Matenda a shuga ndi nephropathy ndimatchulidwe odziwika bwino a matenda a impso a shuga. Mawuwa amafotokoza zotupa za matenda a impso (glomeruli ndi tubules), komanso zombo zomwe zimawadyetsa.
Matenda a diabetes nephropathy ndi owopsa chifukwa amatha kutha kufikira gawo lomaliza (losautsa) la kulephera kwa impso. Poterepa, wodwalayo adzafunika kuyesedwa kapena kupatsirana kwa impso.
Matenda a shuga ndi nephropathy ndi chimodzi mwazomwe zimayambitsa kufa msanga ndi kupunduka kwa odwala. Matenda a shuga sikuti ndi okhawo omwe amachititsa mavuto a impso. Koma pakati pa omwe akudwala dialysis ndikuyimirira pamzere wa impso wothandizira, wina wodwala matenda ashuga kwambiri. Chimodzi mwazifukwa izi ndi kuchuluka kwakukulu kwa matenda ashuga a 2.
Zifukwa zoyambitsa matenda a shuga:
- shuga wambiri wodwala;
- cholesterol osauka ndi triglycerides m'magazi;
- kuthamanga kwa magazi (werengani tsamba lathu la "mlongo" la matenda oopsa);
- kuchepa magazi, ngakhale “kufatsa” (hemoglobin m'magazi <13.0 g / lita);
- kusuta (!).
Zizindikiro za matenda a shuga a Nephropathy
Matenda a shuga amatha kusokoneza impso kwa nthawi yayitali kwambiri, mpaka zaka 20, popanda kuyambitsa zovuta m'maganizo mwa wodwalayo. Zizindikiro za matenda a shuga a nephropathy amapezeka pamene kulephera kwa impso kwayamba kale. Ngati wodwala ali ndi zizindikiro za kulephera kwa impso, ndiye kuti izi zikutanthauza kuti kutaya kwa metabolic kumadziunjikira m'magazi. Chifukwa impso zomwe zakhudzidwa sizingakwanitse kusefukira.
Magawo a matenda ashuga nephropathy. Kuyesa ndi kuwazindikira
Pafupifupi onse odwala matenda ashuga ayenera kuyesedwa pachaka kuwunikira ntchito ya impso. Ngati matenda a diabetes a nephropathy atakula, ndikofunikira kwambiri kuti muzindikire koyambirira, pomwe wodwalayo samamvabe. Chithandizo choyambirira cha matenda a shuga a nephropathy amayamba, ndiye mwayi wopambana, ndiye kuti wodwalayo amatha kukhala ndi moyo wopanda dialysis kapena kumuika impso.
Mu 2000, Unduna wa Zaumoyo ku Russia unavomereza gulu la anthu odwala matenda ashuga ndi magulu. Mulinso mitundu iyi:
- gawo microalbuminuria;
- siteji proteinuria yokhala ndi nitrogen-excreting impso ntchito;
- gawo la matenda aimpso kulephera (mankhwala a dialysis kapena kupatsidwa impso).
Pambuyo pake, akatswiri adayamba kugwiritsa ntchito njira yodziwika bwino yokhudzana ndi matenda a impso a shuga. Mmenemo, osati 3, koma magawo 5 a shuga a nephropathy amadziwika. Onani magawo a matenda a impso osafunikira kuti mumve zambiri. Gawo lanji la matenda ashuga okodzetsa wodwala ena zimadalira kuchuluka kwake kwa kusefedwa (amafotokozeredwa mwatsatanetsatane momwe amatsimikizidwira). Ichi ndiye chizindikiro chofunikira kwambiri chomwe chikuwonetsa momwe impso zimasungidwira bwino.
Pa nthawi yodziwitsa anthu odwala matenda ashuga, ndi bwino kuti dokotala amvetsetse ngati kuwonongeka kwa impso kumayambitsidwa ndi matenda ashuga kapena zina. Kupezeka kosiyanitsa kwa matenda ashuga nephropathy ndi matenda ena a impso kuyenera kupangidwa:
- aakulu pyelonephritis (kutupa kwa impso);
- chifuwa chachikulu cha impso;
- pachimake ndi matenda glomerulonephritis.
Zizindikiro za matenda a pyelonephritis:
- Zizindikiro za kuledzera (kufooka, ludzu, nseru, kusanza, kupweteka mutu);
- kupweteka kumbuyo ndi m'mimba pamtunda wa impso yakhudzidwa;
- kuchuluka kwa kuthamanga kwa magazi;
- mu ⅓ odwala - kukodza mwachangu, kupweteka;
- kuyezetsa kumawonetsa kukhalapo kwa maselo oyera ndi mabakiteriya mu mkodzo;
- chithunzi chojambulidwa ndi ultrasound cha impso.
Zokhudza chifuwa chachikulu cha impso:
- mu mkodzo - leukocytes ndi chifuwa chachikulu cha mycobacterium;
- ndi mawonedwe aubwino (x-ray ya impso yamkati mwa njira yosiyanitsa) - chithunzi.
Zakudya za matenda a impso a shuga
Nthawi zambiri omwe ali ndi vuto la impso odwala matenda ashuga, kuchepetsa magazi kumathandiza kuchepetsa kuthamanga kwa magazi, kuchepetsa kutupa, komanso kuchepetsa kufalikira kwa matenda ashuga. Ngati magazi anu atakhala abwinobwino, ndiye kuti musadye mopitilira mchere wambiri wa 5-6 patsiku. Ngati muli kale ndi matenda oopsa, ndiye kuti kuchepetsa mchere wanu ndi magalamu awiri atatu patsiku.
Tsopano chinthu chofunikira kwambiri. Chithandizo cha boma chimalimbikitsa kudya “moyenera” anthu odwala matenda ashuga, komanso ngakhale ochepa mapuloteni a shuga a nephropathy. Tikukulimbikitsani kuti muganiza zogwiritsa ntchito zakudya zamafuta ochepa kuti muchepetse magazi anu kukhala abwinobwino. Izi zitha kuchitika pa kusefedwa kwa glomerular pamtunda wa 40-60 ml / mphindi / 1.73 m2. Mu nkhani "Zakudya za impso ndi matenda a shuga," mutu wofunikirawu wafotokozedwa mwatsatanetsatane.
Chithandizo cha matenda a shuga a shuga
Njira yayikulu yopetsera komanso kuchiza matenda a shuga a m'mbuyomu ndikuchepetsa shuga m'magazi, kenako ndikuwonetsetsa kuti ali ndi moyo wathanzi. Pamwambapa, mwaphunzira momwe mungapangire izi ndi zakudya zama carb otsika. Ngati kuchuluka kwa shuga m'magazi kumakwezedwa kwambiri kapena nthawi zonse kuchokera kumtunda kupita pa hypoglycemia, ndiye kuti zochitika zina zonse sizingagwire ntchito kwenikweni.
Mankhwala ochizira matenda ashuga nephropathy
Pakuwongolera matenda oopsa, komanso kuchuluka kwa matenda a impso, matenda a shuga nthawi zambiri amapatsidwa mankhwala - ACE inhibitors. Mankhwalawa samangochepetsa kuthamanga kwa magazi, komanso amateteza impso ndi mtima. Kugwiritsa ntchito kwawo kumachepetsa chiopsezo cha kulephera kwa impso. Mwinanso, zoletsa zazitali za ACE zimagwira bwino ntchito kuposa Captopril, yomwe imayenera kutengedwa katatu patsiku.
Wodwala akayamba kukhosomola chifukwa chotenga mankhwala kuchokera ku gulu la ACE zoletsa, ndiye kuti mankhwalawo amaloledwa ndi angiotensin-II receptor blocker. Mankhwala omwe ali mgululi ali okwera mtengo kwambiri kuposa ACE inhibitors, koma ocheperako amayambitsa zovuta. Amateteza impso ndi mtima ndi ntchito yofananira.
Mulingo wothamanga wamagazi kwa odwala matenda a shuga ndi 130/80 ndipo pansipa. Nthawi zambiri, odwala omwe ali ndi matenda a shuga a 2, amatha kuthandizira pogwiritsa ntchito mankhwala osokoneza bongo. Imatha kukhala ndi ACE inhibitor ndi mankhwala osokoneza bongo “kuchokera kuzokakamizidwa” zamagulu ena: okodzetsa, ophera beta, othandizira calcium. ACE inhibitors ndi angiotensin receptor blockers palimodzi osavomerezeka. Mutha kuwerengera za mankhwala ophatikiza matenda oopsa, omwe akulimbikitsidwa kugwiritsa ntchito shuga, apa. Lingaliro lomaliza, lomwe mapiritsi okuthandizira, amapangidwa ndi adokotala okha.
Momwe mavuto a impso amakhudzira chisamaliro cha matenda a shuga
Ngati wodwala wapezeka ndi matenda a shuga, ndiye kuti njira zakuchiritsira zimasinthiratu. Chifukwa chakuti mankhwala ambiri amafunika kuti athetsedwe kapena kuti mulingo wawo ukhale wochepa. Ngati kuchuluka kwa kusefera kwafupika kumacheperachepera, ndiye kuti mlingo wa insulini uyenera kuchepetsedwa, chifukwa impso zofowoka zimapangitsa pang'onopang'ono.
Chonde dziwani kuti mankhwala otchuka a mtundu wa 2 metformin (siofor, glucophage) angagwiritsidwe ntchito pokhapokha poyerekeza ndi 60 ml / min / 1.73 m2. Ngati matenda a impso ya wodwalayo afooka, ndiye kuti chiwopsezo cha lactic acidosis ndichovuta kwambiri. Zikatero, metformin imathetsedwa.
Ngati wodwalayo akuwonetsa magazi m'thupi, ndiye kuti akuyenera kuthandizidwa, ndipo izi zikuchepetsa kukula kwa matenda ashuga. Wodwala amatchulidwa mankhwala omwe amalimbikitsa erythropoiesis, i.e., kupanga maselo ofiira am'magazi. Izi zimangochepetsa chiopsezo cha kulephera kwa impso, komanso zimasintha bwino kwambiri moyo. Ngati odwala matenda ashuga sanakhalebe pa dialysis, zowonjezera zachitsulo zitha kupangidwanso.
Ngati prophylactic chithandizo cha matenda ashuga nephropathy sichithandiza, ndiye kuti kulephera kwa impso kumayamba. Zikakhala choncho, wodwalayo amayenera kuyesedwa, ndipo ngati kuli kotheka, ndikulanditsa impso. Tili ndi nkhani yapadera yokhudza kupatsirana kwa impso, ndipo tikambirana mwachidule za hemodialysis ndi peritoneal dialysis pansipa.
Hemodialysis ndi peritoneal dialysis
Panthawi ya hemodialysis, catheter imayikidwa mu mtsempha wamagazi. Amalumikizidwa ndi chida chakunja cha mbewa chomwe chimayeretsa magazi m'malo mwa impso. Pambuyo poyeretsa, magaziwo amawabwezera kumagazi a wodwalayo. Hemodialysis imatha kuchitika pachipatala. Zitha kuyambitsa kutsika kwa magazi kapena matenda.
Peritoneal dialysis ndi pamene chubu sichinayikidwe mu mtsempha, koma m'mimba. Kenako madzi ambiri amamwetsedwamo ndi njira yotsitsira. Uwu ndi madzi apadera omwe amakoka zinyalala. Amachotsedwa ngati madzimadzi amadzimadzawo kuchokera kumiyendo. Peritoneal dialysis iyenera kuchitidwa tsiku lililonse. Imakhala ndi chiopsezo cha matenda kumalo komwe chubu limalowa m'mimba.
Mu shuga mellitus, kusungirako kwamadzi, kusokonezeka kwa kuchuluka kwa nayitrogeni ndi ma elekitirodi a electrolyte kumayamba pamlingo wapamwamba kwambiri wamasefera. Izi zikutanthauza kuti odwala matenda ashuga ayenera kusinthidwa kuti ayimbe kale kuposa odwala omwe ali ndi matenda a impso. Kusankha kwa dialysis njira kumadalira zomwe dokotala amakonda, koma kwa odwala palibe kusiyana kwakukulu.
Poyamba kuyamba aimpso m'malo mankhwala (dialysis kapena impso kupatsidwa zina) odwala matenda ashuga:
- Mlingo wa kusefa wa glomerular <15 ml / min / 1.73 m2;
- Miyezi yambiri ya potaziyamu m'magazi (> 6.5 mmol / L), yomwe singathe kuchepetsedwa ndi njira zochizira;
- Kusungika kwamadzimadzi m'thupi ndi chiopsezo cha pulmonary edema;
- Zizindikiro zodziwika za kuperewera kwa mphamvu m'thupi.
Amayesetsa kuyezetsa magazi kwa odwala matenda a shuga omwe amathandizidwa ndi dialysis:
- Glycated hemoglobin - ochepera 8%;
- Magazi a hemoglobin - 110-120 g / l;
- Matenda a parathyroid - 150-300 pg / ml;
- Phosphorous - 1.13-1.78 mmol / L;
- Calcium yonse - 2.10-2.37 mmol / l;
- Zogulitsa Ca × P = Zochepera 4.44 mmol2 / l2.
Ngati matenda a impso akayamba kudwala odwala matenda ashuga, erythropoiesis zotupa zimalembedwa (epoetin alpha, epoetin beta, methoxypolyethylene glycol epoetin beta, epoetin omega, darbepoetin alpha), komanso mapiritsi kapena jakisoni. Amayesa kukhala ndi kuthamanga kwa magazi pansi pa 140/90 mm Hg. Art., ACE inhibitors ndi angiotensin-II receptor blockers amakhalabe mankhwala osankhidwa pochiza matenda oopsa. Werengani nkhani yakuti “Hypertension in Type 1 and Type 2 Diabetes” mwatsatanetsatane.
Hemodialysis kapena peritoneal dialysis iyenera kungotengedwa ngati gawo lokhazikika pokonzekera kupatsirana kwa impso. Pambuyo kumuyika kwa impso kwa nthawi yothandizidwa, wodwalayo amachiritsidwa kwathunthu chifukwa cha kulephera kwa impso. Matenda a diabetes a nephropathy akhazikika, kupulumuka kwa odwala kukuchulukirachulukira.
Pokonzekera kufalitsa kwa impso chifukwa cha matenda ashuga, madokotala akuyesayesa kuwona kuti zingatheke bwanji kuti wodwalayo azikhala ndi vuto la mtima (matenda a mtima kapena sitiroko) panthawi kapena pambuyo pa opaleshoni. Kuti izi zitheke, wodwalayo amapimidwa mayeso osiyanasiyana, kuphatikizapo ECG yokhala ndi katundu.
Nthawi zambiri zotsatira za mayesowa zimawonetsa kuti ziwiya zomwe zimadyetsa mtima ndi / kapena ubongo zimakhudzidwanso kwambiri ndi atherosulinosis. Onani nkhani "Renal Artery Stenosis" kuti mumve zambiri. Pankhaniyi, kupatsirana kwa impso, tikulimbikitsidwa kupangitsanso mwamphamvu kuchuluka kwa ziwiya izi.
