Ciwon mara na Nephropathy

Cutar koda mai narkewa tana nufin duk wani rauni a ɓangaren kayan aikin na koda wanda ke haɓaka sakamakon rikice-rikice na rayuwa na carbohydrates da lipids a cikin jiki. Canje-canje na ƙwaƙwalwar ƙwayar cuta na iya shafar ƙwaƙwalwar ƙwayar ɗan adam, tubules, arterioles, da arteries. Cutar zazzabin cizon sauro na faruwa a cikin 70-75% na mutanen da ke da "cuta mai daɗi".

Yana bayyana kanta koyaushe a cikin yanayin halaye masu zuwa:

• Sclerosis na koda dan adam da kuma rassan.
• Sclerosis na arterioles.
• Glomerulosclerosis na yaduwa, nau'in nodular da nau'in exudative.
• Cutar mahaifa.
• Necrosis na koda na papilla.
• Necrotic nephrosis.
• Yanki a cikin tubules na koda na mucopolysaccharides, lipids da glycogen.

Kayan aikin ci gaba

A pathogenesis na mai ciwon sukari nephropathy ake dangantawa da dama na rayuwa da kuma hemodynamic dalilai. Rukunin farko sun haɗa da hyperglycemia (cutar hawan jini) da hyperlipidemia (babban matakan lipids da / ko lipoproteins a cikin jini). Abubuwa masu lalacewa ana wakiltar su ta hanyar hauhawar jini da kuma matsin lamba a cikin ƙwaƙwalwar masara.

Mahimmanci! Hakanan akwai asalin tsinkayen kwayoyin halitta wanda baza'a iya yin rangwame ba.

Canje-canje na rayuwa

Hyperglycemia shine babbar hanyar haɗi a cikin sarkar haɓakar cututtukan ƙwayoyin cuta na kodan a kan asalin "cutar mai daɗi". A bayan asalin babban matakin glucose, yana haɗuwa da sunadarai da ƙima na membranes na koda, wanda ke canza halayensu da ilimin halinsu. Hakanan, adadi mai yawa na monosaccharides mai guba yana tasiri akan ƙwayar sashin jiki, wanda ke motsa samin furotin kinase C yana taimakawa haɓaka ganuwar jijiyoyin jijiyoyin bugun gini.

Hyperglycemia shine babban dalilin etiological a cikin haɓakar rikice-rikice na ciwon sukari

Kunna halayen hadawan abu da iskar shaka na haifar da sakin radicals wadanda zasu iya samun mummunan tasiri har ma da guba a jikin kwayoyin halitta.

Babban matakan lipids da lipoproteins a cikin jini sune abubuwa na gaba game da haɓakar ƙwayoyin cutar nephropathy. Kasancewa glucose a cikin faranti na ciki da arterioles, glucose yana ba da gudummawa ga lalacewarsa da haɓaka taɓarɓarewa. Poarancin lipoproteins masu ƙarancin ƙarfi waɗanda suka lalatar da iskar shaka sun sami damar ratsa ta cikin rufin ciki mai lalacewa na jini. An kama su ta hanyar sel na musamman waɗanda abin da ke tattare da ƙwayoyin tsoka suna haɗuwa da juna.

Abubuwan da ke faruwa a cikin zuciya

Babban matsin lamba a cikin glomeruli na kodan shine babban abin da ke ba da gudummawa ga ci gaban ilimin jijiyoyin jini. Dalilin irin wannan hauhawar jini shine kunnawa cikin tsarin renin-angiotensin (ƙwayar tsohuwar ƙwayar angiotensin-II).

Anaruwar matakin hauhawar jini a jikin ɗan adam wanda ke faruwa a cikin martani ga duk abubuwan da ke sama sun zama inji wanda ya zarce canje-canje na rayuwa a cikin ƙarin haɓakar cigaban cutar ƙwayar cuta a cikin ƙwaƙƙwaran ƙwaƙwalwarta.

Babbar Jagora

Ciwon sukari ne mai rashin lafiya (lamba ga ICD-10 - N08.3 ko E10-E14 shafi 2) sau da yawa yana faruwa ne a kan asalin ciwon sukari mai dogaro da mellitus. Yana tare da cutar ta 1 wanda cutar koda ke cikin farkon wuri a cikin duk abubuwan da ke haifar da mace-mace a cikin marasa lafiya. Tare da nau'in 2, nephropathy yana ɗaukar matsayi na biyu (na farko sune rikice-rikice daga zuciya da jijiyoyin jini).

Kodan shine tacewa wanda ke tsarkake jinin abubuwa masu guba, kayayyakin abinci, guba. Duk wannan yana cikin fitsari. Glomeruli na kodan, wanda sauye-sauye ke faruwa a cikin ciwon sukari, ana ɗaukar su tacewa. Sakamakon hakan ya sabawa tsarin halitta da kuma daidaitawar wutan lantarki, shigarwar garkuwar sunadarai a cikin fitsari, wanda ba'a lura dashi cikin mutane masu lafiya ba.

Glomeruli na kodan - babbar hanyar aikin tace jini

Wannan yana faruwa bisa ga tsarin da ke gaba:

• Matakan farko - mafi ƙarancin sunadaran shiga.
• Ci gaba - manyan kwayoyin sun fadi.
• Hawan jini ya hauhawa, wanda hakan ke hana aiki yadda yake.
• Damagearin lalacewar ƙwayar cuta ya hau har ma da BP mafi girma.
• Rashin furotin a jikin mutum yana haifar da manyan edema da kuma samuwar CKD, wanda aka nuna ta gazawar koda.

Saboda haka, muna magana ne game da da'irar mugunta, sakamakon wanda shine buƙatar hemodialysis, kuma a cikin lokuta masu tsauri, dasawa da koda.

Rarrabawa

Akwai sassa da yawa na cutar a cikin yara da manya: na asibiti, rarrabuwa tsakanin halittu da rarrabuwa ta matakai.

Asibiti

A gaban furotin a cikin fitsari, an ƙaddara matakan creatinine a cikin jini. Bugu da kari, gwargwadon tsari, ana lissafta adadin filmer din duniya, gwargwadon alamun da ke nuna kasancewar CKD da matakinsa.

Ka'ida don kimanta yawan yin tacewa a cikin manya:
140 - shekaru (yawan shekaru) x nauyin jiki (a cikin kg) x coefficient. (miji - 1.23, mata - 1.05) / creatinine (μmol / L) = GFR (ml / min)

Magana don kimanta GFR ga yara:
rashin daidaito (dangane da shekaru) x tsayi (cm) / creatinine (μmol / L) = GFR (ml / min)

Ilimin halittar jiki

Akwai manyan azuzuwan guda huɗu, gwargwadon abin da an ƙayyade canje-canje na dabbobi da na jiki a jikin mai haƙuri.

• Thickening daga cikin membrane na na koda tubules wani ya zama ruwan dare.
• Lationasanta na sel na dunƙule cikin ƙaramin (a) ko mai rauni (b) nau'in.
• Samuwar ƙwayoyin nodules a cikin ƙwayoyin sel (glomerulosclerosis).
• Sclerosis na yanayin da ake fadi.

Tsarin aji

Mataki na farko shine halin hyperfunction na filtration tsarin. Yana tasowa a farkon farkon ciwon sukari. Kodan suna ƙoƙarin cire glucose daga jiki da wuri-wuri, gami da hanyoyin ramuwa. Proteinuria (furotin a cikin fitsari) ba ya nan, kamar dai alamun alamun cutar sankara.

Mataki na biyu shine bayyanar farko. Yana haɓaka shekaru da yawa bayan bayyanar cutar "cuta mai laushi". Ganuwar arteries da arterioles sun yi kauri, amma babu wani furotin a cikin fitsari, haka kuma alamomin asibiti.

Mataki na uku shine matakin microalbuminuria. Gwajin gwaje-gwaje na ƙaddara kasancewar furotin a cikin adadin 30 zuwa 300 MG / rana. Ana nuna lalacewar jijiyoyin jiki da karuwa ta lokaci-lokaci cikin hauhawar jini ba tare da wasu alamun ba.

Nazarin Urinalysis - tushen maganin cutar sankarau nephropathy

Mataki na huɗu - alamomin raunin cutar sankara mai ƙwayar cuta. Ana fitar da wani sinadari mai yawa a cikin fitsari, alamomin sunadarai a cikin jini yana raguwa, kuma puff ya bayyana. Idan matakin proteinuria yana cikin matsakaiciyar tsaka-tsaka, edema tana bayyana akan fuska da kafafu. Ga wanda yake tattare da isasshen furotin daga jikin mutum, sai ya zama babban abin da ake kira exudate na tarawa a cikin ciki, jin daɗi, rami na ciki.

Mataki na biyar shine mummunan yanayin da ake ciki wanda ake kira da cikakkiyar ƙwayar cuta daga cikin tasoshin koda, GFR ƙasa da 10 ml / min. Taimakawa ya ƙunshi ƙasan jijiyoyin jini ko motsa jiki, tunda sauran hanyoyin magani ba su da tasiri.

Hoto na asibiti

Matakai na cututtukan cututtukan cututtukan zuciya suna da alaƙa tare da alamun gani da kuma dakin gwaje-gwaje. Matakai uku na farko ana daukarsu dalla-dalla, tunda babu bayyananniyar bayyananniyar yanayin ilimin cuta. Canje-canje za a iya ƙaddara ta amfani da gwaje-gwajen dakin gwaje-gwaje ko lokacin binciken tarihin ƙirar nama.

Mummunan bayyanar cututtuka suna bayyana a mataki na huɗu, lokacin da marasa lafiya suka fara gunaguni game da alamun da ke gaba:

• kumburin fuska da ƙananan naƙasasshe;
• karuwa cikin karfin jini;
• nauyi asara;
• rauni, rage aiki;
• tashin zuciya, amai
• rashin ci;
• pathological ƙishirwa;
• cefhalgia;
• karancin numfashi
• jin zafi a bayan mafitsara.

Alamar asibiti

An tsara kulawa da marasa lafiya kamar yadda aka tsara don marasa lafiya tare da cutar nephropathy da jigilar cututtukan ƙwaƙwalwar ƙwayar cuta tare da ƙirar tacewa sama da 65 ml / min, tare da cututtukan koda

Ana buƙatar asibiti na gaggawa a cikin yanayi masu zuwa:

• oliguria - ƙananan ƙwayar fitsari a kwance;
• azotemia - karuwar adadin abubuwa masu guba a cikin jini;
• hauhawar jini - ilimin cututtukan metabolism na ruwa-gishiri, yanayin haɓakar edema;
• metabolic acidosis - karuwa a cikin acidity na jini;
• hyperkalemia - yawan adadin potassium a cikin jini.

Hanyar kulawa da haƙuri da kayyade buƙatar asibiti shine mahimmancin likitan halartar

Kwayar cutar sankara

Kwararrun ya fayyace ganewar haƙuri game da ciwon sukari, matakin hawan jini da bambance-bambance, haɓakar kumburi. Da gani yana nazarin yanayin fata, nauyin jikin mai haƙuri, kasancewar kumburin ciki da theirarfinsu, rabo tsakanin fitsari da aka fitar da shi a rana guda.

Babban gwajin jini (yawan abubuwan da aka kirkiro, jihar coagulation, leukocyte formula, ESR), biochemistry (jimlar furotin, albumin, furotin na C-mai amsawa) ya zama tilas. Ana nazarin kimar ƙwanƙwasa (ƙididdigar gaba ɗaya, ƙwaƙwalwar ƙwayar cuta, ELISA na sunadarai, al'adun ƙwayoyin cuta).

An ƙaddara matakan GFR, creatinine, urea, cholesterol, glucose, da abubuwan abubuwan ganowa. Additionalarin hanyoyin bincike:

Ciwon sukari Angiopathy

• Duban dan tayi na kodan da ciki;
• biopsy na biopsy;
• ECG, echocardiography;
• Dopplerography na jirgin ruwan koda;
• X-ray na kirji, ciki;
• alamomin cututtukan thyroid da kwayoyin jijiya.

Idan ya cancanta, likita ya aika da mai haƙuri don tattaunawa tare da likitan mahaifa (don ware maganin ciwon sukari), likitan zuciya (idan akwai alamun gazawar zuciya da arrhythmia), masanin ilimin endocrinologist (don sarrafa cututtukan da ke tattare da cutar), an angiosurgeon (don ƙirƙirar AV fistula a matsayin damar don maganin hemodialysis).

Bambancin ganewar asali

Dole ne a bambanta masu cutar ta masu fama da cutar kansa daga cututtukan nephrotic da kuma cututtukan cututtukan cututtukan ƙwaƙwalwar ƙwayar cuta.

Dabarar gudanar da haƙuri

Tare da haɓaka matakan CKD 1 da 2, kazalika da haɓaka da hawan jini, ana buƙatar abinci mai daidaitacce, yawan wadataccen furotin a jiki. Ana yin lissafin kalori na yau da kullun ta hanyar endocrinologist ko masanin abinci mai gina jiki. Abincin ya hada da rage yawan tilas a cikin adadin gishirin da aka kawo wa jiki (babu fiye da 5 g kowace rana).

Iyakance adadin gishiri a cikin abincin - yuwuwar rage haɓakar puff

An kafa tsarin aikin motsa jiki na rabin sa'a har zuwa sau 5 a mako. Nuna munanan halaye (shan taba da shan giya). Sau ɗaya a kowane watanni 3, wajibi ne don tantance kasancewar furotin a cikin fitsari, kuma don auna hawan jini kowace rana.

Kwayar halittar endocrinologist ta sake fasalin tsarin insulin ko kuma yin amfani da wakilai na hypoglycemic, idan ya cancanta, yana aiwatar da gyara ta soke ko kara wani magani. Wannan yana da mahimmanci saboda hyperglycemia shine mai haifar da ci gaban cututtukan cututtukan cututtukan zuciya.

Magungunan magani

Lokaci na tilas a cikin lura da cutar sankara mai narkewa shine raguwar hawan jini zuwa lambobi na al'ada (a gaban furotin a cikin fitsari, hawan jini ya kamata ya kasance ƙasa da 130/80 mm Hg). Kwayoyi na zabi:

• ACE inhibitors (Perindopril) - ba kawai yana rage karfin jini ba, amma yana rage adadin furotin da aka fitar a cikin fitsari.
• Abubuwan hana masu karɓar Angiotensin masu karɓar sakonnin (Losartan, Eprosartan) - rage hawan jini, rage ayyukan juyayi da ƙodan.
• Thiazide diuretics (Indapamide, Clopamide) - yana tasiri a farkon matakan, yayin da ake tace fil ɗin ya wuce 30 ml / min.
• Maganin kamuwa da cuta (ethacrine acid, furosemide) - an wajabta su a matakai na bayyanannun bayyananniyar cutar nephropathy.
• Masu hana Beta-blockers (Atenolol, Metaprolol).
• Calcium tubule blockers (Verapamil).

Don rage alamun ƙarancin lipoproteins mai yawa, an tsara statins (Simvastatin, Atorvastatin) da fibrates (Ciprofibrate, Fenofibrate).

Yawaitar Zuciya

Littattafan likitanci na zamani ba su da shawarwari kan daidai lokacin da ya zama dole don fara tsarkake jini ta hanyar hemodialysis. Eterayyade buƙata shine mafificin halartar ƙwararrun halartar. A shekara ta 2002, an bayar da Jagorar Yaran Turai, wanda ya ƙunshi bayanan masu zuwa:

• Tsabtacewa ta hanyar dialysis ya kamata ya fara idan ƙimar tacewar ƙasa ta zama ƙasa da 15 ml / min a haɗe tare da ɗayan juzu'i ko ƙari: kumburi, hauhawar jini da gyara, yanayin ilimin abinci, wanda ci gaba yake haɓaka.
• Tsarkake jini ya kamata ya fara da GFR a ƙasa 6 ml / min, koda kuwa an yi aikin ingantaccen magani, kuma babu ƙarin bayyanannun.
• Maganin ciwon sanyi na farkon ga marasa lafiya waɗanda ke cikin haɗari sosai.

Shawarwarin KDOQI suna ba da shawarar cewa ya kamata dialysis ya fara a ƙarƙashin yanayin:

• babban hauka, ba ingantacce ba don gyara tare da magunguna;
• tarancin tacewa kasa da 15 ml / min;
• urea - 30 mmol / l da ke ƙasa;
• da raguwa sosai a cikin ci abinci da matakin motsa jiki na yau da kullun;
• potassium jini kasa da 6 mmol / l.

Hemodialysis - tsarin tsarkakewar jini na kayan aiki wanda aka yi amfani dashi a gazawar koda

Turewa

Marasa lafiya tare da cututtukan ƙwayar cutar sankara na iya buƙatar tiyata ko tiyata na gaggawa. Don dialysis na gaggawa ba tare da samun dama ba, ana buƙatar matatar dialysis na ɗan lokaci.

Ayyukan da aka shirya sune samuwar fistular arteriovenous fistula, dasawa da daskararrewar jijiyoyin jiki, dindindin ko catheter na ciki. Hakanan za'a iya yin tsawa ko balanbalan angioplasty na jirgin ruwan koda.

Matakan hanyoyin kariya

Tushen rigakafin nephropathy da sauran rikice-rikice shine diyya ga masu ciwon sukari. Idan wata cuta ta riga ta bayyana, kuma an gano albumin a cikin fitsari, to ya zama dole a sassauta ci gaban yanayin kamar haka:

• lura da kai na alamun sukari na jini;
• ma'aunin jini na yau da kullun;
• komawa zuwa bayanin martaba na jini na al'ada;
• magani mai guba;
• bijiro da tsarin karancin carbohydrate.

Tare da haɓakar furotin mai ƙarfi, dole a lura da shawarwari masu zuwa:

• nasara mafi kyawun ƙwayar haemoglobin (ƙasa da 8%);
• gyaran alamomin hawan jini (adadi mafi ƙarancin izini - 140/90 mm Hg);
• ci abinci mai mahimmanci na furotin tare da abinci.

Abin takaici, kawai matakan farko na rikitarwa ana ɗaukar su sakewa. Sauran ba su da magani. Istswararru na iya rage jinkirin ci gaba da cutar, kula da ingantaccen lafiyar mai haƙuri. Gano lokaci-lokaci da kuma bin shawarar halartar likitoci sune mabuɗin don kyakkyawan sakamako ga marasa lafiya.