Yini i-nephropathy yesifo sikashukela futhi ikhula kanjani?

Isifo Sikashukela Sikashukela- yini? Le yi-pathology eyingozi eqala ngohlobo 1 nohlobo 2 lwesifo sikashukela, okuholela ekulimaleni kwemithambo yegazi yezinso, ukwehla kwamandla abo okuhlunga nokubonakaliswa kokwehluleka kwe-renal.

I-pathology enjalo ihlala iba yimbangela yokukhubazeka futhi ijwayele ukubulala.

I-Pathogenesis ye-Nephropathy

I-nephropathy yesifo sikashukela inekhodi ye-ICD ye-10 E10.2-E14.2 - izilonda ezibushelelezi ku-mellitus yesifo sikashukela. I-Pathology ibonakala ngoshintsho emithanjeni yegazi enezinso nomsebenzi wokuhlunga we-glomerular (loops we-capillary).

Ukuthuthukiswa kwe-nephropathy kwenzeka ngokumelene nesizinda sokwephulwa kwe-carbohydrate metabolism kanye nokuvela kwe-hyperglycemia.

Kunemibono ehlukene ye-pathogenesis yesi sifo:

1. Umbono we-Metabolic. Izimo ezivame ukwanda kokuhlushwa kweglue glucose zibangela ukungasebenzi kahle kwezinqubo ze-biochemical. Izinguquko zokulinganisela zamanzi-electrolyte, ukuguquguquka kwemikhumbi ye-oxygen kuyancipha, ukushintshwa kwama-acid acid kuyashintsha, okuqukethwe kwamaprotheni agxilisiwe kuyanda, izinso zinobuthi futhi inqubo yokusebenzisa ushukela iyaphazamiseka. Ngokusho komqondo wezakhi zofuzo, ukubonakaliswa kokuphazamiseka kwe-hemodynamic ne-metabolic kuvusa ukwenzeka kwe-nephropathy ngenxa yokuvela kofuzo.
2. Umbono weHemodynamic. Ngokwalo mbono, imbangela ye-nephropathy ukwanda kwengcindezi yegazi, okubangela umfutho wegazi ophakeme kuma-loops we-capillary futhi kuphazamise ukunikezwa kwegazi ezinso. Ngemuva kwalokho, kwenzeka izinguquko ezibalulekile ekwakhekeni kwama-loops, okuboniswa ekufashiseni okusheshayo nokwenziwa komchamo ngokuqukethwe okweqile kwamaprotheni, kuthi ngemuva kwalokho amandla okuhlunga anciphe bese kuthi ukuvela kwe-glomerulososisosis (kufakwe esikhundleni sezicubu ze-glomerular ngamaseli ahlangene). Ngenxa yalokhu, ukwehluleka kwezinso kwenzeka.

Okusengozini kakhulu yesifo sikashukela i-nephropathy yisifo sikashukela esinezinto eziningi ezinjalo:

1. Ubulili. Emadodeni, i-nephropathy ivame ukutholakala.
2. Uhlobo lwesifo sikashukela. Uhlobo 1 diabetesics atholakala emgomeni.
3. Isikhathi lesi sifo. Ngokuyisisekelo, isigaba esibulalayo sokulimala kwezinso siqala ngemuva kweminyaka engu-15 yesifo sikashukela.
4. Umfutho wegazi ophakeme
5. Ukuthatha izidakamizwa ezinomphumela onobuthi ezinso.
6. Ukutheleleka kohlelo lwezitho zofuzo.
7. Ukuphazamiseka kwe-lipid metabolism.
8. Ukusetshenziswa kotshwala nogwayi.
9. Ukhuluphele.
10. Izimo ezivame kakhulu ze-glucose ekhuphukayo ngokuntuleka kwesikhathi eside kwezindlela zokulungisa.

Izimpawu ezigabeni ezahlukahlukene

Lesi sifo sivame ukuvela isikhathi eside futhi sinjenge-asymptomatic esigabeni sokuqala.

Lokhu kuyenza ibe nzima kakhulu le nkinga yokuxilongwa nokwelashwa, njengoba iziguli zivame kakhulu ukufuna usizo ngesikhathi sesigaba se-penultimate noma sokugcina, lapho kungasakwazi ukubasiza.

Ngakho-ke, i-nephropathy yesifo sikashukela ibhekwa njengengxaki eyingozi kakhulu yesifo sikashukela, egcina ngokufa.

Esikhathini esizayo, izimpawu ziziveza ngokuya ngentuthuko ye-pathology.

Kukhona ukwahlukaniswa ngezigaba:

1. Isiteji se-Asymptomatic - ayikho i-clinomatology yokwelashwa, kepha ezifundweni zomchamo kuyanda inani lokuhlunga le-glomerular liyabonakala, futhi ukuphuma kwegazi lezinso kuyanda. Inkomba ye-Microalbumin ingaphansi kwama-30 mg / ngosuku.
2. Isigaba sokushintsha kwesakhiwo siqala eminyakeni embalwa ukusuka kokuvela kokuphazamiseka kwe-endocrine. Izinga lokuhlunga le-glomerular kanye nokuhlushwa kwe-microalbumin akushintshi, kepha kukhona ukuqina kwezindonga ze-capillary kanye nokwanda kwendawo yokuhlangana.
3. Isigaba se-prenephrotic sikhula ngemuva kweminyaka engama-5-6 kusukela ekuqaleni kwesifo sikashukela. Izikhalazo zeziguli azikho. Kwesinye isikhathi, ngemuva kokuzivocavoca umzimba, ukucindezela ama-Pressure kuyabonakala. Ukunikezwa kwegazi kanye nezinga lokuhlunga alishintshiwe, kepha izinga le-microalbumin likhuphuka lisuka kuma-30 liye kwangama-300 mg / ngosuku.
4. Ngemuva kweminyaka engu-15 yokugula, isigaba se-nephrotic siqala. Izikhathi ezithile, kuvela igazi emchini, kuthiwe kutholakala amaprotheni angaphezu kuka-300 mg / ngosuku. Kaningi umfutho wegazi ophakeme ongalungile. Ukuhamba kwegazi emithanjeni yezinso nezinga lokuhlunga le-glomerular liyancipha. I-Urea ne-creatinine esegazini idlula kancane into evumelekile. Ukuvuvukala kwezicubu zobuso nomzimba kuvela. Kukhona ukwanda kwe-ESR ne-cholesterol, kanti ne-hemoglobin iyancipha.
5. Isigaba esibulalayo (nephrossteosis). Umsebenzi wokuhlunga nokuhlushwa kwezinso uyancipha. Ukuqoqwa kwe-urea ne-creatinine egazini kukhula ngokushesha, futhi inani leproteyini liyancipha. I-Cylindruria kanye nokuba khona kwegazi kumchamo namaprotheni kuyabonakala. IHemoglobin iwa kabuhlungu. Ukwembiwa kwe-insulin yizinso kuyaphela futhi akukho shukela lubanjiwe ku-urinalysis. Abanesifo sikashukela bakhala ngokungcindezelwa okubucayi okuqhubekayo nokudumba okukhulu. Izinga le-glucose lehla futhi isidingo se-insulin siyanyamalala. Izimpawu ze-uremia ne-dyspeptic syndrome zikhula, ukudakwa komzimba kwenzeka futhi konke ukuhluleka kwe-renal okungapheli kuyaphela.

Ukuxilongwa kwe-pathology

Ukuxilongwa kwe-nephropathy ekuqaleni kwentuthuko kwenziwa kusetshenziswa:

• ukuhlolwa kwegazi komtholampilo;
• ukuhlolwa kwegazi kwe-biochemistry;
• izifundo zemitholampilo nezokuchama komchamo;
• I-Ultrasound yemithambo yegazi ye-renal;
• amasampula eZimnitsky naseReberg.

Isikhombisi esiyisisekelo okudonselwa kuso ukunakwa kungukuqukethwe kwe-Microalbumin ne-creatinine ku-urinalysis. Uma kunokukhuphuka njalo kwe-microalbumin, ngesimo esamukelekayo sama-30 mg / ngosuku, khona-ke ukuxilongwa kwe-nephropathy kuqinisekisiwe.

Ezigabeni zakamuva, ukuxilongwa kunqunywa ngesisekelo sezinkomba ezinjalo:

• ukubonakala komchamo we-protein okweqile (ngaphezu kwama-300 mg / ngosuku);
• ukwehla kwamaprotheni egazi;
• amazinga aphezulu egazi we-urea ne-creatinine;
• isilinganiso sokuhlunga okuphansi kwe-glomerular (ngaphansi kwe-30 ml / min.);
• ukwanda kwengcindezi;
• ukwehla kwe-hemoglobin ne-calcium;
• ukubonakala kokuvuvukala kobuso nomzimba;
• ukubonakaliswa kwe-acidosis ne-hyperlipidimia kuyabonakala.

Ngaphambi kokwenza isifo, ukuxilongwa kokuqhathanisa kwenziwa namanye ama-pathologies:

1. I-pyelonephritis engapheli. Okubaluleke kakhulu yimiphumela ye-urography, i-ultrasound nezimpawu ze-bacteriuria ne-leukocyturia.
2. I-glomerulonephritis engamahlalakhona nethambile.
3. Isifo sezinso. Inentshisekelo izinkomba zomchamo zobukhona be-mycobacteria nokukhula kwezimbali.

Kulokhu, i-ultrasound, ukuhlaziywa kwe-microflora yomchamo, kusetshenziswa ubuchwephesha bezinso.

I-biopsy yezinso isetshenziswa ezimweni ezinjalo:

• i-proteinuria yokuqala futhi ethuthuka ngokushesha;
• hematuria ephikelelayo;
• I-nephrotic syndrome.

Ukwelashwa kwezifo

Umgomo oyinhloko wokwelashwa kwezidakamizwa ukuvikela ukwenzeka kokuhluleka kwe-renal okungapheli kanye nokuvinjezelwa kwezifo zenhliziyo (imivimbo, ukushaya kwenhliziyo, izifo zenhliziyo ezi-coronary).

Izigaba zokuqala zokuthuthukiswa kwe-nephropathy yesifo sikashukela kufanele zihambisane nokuqokwa kwe-ACE inhibitors ngezinjongo ze-prophylactic kanye nokulawulwa kokuhlaselwa kweglue ngokulungiswa okwalandela.

Ukwelashwa kwesigaba sangaphambi kwe-nephrotic kubandakanya:

1. Ukudla okuphoqelekile okunokwehla kokuqukethwe kwamaprotheni.
2. Ukuqiniswa kokucindezela. Izidakamizwa ezisetshenzisiwe ezifana ne-enalapril, losartan, ramipril. Umthamo akufanele uholele ku-hypotension.
3. Ukubuyiselwa kokusweleka kwamaminerali nokuphazamiseka kwe-metabolic yamafutha, amaprotheni nama-carbohydrate.

Isigaba se-nephrotic siphathwa ngemikhawulo yokudla. Ukudla okudla ukudla okuncane kwamafutha ezilwane namaprotheni ezilwane kunqunyelwe. Ukukhishwa ekudleni kasawoti nokudla okune-potassium ne phosphorus kuyakhonjiswa.

Kunconywa ukuthatha izidakamizwa ezenza wehlise umfutho wegazi futhi zenze ngokwejwayelekile izinga le-cholesterol egazini kanye ne-lipid spectrum yayo (i-folic ne-nicotinic acid, ama-statins). Kulesi sigaba, i-hypoglycemia ivame ukubonwa, okusho ukuthi kungenzeka ukuthi wenqabe ukusebenzisa i-insulin.

Ukwelapha kokugcina, isigaba sokugcina sisekelwa ekugcineni imisebenzi ebalulekile yomzimba:

• ukwanda kwe-hemoglobin - Ama-Ferropleks, ama-Fenyuls asetshenziswa;
• ukuthatha ama-diuretics ukukhulula i-edema - Hypothiazide, Furosemide;
• izinga loshukela wegazi liyalungiswa;
• ukuqeda ukudakwa komzimba;
• izinguquko kwezicubu zamathambo zivinjelwa ngokuthatha i-Vitamin D3;
• ababhuli bomzimba banqunyelwe.

Esigabeni sokugcina, umbuzo wokusetshenziswa kwe-perineal dialysis, i-hemodialysis, kanye nokuthola izinso for transplantation uvuswa ngokushesha.

Isimo sezulu nokuvikela

Ukwelashwa okuqala ngesikhathi kungasusa ukubonakaliswa kwe-microalbuminuria. Kungenzeka ukuvikela ukuvela kokuhluleka kokuqina kwe-renal noma ngesikhathi sokuthuthukiswa kwe-proteinuria.

Ukwelashwa okubambezelekile kweminyaka eyi-10 kuholela ekwehlulekeni kwezinso engxenyeni yohlobo lwesifo sikashukela esingu-1 nakuzo zonke iziguli eziyi-10 ezinesifo sikashukela sohlobo 2.

Uma isigaba sokugcina sekwenzeka bese kuthi ukubonwa kwehluleki kwezinso kutholwe, khona-ke le nqubo ayinakuguqulwa futhi kudluliswa ngokushesha izinso noma i-hemodialysis ukusindisa impilo yesiguli.

Ngokwezibalo, zonke iziguli eziyi-15 ezitholakala zinesifo sikashukela sohlobo 1 futhi ezingaphansi kweminyaka engama-50 zibulawa yi-nephropathy yesifo sikashukela.

Kufanele kulandelwe le mithetho elandelayo:

1. Ukuqapha okwenziwa nsuku zonke kokuhlushwa kashukela egazini. Kala amazinga kashukela ngaphambi nangemva kokudla.
2. Namathela ekudleni, ugweme ukweqa emazingeni kashukela. Ukudla kufanele kube namafutha amancane kanye nama-carbohydrate asheshayo. Kuzofanela wenqabe ushukela. Ikhefu elide phakathi kokudla nokudla ngokweqile kufanele futhi kungafakwa eceleni.
3. Lapho kuvela izimpawu ze-nephropathy, kuyadingeka ukuthi kunciphiswe ukuthathwa kwamaprotheni ezilwane, amafutha bese kungabandakanyi ukudla usawoti.
4. Lapho kuguqulwa izinkomba ezibalulekile, izinyathelo zokulungisa kufanele zithathwe. Umthamo we-insulin kufanele unqunywe uchwepheshe.
5. Yenqaba imikhuba emibi. I-Alcohol isiza ukwandisa okuqukethwe ushukela, ngenkathi i-nicotine yakha imithambo yegazi futhi iphazamisa ukuhamba kwegazi.
6. Ukulawula isisindo somzimba. Amaphawundi angeziwe ayimbangela ejwayelekile yezinguquko ze-glucose. Ngaphezu kwalokho, ukulethwa kwegazi ezitho zomzimba kuyaphazamiseka kusuka kwesisindo ngokweqile futhi izifo zezifo zenhliziyo zenzeka.
7. Gcina ukulingana kwamanzi ngokuphuza amanzi amaningi. Okungenani amalitha ayi-1.5 amanzi kufanele adakwe nsuku zonke.
8. Thuthukisa ukuhanjiswa kwegazi kwizitho zangaphakathi ngokuzivocavoca okulinganiselayo ngokomzimba. Ukuhamba nokudlala ezemidlalo kuyenza ijwayele inhliziyo, kugcwalise igazi ngomoya-mpilo futhi kukhulise ukumelana nomzimba ezintweni eziphikisayo.
9. Gwema ukutheleleka kwethamo lomchamo. I-Hypothermia, inhlanzeko yomuntu siqu enganele kanye nezocansi ezingavikelekile zivusa isifo sezinso.
10. Ungazindli. Ukuphuza umuthi kufanele kwenzeke kuphela ngemuva kokuvumelana nodokotela. Amaresiphi wemithi yendabuko akufanele athathe indawo kadokotela, kepha angasetshenziswa kuphela njengezihibe.
11. Gada umfutho wegazi. Izinkomba kufanele zibe phakathi kwe-130/85.
12. Akunandaba nezinkomba zokucindezela, i-ACE inhibitors kufanele inqunywe.

Izinto zevidiyo ngomonakalo wezinso sikashukela:

Izindlela zokuvimbela kufanele ziqale ngokushesha ngemuva kokuqinisekisa ukutholakala kwesifo sikashukela. Udokotela kufanele avakashelwe ngemuva kweminyaka engu-5 kusukela kuqale lesi sifo kabili ngonyaka kwiziguli ezinesifo sikashukela sohlobo 1 kanye nohlobo 2 sikashukela minyaka yonke.

Ngesikhathi sokuvakasha kodokotela, umchamo kufanele unikezwe ukuqapha iprotheni yomchamo, i-urea, ne-creatinine. Ushintsho lokuqala lwezinkomba, udokotela uzonikeza ukwelashwa okufanele.

Yazisa udokotela ngezimpawu zokuqala ezesabekayo ngendlela yokulala ephazamisekile nokudla, ukubukeka kwe-nausea nobuthakathaka, uma ukuphefumula kwenzeka noma ukudumba kutholakala ngaphansi kwamehlo nezingalo.

Konke lokhu kuzovumela ukuthola ukuthuthukiswa kwe-nephropathy yesifo sikashukela ekuqaleni kwentuthuko futhi kuqalise ukwelashwa okufika ngesikhathi.