Amaqiniso omhlaba wanamuhla, ahambisana nesikhathi sokuphila esiphakeme, izingcindezi ezivamisile, umsebenzi wokuhlala nokudla kude nokudla okunempilo kakhulu, zenze inkinga yesifo sikashukela ibe yimbi kakhulu. Isifo sikashukela singenye yezifo ezingathi sína futhi ezicashile ezweni lesimanje, ngoba ngalesi sifo esisekupheleni hhayi nje uhlelo lwe-endocrine kuphela, kepha futhi nezinye izitho nezinhlelo ezibalulekile, ezibandakanya ukufaka izinkinga okuhambisana nomonakalo wazo.
Uhlelo lokuchama kulesi sifo luhlose ukuthuthukiswa kwezinkinga zesibili zikashukela. Enye yezinkinga ezinkulu kakhulu futhi eziyingozi ukwehluleka kwezinso ku-mellitus yesifo sikashukela, ekhula kancane kancane futhi iholele ekwehleni okuqhubekayo komsebenzi wokusebenza kwamadivayisi we-glomerular we-renal parenchyma.
Ukuthuthukiswa kwesifo sikashukela
Isifo sikashukela yisifo sohlelo lwe-endocrine esenzeka ngendlela engapheli. Isimo sesifo sikashukela sisuselwa ekwandeni okuqhubekayo kokuxineka kwegazi glucose ngenxa yokukhiqizwa okunganele kwe-insulin ye-hormone, ethinta ngqo izinqubo ze-metabolic emzimbeni, ikakhulukazi i-carbohydrate metabolism, noma ngenxa yokwakheka kokumelana cishe kwayo yonke izicubu zomzimba ku-insulin, okuwuhlobo oluthile ukhiye wokudlulisa ama-carbohydrate ngokusebenzisa ulwelwesi lweseli engena esitokisini.
I-carbohydrate engasebenzi kahle kanye ne-lipid metabolism kuholela ekushintsheni kwe-biochemical egazini, okuqala ukuba nomthelela ongemuhle odongeni lwe-vascular of capillaries. Omunye wokuqala ukuhlupheka ngokuqondile ama-capillaries ezinso. Kulokhu kwenezelwa ukwanda komsebenzi wokuhlunga kwesitho ukunxephezela i-hyperglycemia yegazi.
Enye yezinto zokuqala ukubonakaliswa kwe-renal pathology ku-mellitus yesifo sikashukela yi-microalbuminuria, esivele ikhuluma ngezinguquko zokuqala ze-dystrophic kulwelwesi lwama-nephrons. Ukwanda kokusebenza kwezinso kanye nezinguquko emithanjeni yegazi kuholela ekunciphiseni okungenakuqothuka kokugcinwa kwemithombo yama-nephrons. Ikakhulu ngokushesha, izinguquko ziyaqhubeka ngaphandle kokwelashwa okuphelele futhi okwanele kwezidakamizwa kwesiguli sikashukela.
Isakhiwo sezinso
Kuma-anatomically, izinso siyisitho esibhanqiwe esitholakala esikhaleni se-retroperitoneal futhi simbozwe izicubu ezinamafutha. Umsebenzi oyinhloko wesitho ukuhlunga kwe-plasma yegazi nokususwa koketshezi ngokweqile, ama-ion nemikhiqizo ye-metabolic emzimbeni.
Izinso liqukethe izinto ezimbili eziyinhloko: i-cortical kanye ne-cerebral, kuyinto esembizeni lapho kufakwa khona isicwebezelisi se-filtration, lapho kufakwa khona i-plasma bese kumiswa umchamo oyinhloko. I-glomeruli kanye nohlelo lwebhubhu yakha izinsiza ezibushelelezi futhi inomthelela ekusebenzeni ngempumelelo kohlelo lomchamo lomzimba womuntu. I-glomeruli kanye nesistimu ye-tubule zithathelwa kakhulu ngemisipha, i.e. Ukunikezwa kwegazi okunamandla, okuyisisulu se-nephropathy yesifo sikashukela.
Kulesi sifo esifana nesifo sikashukela, izinso ziba yisitho sokuqala esihlosiwe
Izimpawu
Isimo somtholampilo sokulimala kwezinso kusifo sikashukela sinezimpawu ezilandelayo:
I-nephropathy yesifo sikashukela nezimpawu zayo- umfutho wegazi owengeziwe ongahlangene nezimo ezicindezelayo;
- ukuchama kaningi futhi okunamaphutha amaningi - i-polyuria. Ngemuva kwalokho, i-polyuria ithathelwa indawo yokwehla kwenani lamanzi avela emzimbeni;
- ukulunywa kwesikhumba;
- ukuvuthelwa okwenziwe njalo nokugawulwa kwemisipha yamathambo;
- ubuthakathaka obujwayelekile kanye nokubabaza;
- ikhanda.
Zonke lezi zimpawu ezingenhla ziba kancane kancane, futhi imvamisa abanesifo sikashukela bayazisebenzisa futhi abazinaki. Okokuxilongwa, ukuxilongwa kwelabhorethri emtholampilo ngokunquma ukwakheka kwe-biochemical yomchamo nokunqunywa kwezinga lokuhlunga kwe-glomerular yezinso kubalulekile.
- Ukuhlolwa komchamo okujwayelekile kukuvumela ukuthi usuvele ukhombe isimo se-pathological esifana ne-microalbuminuria ezigabeni zokuqala zesifo sikashukela. Kwashiwo ngenhla, kodwa kufanelekile ukuqaphela ukuthi i-microalbuminuria iyisibonakaliso sasebhalabhini futhi ayizibangeli izikhalazo ezivela esigulini. Futhi, ekuhlaziyweni komchamo, ukukhuphuka kweglucose okukhishwe emchameni, kanye nemikhiqizo ye-carbohydrate metabolism - imizimba ye-ketone, kunqunywa. Kwezinye izimo, ama-bacterium namaseli amhlophe egazi angabonakala emchini ngokuthuthukiswa kwe-pyelonephritis ngokumelene nesizinda samanani aphezulu kashukela wegazi.
- Izinga lokuhlunga le-glomerular likuvumela ukuthi unqume ngokuqondile umsebenzi wokusebenza wezinto ezinhle kakhulu zezinso bese usungula izinga lokwehluleka kwezinso.
Ucwaningo
Lapho isiguli sithola isifo sikashukela, into yokuqala eyabelwe ukutadisha umsebenzi wezinso. Futhi, uphawu lokuqala lwalesi sifo yi-microalbuminuria, okuyinhlanganisela ngokwemvelo, ukunciphisa i-hyperglycemia yegazi.
Wonke umuntu onesifo sikashukela kufanele ahlolwe ngokuphelele uhlelo lokuchama okungenani kanye ngonyaka.
Uhlelo lokuhlola luhlanganisa izifundo ezifana nalezi:
- ukuhlolwa kwegazi okune-biochemical ukuthola ukunqunywa kwayo yonke imikhiqizo ye-metabolic edalulwa yizinso;
- ukuhlaziywa komchamo ojwayelekile;
- ukuhlaziywa komchamo wamaprotheni, kufaka phakathi i-albhamuin, nezingxenyana zawo;
- ukuzimisela kwesilinganiso se-glomerular filtration rate nge-creatinine okuhlushwa.
Ukuhlolwa okungenhla kukhombisa ngokuningana ukuthi uhlelo lomchamo lusebenza kahle kanjani kumuntu onesifo sikashukela.
Umphumela wesifo sikashukela ohlelweni lokuchama
Kunezindlela ezimbili eziphambili zokulimala kwezinso ngenxa yalesi sifo. Ukulimazeka kokusebenza kwamazinga okuhlukahluka kwamazinga ahlukahlukene okwenzeka kuzo zonke iziguli, noma kunjalo, ngaphansi kwezimo ezithile, ngokwesibonelo, ngokuncipha komsebenzi wamasistimu wokuvikela ukuzivikela komzimba, kunengozi enkulu yokuba nesibindi sokuvuvukala sohlelo lwezinso lwe-pyelocaliceal yezinso, olufaka isandla ekuthuthukisweni okusheshayo kokuhluleka kwezinso okungamahlalakhona.
Uthando lomzwelo
Ukuphazamiseka emgatsheni wezinso ezikhanyayo kuholela ekwandeni kwe-proteinuria, futhi lokhu kuwuphawu olubalulekile lwalesi sifo
Ukwehlulwa kwezinto zokusebenza ezibushelelezi kungumphumela womsebenzi owengeziwe wezinso, owakhelwe ukunxephezela i-glycemia yegazi. Kakade ngenani likashukela wegazi elingu-10 mmol / l, izinso ziqala ukusebenzisa izindlela zazo zokubekisa zokuphuma kweglucose okweqile kusuka ku-plasma yegazi. Kamuva, umonakalo embhedeni we-miccirculatory wezicubu zobuchopho kanye nezinguquko ze-dystrophic ku-membrane apparatus, enesibopho sokuhlunga kwemikhiqizo ye-metabolic, yengezwa ekuxhumaniseni kohlelo lwezinso lwezinso. Ngemuva kweminyaka embalwa, ushintsho ophikelelayo we-dystrophic ezicutshini zezinso kanye nokwehla komthamo wokuhlunga kubonwa kwabanesifo sikashukela.
Isilonda esithathelanayo nokuvuvukala
Enye yezinkinga ezivame kakhulu zesifo sikashukela esihlobene nohlelo lwe-urinal yi-pyelonephritis. Izimfuneko zokuthuthuka kwayo kungukuphulwa kwenhlanzeko yomuntu siqu, izifo ezivame ukwenzeka kwezitho zangasese kanye nesinye, kanye nokugomeka komzimba okuncishisiwe. Isilinganiso esandayo sikashukela egazini sandisa kuphela ingozi yokuqhamuka noma yokwandisa i-pyelonephritis, ngoba amandla egesi adingekayo ukuthuthukisa ukutheleleka emzimbeni, okukhuphuka ngenxa ye-hyperglycemia.
Ukulimala kokutheleleka nokuvuvukala kuhlelo lwe-pyelocaliceal lwezinso kuholela ekusebenzeni kabi kokudonsa kanye nokuqina komchamo. Lokhu kufaka phakathi ukuthuthukiswa kwe-hydronephrosis futhi kusiza ukusheshisa izinqubo ze-dystrophic kumishini yezinso ebushelelezi.
Ukuqhathaniswa kwezinso okunempilo kanye noshukela oshintshiwe onesifo sikashukela esingesikhathi eside esinxephezelwe
Isifo sezinso esingamahlalakhona
I-nephropathy yesifo sikashukela nokwehluleka kwezinso kungukulimala kwezinso ku-mellitus yesifo sikashukela, kulimaza kakhulu impilo yesiguli futhi kudinga ukulungiswa okuphathelene nezokwelapha noma kwehadiwe.
Ukwehla komsebenzi osebenzayo wezinso ngo-50-75% kuholela ekuqubukeni kwezehluleki kwezinso. Izigaba ezi-5 zokuthuthuka kwezifo zezinso ezingamahlalakhona ziyahlukaniswa. Ngokuqhubeka kokwehluleka kwezinso, zombili lezi zimpawu kanye nezikhalazo zesiguli ziyanda kakhulu.
- isilinganiso sokuhlunga kwe-glomerular esingaphezu kwama-90 ml ngomzuzu, izimpawu zokulimala kohlelo lwe-urinary azibonwa;
- izinga lokuhlunga le-glomerular lisuka ku-60 liye ku-89 ml ngemin. Ku-diabetes, i-microalbuminuria inqunywa ekuhloleni ukuhlolwa kwegazi okujwayelekile;
- GFR kusuka ku-59 kuye ku-40 ml ngemin. Ekuhlaziyweni komchamo, i-macroalbuminuria kanye nokwephulwa kwezindawo zomchamo kunqunywa;
- I-GFR isuka ku-39 iye ku-15 ml ngeminthi, esevele ibonakala ngokuvela kwezimpawu ezingenhla zokuhluleka kwe-renal: ukulunywa kwesikhumba, ukukhathala, ukwanda kwengcindezi yegazi nabanye;
- I-GFR ingaphansi kwe-15 ml ngeminthi ngalinye. Isigaba esibulalayo siholela ku-oliguria ephikelelayo, ukunqwabelana kwemikhiqizo ye-metabolic egazini. Lokhu kungaholela ekwakhiweni kwe-ketoacidotic coma nezinye izinkinga ezisongela impilo.
Ekuphetheni, kubalulekile ukuqaphela ukuthi ukulimala kwezinso sikashukela kunganciphisa kakhulu ngokuxilongwa okufika ngesikhathi, kusungulwa ukutholwa okufanele kanye nokwelashwa okunengqondo kwesifo sikashukela. Ngenxa yalesi sizathu, nge-mellitus yokuqala yesifo sikashukela esitholakele, isiguli kufanele sidluliselwe ukuhlolwa okujwayelekile komchamo, ngoba kusukela ekuqaleni kwalesi sifo, kungenzeka ukuthi kuqinisekiswe ukulimala kwezinso elabhorethri futhi kuvikele ukuthuthuka okuqhubekayo kwesifo sezinso.
Ukwehluleka kwangempela
Ekugcineni, i-mellitus yesifo sikashukela esivele ikhona, ukwelashwa nokulungiswa kwayo okungenziwa noma okungasebenzi, kuholela kumonakalo ophelele ekusetshenzisweni komchamo kwesifo sikashukela. Lokhu kuholela ekwakhekeni kwezimpawu ezinjengalezi:
- ukukhathala, ubuthakathaka nokunganaki;
- ukonakala kwamakhono wokuqonda, okubandakanya ukunakwa nememori;
- isicanucanu nokuhlanza okungahambisani nokudla;
- ukulungiswa kwesikhumba okuqhubekayo ngenxa yokuqongelelwa kwemikhiqizo ye-metabolic egazini;
- imithambo emilenzeni kanye nasezinhlungwini ezibuhlungu zezitho zangaphakathi;
- ukulahlekelwa okwesikhashana ukwazi.
Ukwehluleka kwangempela kwezinga elibekiwe kuholela ekutheni isiguli siphoqelelwe ukuthi senze inqubo ye-hemodialysis kaningana ngenyanga, ngoba izinso zayo siqu azikwazi ukubhekana nomsebenzi we-excretory, okuholela ekuqongeleleni kwemikhiqizo ye-metabolic metabolism kanye nokulimazeka kwezitho zomzimba.
