Mene ne ganewar asali na “Ciwon sukari nephropathy” - kwatancen da hanyoyin magance cutar

Sanadin yawan mace-mace ko tawaya a tsakanin mutane masu fama da ciwon sukari, ba tare da la’akari da nau'in cutar ba, shine sannu sannu da haɓakar masu ciwon sukari.

An lasafta wannan labarin yadda wannan cutar mai haɗari da kuma yadda take tasowa.

Cutar sankarar mahaifa: menene?

Cutar sankarar cututtukan cututtukan ƙwaƙwalwar ƙwaƙwalwar ƙwayar cuta (DN) shine ilimin cututtukan cututtukan ƙwaƙwalwar ƙwaƙwalwar ƙwayar ƙwaƙwalwa wanda ya haɓaka azaman rikicewar ciwon sukari. Sakamakon DN, ikon tace kodan ya ragu, wanda ke haifar da cututtukan nephrotic, kuma daga baya ga gazawar renal.

Cutar lafiya da koda da masu ciwon suga

Latterarshe a cikin 80% na lokuta masu mutuwa ne. Dalilin wannan shine ilimin ilimin halittar jini na glomeruli, tubules. Wannan cuta tana faruwa a kusan kashi 20% na mutanen da ke fama da ciwon sukari.

Haka kuma, maza da masu fama da cutar insulin sun fi waɗanda suke fama da ciwon sukari marasa dogaro da insulin. Babban kololuwar ci gaba da cutar shine sauyawarsa zuwa matakin lalacewa na koda (CRF), wanda yawanci yakan faru ne na shekaru 15-20 na ciwon sukari.

Dalilai

Ana ambaton tushen dalilin ci gaban cututtukan ƙwaƙwalwar koda, cututtukan zuciya, haɗe tare da hauhawar jijiya, yawanci. A zahiri, wannan cutar ba koyaushe bane sakamakon ciwon sukari.

Kamar yadda manyan ka'idojin da ke haifar da wannan cutar, yi la'akari:

• na rayuwa. Raunin glucose na ɗan lokaci yakan haifar da lalacewar cututtukan ƙwayar koda, haifar da lalata koda;
• hemodynamic. Dangane da wannan ka’idar, gurbataccen jini yana haifar da hauhawar jini, wanda ya fara zuwa hauhawar jini, kuma yayin da kayan haɗin ke haɓaka, zuwa raguwa sosai a cikin rage yawan tacewa.
• kwayoyinmai ba da shawara ga kunna abubuwan abubuwan gado a cikin ciwon sukari.

Sauran abubuwanda ke haifar da ci gaban DN sun hada da dyslipidemia da shan sigari.

Digiri

DN yana haɓaka hankali, yana wucewa da yawa matakai;

1. Mataki na farko na faruwa a farkon cutar siga kuma tana tare da hawan jini na koda. A wannan yanayin, sel sel na kashin ya zama mafi girma, akwai karuwa a cikin tacewa da fitar fitsari. Wannan yanayin baya hade da bayyanannun abubuwan waje;
2. yawanci a cikin shekara ta uku na ciwon sukari, matakin farko ya wuce zuwa na biyu. A wannan lokacin, canje-canje na tsarin zai fara faruwa a sel sel na kashin kansa, wanda ke haifar da aiwatar da bangon tasoshin. Ba a lura da alamun bayyanar cututtuka na waje;
3. a matsakaici, bayan shekaru 5, ci gaban mataki na uku yana farawa, wanda ake kira farawa masu ciwon suga. Ana gano shi da wani binciken ko wani irin bincike. Wani ciwo yana bayyana ne ta fuskar bayyanar furotin a cikin fitsari, wanda ke nuna ɓarnar da lalacewar tasoshin kodan, wanda ke haifar da canji a cikin GFR. Wannan yanayin ana kiranta microalbuminuria;
4. bayan wani 5-10 na shekaru, in babu isasshen magani, farawar cututtukan cututtukan cututtukan ƙwayar mahaifa sun shiga cikin matakan da aka ambata, tare da alamun bayyanannu na asibiti. Wannan matakan ana kiransa proteinuria. Mataki na huɗu na DN an nuna shi ta hanyar raguwa sosai a cikin furotin a cikin jini da haɓaka mai ƙarfi. A cikin nau'ikan furotin na mawuyacin hali, shan diuretics ya zama ba shi da tasiri, kuma dole ne ku je zuwa sikelin don cire ƙwayar wuce haddi. Rashin furotin a cikin jini yana haifar da gaskiyar cewa jiki ya fara rushe abubuwan kariya na kansa, yana haifar da nauyi asara mai haƙuri da bayyanar wasu alamu, gami da haɓaka haɓakar hawan jini;
5. na biyar, mataki na karshe na cutar ana kiransa da uremic ko muguwar mataki na lalacewa na koda. A wannan matakin, kodan ba sa iya jure ɓoyewar ɓoye, tunda tasoshinsu sun ƙoshi sosai, kuma tataccen fim ɗin ya ragu zuwa 10 ml / min da ƙasa, alamun bayyanar waje yana ƙaruwa, ya zama halayyar haɗari ga rayuwa.

Kwayar cutar

Wani fasalin wannan cuta mai rauni shine cewa, sannu a hankali yana haɓaka shekaru da yawa, yana da asymptomatic a farkon - madaidaiciya - mataki, tare da cikakken rashi bayyanar cututtuka.

Kiran farko na kiran kai tsaye nuna kai tsaye nephropathy sune:

• hauhawar jini
• gajiya;
• bushe bakin;
• yawan fitar dare da rana;
• polyuria.

A lokaci guda, sakamakon gwaje-gwaje na asibiti na iya nuna rage ƙwayar fitsari takamaiman nauyi, yana nuna haɓakar ƙayyadadden hanji da canje-canje a cikin ƙwaƙwalwar ƙwayar cuta, ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwa a cikin jini.

Daga baya, yayin da ya kai digiri na 4-5 a cikin ci gabansa, cutar ta nuna kanta a cikin tashin zuciya, bayyanar amai, asarar ci, tare da kumburi, gazawar numfashi, ƙoshi, rashin bacci.

Binciko

Gwajin da ake buƙata don yin bincike shine za'ayi ta endocrinologist-diabetologist ko therapist. Ya ƙunshi gwaji na yau da kullun na gwajin fitsari don albumin da furotin, da kuma gwajin jini don creatinine da urea. Wadannan karatun suna ba mu damar gano MDs a farkon matakin farko da kuma hana ci gaba.

Shawarar bincike da aka ba da shawarar:

• kowane watanni 6 - ga marassa lafiya da nau'in ciwon sukari nau'in shekaru fiye da 5;
• kowace shekara - don waɗanda ke da nau'in ciwon sukari na II fiye da shekaru 5.

A matsayin hanyar bayyani don gano microalbuminuria, allunan shan iska da kuma gwajin gwaji don fitsari shima za'a iya amfani dashi, bada izinin mintuna 5 don sanin yanayin albumin da matakin microconcentration.

Ana nuna ci gaban cututtukan cututtukan cututtukan cututtukan zuciya ta hanyar gano albumin a cikin fitsari - 30-300 mg / rana, kazalika da hyperfiltration na glomerular. Sinadarin ko albumin da aka gano a cikin binciken fitsari gabaɗaya a cikin taro fiye da 300 MG / rana yana nuni da sauyawa daga cututtukan cututtukan zuciya zuwa proteinuria.

Wannan yanayin yana haɗuwa da hawan jini da bayyanar alamun alamun cututtukan ƙwayar ƙwayar cuta, wanda ke buƙatar shawarwari na musamman da lura da ƙwararren masanin ilimin ƙwayar cuta .. Thearshe matakai na DN yana haɗuwa da karuwar furotin, ƙananan SFC - 30-15 ml / min da ƙananan, ƙara creatinine, bayyanar azotemia, anemia, acidosis, hyperlipidemia, munafiki, hyperphosphatemia.

Baya ga hanyoyin tukunyar gwajin fitsari, maganin urography na kansa da kuma duban dan tayi, banbancin ganewar ta DN tare da pyelonephritis, glomerulonephritis, da tarin fuka ana kuma yin su.

Matakan warkewa

Yin rigakafi da matsakaicin nisa na yiwuwar ci gaban DN a cikin rashin cin nasara na koda shine babban burin maganin da aka tsara.

Matakan da za a iya warkar da su ana iya rarraba su zuwa matakai da yawa:

1. a cikin binciken cutar microalbuminuria, tallafin glucose ya kasance a cikin kewayon al'ada. A layi daya tare da wannan, ana yawan nuna alamun bayyanar cutar hauhawar jini. Don gyaran haɓakar haɓakar jini, ana amfani da inhibitors na ACE: Delapril, Enapril, Irumed, Captopril, Ramipril da sauransu. Aikin su yana haifar da raguwar hauhawar jini, yana rage jinkirin ci gaban DN. An ƙaddamar da maganin antihypertensive tare da alƙawarin diuretics, statins da alluran antagonists - Verapamil, Nifedipine, Diltiazem, kazalika da abinci na musamman, wanda ke ɗaukar nauyin furotin na yau da kullun na 1 g / kg. Sashi na ACE inhibitors na dalilai na prophylactic ana aiwatar da su koda a gaban hawan jini na yau da kullun. Idan amfani da inhibitors ya haifar da ci gaba da tari, ana iya ba da izinin hana masu hana masu karɓar kayan wuta na II a maimakon;
2. prophylaxis, wanda ya haɗa da alƙawarin rage ƙwayar magunguna don tabbatar da ingantaccen sukari na jini da kula da tsari na hawan jini;
3. a gaban proteinuria, babban magani yana da nufin hana lalacewar koda - ƙarancin matsanancin lalacewar koda. Wannan yana buƙatar tallafi na matakan glucose na jini, gyaran hawan jini, ƙuntatawa na furotin a cikin abinci zuwa 0.8 g / kg da kuma sarrafa yawan shigar ruwa. An haɗu da inhibitors na ACE tare da Amplodipine (mai katange tashar alli), Bisoprolol (β-blocker), magungunan diuretic - Furosemide ko Indapamide. A matakin tashar cutar, maganin detoxification, amfani da sihirin, da kwayoyi don kula da haemoglobin da hana azotemia da osteodystrophy za a buƙata.

An wajabta maganin maye tare da hemodialysis ko peritoneal dialysis tare da rage yawan ƙirar tacewa a ƙasa 10 ml / min. Kuma a cikin aikin likita na kasashen waje don lura da lalacewar na koda na koda, ana amfani da dasa kwayoyin.

Bidiyo masu alaƙa

Game da lura da cutar nephropathy ga masu ciwon sukari a cikin bidiyon:

Wa'adin lokaci na jiyya a matakin microalbuminuria da ingantaccen ɗabi'a shi ne mafi kyawun damar don hana haɓaka cikin cututtukan cututtukan cututtukan cututtukan daji kuma fara aiwatar da baya. Tare da furotinurur, gudanar da magani da ya dace, zaku iya hana ci gaban wani mummunan yanayin - CRF.