Isifo Sikashukela Sikashukela

I-Diabetes nephropathy ibhekisa kunoma yiziphi izilonda ezingxenyeni zezinto zokwelapha ezinempilo eziba umphumela wokuphazamiseka kwengqondo kwe-carbohydrate nama-lipid emzimbeni. Izinguquko ze-pathological zingathinta i-glomeruli yezinso, ama-tubules, ama-arterioles nemithambo yegazi. I-nephropathy yesifo sikashukela kwenzeka kubantu abangama-70-75% abanesifo "esimnandi".

Imvamisa ukuzibonisa ngesimo salezi zimo ezilandelayo:

• I-Sclerosis yemithambo yezinso namagatsha ayo.
• I-Sclerosis of arterioles.
• I-Glomerulossteosis ye -useuse, uhlobo oluyinqolobane nolweqile.
• I-Pyelonephritis.
• I-Necrosis ye-papilla ye-renal.
• I-neecrotic nephrosis.
• Isimo ku-tubules ye-renal ye-mucopolysaccharides, lipids ne-glycogen.

Indlela yokuthuthukisa

I-pathogenesis ye-nephropathy yesifo sikashukela ihlotshaniswa nezinto ezimbalwa ze-metabolic kanye ne-hemodynamic. Iqembu lokuqala lifaka i-hyperglycemia (ushukela wegazi ophakeme) kanye ne-hyperlipidemia (amazinga aphezulu ama-lipids kanye / noma ama-lipoprotein asemgodini wegazi). Izici zeHemodynamic zifanekiselwa yi-arterial hypertension kanye nengcindezi ekhuphukayo ngaphakathi kwe-glomeruli ye-renal.

Kubalulekile! Kukhona futhi isakhi sofuzo esingenakuphungulwa.

Izinguquko zeMetabolic

I-Hyperglycemia isixhumanisi esiyinhloko esicini sokuthuthuka kwe-pathology yezinso ngokumelene nesizinda se- "isifo esimnandi". Ngokuphikisana nesizinda sezinga eliphakeme le-glucose, lijoyina amaprotheni namafutha we-membranes wezinso, aguqula izici zawo zomzimba nezomzimba. Futhi, inani elikhulu lama-monosaccharides anomphumela onobuthi ezicutshini zesitho, esivuselela ukukhiqizwa kwamaprotheni kinase C futhi kusize ukukhulisa ukuqina kwezindonga zemithambo yegazi.

I-Hyperglycemia iyisici esiyinhloko se-etiological ekwakhiweni kwezinkinga zesifo sikashukela

Ukwenza kusebenze ukusabela kwe-oxidation kubangela ukukhishwa kwama-radicals mahhala okungaba nomthelela omubi futhi onobuthi kumaseli wesitho.

Amazinga aphezulu we-lipids nama-lipoprotein egazini ayinto elandelayo ekuthuthukiseni i-nephropathy. Njengoba ibekwe kungqimba lwangaphakathi lwemithambo yemithambo yegazi kanye nama-arterioles, ushukela ubamba iqhaza emonakalweni wawo futhi ukhuphule amandla okuba khona. Ama-lipoproteins asezingeni eliphansi elenza i-oxidation akwazi ukungena ngaphakathi kolwelwesi olungaphakathi lwemithambo yegazi. Babanjwa ngamaseli akhethekile lapho izakhi zezicubu ezixhumayo ziqala ukwakha khona.

Izici zeHemodynamic

Izinga eliphakeme lokucindezela ku-glomeruli yezinso yinto ebangela ukuthi kuqhubeke i-pathology. Imbangela yalomfutho wegazi onjalo ukusebenza kohlelo lwe-renin-angiotensin (i-hormone-esebenzayo ntho angiotensin-II).

Ukwanda kwezinga lokucindezelwa kwegazi emzimbeni womuntu okwenzeka lapho kuphendulwa zonke lezi zinto ezingenhla kuba umatshini odlula ushintsho lwe-metabolic ekuthuthukisweni okuqhubekayo kwe-renal pathology ngamandla ayo e-pathological.

Idatha enkulukazi

I-Diabetesic nephropathy (ikhodi ye-ICD-10 - N08.3 noma i-E10-E14 k. 2) kuvame ukwenzeka ngokumelene nesizinda se-mellitus yesifo sikashukela esincike ku-insulin. Yisifo sohlobo 1 ukuthi isifo sezinso sisendaweni yokuqala kuzo zonke izimbangela zokufa kweziguli. Ngohlobo 2, i-nephropathy ithatha indawo yesibili (eyokuqala izingqinamba ezivela enhliziyweni nemithambo yegazi).

Izinso zingumhluzi ohlanza igazi lezinto ezinobuthi, imikhiqizo ye-metabolic, ubuthi. Konke lokhu kukhishwa emchameni. I-Glomeruli yezinso, lapho izinguquko zenzeka khona kushukela, zithathwa njengezihlunga. Umphumela uba ukwephulwa kwezinqubo zemvelo kanye nokulingana kwama-electrolyte, ukudonsa kwamaprotheni emchameni, ongabukeki kubantu abaphilile.

I-Glomeruli yezinso - indlela eyinhloko yokuhlunga kwegazi

Lokhu kwenzeka ngokwesikimu esilandelayo:

• Izigaba zokuqala - amaprotheni amancane kunazo zonke angena ngaphakathi.
• Ukuqhubeka - ama-molecule amakhulu ayawa.
• Umfutho wegazi uyakhuphuka, ophazamisa umsebenzi wezinso.
• Ukulimala okwengeziwe kwesitho sikhuphuka nge-BP ephezulu kakhulu.
• Ukuntuleka kwamaprotheni emzimbeni kuholela ku-edema ebalulekile nokwakheka kwe-CKD, okuboniswa ukwehluleka kwezinso.

Ngakho-ke, sikhuluma ngombuthano onobunzima, umphumela wawo okuyisidingo se-hemodialysis, futhi ezimweni ezinzima, ukuthunyelwa kwezinso.

Ukuhlukaniswa

Kunokwehlukana okuningana kwalesi sifo ezinganeni nakubantu abadala: ukuhlukaniswa kwemitholampilo, ukwahlukaniswa kwezimpawu morphological kanye ngezigaba ngezigaba.

Okwezempilo

Lapho kukhona amaprotheni kumchamo, amazinga we-creatinine egazini anqunywa. Ngaphezu kwalokho, ngokuya ngamakhomula, izinga lokuhlunga kwe-glomerular libalwa, ngokuya izinkomba lapho ubukhona be-CKD kanye nesigaba salo kunqunywa khona.

Ifomula yokuhlola izinga lokuhlunga kubantu abadala:
I-140 - iminyaka (inombolo yeminyaka) x isisindo somzimba (in kg) x ukuqina. (umyeni - 1.23, abesifazane - 1.05) / creatinine (μmol / L) = GFR (ml / min)

Ifomula yokuhlola i-GFR yezingane:
izingqinamba (ngokuya ngeminyaka) x ukuphakama (cm) / creatinine (μmol / L) = GFR (ml / min)

Okokuziphatha

Kunamakilasi amane aphambili, ngokuya ngawo izinguquko zomzimba nomzimba emzimbeni wesiguli zichaziwe.

• Ukwesabisa ulwelwesi lwezimbungulu ze-renal zesimo esingasodwa.
• Ukwehla kwamaseli we-glomerular intervascular of a amancane (a) noma aqinile (b) Uhlobo.
• Ukwakheka kwezihlakala kumaseli we-intervascular cell (glomerulossteosis).
• I-Sclerosis yemvelo ephimisiwe.

Ukuhlukaniswa kwesiteji

Isigaba sokuqala sivezwa nge-hyperfunction yohlelo lokuhlunga. Ukhula ekuqaleni kwesifo sikashukela. Izinso zizama ukususa ushukela emzimbeni emzimbeni ngokushesha okukhulu, kubandakanya izindlela zokuncindezela. Iproteinuria (amaprotheni omchamo) ayikho, njengoba kunjalo nangezifo ze-pathology.

Isigaba sesibili ukubonakaliswa kokuqala. Kukhula iminyaka eminingana ngemuva kokutholakala kwe- “sifo esimnandi”. Izindonga zemithambo ye-artery kanye ne-arterioles ziyaqina, kepha akunamaprotheni omchamo, kanye nezimpawu zomtholampilo.

Isigaba sesithathu yisigaba se-microalbuminuria. Ukuhlolwa kwelabhoratri kunquma ukuba khona kwamaprotheni enanini lama-30 kuye kwangama-300 mg / ngosuku. Ukulimala kwe-Vascular kuboniswa ngokwenyuka ngezikhathi ezithile komfutho wegazi ngaphandle kwezinye izibonakaliso.

I-Urinalysis - isisekelo sokuxilongwa kwe-nephropathy yesifo sikashukela

Isigaba sesine - izimpawu ezinzima ze-nephropathy yesifo sikashukela. Inani elikhulu lamaprotheni liyakhishwa kumchamo, izinkomba zamaprotheni egazini ziyancipha, bese kubonakala ukubuna. Uma izinga le-proteinuria likububanzi obuphakathi, i-edema ibonakala ebusweni nasemilenzeni. Endabeni ye-excretion yenani elikhulu lamaprotheni avela emzimbeni, i-pathological exudate iqoqana esiswini, e-pleural, pericardial cavities.

Isigaba sesihlanu yisimo esibucayi esibonakaliswa yi-sclerosis ephelele yemikhumbi yezinso, i-GFR engaphansi kwe-10 ml / min. Usizo luqukethe i-hemodialysis noma i-organ transplantation, ngoba ezinye izindlela zokwelapha azisasebenzi.

Izithombe zemitholampilo

Izigaba ze-nephropathy zesifo sikashukela zixhumene nokuboniswa okubukwayo nokwaselabhoratri. Izigaba ezintathu zokuqala zithathwa njengezingenangqondo, ngoba akukho okubonakalayo kokubonisa kwe-pathology. Izinguquko zinganqunywa kuphela ngokusebenzisa i-laborator diagnostics noma ngesikhathi sokuhlolwa komlando kwezicubu zezinso.

Izimpawu ezinqala zivele esigabeni sesine, lapho iziguli ziqala ukukhononda ngalokhu kuboniswa okulandelayo:

• ukuvuvukala kobuso namaphethelo aphansi;
• ukwanda kwengcindezi yegazi;
• ukunciphisa umzimba;
• ubuthakathaka, ukusebenza okwehlisiwe;
• isicanucanu, ukuhlanza
• ukuntuleka kokudla;
• ukoma kwe-pathological;
• i-cephalgia;
• ukuphefumula
• Ubuhlungu emuva kwe-sternum.

Izinkomba zokulaliswa esibhedlela

Ukwelashwa kwe-inpatient kuhlelwa njengoba kuhlelwe iziguli ezinesifo se-nephropathy ne-nephrotic syndrome ngesilinganiso sokuhlunga ngaphezulu kuka-65 ml / min, ngesifo sezinso esihambisana nesifo sezinso esingalapheki esigaba 3 no-4.

Ukulaliswa esibhedlela okuphuthumayo kuyadingeka kulezi zimo ezilandelayo:

• i-oliguria - inani elincane lomchamo elichithekile;
• i-azotemia - inani elikhulayo lezinto ze-nitrogen egazini;
• i-hyperhydrate - indlela yokusebenza kwe-metabolic-usawoti metabolism, ebonakala ngokwakhiwa kwe-edema;
• metabolic acidosis - ukwanda kwe-acidity yegazi;
• i-hyperkalemia - inani le-potassium elikhuphukayo egazini.

Amasu wokuphathwa kweziguli nokunquma isidingo sokulaliswa esibhedlela yilona lungelo lodokotela abakhona

Ukuxilongwa kwe-pathology

Uchwepheshe ucacisa ukutholakala kwesifo sikashukela ngesiguli, izinga lokucindezela kwegazi kanye nomehluko walo, ukuthuthukiswa kokuvuvukala. Kubuka ngokusobala isimo sesikhumba, isisindo somzimba wesiguli, ukuba khona kwe-edema nobulukhuni bayo, isilinganiso phakathi komchamo otholwe futhi okhululiwe ngosuku.

Ukuhlolwa kwegazi okujwayelekile (inani lezinto ezakhiwe, isimo se-coagulation, ifomula ye-leukocyte, i-ESR), kuyadingeka. Kuhlaziywa amanani we-urine (ukuhlaziya okujwayelekile, i-sediment microscopy, i-ELISA yamaprotheni, isiko lamagciwane).

Amazinga we-GFR, i-creatinine, i-urea, i-cholesterol, ushukela, kanye nezinto zomkhondo ayatholakala. Ezinye izindlela zokuxilonga:

Isifo sikashukela i-Angiopathy

• I-Ultrasound yezinso nesisu;
• i-renal izicubu biopsy;
• ECG, echocardiography;
• I-Dopplerography yemikhumbi ye-renal;
• I-X-ray yesifuba, isisu;
• izinkomba zama-hormone egilo kanye ne-parathyroid.

Uma kunesidingo, udokotela uthumela isiguli ukuyobonana nodokotela wezifo zamehlo (ukukhipha i-retinopathy yesifo sikashukela), udokotela wezifo zenhliziyo (ezimweni zezimpawu zokuhluleka kwenhliziyo kanye ne-arrhythmia), i-endocrinologist (ukulawula isifo esikhona), i-angiosurgeon (ukudala i-fistula ye-AV njengokufinyelela kwe-hemodialysis).

Umehluko wokuxilongwa

I-nephropathy yesifo sikashukela kufanele ihlukaniswe kwi-nephrotic syndrome kanye ne-nephritic syndrome.

Amasu wokuphatha isiguli

Ngokuthuthukiswa kwezigaba ze-CKD 1 no-2, kanye nokwenyuka kwengcindezi yegazi, ukudla okulinganiselayo kuyadingeka, ukuthathwa kwamaprotheni amaningi emzimbeni. Ikhalori yansuku zonke ibalwa ngunye yi-endocrinologist noma isazi sezempilo. Ukudla kufaka ukuncishiswa okuphoqelekile kwenani likasawoti elinikezwe emzimbeni (lingadluli ku-5 g ngosuku).

Ukunciphisa inani likasawoti ekudleni - amathuba okunciphisa ukuthuthukiswa kwe-puffness

Umbuso wokuzivocavoca usethelwe uhhafu wehora kuze kube izikhathi ezi-5 ngesonto. Ukwenqaba imikhuba emibi (ukubhema nokuphuza). Kanye njalo ezinyangeni ezi-3, kuyadingeka ukuthola ukuthi kukhona amaprotheni emchini, futhi ulinganise nomfutho wegazi nsuku zonke.

Udokotela we-endocrinologist ubuyekeza uhlelo lwe-insulin therapy noma ukusetshenziswa kwama-hypoglycemic agents, uma kunesidingo, wenza ukulungiswa ngokukhansela noma ngokungeza umuthi othile. Lokhu kubalulekile ngoba i-hyperglycemia iyisisusa ekwakhiweni kwesifo sikashukela.

Ukwelashwa kwezidakamizwa

Umzuzu ophoqelelwe ekwelapheni i-nephropathy yesifo sikashukela ukuncipha kwengcindezi yegazi kuya ezinombolweni ezijwayelekile (lapho kukhona amaprotheni emchini, umfutho wegazi kufanele ube ngaphansi kuka-130/80 mm Hg). Izidakamizwa zokukhetha:

• Ama-inhibitors e-ACE (Perindopril) - akagcini nje ngokunciphisa umfutho wegazi, kodwa futhi anciphisa inani lamaprotheni adalulwa emchanjeni.
• Ama-Angiotensin receptor blockers (Losartan, Eprosartan) - anciphisa umfutho wegazi, anciphise umsebenzi onozwela wezinso.
• I-Thiazide diuretics (Indapamide, Clopamide) - isebenza kahle ezigabeni zokuqala, ngenkathi izinga lokuhlunga lingaphezulu kwama-30 ml / min.
• ILoop diuretics (ethacrine acid, furosemide) - ichazwe ezigabeni zokubonakaliswa okucacile kwe-nephropathy.
• Beta-blockers (Atenolol, Metaprolol).
• I-calcium calcium tubule blockers (iVerapamil).

Ukunciphisa izinkomba zamazinga aphansi we-lipoproteins, ama-statins (Simvastatin, Atorvastatin) nama-fibrate (Ciprofibrate, Fenofibrate) anqunyelwe.

I-Hemodialysis

Izincwadi zezokwelapha zanamuhla azinazo izincomo ngokuqondile lapho kudingeka ukuqala kokuzihlanza kwegazi nge-hemodialysis. Ukunquma isidingo kuyilungelo lochwepheshe ozoba khona. Ngo-2002, kwakhishwa umhlahlandlela wase-Europe osebenzayo, onemininingwane elandelayo:

• Ukuhlanzwa nge-dialysis kufanele kuqale uma izinga lokuhlunga le-glomerular lingaphansi kuka-15 ml / min ngokuhambisana nokuvezwa okukodwa noma ngaphezulu: ukuvuvukala, umfutho wegazi ophakeme ongalawuleki nokulungiswa, i-pathology yesimo sokudla okunempilo, ebonakala ngokuqhubekela phambili.
• Ukuhlanzwa kwegazi kufanele kuqale nge-GFR ngaphansi kwe-6 ml / min, noma ngabe ukwelashwa okuningana kwenziwa, futhi akukho ukubonakaliswa okwengeziwe.
• Ukudayela kusenesikhathi kweziguli ezisengozini enkulu.

Izincomo ze-KDOQI ziphakamisa ukuthi ukudayela kufanele kuqale ngaphansi kwale mibandela elandelayo:

• i-edema ebalulekile, engasebenzi ekuqondisweni ngemithi;
• isilinganiso sokuhlunga esingaphansi kuka-15 ml / min;
• urea - 30 mmol / l nangaphansi;
• ukwehla okukhulu kwesifiso sokudla kanye nezinga lomsebenzi ojwayelekile womzimba;
• i-potassium yegazi ingaphansi kuka-6 mmol / l.

I-Hemodialysis - inqubo yokuhlanzwa kwegazi esetshenziselwa ukwehluleka kwezinso

Ukuhlinzwa

Isiguli esine-nephropathy yesifo sikashukela singadinga ukuhlinzwa okuhleliwe noma okuphuthumayo. Ukudayela okuphuthumayo ngaphandle kokufinyelela, kuyadingeka i-catheter yesikhashana yokudayela.

Imisebenzi ehleliwe ukwakheka kwe-fistula ye-arteriovenous, ukufakwa kwe-vascular prosthesis, catheter yaphakade noma e-peritoneal. I-stenting noma i-balloon angioplasty yemikhumbi ye-renal nayo ingenziwa.

Izindlela zokuvimbela

Isisekelo sokuvinjwa kwe-nephropathy nezinye izinkinga ziyisinxephezelo sikashukela. Uma i-pathology isivele yavela, futhi i-albhamuin emchameni iyatholakala, kubalulekile ukunciphisa ijubane lokuqhubeka kwesimo kanjena:

• ukuzihlola ngokwakho kwezinkomba zoshukela wegazi;
• isilinganiso segazi lansuku zonke;
• ukubuyela kuphrofayili ejwayelekile yamafutha egazi;
• ukwelashwa kwezidakamizwa;
• ukunamathela ekudleni okuphansi kwe-carbohydrate.

Ngokuthuthukiswa kwe-proteinuria enzima, izincomo ezilandelayo kumele zibhekwe:

• ukufinyeleleka kwe-hemoglobin ye-glycated efanele (ngaphansi kwe-8%);
• ukulungiswa kwezinkomba zokucindezela kwegazi (amanani aphezulu avumelekile - 140/90 mm Hg);
• ukuthathwa kwesamba esikhulu samaprotheni ngokudla.

Ngeshwa, izigaba zokuqala zenkimbinkimbi ezibhekwa njengeziguqukayo. Zonke ezinye azelapheki. Ochwepheshe banganciphisa kuphela ukuqhubeka kwesifo, balondoloze inhlala-kahle yesiguli. Ukuxilongwa ngesikhathi kanye nokubambelela eselulekweni sokuya kodokotela isihluthulelo somphumela omuhle kubantu abagulayo.