Cutar amai da gudawa shine sunan gama gari don yawancin rikodin koda na ciwon suga. Wannan kalmar ta bayyana raunukan masu ciwon sukari daga cikin abubuwanda ke hade jikin kodan (glomeruli da tubules), da kuma jiragen da suke ciyar da su.
Cutar amai da gudawa yana da haɗari saboda yana iya kaiwa zuwa matakin ƙarshe (m) na matakin ƙimar renal. A wannan yanayin, mai haƙuri zai buƙaci yin gwajin dialysis ko ƙwayar koda.
Cutar amai da gudawa na ɗaya daga cikin sananniyar mace-mace da rashin ƙarfi a cikin marasa lafiya. Ciwon sukari ya yi nisa da kawai dalilin cutar koda. Amma a cikin wadanda ke fama da dialysis kuma suna tsaye a layi don maganin koda don canzawa, mafi yawan masu ciwon sukari. Dalili guda na wannan shine karuwar haɓaka a cikin haɗarin ciwon sukari na 2.
Dalilan ci gaban masu ciwon sukari:
- hauhawar jini a cikin mara lafiya;
- karancin cholesterol da triglycerides a cikin jini;
- hawan jini (karanta shafin '' 'yar'uwarmu' 'don hauhawar jini);
- anaemia, harda “m” (haemoglobin a cikin jini <13.0 g / lita);
- shan taba (!).
Bayyanar cututtuka na Ciwon Mara na Ciwon Mara
Ciwon sukari na iya yin tasiri mai illa ga kodan na dogon lokaci, har zuwa shekaru 20, ba tare da haifar da wani jin daɗin ji a cikin mai haƙuri ba. Bayyanar cututtukan cututtukan cututtukan zuciya suna faruwa lokacin da ƙarancin koda ya riga ya inganta. Idan mai haƙuri yana da alamun lalacewa na koda, to wannan yana nufin cewa sharar gida na tarawa cikin jini. Saboda kodan da abun ya shafa bazai iya jifar su ba.
Stage mai ciwon sukari nephropathy. Gwaje-gwaje da gwaje-gwaje
Kusan duk masu ciwon sukari suna buƙatar a gwada su kowace shekara don kula da aikin koda. Idan cutar sankara ce ta ci gaba, to yana da matukar muhimmanci a gano shi a matakin farko, yayin da mai haƙuri bai ji alamun ci gaba ba. Maganin farko don cutar masu ciwon sukari yana farawa, mafi girman damar samun nasara, shine, mai haƙuri zai iya rayuwa ba tare da maganin cutar sankara ba ko kuma jujin koda.
A shekara ta 2000, Ma'aikatar Lafiya ta Tarayyar Rasha ta amince da rarrabuwar cutar sankarau ta matakai. Ya hada da wadannan hanyoyin:
- mataki microalbuminuria;
- mataki proteinuria tare da kiyaye aikin nitrogen-excreting renal aikin;
- mataki na kullum na koda gazawar (jiyya tare da dialysis ko koda dasa).
Daga baya, masana sun fara yin amfani da cikakkun bayanai game da rarrabe koda na cututtukan koda. A ciki, ba 3 ba, amma matakai 5 na cutar sankarar mahaifa an rarrabe su. Duba matakan cututtukan koda na koda don ƙarin cikakkun bayanai. Wanne mataki ne mai ciwon sukari na cutar kansa a cikin wannan haƙuri ya danganta da matakin ƙirar gidan nasa (an bayyana shi dalla-dalla yadda aka ƙaddara shi). Wannan shine mafi mahimmancin nuna alama wanda ke nuna yadda an kiyaye aikin koda.
A mataki na gano cutar sankarau, yana da muhimmanci ga likita ya fahimta idan cutar koda ta lalace ta hanyar cutar sankara ko wasu dalilai. Ya kamata a bambance bambance-bambancen cututtukan ƙwayar cutar zazzabin cizon sauro tare da sauran cututtukan koda:
- na kullum pyelonephritis (cutar kumburi da kodan);
- cututtukan koda;
- m da na kullum glomerulonephritis.
Alamun cutar pyelonephritis na kullum:
- bayyanar cututtuka na maye (rauni, ƙishirwa, tashin zuciya, amai, ciwon kai);
- jin zafi a cikin ƙananan baya da ciki a gefe na koda wanda aka shafa;
- karuwa cikin karfin jini;
- a cikin ⅓ marasa lafiya - saurin urination mai raɗaɗi;
- gwaje-gwaje sun nuna kasancewar farin sel jini da ƙwayoyin cuta a cikin fitsari;
- hoto mai hoto tare da duban dan tayi na kodan.
Fasali na cutar tarin fuka:
- a cikin fitsari - leukocytes da tarin fuka na mycobacterium;
- tare da urography na ciki (x-ray na kodan tare da gudanarwar cikin ciki na wani sabanin matsakaici) - hoto mai fasali.
Abincin don koda rikitarwa na ciwon sukari
A yawancin halaye masu matsalar cututtukan koda, rage cin abinci mai gishiri yana taimakawa rage karfin jini, rage kumburi, da kuma saurin ci gaban cututtukan cututtukan zuciya. Idan hawan jininka al'ada ne, to, kada ku ci gishiri fiye da 5-6 na gishiri a rana. Idan kunada hauhawar jini, to sai a rage yawan cin gishiri zuwa 2-3 a rana.
Yanzu abu mafi mahimmanci. Magungunan hukuma suna ba da shawarar “daidaitaccen” abinci don cutar sankara, har ma da rage cin abinci mai gina jiki ga masu ciwon sukari. Muna ba da shawara ku yi la'akari da amfani da abincin low-carbohydrate don rage girman sukarin jinin ku zuwa al'ada. Za'a iya yin wannan a ƙimar tacewar duniya sama da 40-60 ml / min / 1.73 m2. A cikin labarin "Abincin abinci don kodan tare da ciwon sukari," an bayyana wannan batun daki-daki.
Ciwon Mara na Ciwon Mara
Babbar hanyar hanawa da kuma maganin cututtukan cututtukan zuciya shine rage yawan sukarin jini, sannan kuma kula dashi kusa da al'ada ga mutane masu lafiya. A sama, kun koyi yadda ake yin wannan tare da abincin karas-mai ƙwari. Idan matakin glucose na mai haƙuri yana tsawan lokaci ko duk tsawon lokacin daga sama zuwa hypoglycemia, to duk sauran ayyukan zasu zama marasa amfani.
Magunguna don kula da cututtukan cututtukan cututtukan cututtukan ƙwayar cuta
Don kula da hauhawar jini, da kuma hauhawar jini a cikin ƙodan, yawanci cututtukan cututtukan zuciya suna ba da magunguna - inhibitors na ACE. Wadannan kwayoyi ba wai kawai saukar karfin jini ba, har ma suna kare kodan da zuciya. Amfani da su yana rage haɗarin rashin tasirin ma'amala. Wataƙila, masu hana aiki na ACE masu ɗaukar hoto suna aiki fiye da kyawun ƙarfe, wanda yakamata a sha sau 3-4 a rana.
Idan mai haƙuri ya kamu da bushewa a sakamakon shan magani daga rukuni na masu hana ACE, to an maye gurbin maganin tare da mai hana karɓa na angiotensin-II. Magunguna a cikin wannan rukunin suna da tsada fiye da masu hana ACE, amma da ƙyar suna haifar da sakamako masu illa. Suna kare kodan da zuciya tare da kusan tasirin iri ɗaya.
Matsayin matakin karfin jini na marasa lafiya da ke fama da ciwon sukari shine 130/80 da ke ƙasa. Yawanci, a cikin marasa lafiya da ke dauke da ciwon sukari na 2, za a iya samun hakan ta amfani da haɗuwa da kwayoyi. Zai iya haɗawa da inhibitor na ACE da kwayoyi "daga matsin lamba" na sauran kungiyoyi: diuretics, beta-blockers, alli antagonists. ACE masu hana abubuwa da kuma masu hana karɓa na angiotensin tare ba da shawarar ba. Kuna iya karanta game da magunguna masu haɗuwa don hauhawar jini, wanda aka ba da shawarar don amfani da ciwon sukari, a nan. Decisionarshe na ƙarshe, wanda allunan don tsara, likita ne kawai suka yi.
Yadda matsalolin koda ke shafar kula da ciwon suga
Idan aka gano mara lafiyar mai fama da cutar sankara, to hanyoyin da ake bi don magance cutar sankaran jiki an canza su sosai. Saboda yawancin kwayoyi suna buƙatar a soke su ko kuma rage adadin su. Idan adadin filtular duniya zai ragu sosai, to ya kamata a rage yawan sashin insulin din, saboda ƙodan mai rauni ya fi hankali a hankali.
Da fatan za a iya amfani da sanannen magani na nau'in metformin guda biyu na sukari (siofor, glucophage) wanda za'a iya amfani dashi kawai a ƙimar ƙirar glomerular sama da 60 ml / min / 1.73 m2. Idan aikin koda na mai haƙuri ya raunana, to, haɗarin lactic acidosis matsala ce mai haɗari sosai. A irin waɗannan yanayi, an soke metformin.
Idan binciken da aka yi na haƙuri ya nuna cutar rashin jini, to lallai yana buƙatar kulawa, kuma wannan zai rage ci gaban ciwon kansa. An tsara mai haƙuri da kwayoyi waɗanda ke motsa erythropoiesis, i.e., samar da ƙwayoyin jan jini a cikin ƙwayar kasusuwa. Wannan ba kawai ya rage hadarin rashin koda ba, har ma yana inganta ingancin rayuwa gaba ɗaya. Idan mai ciwon sukari bai riga ya kasance game da dialysis ba, ana iya kuma haɗa magungunan baƙin ƙarfe.
Idan prophylactic lura da ciwon sukari nephropathy ba ya taimaka, to, gazawar ci gaban. A wannan halin, mai haƙuri dole ne ya ɗauki dialysis, kuma in ya yiwu, to, yi haɓakar koda. Muna da wani labarin daban game da dasawa koda, kuma zamu ɗan tattauna game da maganin hemodialysis da peritoneal dialysis a ƙasa.
Cututtukan zuciya da jijiyoyin jini
Yayin aikin hemodialysis, an saka catheter a cikin jijiya mai haƙuri. An haɗa shi da kayan injin na waje wanda ke tsarkake jini maimakon ƙodan. Bayan an tsaftace, an sake tura jinin zuwa magudanar jinin mara lafiya. Za'a iya yin amfani da shi kawai a cikin asibiti. Zai iya haifar da raguwa cikin karfin jini ko kamuwa da cuta.
Maganin hana zafin ciki shine lokacin da ba a saka bututu a cikin jijiya ba, amma cikin rami na ciki. Sannan ana ciyar da babban adadin ruwa a ciki ta hanyar magudanar ruwa. Wannan ruwa ne na musamman wanda ke jawo sharar gida. An cire su yayin da ruwan ke fitarwa daga kogon. Dole ne a yi dijital a kowace rana. Yana ɗaukar haɗarin kamuwa da cuta a wuraren da bututun ya shiga cikin rami na ciki.
A cikin ciwon sukari na mellitus, riƙewar ruwa, damuwa a cikin nitrogen da ma'aunin electrolyte suna haɓakawa a cikin mafi girman ƙirar tacewa ta duniya. Wannan yana nufin cewa ya kamata a sauya masu haƙuri da ciwon sukari zuwa dialysis a baya fiye da marasa lafiya tare da wasu cututtukan koda. Zaɓin hanyar dialysis ya dogara da fifikon likitan, amma ga marasa lafiya babu bambanci sosai.
A lokacin da za a fara renal sauyawa far (dialysis ko koda dasa) a cikin marasa lafiya da ciwon sukari mellitus:
- Rashin glomerular filtriili <15 ml / min / 1.73 m2;
- Matsakaicin matakan potassium a cikin jini (> 6.5 mmol / L), wanda ba za'a iya rage ta ta hanyar hanyoyin kulawa da ra'ayin mazan jiya ba;
- Mai tsananin riƙe riƙewar ruwa a cikin jiki tare da haɗarin huhun huhun ciki;
- Bayyanannun alamun cutar rashin abinci mai gina jiki.
Manufofin gwaje-gwaje na jini a cikin marasa lafiya da masu ciwon sukari waɗanda ke bi da su tare da dialysis:
- Glycated haemoglobin - kasa da 8%;
- Hawan jini - 110-120 g / l;
- Parathyroid hormone - 150-300 pg / ml;
- Phosphorus - 1.13-1.78 mmol / L;
- Jimlar alli - 2.10-2.37 mmol / l;
- Samfurin Ca × P = Kasa da 4.44 mmol2 / l2.
Idan cututtukan koda na haɓaka a cikin marasa lafiya masu ciwon sukari, ƙwaƙwalwar maganin erythropoiesis an wajabta su (epoetin alpha, betaetin beta, methoxypolyethylene glycol epoetin beta, omeetin omega, darbepoetin alpha), har da allunan ƙarfe ko injections. Suna ƙoƙari su kula da karfin jini a ƙasa da 140/90 mm Hg. Art., ACE inhibitors da masu hana karɓar angiotensin-II sune magungunan zaɓaɓɓen don maganin hauhawar jini. Karanta labarin "hauhawar jini a nau'in 1 da Ciwon Cutar 2" a cikin dalla-dalla.
Ya kamata a yi la’akari da ƙinjin Hemodialysis ko na ɗakunan ciki kawai azaman mataki na ɗan lokaci ne don shiri don juyawa koda. Bayan kamuwa da koda don lokacin aikin da yake yi, mai haƙuri ya warke gaba ɗaya daga rashin aikin koda. Cutar sankarar bargo tana kwantar da hankali, rayuwa mai haƙuri tana ƙaruwa.
Lokacin da ake shirin juyawa da ƙwayar cutar koda don ciwon sukari, likitoci suna ƙoƙarin tantance yadda watakila mai haƙuri zai sami haɗarin zuciya (bugun zuciya ko bugun jini) yayin ko bayan tiyata. A saboda wannan, mara lafiya yana yin gwaje-gwaje daban-daban, gami da ECG tare da kaya.
Sau da yawa sakamakon waɗannan gwaje-gwajen yana nuna cewa tasoshin da ke ciyar da zuciya da / ko kwakwalwa suna fama da cutar atherosclerosis. Duba labarin "Renal artery Stenosis" don cikakkun bayanai. A wannan yanayin, kafin dasawar koda, ana bada shawara ga farfadowa cikin jin daɗin waɗannan tasoshin.
