe.
Inkomba engenhla kwe-7% ivunyelwe kulezi ziguli ezinengozi enkulu yokuthola izimo ze-hypoglycemic, kanye nalezo ziguli ezinesifo senhliziyo futhi isikhathi sokuphila kwazo kulindeleke ukuthi sinqunyelwe.
Ngokulashwa kwe-insulin, ukulungiswa kwesimo kwenziwa ngokubuyekezwa kwemithi esetshenzisiwe, ukuphatha kwabo kanye nama-regimens umthamo. Uhlobo oluhle kakhulu lubhekwa njengomjovo we-insulin isikhathi eside izikhathi ezi-1-2 ngosuku nomuthi “omfishane” ngaphambi kokudla ngakunye emzimbeni.
Izidakamizwa ezinciphisa ushukela ekwelapheni isifo sikashukela i-nephropathy nazo zinezici zokusebenzisa. Lapho ukhetha, kubalulekile ukubheka izindlela zokukhipha izinto ezisebenzayo emzimbeni wesiguli kanye ne-pharmacodynamics yezidakamizwa.
Amaphuzu abalulekile
Izincomo zesimanje zochwepheshe:
Isifo sikashukela i-Angiopathy- AmaBiguanides awasetshenziselwa ukwehluleka kwezinso ngenxa yengozi ye-lactic acidosis coma.
- Ama-Thiazolinediones awanqunyelwe ngenxa yokuthi abangela ukugcinwa kwamanzi emzimbeni.
- I-Glibenclamide ingadala ukuncipha okukhulu koshukela wegazi ngenxa ye-pathology yezinso.
- Ngokuphendula okujwayelekile komzimba, i-Repaglinide, Gliclazide ivunyelwe. Uma kungekho kusebenza, kukhonjiswa ukwelashwa kwe-insulin.
Ukulungiswa kwengcindezi yegazi
Ukusebenza kwe-Optimum kungaphansi kwe-140/85 mm Hg. Ubuciko. Noma kunjalo, izinombolo zingaphansi kwe-120/70 mm RT. Ubuciko. kufanele futhi kugwenywe. Okokuqala, amaqembu alandelayo wezidakamizwa nabameli bawo basebenzisela ukwelashwa:
- Ama-inhibitors e-ACE - Lisinopril, enalapril;
- ama-angiotensin receptor blockers - iLosartan, i-Olmesartan;
- ama-saluretics - iFurosemide, i-Indapamide;
- ama-blockers wesiteshi se-calcium - uVerapamil.
Ukulungiswa kwezinkomba zokucindezela kwegazi - isigaba sokwelashwa okusebenzayo
Kubalulekile! Amaqembu amabili okuqala angabeka elinye nelinye endaweni yokubakhona kwe-hypersensitivity ngayinye kwizakhi ezisebenzayo.
Ukulungiswa kokuphazamiseka kwemetabolism yamafutha
Iziguli ezinesifo sikashukela i-mellitus, isifo sezinso esingamahlalakhona kanye ne-dyslipidemia zibonakaliswa yingozi enkulu yama-pathologies aqhamuka enhliziyweni nemithambo yegazi. Kungakho ochwepheshe bancoma ukulungisa izinkomba zamafutha egazi uma kunesifo "esimnandi".
Amanani Avumelekile:
- kwe-cholesterol - ngaphansi kuka-4.6 mmol / l;
- kuma-triglycerides - ngaphansi kuka-2.6 mmol / l, futhi ezimweni zezifo zenhliziyo nemithambo yegazi - ngaphansi kuka-1.7 mmol / l.
Ukwelashwa usebenzisa amaqembu amabili ayinhloko izidakamizwa: ama-statin nama-fibrate. Ukwelashwa kwe-Statin kuqala lapho amazinga we-cholesterol efinyelela ku-3.6 mmol / l (inqobo nje uma kungekho zifo engxenyeni yesistimu yenhliziyo). Uma kukhona ama-pathologies we-concomitant, ukwelashwa kufanele kuqale nganoma yimaphi amanani we-cholesterol.
Izimo
Kubandakanya izizukulwane eziningana zemithi (iLovastatin, Fluvastatin, Atorvastatin, Rosuvastatin). Izidakamizwa ziyakwazi ukususa i-cholesterol eyeqile emzimbeni, zinciphise i-LDL.
I-Atorvastatin - ummeleli wezidakamizwa ezokwehlisa i-lipid
I-Statins ivimbela isenzo se-enzyme ethile ebhekene nokukhiqizwa kwe-cholesterol esibindini. Futhi, izidakamizwa zikhulisa isibalo samanani aphansi we-lipoprotein receptors emangqamuzaneni, okuholela ekuvezweni okukhulu kokugcina okuvela emzimbeni.
Izicucu
Leli qembu lezidakamizwa linendlela ehlukile yokusebenza. Into esebenzayo ingashintsha inqubo yokuhambisa i-cholesterol ezingeni lofuzo. Abamele:
- Fenofibrate;
- Clofibrate;
- I-Ciprofibrate.
Ukulungiswa Kokuhlunga Kokuhlunga kabusha
Imininingwane yemitholampilo iphakamisa ukuthi ukulungiswa koshukela wegazi nokunakekelwa okujulile kungenzeka kungavimbeli ukuthuthukiswa kwe-albhamuinuria (isimo lapho kuvela khona izinto ezinamaphrotheni emchameni, okungafanele ngabe).
Njengomthetho, kunqunywe i-nephroprotector Sulodexide. Lesi sidakamizwa sisetshenziselwa ukubuyisa ukugcwala kwe-renal glomeruli, okuholela ekunciphiseni kokuphuma kweprotheni emzimbeni. Ukwelashwa kwe-Sulodexide kuboniswa njalo ezinyangeni eziyi-6.
Ukululama kwe-Electrolyte
Kusetshenziswa irejimeni elandelayo yokwelashwa:
- Ukulwa namazinga aphezulu we-potassium egazini. Sebenzisa ikhambi le-calcium gluconate, i-insulin ene-glucose, isisombululo se-sodium bicarbonate. Ukungasebenzi kwezidakamizwa kuwuphawu lwe-hemodialysis.
- Ukuqedwa kwe-azotemia (amazinga aphezulu ezinto ze-nitrogenous egazini). Ama-Enterosorbents (i-carbon esebenze, iPovidone, i-Enterodeum) anqunyelwe.
- Ukulungiswa kwamazinga aphezulu we-phosphate nezinombolo eziphansi ze-calcium. Kwethulwa isisombululo se-calcium carbonate, iron sulfate, i-Epoetin-beta.
Ukwelashwa kokungenelela kungenye yezinyathelo zokwelashwa kwe-nephropathy yesifo sikashukela
Ukwelashwa kwesigaba esibulalayo se-nephropathy
Umuthi wesimanje unikeza izindlela ezi-3 eziphambili zokwelashwa esigabeni sokugcina sokungaphumeleli kwe-renal esingamahlalakhona, esingakhulisa impilo yesiguli. Lokhu kufaka phakathi i-hemodialysis, i-peritoneal dialysis kanye nokufakelwa kwezinso.
Ukuxilonga
Indlela iqukethe ekwenzeni ukuhlanzwa kwegazi ngegazi. Kulokhu, udokotela ulungiselela ukungena kwe-venous okukhishwa kuyo igazi. Ngemuva kwalokho ingena emishini "yezinso yokufakelwa", lapho ihlanza khona, ithuthukiswe ngezinto eziwusizo, kanye nokubuyela emzimbeni.
Izinzuzo zendlela ukungabi bikho kwesidingo sansuku zonke (imvamisa izikhathi ezi-2-3 ngesonto), isiguli sihlala siqashwa ngudokotela. Le ndlela iyatholakala ngisho nakulezo ziguli ezingakwazi ukuzisebenza.
Okubi:
- kunzima ukunikeza ukufinyelela kwama-venous, ngoba izikebhe zintekenteke kakhulu;
- kunzima ukulawula izinkomba zokucindezela kwegazi;
- ukulimala kwenhliziyo nemithambo yegazi kuqhubeka ngokushesha;
- Kunzima ukulawula amazinga kashukela egazini;
- isiguli sinamathele esibhedlela ngokuphelele.
I-Peritoneal dialysis
Lolu hlobo lwenqubo lungenziwa yisiguli. I-catheter ifakwa ku-pelvis encane ngokusebenzisa udonga lwesisu lwangaphakathi, olushiyelwa isikhathi eside. Ngalesi catheter, ukufakwa kanye nokukhishwa kwekhambi elithile kuyenziwa, okufana nokwakheka ngeplasma yegazi.
Okubi yisidingo sokukhwabanisa nsuku zonke, ukungakwazi ukwenza ngokuncipha okukhulu kwe-visual acuity, kanye nengozi yokuqhamuka nezinkinga ngendlela yokuvuvukala kwe-peritoneum.
Ukufakwa kwezinso
Ukufakelwa kuthathwa njengendlela yokwelapha ebizayo, kodwa esebenza ngempumelelo kakhulu. Ngesikhathi sokusebenza kokufakelwa, ukuqedwa ngokuphelele kokuhluleka kwezinso kungenzeka, ingozi yokuthola ezinye izinkinga zesifo sikashukela i-mellitus (ngokwesibonelo, i-retinopathy) iyancishiswa.
Transplantation - indlela ephumelelayo yokubhekana nesigaba esibulalayo sezinkinga
Iziguli zilulama ngokushesha ngemuva kokuhlinzwa. Ukusinda ngonyaka wokuqala kungaphezulu kwama-93%.
Ububi bokufakelwa yilezi:
- ingozi yokuthi umzimba uzokwenqaba isitho esitshaliwe;
- ngokumelene nesizinda sokusetshenziswa kwemithi ye-steroid, kunzima ukulawula izinqubo ze-metabolic emzimbeni;
- ingozi enkulu yokuqhamuka nezinkinga zesifo esithathelwanayo.
Ngemuva kwenkathi ethile yesikhathi, i-nephropathy yesifo sikashukela nayo ingaba nomthelela ekuxhunyelweni.
Isimo sezulu
Ukwelashwa kwe-insulin noma ukusetshenziswa kwezidakamizwa ezinciphisa ushukela kunganciphisa ubungozi be-nephropathy yesifo sikashukela ngo-55%. Lokhu futhi kukuvumela ukuthi uthole isinxephezelo sikashukela, esivimbela ukuthuthukiswa kwezinye izinkinga zesifo. Inani lokufa linciphisa kakhulu ukwelashwa kwangaphambili nge-ACE inhibitors.
Amathuba emithi yesimanje angathuthukisa ikhwalithi yempilo yeziguli ezinezinkinga zezinso. Lapho wenza ukuhlanzwa kwegazi okusekwe nge-Hardware, izinga lokusinda lifinyelela kuma-55% ngaphezulu kweminyaka emi-5, kuthi ngemuva kokufakelwa kwesibindi, cishe okungama-80% esikhathini esifanayo.
