Tanthauzo la "diabetesic nephropathy" ndi lingaliro lophatikiza lomwe limaphatikiza zovuta za matenda zomwe zimapangitsa kuwonongeka kwamitsempha mu impso motsutsana ndi maziko a matenda a shuga oopsa.
Nthawi zambiri dzina loti "Kimmelstil-Wilson syndrome" limagwiritsidwa ntchito pothandiza matenda awa, chifukwa malingaliro a nephropathy ndi glomerulossteosis amagwiritsidwa ntchito ngati tanthauzo.
Kwa odwala matenda ashuga nephropathy malinga ndi ICD 10, 2 code used. Chifukwa chake, code ya matenda ashuga a nephropathy malinga ndi ICD 10 imatha kukhala ndi zonse za E.10-14.2 (shuga mellitus ndi kuwonongeka kwa impso) ndi N08.3 (zotupa za glomerular mu shuga). Nthawi zambiri, kuwonongeka kwa impso kumawoneka modalira insulin, mtundu woyamba - 40-50%, ndipo mu mtundu wachiwiri, kufalikira kwa nephropathy ndi 15-30%.
Zifukwa zachitukuko
Madokotala ali ndi malingaliro atatu ofunikira pazomwe zimayambitsa nephropathy:
- kusinthana. Chinsinsi cha chiphunzitsocho ndichakuti gawo lalikulu lowononga limadziwika ndi kuchuluka kwa glucose m'magazi, chifukwa chomwe magazi amitsempha amasokonekera, ndipo mafuta amayikidwa mumitsempha, yomwe imatsogolera ku nephropathy;
- chibadwa. Ndiye kuti, cholowa chamtsogolo ku matendawa. Tanthauzo la chiphunzitsochi ndikuti ndi mitundu ya majini yomwe imayambitsa matenda monga matenda ashuga komanso matenda a shuga;
- hemodynamic. Chiphunzitsochi ndichakuti ndi matenda ashuga, pali kuphwanya kwa hemodynamics, ndiko kuti, kufalikira kwa magazi mu impso, komwe kumapangitsa kuchuluka kwa albumin mkodzo - mapuloteni omwe amawononga mitsempha yamagazi, kuwonongeka komwe kumakhala kovuta (sclerosis).
Kuphatikiza apo, zifukwa zomwe zimapangidwira kukula kwa nephropathy malinga ndi ICD 10 nthawi zambiri zimaphatikizapo:
- kusuta
- shuga wamagazi ambiri;
- kuthamanga kwa magazi;
- triglycerides osauka ndi cholesterol;
- kuchepa magazi
Nthawi zambiri, mu gulu la nephropathy, matenda otsatirawa amapezeka:
- diabetesic glomerulossteosis;
- aimpso mtsempha wamagazi;
- necrosis ya impso ngalande;
- mafuta malo mu impso ngalande;
- pyelonephritis.
Zizindikiro
Choyamba, ndikofunikira kunena kuti shuga imatha kukhala yowononga impso za wodwalayo kwanthawi yayitali, ndipo wodwalayo sadzakhala ndi zosasangalatsa.
Nthawi zambiri, zizindikiro za matenda a shuga a nephropathy zimayamba kupezeka kale panthawi yomwe kulephera kwa impso kumayamba.
Panthawi yam'mbuyomu, odwala amatha kuwonjezeka kuthamanga kwa magazi, proteinuria, komanso kuwonjezeka kwa 15-25% mu kukula kwa impso. Pa kupita patsogolo, odwala ali ndi diuretic-immune nephrotic syndrome, matenda oopsa, komanso kutsika kwa kusefukira kwa glomerular. Gawo lotsatira - matenda a impso - limadziwika ndi kukhalapo kwa azotemia, aimpso osteodystrophy, ochepa matenda oopsa komanso kulimbikira kwa edematous syndrome.
Kodi imapezeka bwanji?
Kuti mudziwe nephropathy, mbiri ya wodwala ndi mayeso a labotale imagwiritsidwa ntchito. Njira yayikulu mu gawo loyambirira ndi kudziwa mulingo wa albumin mumkodzo.
Njira zotsatirazi zingagwiritsidwe ntchito kuzindikira matenda a shuga ndi nephropathy malinga ndi ICD 10:
- kutsimikiza kwa GFR pogwiritsa ntchito mayeso a Reberg.
- impso.
- Dopplerography ya impso ndi zotengera zotumphukira (ultrasound).
Kuphatikiza apo, ophthalmoscopy ithandizanso kudziwa mtundu ndi gawo la retinopathy, ndipo electrocardiogram ithandizanso kuzindikira hypertrophy yamanzere yamanzere.
Chithandizo
Pochiza matenda a impso, chikhalidwe chachikulu ndicho kuvomerezeka kwa matenda a shuga. Udindo wofunikira umachitika ndi kufalikira kwa matenda a lipid komanso kukhazikika kwa kuthamanga kwa magazi. Nephropathy amathandizidwa ndimankhwala omwe amateteza impso komanso kutsitsa magazi.
Zitsanzo za zakudya zomwe zimakhala ndi mafuta osavuta
Njira imodzi yochiritsira ndi kudya. Zakudya za nephropathy ziyenera kukhala kuchepetsa kuchuluka kwa mafuta osavuta ndipo zimakhala ndi mapuloteni ofunikira.
Mukamadya, madzimadzi sakhala ochepa, kuphatikiza, madzimadzi ayenera kukhala ndi potaziyamu (mwachitsanzo, madzi osaphatikizika). Ngati wodwalayo achepetsa GFR, zakudya zama protein ochepa, koma nthawi yomweyo zimakhala ndi kuchuluka kwa zopatsa mphamvu, zimalimbikitsidwa. Ngati nephropathy ya wodwala ikuphatikizidwa ndi ochepa matenda oopsa, chakudya chamchere chochepa chimalimbikitsidwa.
Palliative aimpso mankhwala
Ngati wodwala akuchepetsa kwambiri kuchuluka kwa kusungunuka kwa glomerular kwa chisonyezo chotsika ndi 15 ml / mphindi / m2, dokotala wopereka lingaliro lakuyambiranso, lomwe lingayimiridwe ndi hemodialysis, peritoneal dialysis kapena kupatsidwa zina.
Chinsinsi cha hemodialysis ndikudziyeretsa magazi ndi zida "zochitira impso". Ndondomeko ziyenera kuchitidwa katatu pa sabata, pafupifupi maola 4.
Peritoneal dialysis imaphatikizapo kuyeretsa magazi kudzera mu peritoneum. Tsiku lililonse, nthawi 3-5 wodwala amapaka jakisoni wa dialysis mwachindunji pamimba. Mosiyana ndi hemodialysis pamwambapa, peritoneal dialysis imatha kuchitika kunyumba.
Kuthana kwa impso ndi njira yowonjezereka yolimbana ndi nephropathy. Pankhaniyi, wodwalayo ayenera kumwa mankhwala omwe amachepetsa chitetezo cha mthupi, kupewa kukana.
Njira zitatu zopewera
Njira yodalirika yopewera kukula kwa nephropathy ndi chindapusa chovomerezeka cha matenda ashuga:
- Kupewera kwakukulu ndikupewa wa microalbuminuria. Zinthu zazikuluzikulu zomwe zingayambitse kukula kwa microalbuminuria ndi: kutalika kwa shuga kuyambira zaka 1 mpaka 5, cholowa, kusuta fodya, retinopathy, hyperlipidemia, komanso kusowa kwa magwiridwe antchito aimpso;
- kupewa kwachiwiri kumachepetsa kuchepa kwa matendawa kwa odwala omwe athetse kale GFR kapena kuchuluka kwa albumin yovomerezeka mu mkodzo wawo. Gawo ili la kupewa limaphatikizapo: chakudya chama protein ochepa, kuwongolera kwa magazi, kukhazikika kwa mawonekedwe a lipid m'magazi, kuwongolera glycemic ndi matenda a intrarenal hemodynamics;
- kupewa kwapamwamba kumachitika pa gawo la proteinuria. Cholinga chachikulu cha siteji ndikuchepetsa chiopsezo cha kuchepa kwa impso, komwe, kumadziwika ndi: matenda oopsa, chindapusa chokwanira cha kagayidwe kazakudya, proteinuria yayikulu ndi hyperlipidemia.
Makanema okhudzana nawo
Zokhudza zomwe zimayambitsa ndikuchiza matenda a matenda a shuga a nephropathy omwe akuwonetsedwa pa TV "Khalani athanzi!" ndi Elena Malysheva:
Ngakhale kuti pakati pa zovuta zonse za matenda a shuga, nephropathy ndi amodzi mwa malo otsogola, kuyang'anira mosamala njira zopewera kuphatikiza ndi kupezeka kwa nthawi yeniyeni komanso chithandizo choyenera chithandizira mochedwa kukula kwa matendawa.
