ʻO ka pōʻino maʻamau o ka maʻi ma ka maʻi maʻi, he maʻi nephropathy maʻi: ka helu ʻana i nā mahele a me ko lākou ʻano ʻano

Hōʻike ka nephropathy diabetic i ka mōʻaukala o ka maʻi i hōʻike ʻia no ka maʻi ʻeha o ka maʻi maʻi (CKD) me ke ʻano o ke ʻano o ka hoʻopiʻi.

Ke kuhikuhi nei ke ala no ka diabetes mellitus i kēia ka helu e like me ka ICD-10 (International Classification of Diseases of the 10th revision):

ʻO ka nephropathy Diabetic: nā hōʻailona, ​​nā pae, mālama

ʻO ka pōʻino o ka nephropathy maʻi ma muli o ke kumu ʻaʻole i hōʻike ʻo pathology ʻo ia iho i ka clinically no ka manawa lōʻihi, e hoʻololi mau nei i ka papa inoa renalics.

Hōʻike pinepine nā hoʻopiʻi i ka papa hana hoʻonāukiuki, i ka manawa e hiki ai ka maʻi mai ke ola ʻana no ka mālama conservative

ʻO ka nephropathy Diabetic kekahi o nā mea maikaʻi loa no ka prognosis o ka maʻi i ka maʻi kūikawā a me kahi hoʻopiʻi weliweli ʻana i ke ola o ka maʻi mellitus.

ʻO kēia hoʻohālikelike o ka hōʻino kino i ke kumu ke kumu nui o ka hoʻololi ʻana o ka pēpē i nā ʻāina ulu, i ʻike ʻia ma ka 30-50% o nā mea maʻi me ka maʻi diabetes type 1 a me 15-25% o nā mea maʻi me ka maʻi diabetes type 2.

Nā papa hana o ka maʻi

Mai ka makahiki 1983, ua hana ʻia ka papa kuhikuhi e like me nā papa o ka nephropathy maʻi maʻi e like me ke ʻano ʻo Mogensen.

Ua ʻoi aku ka maikaʻi o ka hoʻopiʻi ʻana o ka maʻi type 1 no ka mea ʻoi aku ka hopena o ka pathology hiki ke hoʻoholo pololei ʻia.

ʻO nā hoʻololi i loko o nā pūpū me ka nephropathy maʻi

ʻO ke kiʻi o ka lāʻau lapaʻau o ka hoʻopiʻi ʻana i ka wā ma mua ʻaʻole i hōʻike i nā hōʻailona a ʻike ʻole ka mea maʻi i kona kū ʻana i nā makahiki he nui, a hiki i ka hoʻomaka ʻana o ka hana renal.

ʻO nā pae kahi o pathology.

1. Hoʻohana o nā keiki

Ua manaʻo ia ia e kūkulu ʻia ana ka microangiopathy glomerular ma hope o 5 mau makahiki o ka nānā ʻana i ka maʻi maʻi 1. Eia naʻe, hiki i ka lāʻau lapaʻau hou ke kiʻi i ka hiki ʻana o nā loli pathological e pili ana i ka glomeruli mai ka manawa i hōʻike ʻia ai. ʻO nā hōʻailona o waho, a me ka maʻi edematous syndrome, ua hala. I kēia hihia, aia ka protein i ka urine i ka nui o ka nui a ʻaʻole i loaʻa ke kahe koko ke ʻano he nui.

Inā piʻi ke kiʻekiʻe o ka glycemia ma luna o 13-14 mmol / l, loaʻa ke kuapo laina i ka nui o ka filtration.

I ka hōʻemi ʻia o ka maʻi diabetes, hoʻomaʻamaʻa ʻo GFR.

Inā ʻike ʻia ke ʻano maʻi mellitus type 1, i ka wā i kuhikuhi ʻia ai ka lāʻau insulin me ke kali ʻana, hiki i nā loli like ʻole ke hoʻololi i nā ʻōpū a me ka piʻi ʻana o ka filtration maʻamau.

2. Nā loli hoʻololi

ʻAʻole hōʻike kēia wā ma nā hōʻailona. Hoʻohui ʻia me nā hōʻailona pathological i loaʻa i ka pae 1 o ke kaʻina, e nānā ʻia nā loli mua o ka pūliki.

3. nephropathy Diabetic

Hōʻike i ka pae hope loa o ka nephropathy maʻi. ʻAʻole kūpono nā hōʻailona kūikawā. Aia ka papa hana o ke ana me ka maʻamau a hoʻokiʻekiʻe ʻia paha o ka SCFE a hoʻonui i ka lele koko. Eia kekahi:

ʻO ka ʻehā a i ʻole ke kau ʻana o ka microalbuminuria (30-300 mg / lā) i nānā ʻia 5 mau makahiki ma hope o ka hoʻomaka ʻana o ka maʻi diabetes.

Hoʻohana maikaʻi ʻia nā wahi mua ʻekolu o ka maʻi nephropathy maʻi inā hāʻawi ʻia ke ʻano lāʻau lapaʻau pono manawa a hoʻoponopono ʻia ke kō o ke koko. Ma hope mai, ʻaʻole ka mea e hoʻokaʻawale i ke ʻano o nā pūlima iā ia iho e hoʻopau hou, a ʻo ka pahuhopu o ka mālama ʻana e pale i kēia ʻano. Hoʻohālikelike ke kūlana i ka haʻalele ʻana o nā hōʻailona. Hoʻohana pinepine ia e hoʻokau i nā kaʻina hana o kahi pākuʻikuʻi liʻiliʻi (kidney biopsy).

4. Nephropathy hōʻeha koʻikoʻi

Hōʻike ka hōʻike hōʻike iā ia iho i 10-15 mau makahiki ma hope o ka hoʻomaka ʻana o ka maʻi diabetes. Hōʻike ia e kahi hōʻemi o ka wikiwiki o ka filtration strawberry i 10-15 ml / min. kēlā me kēia makahiki, ma muli o ka hōʻeha ʻana i nā moku koko.ʻO ka hōʻike o ka proteinuria (ma luna o 300 mg / lā). ʻO kēia ʻoi loa ka mea e pili ana i ka 50-70% o ka glomeruli i kahi sclerosis a me nā loli i loko o nā keiki ua lilo ia i hikiʻole. I kēia hoʻomakaʻana, hoʻomaka ka hōʻailona mālamalama o ka nephropathy diabetic:

ʻO ka hoʻonāukiuki a me ka hoʻohaʻahaʻa i ka pae koko ke ʻano o nā hōʻailona o ka nephropathy maʻi.

Hoʻemi ʻia ka nele o ka protein i ke koko me ka hoʻoili ʻana i kāna pono ponoʻi, ʻo ia hoʻi me nā pūhui protein, e kōkua ana i ka hoʻomaʻamaʻa ʻana i ke kaulike o ka protein. Hoʻomaʻa ʻo ka make iho o ke kino. Hōʻemi nui ka mea maʻi, akā ʻaʻole ia e ʻike i kēia ʻoiaʻiʻo no ka hoʻonui ʻana i ka edema. ʻO ke kōkua o ka diuretics e lilo i ka maikaʻi a hoʻoneʻe ʻia ka wai me ka puncture.

I ka wā o ka proteinuria, ma aneane āpau, ʻike ʻia ka retinopathy - nā hoʻololi ʻana i ka pathological i loko o nā moku o ka eyeball, ma muli o ke ʻano o ka hāʻawi ʻana o ke koko i ka retina i hoʻopau ʻia, kona dystrophy, optic atrophy a, ma muli o ia, ʻike ʻia ka makapō. Hoʻohālikelike nā poʻe loea i kēia mau loli pathological, e like me ka renal retinal syndrome.

Me ka proteinuria, hoʻomohala ʻia nā maʻi cardiovascular.

5. ʻememia. ʻO Renal hiki ʻole

Hōʻano ʻia ke kahua e ka sclerosis piha o nā moku a me ke ahulau. ʻO ka paʻakikī o loko. Loaʻa kahi hāʻule ma GFR (ma mua o 10 ml / min). Hōʻalo ka pīpī a me ka hoʻomaʻemaʻe koko, ke piʻi ʻana o ka hoʻoulu ʻana o ka maʻi paʻakai i ka lolo. Manaohila:

Ma hope o 4-5 mau makahiki, e hele ke kahua i ka wela. ʻAʻole hiki ke loaʻa kēia kūlana.

Inā hele ka ulu ʻana o ka pilikia papalapa, hiki i ke ʻano o Dan-Zabrody ke ʻano, e hōʻike ʻia e ka hoʻomaʻamaʻa noʻonoʻo ʻana i ke ʻano o ka mea maʻi. Hoemi ʻia i ka hana o ka insulinase a hoʻōla i ka hoʻōla ʻana o ka pōpoki o ka insulin a hoʻonāukiuki i ka hyperglycemia a me ka glucosuria.

Ma hope o 20-25 mau makahiki mai ka hoʻomaka ʻana o ka maʻi diabetes, ua lilo ka hina o ke aʻa. ʻAʻole hiki i ka hoʻolālā ʻana:

Nā huapau

Pono e nānā ʻia kahi hoʻokolohua makahiki maʻamau no ka ʻike ʻana i ka nephropathy maʻi.

I ka mua, e noiʻi ka loea i ke kūlana maʻamau o ka mea maʻi, a hoʻopaʻa pū kekahi i ke ʻano, ka pae a me ka manawa o ka loaʻa ʻana o ka maʻi maʻi.

ʻO ka huli mua ʻana o ka nephropathy maʻi maʻi ʻo ke kī i ka mālama kūleʻa. No kēia mau pahuhopu, hoʻohana ʻia kahi papahana screening maʻi diabetes maʻi diabetes no ka maʻi diabetes. E like me kēia papahana, no ka loaʻa ʻana o nā ʻōpiopio, pono ia e hōʻike i kahi loiloi maʻi maʻamau o ka urine. Ke ʻike ʻia ka proteinuria, ka mea e pono ai ke hōʻoia ʻia e nā noi ʻana hou, ua hana ʻia ka maʻi me ka nephropathy maʻi, ua hōʻike ʻia ke ʻano o ka proteinuria a me nā ala mālama kūpono.

Inā hala ʻole ka proteinuria, e nānā ʻia ka pīpī no microalbuminuria. Hoʻopili pololei kēia ʻano me kahi maʻi maʻi ma mua. ʻAʻole kūpono nā kiʻekiʻe o ka waihona o ka protein i ka urine ma mua o 30 mg / lā. Me microalbuminuria, ʻo ka ʻike kumuhana albumin mai 30 a 300 mg / lā, e hōʻike ana i ka hoʻomaka ʻana o nā loli pathological i loko o nā pūpū.I ka hoʻāʻo ʻia ka miki iā ʻekolu mau manawa no ka 612 mau hebedoma a ʻike ʻia kahi kiʻekiʻe albumin kiʻekiʻe, ʻike ʻia ka “maʻi nephropathy diabala, kahi pae microalbuminuria” a hāʻawi ʻia nā noi no ka wehe ʻana.

No ka wehewehe pono ʻana i ka maʻi maʻi, pono:

ʻO nā hopena ʻehā o ka maʻi nephropathy maʻi i hōʻike maʻalahi ʻia. ʻO nā ʻōuli like ʻole he mau mea i loko o lākou:

Nā hopena ʻokoʻa ma ka maʻi nephropathy maʻi me ka maʻi pāpaʻi, pyelonephritis kūloko, ka maʻi a me ka maʻi glomerulonephritis, etc.

ʻO kekahi manawa hele i nā poʻe loea i kahi biopsy o kahi keiki. ʻO ka pinepine, ʻo kēia ʻano diagnostic i hoʻohana ʻia i loko o nā hihia penei:

Nā maʻi biopsy i hana ʻia ma lalo o ka mana o ka ultrasound

ʻOkoʻa ka loaʻa ʻana o nā nephropathy diabetes.

ʻO ka papa mua a me ka lua o ka mālama pono ʻana i ka mālama ʻana i ka manawa maʻi i hoʻokumu ʻia ai, e pale ai i nā loli pathological i loko o nā moku a me nā lolo. Mālama pū ʻia kekahi pūliki paʻa i loko o ke kino me ke kōkua o nā lāʻau lapaʻau e hōʻemi ana i kona pae.

I ka hoʻomaka ʻana o ka microalbuminuria, ʻo ka pahuhopu o ka mālama ʻana e hoʻomaikaʻi i ke koko, a me ka glucose o ke koko.

Hoʻomoe nā poʻe loea i nā angiotensin-hoʻohuli i ka hoʻoneʻe o ka enzyme (ACE inhibitors): Enalapril, Lisinopril, Fosinopril. Hoʻokomo kēia mau lāʻau i ka kahe o ke koko, paʻa i ka hana o nā keiki. ʻO nā lāʻau lapaʻau me ka hopena lōʻihi, i lawe ʻia ʻole ʻia ma mua o hoʻokahi i ka lā, ʻo ia ke noi nui loa.

Hoʻomaopopo ʻia kahi meaʻai i loko o ka mana o ka protein ʻaʻole pono eʻoi aku ma mua o 1 mg no 1 kg o ka paona maʻi.

I mea e pale ai i nā hoʻoiho ʻole ʻia, ma nā hana ʻekolu i nā ʻōpū palaualelo, pono ia e kaohi maoli i ka glycemia, dyslipidemia a me ke koko.

I ke kahua o ka proteinuria, me nā mea kōkua ACE inhibitors, kahi i hoʻopaʻa ʻia ʻo nā hāpona kalima. Hāʻawi lākou i edema me ke kōkua o diuretics (Furosemide, Lasix, Hypothiazide) a inu. Hele lākou i ka pāʻai ʻana ʻoi aku. ʻO ka pahuhopu o ka mālama ʻana i kēia mahele ke hoʻololi i ke kahe o ke koko a me ke kaʻe koko i mea e pale ai i ka hāʻule ʻole ʻana.

I ka manawa hope o ka maʻi nephropathy maʻi, ua ʻano hāpono ka mālama ʻana. Pono ka mea maʻi i ka dialysis (hoʻomaʻemaʻe koko mai nā toxins. Ke hoʻohana ʻana i kahi polokalamu kūikawā) a i ʻole ka hoʻololi kino keiki.

Hiki iā Dialyzer iā ʻoe ke hoʻomaʻemaʻe i ke koko o nā toxins

Pono ke kīpoki maʻi nephropathy haʻahaʻa e hoʻemi i ka protein-pale, hoʻālaʻa a me ka momona me nā mea nui e pono ai e mālama i ke olakino maikaʻi loa o ka maʻi maʻi. I kēlā me nā manawa like o ka hana pathological i loko o nā keiki, ua hoʻohana ʻia nā kīʻaha haʻahaʻa haʻahaʻa haʻahaʻa 7P, 7a a me 7b, nā mea i loaʻa i ka mālama paʻakikī o nā ʻōpiopio.

Ma hope o ke kamaʻilio me ke kauka, hiki nō ke hoʻohana i nā ʻano ʻē aʻe. ʻAʻole hiki iā lākou ke hana ma ke ʻano he mālama kūʻokoʻa, akā hoʻokō pono i ka lāʻau lapaʻau.

Nā hana kūpono

E kōkua kēia mau lula i ka pale ʻana i ka nephropathy maʻi maʻi, pono e mālama ʻia mai ka manawa o ka maʻi maʻi.

• E mālama i ka pae momona o kou kino.
• E hoʻoponopono i ke kahe koko, i kekahi mau lā me nā lāʻau lapaʻau.
• Kāohi i ka atherosclerosis.
• E hahai i kahi meaʻai.

ʻAʻole e poina i nā hōʻailona o ka nephropathy maʻi maʻi ʻaʻole i hōʻike iā lākou iho no ka manawa lōʻihi a ke kipa wale aku i ka maʻi kauka a me ka hōʻike ʻana i nā hoʻokolohua e kōkua i ka haʻalele ʻana i nā hopena hiki ʻole.

1st 1st - hyperfunctional hypertrophy:

Kuhi ʻia aku ia ma ka hoʻomaka ʻana o ke maʻi maʻi (pinepine ʻano 1) a hoʻopiʻi ʻia me ka piʻi ʻana o ka nui o ka glomeruli o nā pēpē. Hoʻohālikelike ia e ka hyperperfusion, hyperfiltration a me normoalbuminuria (he emi iho ma ka 30 mg / lā). Ua ʻike ʻia ka Microalbuminuria i kekahi mau hihia i ka wā e hoʻomehana ai i ka insulin. Ua kiʻekiʻe ka wikiwiki o ka CF, akā ua hoʻohuli ʻia.

ʻAno 2 - ke ʻano o nā loli mua.

ʻAʻohe mea lapaʻau i hōʻike ʻia aʻe. Kuhi ʻia ia mau makahiki ma hope o ka hoʻomaka ʻana o ka maʻi diabetes a ʻike ʻia i ka palalelo ʻana o ka membement basement glomerular a me ka hoʻonui ʻana aʻe i ka nui o ka mesangium.

Hiki i kēia hana i mau makahiki 5, hōʻike ʻia e ka hyperfiltration a me normoalbuminuria (he emi iho ma ka 30 mg / lā). Me ka decompensation diabetes a me ka hoʻoikaika kino, hiki ke ʻike i ka microalbuminuria. Ua hoʻonui nui ʻia ka wikiwiki o CF.

Ka lā hana 4 - ua hōʻike ʻia

Hoʻoulu ka hana Renal a me ka uremia. Hōʻike ʻia ke kahua me ka nui o ka helu CF (ma lalo o 30 ml i hoʻokahi mau minuke), holoʻokoʻa a i ʻole nodular glomerulosclerosis. Ma ke ʻano o ka hiki ʻana o ka renal gagal, ke hōʻike ʻia nei nā mea e like me ka maʻi maʻi ma ka maʻi hyperglycemia, hiki ke hoʻemi nui ʻia ka glycosuria. ʻO ka emi ʻana o ka insulin e hōʻemi ma muli o ka emi o ka hōʻemi o ka hōʻemi a me ka hoʻokaʻawale urinary (Zubrod-Dan hanana). Me ka hoʻonuiʻana o ka creatinine koko i ʻoi aku ma mua o 2 mau manawa, e ulu ana ka anemia ma muli o ka emi o ka syntry erythropoietin. Ke holomua nei ka maʻi Neprotic, ʻaʻole hoʻomaʻamaʻa ʻia ke hypertension e nā lāʻau lapaʻau antihypertensive. Me ka hoʻonui o ka pae creatinine e 5-6 manawa, ʻike ʻia ka dyspeptic syndrome a me nā hōʻailona āpau o uremia. ʻO ke ola hou o ka mea maʻi ke hiki wale nō me ke kōkua o ka peritoneal a i ʻole hemodialysis papahana paha me ka hoʻololi hou ʻana o ka naʻau. I kēia manawa, ua kau ʻia ka hoʻonohonoho ʻana o nā papa ʻo ka maʻi nephropathy o ka maʻi diabetes (Nā alakaʻi o ka Ministry of Health of Russia, 2002).

ʻO nā ʻano maʻi o ka nephropathy diabetes:

ʻEkolu mau hanana o ka maʻi nephropathy maʻi.

• ke kumu o ka hana ʻole o ke aʻalolo āpau (conservative, terminal).

Pono e hōʻike ʻia ke ʻano o ka microalbuminuria e ka hoʻonui i ka hoʻonui ʻana o ka albumin i loko o ka pāʻai i ka pae mai 30 a 300 mg i kēlā me kēia lā; ma ka urinalysis maʻamau, ʻaʻole ʻike ʻia ka protein. Hoʻomaʻamaʻa: ʻO ACE inhibitors ʻoiai me ke kahe koko maʻamau, ke hoʻoponopono ʻana i ka dyslipidemia, ka palena o ka protein holoholona (ʻaʻole iʻoi aku ma mua o 1 g no ka 1 kg o ka paona o ke kino).

Hōʻike ʻia ka hana o ka proteinuria ma ke ʻano o ka noho ʻana o kahi protein i ʻike ʻia ma kahi urinalysis maʻamau. I kēia hihia, ʻike ʻia kahi emi o ka CF a me ka hoʻonui ʻana o ke kahe koko. Hoʻomaʻamaʻa: ʻO ka ACE inhibitors me ka mālama ʻana i ke kahe koko ʻaʻole nui ma mua o 120/75 mm RT. ʻAniā. ka hoʻoponopono ʻana o dyslipidemia, ka palena o ka protein holoholona (ʻaʻole iʻoi aku ma mua o 0.8 g no 1 kg o ke kino o ke kino).

ʻIke ʻia ke ʻano o ka hana ʻole o ka pilikia papaliki ke piʻi wale ʻia ka pae ʻana o ka pae creatinine ma mua o 120 μmol / l (kahi like me ka 1,4 mg%) ka mea i hoʻoholo ʻia i loko o ke koko o ka mea maʻi. I ka manawa like, ua hoʻoholo ʻia ka emi ʻana o ka helu o ka CF ma lalo o 30 ml / min, a me ke hoʻonui ʻana o ka nui o ka urea koko.

Ka hopena o ka nephropathy maʻi maʻi:

• nā papa o ka ACE (me ka hoʻonui o ka creatinine i ʻoi aku ma mua o nā 3 mauʻano) + ka lōʻihi o ka calcium antagonist calcium (aloard nifedipine, amlodipine, lacidipine) me ka mālama ʻana o ke koko koko ma lalo o 120/75 mm RT. Art.,

• ka palena o ka ʻai ʻana o ka meaʻai holoholona (ʻaʻole iʻoi aku ma mua o 0.6 g no 1 kg o ka paona o ke kino),

• nā mea kani keto o nā waikawa amino 14-16 g i kēlā me kēia lā,

• ka palena o ka phosphate me ka meaʻai ma lalo o 7 mg / kg paona kino

• hoʻonui i ka intake calcium ma kahi o ka 1,500 mg i kēlā me kēia lā ma muli o ka meaʻai meaʻaiʻaiʻai a me nā mea kanu o nā paʻakai kalima, ka vitamin D (ʻo ke ʻano ikaika wale nō ka calcitriol),

• ka nānā ʻana o ka anemia me nā lāʻau lapaʻau erythropoietin,

• me ka hyperkalemia - ka diuretics loop,

• nā hemodialysis (hōʻailona: CF - ka liʻiliʻi o ka 15 ml / min, ka mea hana koko - ʻoi aku ma mua o 600 mol / l).

ʻO ka mālama ʻana i ka maʻi diabetes i nā makahiki 5 mua o ka maʻi e hoʻonui nui ana i ka ulu ʻana o ka nephropathy. Me ka mālama ponoʻana i ka glycemia, hiki ke hoʻololi ʻia ka hemodynamics intrarenal a me ka nui o ka lua. Hiki i ka hoʻohana ʻana o ka ACE inhibitors ke kōkua i kēia. Hiki ke kūpaʻa a lohi i ka holomua o ka nephropathy. Hōʻike ka hiʻohiʻona o ka proteinuria nui i kahi hana hōʻino nui i loko o nā keiki, kahi ma kahi o 50-75% o ka glomeruli i kahakaha ʻia, a ua lilo ka palapala morphological a me ka hana. Mai ka hoʻomaka ʻana o ka proteinuria, ua emi ka piʻi ʻana o ka helu CF ma kahi helu 1 ml / min i kēlā me kēia mahina, ma kahi o 10 ml / min i ka makahiki. ʻO ka hoʻolālāʻana o ke kau hope loa o ka hana ʻole o ka renal e kali ʻia ma hope o 7-10 mau makahiki mai ka hoʻomaka ʻana o proteinuria. I ka hoʻomakaʻana o ke hōʻike o ka nephropathy, he paʻakikī nui ka lohi i kona holomua a kali i ka hoʻomaka ʻana o ka maʻi ureme o ka maʻi.

E hōʻike i ke ʻano o ka MAU o ka nephropathy maʻi, pili:

1) ke aʻo ʻana o microalbuminuria - UIA (hoʻāʻo ʻia ka hōʻike "Mikral test" - Hoffman la Roche),

2) nā ala immunochemical,

3) ka polokalamu "DCA-2000 +".

ʻO ke ʻano e nānā pono ai i nā poʻe maʻi me ka nephropathy maʻi i nā papa ʻaina e pono ai, ʻaʻole i hana ʻia e nā endocrinologists a me nā maʻi maʻi maʻi a hiki i ka nephropathy maʻi ma kahi o ke koʻikoʻi o ka hana ʻole. ʻO ka hoʻohana ʻana o ka protein holoholona iʻoi aku ma mua o 1,5 g no 1 kg o ke kaumaha o ke kino hiki ke loaʻa kahi hopena nephrotoxic.

ʻO ka pōʻino maʻamau o ka maʻi ma ka maʻi maʻi, he maʻi nephropathy maʻi: ka helu ʻana i nā mahele a me ko lākou ʻano ʻano

Ua loaʻa i ka nephropathy diabetic ka primacy ma waena o nā hopena o ka maʻi mellitus, no ka hilinaʻi nui i ka insulin (ke ʻano mua). Ma kēia pūʻulu o nā mea maʻi, e ʻike ʻia ia ke kumu nui o ka make.

ʻO nā loli i loko o nā pūpū i nā manawa mua o ka maʻi, a me ka papa hope (hope) o ka maʻi o ka maʻi ʻaʻole he mea ʻē aʻe ma mua o ka renal failed (hōʻemi ʻia me CRF).

Ke lawe nei i nā hana pale, hōʻiliʻili pono i ka manawa kūpono loa, hoʻomaʻamaʻa maikaʻi a me kaʻai ʻana, ka hoʻomohala ʻana i nā nephropathy i ka maʻi diabetes, hiki ke hōʻemi ʻia a hoʻomanee i ka lōʻihi loa.

Ka helu ʻana o ka maʻi, ka mea i hoʻohana pinepine ʻia e ka hoʻomaʻamaʻa ʻana e ka poʻe loea, hōʻike ana i nā mahele o nā hoʻololi ʻana i ke kumu hoʻohuli i ka maʻi e hōʻeha nei i ka maʻi mellitus.

ʻO ka huaʻōlelo ʻo "nephropathy diabetic" ʻaʻole i maʻi āpau, akā he nui o nā pilikia kūikawā e pili ana i ka hoʻopōʻino i nā moku ʻoihana e kūleʻa ana i ka hoʻomohala ʻana i kahi ʻano maʻi mellitus o ka maʻi mellitus: glomerulosclerosis, arteriosclerosis o nā mākeke i loko o ka pūpū, ka lawe ʻana o nā momona i nā ngala renal, ko lākou necrosis, pyelonephritis, etc.

I ka poʻe maʻi me ka maʻi o ka lua o ka ʻano (non-insulin-dependance), nephropathy wale nō i nā 15-30% o nā hihia. ʻO Nepropathy, e ulu ana e pili ana i ke ʻano o ke ʻano maʻi mellitus maʻi mika, ua kapa ʻia ʻia ʻo Kimmelstil-Wilson syndrome, ma ka aniani me ke ʻano o ka glomerulosclerosis mua, a me ka ʻōlelo "glomerulosclerosis" maʻi pinepine ʻia e like me ka uniana ma ka "nephropathy" i nā puke lapaʻau a me nā palapala maʻi.

ʻO ka nephropathy Diabetic he maʻi holomua holomua, ʻo kona kiʻi kulekele i hilinaʻi i nā hana o nā loli pathological. I ka hoʻomohala ʻana o ka maʻi nephropathy maʻi, ua hoʻokaʻawale ʻia nā ʻokoʻa o ka microalbuminuria, proteinuria a me ka papa hana o ka hiki ʻole o ka maikaʻi ʻole.

No ka manawa lōʻihi, ʻo ka maʻi nephropathy diabetes, he asymptomatic, me kahi ʻole o kahi hōʻike o waho. I ka hoʻomaka mua o ka maʻi nephropathy maʻi, ua hoʻonui ʻia ka nui o ka glomeruli o nā keiki (hyperfunctional hypertrophy), hoʻonui i ke kahe koko renal a me kahi hoʻonui o glomerular filtration rate (GFR) i hoʻomaopopo ʻia. I kekahi mau makahiki ma hope o ka puka ʻana o ka maʻi maʻi, ua ʻike ʻia nā loli mua o ka hana i loko o ka glomerular apparatus o nā keiki. Nui ka nui o ka kānana glomerular, a me ka hoʻopuka ʻana o ka albumin i ka urine, ʻaʻole iʻoi aku i nā mea maʻamau (30-300 mg / lā a 20-200 mg / ml i ke kakahiaka kakahiaka o ka urine). Hiki ke nānā ʻia he hoʻonui manawa nui i ke koko. ʻO ka wehe ʻana i nā maʻi me ka nephropathy maʻi i mālama ʻia i ke ala hope o nā maʻi.

Kūkulu ʻia ka maʻi nephropathy maʻi i hope ma hope o nā makahiki 15-20 me ka type 1 diabetes mellitus a hōʻailona ʻia e ka proteinuria mau loa (pae ʻai i ka urine> 300 mg / lā), e hōʻike ana i ka hiki ʻole o ka loiloi. Hoʻopili ke kahe koko a me ka GFR, lilo i ka ulu ʻana o ka maʻi a me ka paʻakikī ke hoʻoponopono. Hoʻokūkū ka neurrotic syndrome i hōʻike ʻia e ka hypoalbuminemia, hypercholesterolemia, peripheral a me ka edema edema. Nā mea hana koko a me nā kiʻekiʻe o ka urea pae a maʻamau a hoʻokiʻekiʻe paha.

I ka hoʻomaka ʻana o ka maʻi nephropathy maʻi, he nui ka emi ʻana o ka hana filtration a me nā hana koʻikoʻi o nā pēpē: nui proteinuria, haʻahaʻa GFR, nui ka nui o ka urea koko a me ka mea hana, hoʻomohala i ka anemia, edema koʻikoʻi. I kēia hākā, hyperglycemia, glucosuria, urinary excretion o ka endogenous insulin, a me ka makemake i ka exogenous insulin hiki ke hoʻemi nui ʻia. Ka holomua o ka maʻi Neprotic, piʻi ke koko i nā kiʻekiʻe kiʻekiʻe, ʻo ke dyspeptic syndrome, uremia a me ka hoʻomaʻū ʻole o ka renal i ke ʻano me nā hōʻailona o ka hōʻino kino ʻana i ke kino ma o nā huahana metabolic a me ka hōʻino i nā mea kino a me nā ʻōnaehana.

Ke hoʻoponopono ʻana i nā pae I-III

ʻO nā lula kumu no ka pale ʻana a me ka mālama ʻana i ka nephropathy maʻi maʻi i nā manawa I-III e loaʻa:

ʻO ka Hyperglycemia kahi mea hoʻonaninani no nā loli hoʻololi a hoʻoikaika i nā maʻi. ʻO nā mau noiʻi nui loa ʻelua - ʻo DST (Diabetes Control and Complication Study, 1993) a me UKPDS (United Kingdom Prospective Diabetes Study, 1998) - hōʻike i nā hana o ka mana glycemic control pili i ka hopena nui o ka hiki o microalbuminuria a me albuminuria i nā maʻi me ka maʻi mellitus 1 a me 2 ʻano. ʻO ka uku hoʻonaʻauao kūpono no ka hoʻohaʻahaʻa kalama, e kōkua ana i ka pale ʻana i ka hoʻomohala ʻana o ka hoʻopiʻi vascular, hōʻike ʻia i nā kumu glycemic normal a i ʻole a me ka HbA1c

Hoʻopili i nā ACE inhibitors, nā antagonist calcium mai ka hui verapamil i nā hopena nephroprotective a me ka cardioprotective.

Hoʻokō ʻia ka hana koʻikoʻi o ka mālama ʻana i ka maʻi hypertension arterial e ka ngiotensin II antagonist. ʻO kā lākou nephroprotective hana i ke ʻano maʻi diabetes mellitus type 2 a me nā nephropathy diabuhi i hōʻike ʻia i loko o nā noiʻi nui ʻekolu - IRMA 2, IDNT, RENAAL. Hoʻomaopopo ʻia kēia lāʻau lapaʻau ma ka hopena o nā hopena ʻaoʻao o nā inhibitor ACE (ʻoi aku hoʻi i nā mea maʻi me ka maʻi type 2).

He mea hoʻomaʻamaʻa ia e hoʻohana i nā inhibitor ACE (a i ʻole na kaiotensin II receptor blockers) i hui pū me ka nexroprotector sulodexide, e hoʻihoʻi hou i ka mana o ka pelapale o ka membementes papa o ka glomeruli o ka pūpū a hoʻemi i ka nalowale o ka protein i ka urine.

Sulodexide 600 LU intramuscularly 1 mau manawa i ka lā 5 lā i ka hebedoma me kahi hoʻomaha o 2-lā, 3 mau pule, a laila i loko o 250 LU hoʻokahi manawa i ka lā, 2 mau mahina.

Pono ʻia kēlā ʻano hana i mālama ʻia 2 i hoʻokahi makahiki o ka makahiki.

Me ke kiʻekiʻe o ke koko, e aʻo ʻia ka hoʻohana ʻana o ke ʻano hui.

Therapy no dyslipidemia ma ka nephropathy maʻi

ʻO 70% o nā maʻi me ka maʻi mellitus me ka maʻi diabetes nephropathy maʻi IV a ma luna aʻe ua loaʻa ka dyslipidemia. Inā ʻike ka hilahila metabolid (LDL> 2.6 mmol / L, TG> 1.7 mmol / L), hoʻoponopono ʻia ka hyperlipidemia (kaʻai ʻana i ka waiʻawaʻu lipid), me ka lawa ʻole o ka hopena - nā lāʻau lipid-hōʻemi.

Me LDL> 3 mmol / L, kahi hōʻike mau o nā statins i hōʻike ʻia:

ʻO ka hoʻihoʻi hou ʻana i ka hemodynamics intracubular i ka manawa o ka microalbuminuria hiki ke hoʻokō i ka hoʻopau ʻana i ka ʻai o nā protein holoholona i 1 g / kg / lā.

ʻO nā kumu no ka pilina ʻo ka psogonadism ma aneʻi

Eia nā papa nui 5 e loli maikaʻi i kēlā me kēia me ka nephropathy maʻi, inā ʻaʻole ʻoe e mahele i ke kaʻina i ka hoʻomaka.

ʻO nā papa hana mua he kapa ʻia he preclinical, no ka mea ʻaʻohe hoʻopaʻi ʻia me lākou. E hoʻoholo i ka hiki ʻana o nā pōʻino o ka pōpoki hiki ke hana wale nō ma o ka hoʻokolohua ʻana i nā hoʻokolohua kūikawā me ka microscopy o ke akeʻano. Eia nō naʻe, he mea nui ke hiki ke hoʻomaopopo pono i ka maʻi i kēia mau manawa, mai ka wā ma hope ua lilo ia i mea hou ʻole.

He aha ka maʻi diabetes nephropathy

ʻO ka poino i nā keiki ma ka maʻi pākīwī ke hoʻopiʻi ka hopena, pili ia me ka luku o ka paia vascular me ke kō koko nui. ʻO ia he asymptomatic no ka manawa lōʻihi, a me ka neʻeʻana, ua kāpae ia i ka kānanaʻana i ka urine.

Hoʻopuka ka hana Renal. Aia kahi mea e pono ai e hoʻopili i nā maʻi me ka hemodialysis apparatus e hoʻomaʻemaʻe i ke koko o nā pūnao o nā mea laʻa. I kēlā mau hihia, pili ke ola o ka mea maʻi i ka hiki ke hoʻololi i kahi pepela a me kona ola.

A eia kahi ʻoi aʻe nei no ka loiloi o ka urine no ka maʻi maʻi.

ʻO nā kumu no ka hoʻomohala ʻana

ʻO ka mea nui e alakaʻi ai i nā hoʻopiʻi i ka maʻi diabetes he koko koko kiʻekiʻe. ʻO ia ka mea e ʻole ʻole i ka mea maʻi me nā koi a ka papaʻai, lawe i ka hapa haʻahaʻa o nā laikini nona. Ke hopena, ua kū mai kēlā mau loli:

• hoʻohuihui nā molekula i loko o ka glomeruli me ka glucose (glycation) a nalowale i kā lākou mau hana,
• Ua luku ʻia nā pā o vascular,
• kauhaʻi ka hapa o ka wai a me ka paʻakai.
• hoʻemi ka ʻoliala
• poʻomanaʻo nā mea hōʻona e hōʻino paha i ka ʻōpū a hoʻonui i ka vascular permeability e hōʻiliʻili.

ʻO nā hopena paʻakikī no ka holomua wikiwiki

Inā hyperglycemia (kiʻekiʻe glucose) ka papa nui o ke ala no ka nephropathy, a laila hoʻoholo nā mea pili i ka helu o kona helehelena a me ka paʻakikī. ʻO ka ʻoi loa ka mea ʻike ʻia:

• kau kaumaha
• hypertension arterial: i ke kahe nui, i ka hoʻomaka, hoʻonui ʻia ka kānana, ka hoʻemi ʻana o ka palaka i ka urine e hoʻonui, a laila ma kahi o glomeruli, ʻōwili aʻeha (glomerulosclerosis) e kū mai ana, kau a kau ka kānana kānana i ka urine.
• nā mea hoʻonāukiuki o ka lipid molihala o ke koko, obesity ma muli o ka hoʻohemo ʻana o nā kolala paʻakikī i loko o nā moku, ka hopena maoli o ka hōʻeha ʻana i nā momona ma luna o nā pūpū,
• maʻi maʻi maʻi urinary
• ulaula
• he ʻai momona nui i ka ʻiʻo ʻai me ka paʻakai,
• ka hana ʻana i nā lāʻau lapaʻau e hoʻonāukiuki ai i ka hana o ke keiki,
• atherosclerosis o nā renal renal,
• leo haʻahaʻa o ka pahi no ka neuropathy autonomic.

Kālaulea

Aia ia i ka hoʻomaka mua o ka maʻi diabetes ma muli o ka hoʻonui nui ʻana o ke kaumaha ma luna o nā pēpē a me ka hopena o ka urine. Ma muli o ka hoʻonui nui o ke kōhi koko, hoʻāʻo ka ʻōpū i ka wehe ʻana mai ke kino me ka wikiwiki. No kēia, hoʻonui i ka nui o ka glomeruli, ka nui o ke kahe koko, ka wikiwiki a me ka nui o ka filtration hoʻonui. I kēia hihia, hiki i nā ala ke i ka protein i ka urine. Hōʻike pau kēia mau hōʻike āpau me ka mālama kūpono o ka maʻi maʻi.

ʻO Hepropathy o nā hoʻololi mua i ka hoʻonohonoho ʻana o nā keiki

Ma hope o 2 mau makahiki mai ka hoʻomaka ʻana o ka maʻi i ka glomeruli, kūmole ka membrane basement (kahi kānana e kānana nei i nā protein nui) a me ka nui o ke kiko ma waena o nā moku (mesangium) hoʻonui. ʻAʻohe mea hōʻailona, ​​wikiwiki ka filtration urine, me ka hoʻoikaika mua o ke kino a me ka hoʻokaʻawale ʻana i ka maʻi maʻi, a hiki i ka 50 mg o ka palaki i hoʻokuʻu ʻia i kēlā me kēia lā, ʻoi ka liʻiliʻi ma mua o ka maʻamau (30 mg). ʻO ka neʻe ʻana o ka neʻe ʻana i kēia hana ke hōʻike ʻia kahi hana like ʻole.

Pahuela

Hoʻomaka ʻelima mau makahiki ma hope o ka hoʻomaka ʻana o ka maʻi. E lilo ka lilo ʻana o ka protein i ka 300 mg a puni ka lā. Hoʻonui ʻia ka kānana kānalua a ke kokoke nei ia. Hoʻonui ka lolo, nui me ka hoʻoikaika kino. I kēia hoʻokuʻi, hiki ke hoʻokau i ke kūlana o ka mea maʻi a pale i nā keiki maʻi mai ka luku hou aku.

Hoʻopau i nā nephropathy

I nā maʻi, hoʻemi ka kānalua o ka urine i 30 ml a i ʻole ma lalo o ka mau minuke. Hoʻopilikia ʻia ka mea hoʻōla o nā huahana metabola, hōʻiliʻili i nā mea momona huehue (nā mea hana a me ka uric acid) e hōʻiliʻili. Ma nā pēpē i loko o kēia manawa, hoʻomaʻamaʻa ʻole nā ​​mea hana i koe. Kūʻai ka Insulin i ke koko ma kahi lōʻihi, ua hoʻemi ʻia nō hoʻi kona excretion, no laila, e hoʻemi ʻia ka nui o ka lāʻau no ka poʻe maʻi.

Hoʻopau ka lāʻau liʻiliʻi i ka erythropoietin, kahi e pono ai no ka hoʻonuiʻana i nā sela koko ʻula, e kū ana ka anemia. Ke māhuahua nei ka puhi a me ke hypertension. Hiki i nā mea maʻi ke hilinaʻi nui loa i nā kaukau no ka hoʻomaʻemaʻe koko maoli - papahana hemodialysis. Pono lākou i kahi palela kidney.

ʻO Microalbuminuria

ʻO ka hōʻailona koʻikoʻi ka hoʻokuʻu a hiki i ka 300 mg o ka protein. ^ E Ha yM. Inā hele ka mea maʻi i ka hōʻike maʻamau ʻo ia i ka urine, a laila hōʻike ia i ke ʻano maʻamau. Malia paha e hoʻonui i ke kahe o ke koko, i ka wā e nānā ai i ke kālā hoʻoweliweli i nā loli i ka retina (retinopathy) a me ka nānāʻana i nā pilikia o nā haʻahaʻa haʻahaʻa.

Proteinuria

ʻO ka noho ʻana ka ʻoi aku o 300 mg o ka protein i ʻike ʻia i ka urinalysis maʻamau. ʻO kahi hōʻailona o ka nephropathy i ka maʻi ma ka maʻi ka kaawale ʻana o nā puʻupuʻu koko ʻulaʻula a me nā keʻena koko keʻokeʻo (inā ʻaʻohe hopena o ka urinary tract). Ke piʻi wikiwiki nei ka paʻakikī. I ka ulu ʻana o ka hypertension i kēia manawa ka ʻoi aku ka pilikia no ka pōʻino o ka keiki ma mua o ke koko koko kiʻekiʻe.

ʻO ka maʻamau, loaʻa nā maʻi āpau i ka retinopathy, a ma kahi hōʻeha paʻakikī. ʻO kēlā me nā loli like i ʻole (nephroretinal syndrome) e nānā i ka nānā ʻana o ke kālā ma ka nānā ʻana i ka manawa o ka hoʻomaka ʻana i nā hana kūlohelohe ʻole i nā maʻi.

I ka wā o ka proteinuria, ua ʻike pū ʻia lākou.

• muhua pehu a me nā maʻi maʻi o ka maʻi maʻi,
• orthostatic hypotension - ke pohō nei i ke kahe mai ka wā o ka moena,
• ischemia muscle cardiac, angina pectoris, a i nā poʻe 25-35 mau makahiki koikoi,
• atypical myocardial infarction me ka ʻeha ʻole,
• hoʻemi ka hana o ka ʻōpū o ka ʻōpū, ka ʻawaʻawa a me ke kua.
• huakai.

Nā hōʻailona maʻi i nā pākeke a me nā keiki

ʻO ka manawa pinepine loa, me nā ʻano mua o ka maʻi mellitus, kahi maʻi maʻamau o ka nephropathy e nānā e like me nā papa hana.Hoʻonui mua i ka hoʻokaʻa ʻana i ka urine - ka wikiwiki a me ka nui o ka urination e kū pinepine me ka lawa ʻole o ke kōhi koko.

A laila hoʻomaikaʻi ka nohona o ka mea maʻi, hoʻonaninani ʻia ka huna huna hāmeʻa. Kahi ka lōʻihi o kēia hana e pili ana i ka kokoke e pili ana i nā hōʻailona o ka glucose, ke kolamu o ke koko a me ke kahe koko. Me ka holomua, ua hoʻololi ʻia ka microalbuminuria e ka proteinuria a me ka maikaʻi ʻole ʻana.

Nā kānana hoʻāʻo a ka wai

I ka lua o nā maʻi o ka maʻi maʻi, ʻoi aku ka nui o nā ʻāpana he ʻelua wale nō ka hoʻokaʻawale. ʻAʻole ia i hōʻike mua ʻia e nā hōʻailona, ​​akā ma ka urine hiki iā ʻoe ke ʻike i ka protein me nā hoʻokolohua kūikawā, a laila loli nui ka mea maʻi, piʻi ka paʻakikī a paʻakikī ke hoʻemi me ka lāʻau antihypertensive.

ʻO ka hapa nui o nā maʻi i ka manawa nephropathy i ka wā kahiko. No laila, ma ke kiʻi haumanu he mau hōʻailona o nā ʻōpiopio o ka maʻi diabetes (retinopathy, autonomic and peripheral neuropathy), a me nā maʻi i hōʻike ʻia i kēia manawa o ke ola - hypertension, angina pectoris, heart failed. E pale aku i kēia kiʻi, hiki ʻole ke hoʻololi pinepine i ka pilikia o ka pilikia i ke aʻeha o ka cerebral a me ka coronary circulate me ka hopena hiki.

Hiki i nā hoʻopiʻi ka nephropathy

Ma kahi o ka nalowale i ka protein i loko o ka uahi, ʻoi aku ka pōʻino o ka hopena i nā hopena ʻē aʻe.

• anemia renal ma ke ʻano o ka hoʻohaʻahaʻa ʻana i ka erythropoietin,
• ʻOsteodystrophy ma muli o ka pale o ka metabolism calcium, kahi hōʻemi i ka hana o ka ʻano ikaika o ka vitamina D. I nā mea maʻi, ua luku ʻia ka iwi, ʻeha nā ʻeha, hōʻeha nā ʻeha o nā iwi a me nā ʻōpū, ua ʻike ʻia nā hiʻi me nā hōʻeha liʻiliʻi. Hoʻokomo ʻia nā paʻakai kalekona i loko o nā keiki, nā ʻōpū kūloko, nā moku,
• ka laʻala o ke kino me nā pūhui nitrogen - ʻo ka ʻalā o ka ʻili, luaʻi, ʻano nui me ka hanu pinepine ʻana, ka ʻeu o ka ʻūa i ka ea hanu.

ʻO ka hoʻomohala ʻalaʻili

Hoʻonāukiuki ʻia ka Hyperglycemia e ka maʻi mellitus i mea e piʻi ai ke kahe koko (i hōʻoki ʻia me ka BP), ka mea e wikiwiki ai i ka kānana i hana ʻia e glomeruli, glomeruli o ka ʻōnaehana o ka nephron, he mea hana ia o nā keiki.

Eia kekahi, ʻo ka mea nui o ke kō e hoʻololi ai i ke ʻano o nā ʻōmole e hana i kēlā me kēia glomerulus. ʻO kēia mau aniani ke alakaʻi i ka sclerosis (paʻakikī) o ka glomeruli a me ka nui o ka lole o nā nephrons, a, no laila, i ke nephropathy.

I kēia manawa, hoʻohana pinepine nā kauka i kā lākou hana i ka papa mele ʻo Mogensen, i kūkulu hou i ka makahiki 1983 a e wehewehe ana i kahi ʻano maʻi o kēia maʻi:

1. maʻi o ka pēpē i hana mua i ka manawa mua o ka maʻi mellitus hōʻike kino iā ia iho ma o ka hypertrophy, hyperperfusion a me ka hyperfiltration o nā keiki,
2. ke ʻano o nā loli o I-strukture i ka pūpū me ka mānoanoa o ka membement basement glomerular, hoʻonui i ka mesangium a me ka hyperfiltration like. ʻIʻa ʻia i ka manawa mai 2 a 5 mau makahiki ma hope o ka maʻi maʻi,
3. hoʻomaka i ka nephropathy. Hoʻomaka ʻaʻole ma mua o 5 mau makahiki ma hope o ka hoʻomaka ʻana o ka maʻi a hana iā ia iho me ka microalbuminuria (mai 300 a 300 mg / lā) a me ka hoʻonui ʻana o ka maʻi kānana glomerular (hōʻuluʻulu i ka GFR),
4. Hoʻokumu ka nephropathy i ka maʻi diabetes i ka wā o 10-15 mau makahiki, e hōʻike ana iā ia iho i ka proteinuria, hypertension, hoʻoneʻe i ka GFR a me ka sclerosis, e uhi ana mai 50 a 75% o glomeruli,
5. Maʻa uremia he 15-20 mau makahiki ma hope o ke ahulau a hōʻike i ka nodular a piha paha, piha ka glomerulosclerosis piha, hoʻemi i ka GFR ma mua o ka hyperfiltration renal. Hōʻike ia iā ia iho i ka wikiwiki o ke kahe o ke koko ma ka glomeruli o ka renal, e hoʻonui ana i ka nui o ka urine a me nā mea make pono. ʻAi ʻia a hala 5 mau makahiki
6. microalbuminuria - kahi liʻiliʻi i hoʻonui ʻia i ka pae o nā protein albumin i loko o ka urine (mai 30 a 300 mg / lā). ʻO ka maʻi maʻamau a me ka mālama ʻana i kēia manawa e hiki ke hoʻonui iā ia i 10 mau makahiki,
7. macroalbuminuria (UIA) a i ka proteinuria. ʻO kēia kahiemi hōʻemi i ka wikiwiki o ka filtration, he kuʻi pinepine i ka kahe koko. Hiki i ka nui o nā protein albumin i loko o ka lānai ma waena o 200 a oi aku ma mua o 2000 mg / bitch. ʻO ka nephropathy diabetic o ke ʻano UIA e kū mai ana ma ka makahiki 10-15 i ke hoʻomaka ʻana o ka maʻi diabetes,
8. nephropathy haʻi. Hōʻano ʻia e ke aniani o ka filtration rate glomerular haʻahaʻa (GFR) a me ka hoʻolalelale ʻana o nā moku ʻōhua i nā loli sclerotic. Hiki ke mālama ʻia i kēia manawa ma hope o nā makahiki he 15 ma hope o ka hoʻololi o ka pūpū.
9. uamaiʻe paʻa ʻana i ka maʻi (CRF). ʻIke ʻia ma hope o 20-25 mau makahiki o ke ola me ka maʻi maʻi.

ʻO ka 2 mau mua o ka maʻi nephropathy maʻi (renal hyperfiltration a me microalbuminuria) i hōʻike ʻia me ka waiho ʻole o nā hōʻailona waho, ka nui o ka urine. ʻO kēia ka palena preclinical o ka nephropathy maʻi.

I ka pae ʻana o proteinuria, ua ʻike mua ʻia nā hōʻailona o ka maʻi.

• ka puka ʻana (mai ka hā mua o ka maka a me nā wāwae i ka huki ʻana o nā ʻōpū o ke kino),
• nā makai ka nui o ke koko i mālama ʻia.
• ka hoemi nui ʻana o ka paona a me ke kuko,
• hauā, makewai,
• malaise, palupalu, luhi.

Ma nā hana hope o ke ala o ka maʻi, e hoʻomāhuahua ʻia nā hōʻailona ma luna, e hāheʻe ʻia nā koko i loko o ka urine, ke kahe ʻana o ke koko i loko o nā moku o ke akeʻa e piʻi i nā hoʻohālikelike o ka maʻi lolo.

He mea koʻikoʻi loa ia e hōʻike i kahi maʻi i ka wā mua o ka neʻe ʻana o ka hoʻomohala ʻana, aia wale nō ma o ka hele ʻana i nā hōʻike kūikawā e ʻike i ka nui o ka protein albumin i loko o ka urine.

He mea nui ia e ʻike! ʻO nā pilikia me nā haʻalulu gula ma mua o ka manawa hiki ke alakaʻi i kahi maʻi āpau āpau, e like me nā pilikia me ka hihiʻo, ka ʻili a me ka lauoho, nā ʻōpio, nā gangrene a me nā ʻeha maʻi maʻi ʻole! Ua aʻo ka poʻe i ka ʻike ʻawaʻawa e hana i nā pae holi holi ...

ʻO ka nephropathy Diabetic ka inoa maʻamau no ka hapanui o nā pilikia o ka maʻi maʻi. Hōʻike kēia ʻano i nā maʻi maʻi o nā mea kānana o nā kānana (glomeruli a me nā tubula), a me nā kīʻaha e hānai ana iā lākou.

Pilikia ke nephropathy diabetic no ka mea hiki iā ia ke alakaʻi i ka hana hope (hope) o ka hala ʻole o ka renal. I kēia hihia, pono ka mea maʻi e loaʻa i ka dialysis a i ʻole ke hoʻololi ʻana i ka palaka.

ʻO ke nephropathy Diabetic kekahi o nā kumu maʻamau o ka make a me ka pilikia ma nā maʻi. ʻO kahi maʻi maʻi kokoke loa i ka kumu wale nō o nā pilikia o ke keiki. Akā i waena o nā mea e dialysis a kū i ka laina no ka mea hāʻawi manawaleʻa no ka hoʻololi, ka maʻi nui loa. ʻO ke kumu hoʻokahi ke hoʻonui koʻikoʻi o ka loaʻa ʻana o ka maʻi diabetes type 2.

I ka poʻe maʻi me ka maʻi o ka lua o ka ʻano (non-insulin-dependance), nephropathy wale nō i nā 15-30% o nā hihia. ʻO Neftropathy, e ulu ku e pili ana i ke ʻano o ka maʻi mellitus maʻi mika, ua kapa ʻia ʻo Kimmelstil-Wilson syndrome, ma ka aniani me ke ʻano o ka glomerulosclerosis, a me ka huaʻōlelo "glomerulosclerosis" nona iho ka hoʻohana 'ia e like me ka' a me ka 'aelike' no ka "nephropathy"

Nā kumu o ke ʻano neʻe Diabetic

Hoʻopilikia ʻia ka nephropathy diabetic e nā loli pathological i nā moku ʻai a me ka glomeruli o nā loina capillary (glomeruli) e hana ai i kahi hana filtration. ʻOiai nā manaʻo like ʻole o ka pathogenesis o ka nephropathy diabetes i manaʻo ʻia i ka endocrinology, ʻo ke kumu nui a me ka hoʻomaka ʻana no ka hoʻomohala ʻana, ʻo ka hyperglycemia. Hoʻololi ka nephropathy diabetes ma muli o ka manawa lōʻihi o ka uku o ka hōʻemi ʻona o ka hoʻoliʻoliʻoli.

Wahi a ka metabola kumuhana o ka nephropathy maʻi, hele mau pinepine ka hyperglycemia i ka hoʻololi ʻana i nā kaʻina biochemical: ʻaʻole kaila o ka glycosylation o nā molekōna o ka molome glomeruli a me ka hoʻohaʻahaʻa i kā lākou hana hana, ka hoʻokuʻuʻana i ka home-electrolyte homeostasis, metabolism o nā momona momona, hoʻemi i ka hoʻoneʻe ʻana o ka oxygen acid, a me ka hoʻohaʻahaʻa ʻana i ka hana huakaʻi. ʻōpala o ka lolo, hoʻonui ʻia i ka manawa o ka vme.

ʻO ke kumuhana hemodynamic i ka hoʻomohala ʻana o ka nephropathy maʻi i ka hana nui i ka hypertension arterial a me ka pīʻalo ʻana i ke kahe loko o ka intrarenal: kahi ʻike ʻole i ka leo o ka lawe ʻana a me ka lawe ʻana i ka arterioles a me ka hoʻonui ʻana i ke koko o loko o ka glomeruli. E alakaʻi ka lōʻihi o ka maʻi hypertension i ka loli kūlohelohe o ka glomeruli: ka mua, ka hyperfiltration me ka wikiwiki o ka hoʻokumu ʻana i ka urine a me ka hoʻokuʻu ʻana i nā protein, a laila hoʻololi i ka ʻōnaehana glomerular a me ka hoʻopili (glomerulosclerosis) me ka hoʻopihapiha glomerular piha, kahi hoʻemi i kā lākou kānana loiloi a me ka hoʻomohala ʻana o nā hana renal.

Hoʻokumu ka manaʻo genetic i ka mua o ka mea maʻi me ka nephropathy maʻi genetically hoʻonā i nā mea predisposing mau mea i hōʻike ʻia, i loko o ka maʻi metabolic a me ka hemodynamic. I loko o nā pathogenesis o nephropathy maʻi, ua komo nā mea hoʻomehana ʻekolu o kēlā me kēia.

ʻO nā mea pilikia no ka nephropathy diabetes i ka hypertension arterial, hyperglycemia lohi ka lōʻihi, nā maʻi o ka urinary, metabolism momona momona a me ka momona nui, ke kāne male, ka uahiʻu, a me ka hoʻohana ʻana o nā lāʻau nephrotoxic.

Nā kumu o ka hoʻomohala ʻana o ka maʻi i ka lāʻau lapaʻau, i hui ʻia i ʻekolu mau pūʻulu: genetic, hemodynamic and metabolic.

ʻO ka hui mua o nā kumu he predisposition hoʻoilina. I ka manawa like, hoʻonui ka hopena i ka ulu ʻana o ka nephropathy me ka maʻi hypertension, hypertension, maʻi maʻi maʻi o ka urinary system, obesity, hōʻino no ka hewa maikaʻi, anemia a me ka hoʻohana ʻana i nā lāʻau lapaʻau e loaʻa ai ka hopena o ka urinary system.

ʻO ka hui ʻelua o nā kumu hemodynamic e komo me ka pīhoihoi pale o nā keiki. Me ka lawa ʻole o ka hoʻonaʻauao ʻana i nā kumukanawai o ka urinary system, he piʻi nui o ka nui o ka protein i ka urine, e hoʻopau ʻia ke hana o ke kino. A laila aia he overgrowth o kahi i hoʻopili ai o nā keiki - ulu ka sclerosis kiko.

ʻO ke kolu o nā kumu ke hala ʻole i nā kaʻina metabolic i loko o ke kino, ka mea e piʻi ai ka nui o ke kō o ke koko, kahi e kūʻai ai ka protein a me ka hemoglobin. Hoʻopilikia ʻia ke kaʻina hana o kaʻili glucose.

Ma kēia mau kaʻina e alakaʻi i nā loli hoʻololi i loko o ka pūpū, ka piʻi ʻana o ke ʻano o nā kiko vascular, ka puka i loko o ka lumen o nā moku, hoʻomohala ka ʻōpū. I ka hopena, ke hoʻoneʻe nei ke kaʻina hana a hana i waho o ka urine, hōʻemi ke koena o ke koena i ke koko.

ʻO ka glucose plasma kiʻekiʻe ke kumu nui o ka hoʻomohala ʻana o ka maʻi nephropathy maʻi. Nā wai hoʻohālikelike o ka waiwai ma ka paia vascular e hoʻokau i kekahi o nā loli pathological:

• ʻO ka edema kūloko a me ka hana hou ʻana i nā kahe koko e kū ana mai ka hoʻokumu ʻana o nā huahana metabolism glucose i loko o kaʻeha, e hōʻuluʻulu ʻia i loko o nā papa o loko o nā kīʻaha koko.
• ʻO kahi hypomular hypertension e ulu mau ka neʻe o ka neʻe i ka nephrons.
• ʻO nā mea hoʻohālikelike o nā hana o nā podocytes, kahi e hāʻawi ai i nā kaʻina filtration i loko o nā kino o ka renal.
• Hoʻokumu ʻia ka ʻōnaehana renin-angiotensin, i hoʻolālā ʻia e pale aku ai i ka piʻi o ke koko.
• ʻO ka neuropathy Diabetic - ua hoʻohuli ʻia nā moku i hoʻopuni ʻia o ka peripheral nerve system, no laila ua hoʻohuli ʻia ka hana renal.

He mea nui ia no nā maʻi me ka maʻi maʻi e kiaʻi mau i ko lākou olakino. Aia kekahi mau hanana kūpono e alakaʻi i ke ʻano o ka nephropathy:

• pono ʻole i ka pae glycemic level,
• i ka ulaula (ka nui o ka pilikia i ka wā e hoʻopau ai ma mua o 30 mau sikalena / lā),
• ka ulu mua ʻana o ka maʻi diabetes-type type,
• ka hoʻonui paʻa ʻana i ke koko,
• ka hiki ʻana o nā mea hoʻohui i ka mōʻaukala ʻohana,
• hipololeka,
• anemia

ʻO nephropathy Diabetic: pae kōpana, nā hōʻailona, ​​ka maʻi, ka mālama ʻana

- hana pu me PU me ka hana o ke ʻāʻiwa e mālama i nā hana o nā keiki,

Hōʻike ʻia ka hōʻike UIA ma ka uʻi albumin urin mai 30 a 300 mg / lā (a i ʻole ka hoʻonohonoho ʻana i albumin i loko o ke kinipōpō kakahiaka mai 20 a 200 mg / ml). Ma kēia hihia, e noho mau ana ka helu filtration glomerular (GFR) i loko o nā palena maʻamau, ka maʻamau o ka hoʻopōkole o ka nitrogencrcrory o nā puʻuwai, he maʻamau ka pae o ke ʻano o ke koko i ka maʻi maʻamau o ka maʻi 1 a hiki ke hoʻonui ʻia i ka diabetes type 2. Inā hoʻomaka ka mālama ʻana i ka manawa, hiki i kēia ʻano hana hōʻeha pili hou aʻe.

Hōʻike ka ʻano o ke ʻano Stage PU i ka excretion o ka albumin me ka urine ma mua o 300 mg / lā a i ʻole ka protein iʻoi aku ma mua o 0,5 g / lā. Ma ka manawa like, kahi hoʻomaha paʻa i ka GFR e hoʻomaka i ka awelika o 10-12 ml / min / makahiki, a me ka ulu mau o ka hypertension hoʻomau. Ma 30% o nā mea maʻi he maʻi nephrotic maʻamau me PU ma mua o 3.5 g / lā, hypoalbuminemia, hypercholesterolemia, hypertension, edema o nā haʻahaʻa haʻahaʻa.

I ka manawa like, noho mau ka serum creatinine a me urea i loko o nā waiwai maʻamau. Hiki i ka mālama ʻana i kēia hana o DN ke pale i ka hōʻemi nui o ka hōʻemi ʻana i ka GFR no ka manawa lōʻihi, ke hoʻoluhi nei i ka hoʻomaka ʻana o kahi pilikia hoka.

Hōʻike ʻia ke ʻano o ka hana ʻole o ka pilikia hamal i ka hōʻemi o ka GFR ma lalo o 89 ml / min / 1.73 m2 (ka helu ʻana i nā mahele o ke ala o ka renal pathology K / DOQI). I ka manawa like, mālama ʻia ka proteinuria, ke piʻi aʻe o ka pae o ka serum a me nā urea.

Ke hoʻonui nei ka paʻakikī o ka hypertension. Me ka hoʻohaʻahaʻa ʻana i GFR e emi iho ma mua o 15 ml / min / 1.73 m2, ulu nā ESRD i kū ʻole i ke ola a koi aku i ka hoʻololi hou ʻana i nā maʻi (hemodialysis, peritoneal dialysis, a i ʻole hoʻololi ʻia).

Inā ʻaʻole i hoʻokaʻawale ʻia, hoʻomau mau ka nephropathy. He mau kaupalena ka maʻi diabetes glomerulosclerosis:

Nā hōʻailona o kaʻeha

ʻO nā hōʻike olakino e pili ana i ka nephropathy diabetes a me ka hoʻokaʻawale ʻana i nā mahele e hōʻike ana i ka holomua o ka luku o ka pūpū a me ka emi ʻana o kā lākou hiki ke hoʻokaʻawale i nā mea oona mai ke koko.

Hōʻike ka hana mua i ka hoʻonui ʻia o ka hana hana - ka piʻi ʻana o ka helu o ka filtration urine ma o 20-40% a hoʻonui i ke kahe koko i nā keiki. ʻAʻohe mau hōʻailona lapaʻau i kēia manawa o ka maʻi nephropathy maʻi, a ua hoʻololi ʻia nā loli i loko o nā puʻuwai me ka normalization o ka glycemia kokoke i kahi maʻamau.

I ka lua o ka hana, hoʻomaka ka hoʻololi ʻana i nā hoʻololi i ke aʻalāʻau: nā mālamalama hoʻohuihui glomerular e kū ai a lilo i nā molekōmole liʻiliʻi. ʻAʻohe ʻano hōʻailona o ka maʻi, maʻamau ka hoʻāʻo o ka urine, ʻaʻole e loli ke ʻano o ke koko.

Hōʻike ka nephropathy diabetic o ke ʻano o ka microalbuminuria e ka hoʻokuʻu ʻana o nā albumin i loko o kēlā me kēia lā o 30 a 300 300 mg. Ma ke ʻano maʻi diabetes 1, he mau makahiki 3-5 ma hope o ka hoʻomaka ʻana o ka maʻi, a ʻo ka nephritis i nā maʻi diabetes type 2 hiki ke hele pū me nā hiʻohiʻona o ka protein i ka pāʻai mai ka hoʻomaka ʻana.

ʻO ka hoʻonui pinepine ʻia o ka glomeruli o nā keiki no ka protein ka mea e pili pū me ia mau ʻano:

• Ka ʻemi hoʻemi i ka maʻi diabetes.
• Ke koko kiʻekiʻe.
• He kolamu koko nui.
• Nā Mikro a me nā macroangiopathies.

Inā i kēia manawa, ke hoʻomau nei ka mālama mau ʻana i ka hōʻailona o ka glycemia a me ke kahe o ke koko, a laila hiki ke hoʻihoʻi hou ʻia ka kūlana o ka renody hemodynamics a me ka viva permeability.

Loaʻa ia i nā mea maʻi me ka maʻi maʻi ma hope o nā makahiki 15 o ka maʻi. Hoʻomau ka kānana glomerular i kēlā me kēia mahina, e alakaʻi ana i kahi hōʻaia o ka renal terminal ma hope o 5-7 makahiki.

Hoʻomaopopo ka hōʻailona o ka nephropathy maʻi i kēia manawa i ke koko kiʻekiʻe a me nā hōʻino vascular.

Hōʻike ka hoʻonaninani o ke nephrotic syndrome i ka hōʻemi o ka protein koko a me ke kolamu nui, nā lipoproteins haʻahaʻa haʻahaʻa.

ʻO ka Edema ma ka nephropathy maʻi i kū i ka diuretics.Hōʻike mua lākou i ka maka a me ka wāwae haʻahaʻa, a laila e hoʻopalaha i ka ʻōpū o ka ʻōpū a me ka ʻōpū, a me nā pā pericardial. Ke holomua nei nā mea maʻi i ka nāwaliwali, nausea, pōkole o ka hanu, komo pū ka naʻau

Ma ke kānāwai, nephropathy diabetic e hui pū me ka retinopathy, polyneuropathy a me ka maʻi puʻuwai coronary. Hiki i ke neuropathy Autonomic i kahi ʻano hōʻeha ʻole o ka infococote myocardial, atony o ka wahi pākahi, orthostatic hypotension a me ka erectile dysfunction. ʻIke ʻia kēia hana i ka hoʻoneʻe ʻole ʻana, ʻoiai ua luku ʻia ma mua o 50% o ka glomeruli.

ʻO ka papahele ʻana o ka nephropathy maʻi maʻi hoʻokaʻawale i ka pae hope loa e like me ka maʻi maʻi. Hōʻike ka hopena o ka renal maʻi i kahi hoʻonui i ke koko o nā pūnao nitrousous - ka mea hana a me ka urea, kahi hōʻemi i ka pāhare pākuʻi a me ka hoʻonui ʻana i nā fosilato serum, kahi hoʻemi i ka huina filtration glomerular.

ʻO kēia mau hōʻailonaʻamau i hōʻike ʻia i ka nephropathy diabetic i kahi o ka hikiʻole o ka renal:

1. Ke holomua me ka haehae o ka ha.
2. ʻO ka maʻi edematous koʻikoʻi.
3. Kahiki iki o ka hanu, tachycardia.
4. ʻO nā hōʻailona o ka edema pulmonary.
5. E hoʻomau i ka anemia maʻi nui.
6. Osteoporosis

1. hyperfiltration o nā keiki. Hōʻike ia iā ia iho i ka wikiwiki o ke kahe o ke koko ma ka glomeruli o ka renal, e hoʻonui ana i ka nui o ka urine a me nā mea make pono. ʻAi ʻia a hala 5 mau makahiki
2. microalbuminuria - kahi liʻiliʻi i hoʻonui ʻia i ka pae o nā protein albumin i loko o ka urine (mai 30 a 300 mg / lā). ʻO ka maʻi maʻamau a me ka mālama ʻana i kēia manawa e hiki ke hoʻonui iā ia i 10 mau makahiki,
3. macroalbuminuria (UIA) a i ka proteinuria. ʻO kēia kahiemi hōʻemi i ka wikiwiki o ka filtration, he kuʻi pinepine i ka kahe koko. Hiki i ka nui o nā protein albumin i loko o ka lānai ma waena o 200 a oi aku ma mua o 2000 mg / bitch. ʻO ka nephropathy diabetic o ke ʻano UIA e kū mai ana ma ka makahiki 10-15 i ke hoʻomaka ʻana o ka maʻi diabetes,
4. nephropathy haʻi. Hōʻano ʻia e ke aniani o ka filtration rate glomerular haʻahaʻa (GFR) a me ka hoʻolalelale ʻana o nā moku ʻōhua i nā loli sclerotic. Hiki ke mālama ʻia i kēia manawa ma hope o nā makahiki he 15 ma hope o ka hoʻololi o ka pūpū.
5. uamaiʻe paʻa ʻana i ka maʻi (CRF). ʻIke ʻia ma hope o 20-25 mau makahiki o ke ola me ka maʻi maʻi.

Puhi a me ka pale ʻana i ka nephropathy maʻi

Pono e hoʻomaka koke ke mālama ʻana no ka maʻi nephropathy maʻi ma hope o ka loaʻa ʻana o ka maʻi maʻi. ʻO nā ʻōkuhi no ka pale ʻana o ka nephropathy i ka maʻi diabetes me ka mālama ʻana i ke kō o ke koko a me ka pae o ka kolamu, e mālama ana i ke kaʻe o ke koko, e hahai ana i kahi papaʻai, a me nā ʻōlelo a ke kauka hou. Pono ka papa ʻaina haʻahaʻa haʻahaʻa e kuhikuhi ʻia e ka endocrinologist a me nephrologist.

ʻO ka nephropathy Diabetic kahi maʻi e hoʻomohala ma ke ʻano o ka hoʻopiʻi ʻana o kahi maʻi ma muli o ka maʻi maʻi. Aia he 5 mau papa i kona hoʻomohala ʻia. Wahi a ke kahua o ka papa, ua kuhikuhi ʻia ka mālama kūpono ʻana, kahi e hoʻoneʻe ai i ka hoʻopau ʻana i nā hōʻailona o ka maʻi maʻi a me ka nephropathy.

ʻO nā 3 mau wahi mua o ka maʻi maʻi nephropathy wale nō ka mea e hoʻomaikaʻi ʻia me ka mālama ʻana i ka manawa kūpono. Me ka hoʻomohala o ka proteinuria, hiki i ka mea ke pale wale nō i ka holomua o ka hiki ʻole o ka maikaʻi ʻole o ke kaulike.

• e kiaʻi mau i ka pae o ka glucose i loko o ke koko,
• pale i ka hoʻomohala ʻana o ka atherosclerosis,
• hahai i nā meaʻai i kauoha ʻia e ke kauka
• lawe i nā ʻōhua e hoʻonaninani i ke koko.

ʻO Microalbuminuria me ka kūpono kūpono o ka hana kūpono wale nō ke ʻano o ka maʻi hou o ka nephropathy maʻi. Ma ka hoʻomaka ʻana o ka proteinuria, hiki i ka hiki ke pale i ka hoʻomohala ʻana o ka maʻi i ka hiki ʻole o ka renal hina ʻole, ʻoiai e hōʻea ana i ke kahua o ka maʻi nephropathy maʻi i ke ala i kūlike ʻole i ke ola.

I kēia manawa, kūkulu ka nephropathy diabetes a me ka CRF ma muli o ia ke hōʻike ʻana i ke kumu no ka hoʻololi ʻana i nā maʻi maʻi - hemodialysis a i ʻole hoʻololi o ka maʻi maʻi.Ma muli o CRF ma muli o ka nephropathy maʻi maʻi 15% o nā make āpau ma waena o nā mea maʻi me ka maʻi type 1 i lalo o 50 mau makahiki o kona ola.

ʻO ka mālama ʻana i ka nephropathy maʻi pāloko me ka nānā ʻana o ka ʻōnaehana ʻōnaehana me ka maʻi mellitus e kahi endocrinologist-diabetesologist, hoʻoponopono kūpono i ka maʻi, ka mālama pono ʻana o nā pae glycemia, pili i nā ʻōlelo a ke kauka.

Ke hoʻoponopono ola

ʻOiai e pili ana i ke ʻano o ka nephropathy, ua ʻōlelo ʻia nā loli ola. ʻOiai ua hōʻoia ʻia ua kōkua kēia mau lula i ka hoʻokuʻu ʻana i ka hoʻomaka ʻana o ka pilikia o ka pilikia a ʻaʻole pono i nā kumukūʻai kālā, ʻoiai, ua hoʻokō ʻia lākou e ka 30% o nā mea maʻi i lawa, e pili ana i 15% ka ʻāpana, a ʻo ke koena ke hōʻole iā lākou. Nā ʻōlelo lapaʻau e pili ana i ka nephropathy:

• hōʻemi i ka nui o ka lawe waiwai i ka nui o nā karamona i 300 g i kēlā me kēia lā, a me ka momona a me ka uku ʻilihune a hiki i ka 200 g,
• hoopau i ka momona, keʻa a me ka lada i ka meaʻai, e hoʻemi i ka ʻai ʻana i nā meaʻai ʻai,
• hele aku i ka ulaula a me ka inu rama,
• loaʻa ka normalization o ke kaumaha o ke kino, ʻo ka ʻōpū i ka wahine ʻaʻole eʻoi aku ma kahi o 87 cm, a i nā kāne 100 cm,
• ma lalo o ka pēpē maʻamau o ka sodium klorida ʻaʻole pono eʻoi aku ma mua o 5 g, a me ke ʻano hypertension 3 g,
• ma kahi hoʻomaka, hoʻohālikelike i ka protein i ka meaʻai i ka 0.8 g / kg ke kino kino i kēlā me kēia lā, a inā he pilikia ʻole, ̶ i 0.6 g,
• e hoʻomaikaʻi i ka kahe o ke koko, pono ʻoe mai ka hapalua hola o ka hana pilikino i kēlā me kēia lā.

E nānā i ke wikiō ma nephropathy diabetic:

Hoʻomaka

Ke hoʻohana nei i ka insulin e like me ka hypoglycemic wale nō a hui pū paha me nā papa (no ke ʻano type 2), pono ʻoe e hoʻokō i nā huaʻōlelo aʻe:

• glucose (i mmol / l) a hiki i ka 6.5 ma luna o ka ʻōpū ʻole a ma hope o ka ʻai ʻana a hiki i 10.
• hemoglobin glycated - a i ka 6.5-7%.

Ke hoʻohaʻahaʻa nei i ke koko i 130/80 mm RT. ʻAniā. ʻo ka lua o ka hana nui ma ka pale ʻana i ke nephropathy, a me kona hoʻomohala ʻana i hiki mai i ka mua. Hāʻawi ʻia i ka hoʻomau ʻia o ka hypertension, ua kuhikuhi ʻia ka mea maʻi i ka mālama ʻana me nā lāʻau lapaʻau o kēia mau pūʻulu.

• ʻO nā mea hoʻopaʻa o ACE (Lisinopril, Kapoten),
• antionaatori receptor naiotensin ("Lozap", "Candesar"),
• nā pākale kalapona (Isoptin, Diacordin),
• diuretics in renal failed ("Lasix", "Trifas").

Hoʻokele ka ACE inhibitors a me angiotensin receptor antagonist e hoʻopale i nā ʻeha a me nā kīʻaha koko mai ka luku ʻana a hiki ke hōʻemi i ka nalowale i ka protein. No laila, ʻae ʻia lākou e hoʻohana ʻia e kū'ē i ke ʻano o ke kaumaha maʻamau. Hoʻopilikia ke anemia i ke kūlana o nā maʻi, ko lākou hoʻomanawanui i nā kaʻina hemodialysis. No ka hoʻoponopono ʻana, ua kuhikuhi ʻia nā erythropoietin a me nā paʻakai hao.

Pono ka poʻe maʻi āpau me ka maʻi maʻi e hoʻokō i ka hōʻemi o ka kolesterol i ka pae maʻamau ma ka hōʻole ʻana i ka momona momona a hoʻopaʻa ʻia nā momona holoholona. I kahi hihia o kaʻai haʻahaʻa, pono ʻia ʻo Zokor a me Atokor.

Nā keiki helehelena a me kāna mau hiʻohiʻona

E like me ka ʻike i loko o nā pīkoi organ, he hiki ke hoʻonui nui i ka hoʻomanawanui ma hope o ka hoʻololi. ʻO ke kūlana nui loa no ka hana ʻo ia ka ʻimi ʻana i kahi hāʻawi e kūpono i ka mea maʻi e ka pae ʻana o nā huaka.

Ma hope o ka hiki ʻana i ka hoʻololi kūleʻa, pono e loaʻa nā maʻi homaʻi i nā lāʻau lapaʻau e kaohi i ka pane ʻana o ke kino i loaʻa ai ke aʻa. Ke hoʻoneʻe ʻia kahi huelo mai kahi mea ola (maʻa mau mea he ʻohana, lawe ʻia kekahi keiki mai iā ia aku, a inā he mea lawelawe ka mea i make, a laila hoʻohālikelike ʻia ka pancreas.

Nā keiki helehelena

Hoʻomaopopo no nā maʻi

ʻO ke kahua hope loa, kahi i mālama ʻia ai ka hana ʻoi aku ka hiki, ke microalbuminuria. Me ka proteinuria, ua hoʻokō ʻia nā hopena ʻokoʻa, a me ka hoʻomaka ʻana o ka hiki ʻole o ka pilikia kōpiko, pono e hoʻomanaʻo ʻia i kona pae hope ʻole i ka ola. E kūʻē i ke kua mua o nā hui hoʻololi hemodialysis, a ma hope aʻe o ka hoʻololi ʻana i kahi palaka, hoʻomaikaʻi iki ka prognosis.Hiki i ka ʻenehana hana i hiki iā ʻoe ke hoʻonui i ke ola o ka mea maʻi, akā makemake ʻo ia i ka mālama mau ʻana e ka nephrologist, endocrinologist.

A eia aʻe kahi e pili ana i ka pale ʻana o nā hoʻopiʻi o ka maʻi diabetes.

Hoʻolilo ka nephropathy diabetic e like me ke koi ʻana o vascular a maʻi maʻi. Mālama ia i ke kō koko nui, a me ka hypertension arterial, ʻoi aku ka nui o nā lipids i loko o ke koko, a me nā maʻi ʻōnaehana concomitant e kōkua i ka holomua. I ka hoʻomaka ʻana o ka microalbuminuria, hiki ke loaʻa ke kala paʻa, ma ka wā e hiki mai ana, piʻi ka nui o ka palaka, a me nā hana ʻole o ka renal.

No ka mālamaʻana, hoʻohana ʻia nā lāʻau lapaʻau e pili ana i ke ʻano o ke hoʻoponopono ʻana i ke ʻano o ke ʻano, me ka pilikia ʻole o ka pale ʻana i ka maʻi, dialysis a me kahi hoʻololi ʻana.

ʻO ka lawe ʻana i kahi hoʻāʻo urine no ka maʻi maʻi i mālama ʻia i kēlā me kēia ʻeono mahina. He mea maʻamau ia no ka microalbuminuria. ʻO nā hōʻailona i kahi keiki, me ke ʻano type type 1 a me ke ʻano 2, e kōkua i ka hoʻokumu ʻana i nā maʻi hou.

Hoʻonui pinepine ʻia ka retinopathy diabetes i nā maʻi maʻi pinepine. Aia ke kumu i hōʻike ʻia nei ka ʻano mai ka helu ʻana - proliferative a i ʻole nā ​​proliferative - hilinaʻi ʻia ka mālama ʻana. ʻO ke kumu ke kumu gula kiʻekiʻe, ke ʻano maikaʻi. Hōʻikeʻike nui nā hōʻailona male i nā keiki. E kōkua ka pale ʻana i ka hōʻalo ʻana i nā hoʻopiʻi ʻana.

ʻO nā maʻi hoʻopiʻi maʻi maʻi i pale ʻole i kēlā me kona ʻano. He mea nui ia i nā keiki i ka wā hāpai. Aia nā pae mua a me ke koʻikoʻi, nā hopena a me ka hopena o ka hoʻopiʻi ma ka maʻi type a me ka type 2.

Aia nā maʻi neuropathy maʻi o nā haʻahaʻa haʻahaʻa ma muli o nā hoʻolōʻihi lōʻihi i ke kōhi koko. ʻO nā hōʻailona nui e pili ana, ʻāʻī o nā wāwae, ʻeha. Hoʻokomo ʻia ka hoʻomaʻamaʻa ʻana i nā ʻano lāʻau like ʻole. Hiki iā ʻoe ke hoʻohālikelike, a i ʻōlelo ʻia aku ai nā hale hana ʻoihana a me nā ʻano ʻē aʻe.

ʻO kahi mea ʻai no ka diabetes type 2 e pono e pale i ka holomua o ka maʻi a me nā hopena. ʻO ka mālamaʻai no nā poʻe ʻelemakule a me nā ʻōpio kekahi papa kuhikuhi lāʻau kūikawā. Inā maʻi me ka maʻi maʻi o ka maʻi hypertension, a laila loaʻa nā manaʻo hou.

Charles, Type type diabetes 2, ke ʻano maʻi nephropathy maʻi maʻi

Ke kūlana male: male

Kahi hanau: Jaffna Lka

ʻO ka mea maʻi, ʻo Charles, i loaʻa i ka polydipsia, gluttony, polyuria no 22 mau makahiki a me ka proteinuria no 10 mau makahiki. Ma ʻAukake 20, 2013, ua hele mai ʻo ia i ka haukapila no ka mālama ʻana.

Kūʻai ma mua o ka mālama ʻana. ʻO ke koko koko 150 80mmHg. Mālama ka puʻuwai 70, akahai fossa edema i nā pae haʻahaʻa haʻahaʻa.

Ka hoʻāʻo ʻana ma kā mākou haukapila: Hemoglobin 82 g L, erythrocytes 2.80 × 1012 L, serum creatinine 513umol L, ka wai urea nitrogen 25.4mmol L. Uric waiholo 732umol L, wikiwiki i ka ʻai 6.9mmol L, ka hemoglobins glycosylated 4.56%.

Diagnosis: Type 2 diabetes mellitus, stage 5 nephropathy maʻi maʻi, anemia renal, hypertension renal, hyperuricemia, retinopathy maʻi kanesa, maʻi neuropathy peripheral.

Hoʻolahalaha ʻia i kā mākou keʻena. hoʻokaʻawale i nā ʻauhau mai ke kino ma o ka maʻi, e like me ka hoʻoulu ʻana i ka lāʻau lapaʻau, lawe i ka lāʻau lapaʻau Kina i loko, he enema, etc. Ua hoʻohana kekahi mau loea i kekahi mau lāʻau lapaʻau e mālama ai i ke kō koko, hoʻohaʻahaʻa i ke koko koko a hoʻomaikaʻi i ka nalo a pale i ka pale ʻana a me ka hoʻonā ʻana.

ʻO ke kūlana ma hope o ka mālama ʻana. Ma hope o 33 mau lā o ka mālama ʻana i nā ʻōnaehana, ua kāohi pono kona ʻano. A ʻo ke kahe koko 120 80mmHg, ka nui o ka puʻuwai 76, ʻaʻohe kūleʻe i nā ʻāpana haʻahaʻa haʻahaʻa, hemoglobin 110 g L, protein i loko o ka urine +, 114umol uric acid L. I ka manawa like, aʻo ko mākou nephrologist i mākaukau iā ia e hoʻolohe i ka hoʻomaha ʻana, e hana i ka hana maʻalahi, pale i ka hoʻokaumaha ikaika, pale i nā anu, nā maʻi, mālama i ka ʻai haʻahaʻa ma ka paʻakai, haʻahaʻa ka momona, kiʻekiʻe ka protein, haʻahaʻa ka maʻemaʻe, ʻohi i nā meaʻai kīkaha, ʻai i nā huaʻai a me nā mea kanu,

E ka maʻi ahonui! Hiki iā ʻoe ke nīnau i nā nīnau ma ka pūnaewele. E ho'āʻo mākou e hāʻawi iā ʻoe i kahi pane i loko o ka manawa pōkole.

ʻO ka nephropathy Diabetic kahi palalā o ka aʻalopona e hoʻopili nei i ke kaʻina o ka maʻi maʻi. ʻOi aku ka maʻamau o ka maʻi maʻamau 1, ʻo ka hoʻomaka ʻana o ka maʻi i ka wā'ōpiopio ka mea e hoʻoholo ai i ka nui o ka hiki ʻana o ka ulu wikiwiki ʻana o nā hoʻopiʻi. Hoʻopilikia ka lōʻihi o ka maʻi i ka pae o ka hōʻino ʻana i ka aʻalā.

ʻO ka hoʻomohala ʻana o ka hiki ʻole o ka hana renal i hoʻololi pinepine ʻia i nā hōʻike o ka maʻi maʻi. E hōʻeha ai i kahi koi koʻikoʻi i ke kūlana o ka mea maʻi, hiki i ke kumu kumu o ka make.

ʻO ka mālama mau ʻana, ka mālama wā kūpono ʻana, a me ka nānā ʻana o kona mālamalama e hoʻolōʻihi i ka holomua o kēia kaʻina hana.

Nā hana hana o ka hoʻomaka a me ka hoʻomohala

ʻO ka pathogenesis o nephropathy ma muli o ka hōʻino ʻana i nā lāʻau liʻiliʻi o nā keiki. Aia kekahi i ka hoʻonui i ka epithelium e uhi ana i nā moku mai loko o ka pūloli (endothelium), ka huhū o ka membrane o vom glomeruli (membrane membrane). Ke kū nei ka hoʻonui ʻia o nā capillaries (microaneurysms). Hoʻopiha ʻia nā wahi intercapillary i nā molekela o nā protein a me nā puna (glycoproteins), ulu ka ulu ʻana. ʻO kēia mau hiʻohiʻona e alakaʻi i ka hoʻokumuʻana o ka glomerulosclerosis.

I ka nui o nā hihia, ulu kahi ʻano hoʻopukapuka. Hoʻohālikelike ʻia ia me kahi mānoanoa ʻē aʻe o ka membement basement. Ke holomua nei ka pathology no ka manawa lōʻihi, hiki ʻole i ka alakaʻi i ke kūkulu ʻana i kahi pilikia ʻole ʻole i hōʻike ʻia e nā maʻi. ʻO kahi ʻano ʻokoʻa o kēia kaʻina hana ʻo ia ka hoʻomohala ʻana, ʻaʻole ma ka maʻi mellitus wale nō, akā i nā maʻi ʻē aʻe, kahi i hōʻike ʻia e ka pōʻino o nā moku ʻoi (hypertension).

He ʻano maʻamau ka ʻano o ka nodular, ʻoi aku ka maikaʻi o ka maʻi mellitus type 1, ʻike ʻia a me kahi manawa pōkole loa o ka maʻi, a holomua wikiwiki. Hoʻokaʻawale ʻia nā palena (i ke ʻano o nā nodules) nā pāpale o nā capillaries, a laila ka emi ʻana o ka lumen moku, a me ka kūkulu hou ʻana o ke ʻano o ka aneurysms. Hōʻalo kēia i nā kahe koko ʻole neʻe.

Ka International Classification of Disease Revision 10 he ʻokoʻa ka ICD 10 mau code no ka hoʻopalike ʻana i nā loli, intravascular sclerosis o ka pūpū, a no ka ʻano nodular i kapa ʻia ʻo Kimmelstil-Wilson syndrome. Eia naʻe, pili ka home nephrology kūloko ma lalo o kēia maʻi e pili ana i nā pōʻino āpau o ka maʻi diabetes.

Me ka maʻi maʻamau, ua pākia nā hana a pau o ka glomeruli, e hele mālie nei i kahi halaʻole i ka hana nui o nā keiki - ka urine filtration

Hoʻololi pū ka ʻāpana nephropathy i ka maʻi ʻaʻai e ka pōʻino o nā moku arterial medium-e lawe ana i ke koko i ka glomeruli, ka hoʻomohala ʻana o nā kaʻina sclerotic ma nā wahi i waena o nā moku. ʻO nā papa renal, e like me glomeruli, nalowale ke kūlohelohe. Ma keʻano holoʻokoʻa, hoʻomohala ʻia ka kānana o ka filtration o ke kaila koko a ka puka o waho o ka urine i loko o ka ulu ʻana o ka pēpē.

Nā papa hana o ka hoʻolālā ʻana i ke kaʻina pili

Kūkulu ʻia ka papa nephropathy i ka maʻi diabetes i ka holomua ʻōpiopio a me ka nāhū ʻana o ka hana renal, hōʻike kino kulana, a me ka loli o nā ʻāpana laboratorium.

ʻO nā ʻano maʻi o ka nephropathy diabetes:

I ka papa mua, loaʻa ka nui o ke kahe o ke koko, ka filtration urine i nā nephrons renal e kū'ē i kahi o ke ala o ka hoʻonui i ka nui glomerular. I kēia hihia, ʻo ka excretion o nā mea momona o ka molika haʻahaʻa haʻahaʻa (ʻo ka mea nui ka albumin) me ka urine i loko o kēlā me kēia lā (ʻaʻole iʻoi aku ma mua o 30 mg).

Ma ka ʻāpana ʻelua, ua hoʻohui ʻia ka mānoanoa o ka membrane basement, proliferation o ka hoʻopili pili ma nā wahi i waena o nā moku o nā calibers ʻē aʻe. Hiki i ka mea o ka albumin i ka urine ke hoʻonui i ka pākau me ke kiʻekiʻe o ka glucose koko, ka hoʻēmi ʻana o ka maʻi mellitus a me ka hana kino.

I ke kolu o ke kolu, aia nō ka hoʻonui mau o ka hoʻokuʻu i kēlā me kēia lā i ka albumin (a hiki i 300 mg).

I ka ʻehā o nā lā, ʻike mua ʻia nā hōʻailona o ka maʻi o ka maʻi. Hoʻomaka ka pae o ka filtration o ka urine i ka glomeruli i ka emi, ua hoʻoholo ka proteinuria, ʻo ia hoʻi, ʻo ka hoʻokuʻu ʻana i ka protein ma mua o 500 mg i ka lā.

ʻO ka hapalima ka pae hope loa, ʻo ka palena o ka filtration glomerular e emi loa i lalo (e emi ana ma mua o 10 ml i 1 mau minuke), pālahalaha a ʻokoʻa ka nodular sclerosis.

Hoʻonui pinepine ʻo Renal i kahi kumu kumu o ka make ma nā mea maʻi me ka maʻi maʻi

Nā hiʻohiʻona o nā hōʻike pilikino

Hōʻike wale ʻia nā papa mua o ka hoʻomohala ʻana i ka nephropathy i nā loli wale nō i nā hana hoʻohalike a ʻaʻohe mau hōʻailona maoli, ʻo ia hoʻi, he mau preclinical mau. I nā papa mua ʻelua, ʻaʻohe mau hoʻopiʻi ʻana i ʻike ʻia. I ke kolu o ka hana hou, i ka wā o ka hoʻokolokolo ʻana o ka mea maʻi, he piʻi pinepine ʻia i ke koko.

ʻO ka hā ʻehā ʻo kahi kikoʻī kikoʻī kikoʻī.

I ka hapanui i ʻike pinepine ʻia:

Me kēia ʻano o ka hypertension arterial, hiki i nā mea maʻi keʻike i kahi hoʻonui o ke kaomi. Ma ke ʻano he kānāwai, e kū i ke ʻano o nā helu he nui (a hiki i 180-200 / 110-120 mm Hg), hōʻeha, pilikia, ʻike ʻole ka nāwaliwali.

ʻO ke ala kūpono e hoʻoholo ai i ke ʻano o ka hypertension arterial, ka pae o ka piʻi ʻana o ke kaohi o ke ʻano o ka lā ma ke ʻano he ana me ka nānā ʻana a nānā ʻole ʻia.

I ka manawa hope loa, ʻoi aku ka maʻi o ka maʻi maʻi, ʻaʻole e loli wale nō ke kiʻi ʻana o nā maʻi o ke kino, akā i ka wā o ka maʻi mellitus. Hōʻike ʻia ka palaualelo ma o ka nāwaliwali o ka nāwaliwali, ke kīlohelohe i ʻole, ke ʻano hoʻonaninani, hiki i ka ʻili keokeo. ʻAʻole wale ka hopena o nā luhi, akā, ʻo nā mea hanu a me nā mea ola kino.

ʻO ka hoʻonui ʻana i ka hoʻoulu ʻia o ke koko, haʻi ʻia ʻo edema, mau. Pono ka emi ʻana o ka insulin, hāʻule ke kō o ke koko a me nā pae iʻa. ʻAʻole kēia mau ʻōuli e hōʻike i kahi holomua i ke kūlana o ka mea maʻi, akā e ʻōlelo i ka mau hōʻino wale ʻana o ka iwi renal, kahi hoʻomaikaʻi koʻikoʻi.

Inā hoʻomaka ka mea maʻi me ka maʻi diabetes e hoʻonui i ke koina arterial, pono ia e nānā i ka hana o ka kidney

Nā Hoʻolauna Kūʻē Uila

ʻO ka hoʻomohala ʻana o ka pōʻino o ka pūpū i nā maʻi me ka maʻi mellitus e lawe ʻia e nā endocrinologist me ka hoʻohana ʻana i nā mea lapaʻau, ka ʻoihana, nā hana hana. Hoʻoholo ʻia ka hana poʻomanaʻo o ka hoʻopiʻi a ka mea maʻi, ʻike ʻia nā hōʻike hou o ka maʻi, ʻike ʻia ke ʻano o ka mea maʻi. Ua hōʻoia ʻia ka maʻi maʻi e nā ʻenehana loea. Inā pono, ua kūkākūkā ka nephrologist.

Nā ʻōnaehana diagnostic pilikino:

ʻO Biopsy kahi hana hou. Hāʻawi ʻoe iā ʻoe e loaʻa i ke ʻano o nā pōʻino o ka pūpū, ka pae o ka proliferation o ke kiko konohiki, e loli i ka moe vascular.

Hoʻomaopopo ka loiloi ultrasound i nā manawa a pau o ka hōʻeha o ka lolo ma ka maʻi mellitus, e hoʻoholo ana i ka pae o ka hōʻino a me ka hoʻonui ʻana o nā loli pathological

ʻAʻole hiki ke hoʻomaopopo i ka pathology renal i ka hoʻomaka mua ʻana o nā hoʻopiʻi ʻana e nā ʻenehana halepine, ʻo ka maʻamau o ka pae o ka urine albumin. Ma ka lua - me ke hoʻonui ʻana o ka hanu ma luna o kahi akea (hoʻoikaika kino, ke ʻano, kaʻai ʻana i ka meaʻai me ka nui o ka piʻi ʻana o ke kō koko koko), ʻike iki ka liʻiliʻi o ka albumin. I ke kolu o ke kolu, ʻike ʻia ka microalbuminuria hoʻomau (a hiki i ka 300 mg i kēlā me kēia lā).

I ka hoʻokolohua ʻana i kahi mea maʻi me kahi hā o ka nephropathy ʻehā, e hōʻike ana kahi hōʻike o ka urine i kahi nui o ka protein (e piʻi ana i 300 mg i kēlā me kēia lā), he microhematuria inconsistent (ke ʻano o nā pona koko ʻulaʻula i ka urine). Kūleʻa pinepine ka anemia (me ka hoʻohaʻahaʻa ʻana i nā pae koko ʻulaʻula a me ka hemoglobin), a me ka hoʻonui ʻia ESR (erythrocyte sedimentation rate) e like me nā hopena o kahi hōʻike koko maʻamau. A me ka mahuahua o ka pae creatinine pae me ka nānā pinepine ʻia (me ka noiʻi biochemical).

ʻO ka hana hope loa, hōʻike ʻia ke ʻano o ka hoʻonui ʻana i ka likinine a me kahi hoʻohaʻahaʻa i ka pae filtration glomerular. ʻO ia kēia mau hōʻailona ʻelua e hoʻoholo i ka hōʻeha o ka pilikia ʻole o ka renal. Ua hoʻohālikelike ka Proteinuria i ka nephrotic syndrome, ka mea i hōʻike ʻia e ka lā i kēlā me kēia lā i ʻoi aku i ka 3 g. Ua hoʻonui ʻia ke anemia i loko o ke koko, a ua hoʻemi ʻia ka pae o nā protein (ka nui o ka protein, albumin).

Hiki ke hoʻokokoke pono

Hoʻomaka ka mālamaʻana i ka nephropathy maʻi maʻi me ka hoʻomaka ʻana o ka microalbuminuria. Pono ia e kuhikuhi i nā lāʻau lapaʻau e hoʻohaʻahaʻa i ke koko, e ʻike ʻole i kona helu. I loko o kēia manawa, pono ia e wehewehe i ka mea maʻi i ke kumu e pono ai ka mālama ʻana.

Nā hopena o ka lāʻau antihypertensive i ka wā mua o ka nephropathy:

No laila, ka hoʻomaka mua o ka lāʻau antihypertensive ma ke ʻano o ka maʻi hypertension arterial, ʻo ka proteinuria ma mua o 3 g i kēlā me kēia lā ke kīhaka a belated, ʻaʻole hiki ke hoʻopilikia i ka wānō o ka maʻi.

He mea kūpono loa ke kuhikuhi i nā lāʻau lapaʻau e loaʻa ai ka hopena palekana i ka lolo o ke akeʻai. Nā mea hoʻohālikelike o ka angiotensin-hoʻohuli i ka enzyme (ACE) e hoʻokokoke i kēia mau koi, e hoʻemi ana i ka kānana o ka albumin i ka pā māmā a me ka hoʻēmi ʻana i ka pume i loko o nā moku glomerular. ʻO ka lohi i ka pūpū i hana maʻamau, e hoʻoiho i ka hopena pale (nephroprotective). ʻO ka captopril maʻamau e hoʻohana nui ʻia, enalapril, perindopril.

I ka hoʻomaka ʻana o ka nephropathy, ua hoʻohālikelike kēia mau lāʻau. Me ka hoʻonui nui o ka creatinine i ke koko (ma luna o 300 μmol / L), a me ke ke kiʻekiʻe ʻana o ka paʻakai pākia (ma luna o 5.0-6.0 mmol / L), ka mea maʻamau no ka hiki ʻole o ka renal, ke hoʻohana nui ʻia kēia mau lāʻau lapaʻau . ^ E Ha yM.

ʻO kekahi ma loko o ka mea kaua o ke kauka he angiotensin II mea hoʻokele pahu kākele (losartan, candesartan). Hāʻawi ʻia i kahi papahana hoʻokahi, ka mea i hoʻopili ʻia e kēia mau pūʻulu o nā lāʻau lapaʻau, hoʻoholo pono ke kauka kahi i kahi e hāʻawi ai i ka makemake.

Me ka loaʻa ʻole o ka hopena, ua hoʻopili ʻia kēia mau mea,

Hōʻike nui nā kulekele lapaʻau e pili ana i nā lāʻau i koho a koho i nā beta-receptors i palekana no ka poʻe maʻi me ka maʻi maʻi. Ua hoʻololi lākou i nā beta-blockers koho-koho (propranolol), ke hoʻohana nei i ka maʻi maʻi maʻi contraindicated.

Me nā hiʻohiʻona o ka nele o ka renal, ka proteinuria, iʻai ka ʻāpana i ka mālama.

Me ka nephropathy maʻi maʻi, nā mea kanu a me nā huaʻai ʻole i loaʻa ʻole e pili ana i ka ʻai, ʻo ke alapine o kaʻai ʻana o ka meaʻai a hiki i nā manawa 6 i ka lā

Nā Manaʻo o Nutrent Manaʻo:

Pono e kāohi i ka nui o ka paʻakai i ka ʻai, ʻaʻole wale nō e kāohi i ka ʻaila metabolism, akā no ka hopena o ka hopena o ka hopena. Inā kiʻekiʻe ka nui o ka paʻakai, a laila hoʻoliʻi nui ka poʻe antihypertensive i ko lākou ulu ʻana.ʻO ka piʻi ʻana o ka pane i kēia hihia, ʻaʻole ia e loaʻa i nā hopena.

Me ka hoʻomohala ʻana o ka maʻi edematous, kahi hōʻike hou o ka diuretics loop (furosemide, torasemide, indapamide) hōʻike ʻia.

Manaʻo nā kauka i ka hōʻemi nui loa o ka filtration rate i ka glomeruli (ma mua o 10 ml / min) i kahi hana renal i hoʻohālikelike ʻia, a hoʻoholo ma ke kola hou ʻana. Hemodialysis i hoʻonohonoho ʻia, e kōkua ana ka dialysis peritoneal me ke kōkua o nā ʻenehana kūikawā e hoʻomaʻemaʻe i ke koko o nā huahana metabolic, e pale ai i ka hoʻohālikelike. Eia naʻe, hiki i ka hūnā wale nō ke hoʻoponopono i ka pilikia ma ke hihia o ka pani ʻana i ka hopena.

Me ka hemodialysis, lawe ʻia ka ʻoihana ma nā laʻina o ka pōʻino o ka pōʻino i ka maʻi diabetes, i ka wā hiki i nā mea hiki ke mālama ʻia.

ʻO nā hōʻeha o ka nephropathy a me nā hana e pale ai

Inā he maʻi ka maʻi maʻi me nā syndromes lāʻau lapaʻau kūikawā, a laila paʻakikī ka hōʻailona o ke kaupaona ʻana i ka hana o ka pathological. No ka manawa lōʻihi (me ke ʻano o ka maʻi diabetes 2, hiki a i ʻelua mau makahiki he iwakālua), ʻaʻohe hōʻailona o ka hōʻeha o ka lolo. Hoʻokahi wale nō ka hoʻokaʻawale ʻana i ka protein nui, ʻike pono ka edema kikoʻī i ka pae proteinuria, a kū aʻe ka maʻi koko. ʻO ka maʻi hypertensive, ma ke ʻano he kānāwai, ʻaʻole ia e hoʻonā i nā hoʻopiʻi a i nā loli paha i ke kūlana o ka mea maʻi. ʻAno pōʻino kēia no ka mea, ma muli o ka hoʻonui nui o ke koko, hiki ke hoʻopiʻi ka maʻi vascular: myocardial infarction, cerebrovascular accident, a i ʻole he hōʻeha.

ʻO ka pilikia e inā ʻaʻole i manaʻo a minamina nā mea maʻi ʻole, ʻaʻole ʻo ia e ʻimi i ke kōkua o kahi kauka. Ma ka maʻi mellitus, hoʻomanawanui ka maʻi i ka maʻi, e wehewehe iā ia e ke kahe ʻana o ke kō koko a me nā huahana metabolic (nā kime ketone, acetone).

Me ka hoʻomohala ʻana o ka hana mua o ka renal hiki ʻole, ʻike ʻia kāna mau hōʻike. ʻO ka nāwaliwali ākea, kahi manaʻo o ka hōʻeha a me ka hoʻokaʻawale ʻole i hiki ke hoʻopili ʻia i ka hopena o ka metabolic i loko o ka maʻi mellitus. I loko o ka manawa o nā hōʻailona hoʻomohala, ʻike ʻia nā hōʻailona o ka palaka me nā pūhui nitrogen, a ulu ka uremia. Akā, ʻaʻole hiki i kēia papa hana ke hōʻole a paʻakikī e pane i nā hoʻoponopono lāʻau lapaʻau liʻiliʻi.

No laila, pono e nānā mau a nānā pono ʻia ka nānā ʻana o ka mea maʻi, no ka hiki ke hiki ke hoʻomaopopo i nā hoʻopiʻi i ka manawa.

Kākoʻo i ka hoʻomohala a me ka holomua o ka nephropathy maʻi:

ʻO kahi ʻano o ka hoʻomohala ʻana i ka maʻi nephropathy maʻi:

• Ke ʻano hana (hyperal function) - hoʻonui i ka filtration a me ke kahe koko i ke glomeruli, e hopena ana i ka maʻi hypertrophy. Ke hoʻokō nei kēia hana i ke kuleana nui i ka neʻe ʻana o ka nephropathy.
• II kahua (ka hoʻomaka ʻana i nā loli kūlohelohe i ka ʻōpū o ka pēpē - subclinical, "mute") - ke hoʻololi nei ka helehelena i ke ʻano, he membrane lalo. ʻAʻohe albuminuria, ʻo nā ʻāpana wale nō o ka albumin i hoʻoholo ʻia i loko o ka urine (albumin - "hōʻemi"). Hiki paha i ka hypertension arterial. Hōʻike kēia pae i ka makahiki 5 i mua o ka hoʻomaka ʻana o ka albuminuria.
• III hana (ka hoʻomaka nephropathy, a i ʻole kahi o ka microalbuminuria) - ulu i loko o ka manawa 5-15 mau makahiki mai ka manawa i hoʻokumu ʻia ai ka mellitus maʻi diabetes. Hiki ke loli ka Microalbuminuria ma mua o 50% o nā maʻi.
• IV kūlana (nephropathy koʻikoʻi, a i ʻole macroalbuminuria) - ulu i hope ma hope o 10-20 mau makahiki mai ka loaʻa ʻana o ka maʻi maʻi. Hōʻike ʻia kēia ʻano me ka emi ʻana o ka helu filtration glomerular a me nā hypertension koʻikoʻi koʻikoʻi.
• V kiko (uremic, terminal) - hōʻike ia iā ia iho ma mua o 20 mau makahiki mai ka hōʻike ʻana i ka maʻi diabetes a ʻoi aku paha ma mua o 5 mau makahiki mai ka ʻike i ka proteinuria. Hōʻailona ka nānā ʻana o ka hana excretion nitrogen, hōʻemi i ka kānana glomerular, nui a me ke ʻano hypertension koʻikoʻi. Hōʻike ʻia kēlā mau maʻi i ka hemodialysis, hoʻololi ʻia o ka pēpē.

ʻO ka Hyperglycemia kahi hana e hoʻomaka ai no ka hoʻomohala ʻana i ka nephropathy maʻi, a me ka angiopathy ma ka laulā. ʻO ka kaohiʻana o ka glycemic kiʻekiʻe ka hopena e hoʻemi nui i ka hopena o ka hoʻomohalaʻana i nā pathology.

I waena o nā hana pono nui ka hōʻiliʻili ʻana o nā huahana hopena o ka glycosylation o ka protein, ka hoʻolaʻa o ka hexosamine a me nā ala o ka polyol o nā metabolism glucose, nā protein kinase C, nā mea ulu, cytokines, a me ke kaumaha oxidative.

E hoʻāʻo nā ʻohana ʻohana i ka VIL a me ka maʻi hepatitis

ʻO ka hoʻololi kino o ka pathomorphological i wehewehe ʻia me ka hoʻohuihui ʻana o ka membrane papa o ka capillaries, ka hōʻiliʻili o ka hyaline ma ka lewa o ka paena, ka hoʻonui ʻana i nā capillaries me ka loaʻa ʻana o aneurysms, intracubic hypertension, diabetes glomerulosclerosis. ʻO ka pūkaʻomaʻi kekahi ʻano, ʻo ia ka mea e hōʻike iā ia iho i ke ʻano o ka hyperplasia tubular, ka huhū o ka membement basement, a me ka hoʻonui nui o ka electrolytes i loko o nā hana tubular.

Nā Palapala Diagnosis

Ua hoʻokumu ʻia ka maʻi maʻi nephropathy maʻi, me ke mālama ʻana i ke ʻano, ʻano a me ka lōʻihi o ka maʻi maʻi. ʻO ka nānāʻana i ka microalbuminuria, proteinuria a me ka azotemia e nānā pū ʻia ana. ʻO ke kumu mua a me ke kūleʻa loa loa ka hoʻoholo ʻana i ka microalbuminuria. ʻO nā manaʻo no microalbuminuria ka excretion o albumin i loko o ka urine (30-300 mg / lā) a i ʻole 20-200 μg / min (pō pōmole).

No ka hōʻike pololei ʻana i ka maʻi nephropathy diabetes, koi ʻia nā noiʻi aʻe:

• Nā koho o ka microalbuminuria ʻekolu mau manawa.
• ʻO ka loiloi o ka albuminuria - e ka loiloi laulā o ka urine a i loko o ka urine lā.
• Ka hoʻomoʻomakika pākahi ʻokoʻa.
• ʻO ka koho i ka waiwai o ka creatinine a me ka urea (serum koko), glomerular filtration rate.

ʻO ka mālama glycemic intens a me ka normalization o ke kahe koko, ʻo ia nā mea nui i ka hoʻoponopono ʻana i nā hōʻike o nā nephropathy maʻi me ka hoʻohaʻahaʻa nui ʻana i ka holomua (pae kiʻekiʻe - HbA1C -

Helu papa Mogensen

I kēia manawa, hoʻohana pinepine nā kauka i kā lākou hana i ka papa mele ʻo Mogensen, i kūkulu hou i ka makahiki 1983 a e wehewehe ana i kahi ʻano maʻi o kēia maʻi:

1. maʻi o ka pēpē i hana mua i ka manawa mua o ka maʻi mellitus hōʻike kino iā ia iho ma o ka hypertrophy, hyperperfusion a me ka hyperfiltration o nā keiki,
2. ke ʻano o nā loli o I-strukture i ka pūpū me ka mānoanoa o ka membement basement glomerular, hoʻonui i ka mesangium a me ka hyperfiltration like. ʻIʻa ʻia i ka manawa mai 2 a 5 mau makahiki ma hope o ka maʻi maʻi,
3. hoʻomaka i ka nephropathy. Hoʻomaka ʻaʻole ma mua o 5 mau makahiki ma hope o ka hoʻomaka ʻana o ka maʻi a hana iā ia iho me ka microalbuminuria (mai 300 a 300 mg / lā) a me ka hoʻonui ʻana o ka maʻi kānana glomerular (hōʻuluʻulu i ka GFR),
4. Hoʻokumu ka nephropathy i ka maʻi diabetes i ka wā o 10-15 mau makahiki, e hōʻike ana iā ia iho i ka proteinuria, hypertension, hoʻoneʻe i ka GFR a me ka sclerosis, e uhi ana mai 50 a 75% o glomeruli,
5. hana ka uremia he 15-20 mau makahiki ma hope o ka maʻi diabetes a hōʻailona ʻia e ka nodular a i ʻole ka piha, ka glomerulosclerosis piha hoʻohālikelike, hōʻemi ia i ka GFR i ka hoʻonohonoho ʻana i nā loli pili

He nui i ka hoʻohana pono a me nā puke e pili ana i nā lāʻau lapaʻau, ʻo ka papa inoa e like me nā papa o ka nephropathy maʻi i hoʻokumu ʻia i nā loli i loko o nā maʻi ua paʻa pū hoʻi ia.

1. ʻoiono ʻaihue. ^ E Ha yM. Hōʻike ia iā ia iho i ka wikiwiki o ke kahe o ke koko ma ka glomeruli o ka renal, e hoʻonui ana i ka nui o ka urine a me nā mea make pono. ʻAi ʻia a hala 5 mau makahiki
2. microalbuminuria - ke hoʻonui iki i kahi kiʻekiʻe o nā protein albumin i loko o ka urine (mai 30 a 300 mg / lā). ʻO ka maʻi maʻamau a me ka mālama ʻana i kēia manawa e hiki ke hoʻonui iā ia i 10 mau makahiki,
3. macroalbuminuria (UIA) a i ka proteinuria. ^ E Ha yM. ʻO kēia kahiemi hōʻemi i ka wikiwiki o ka filtration, he kuʻi pinepine i ka kahe koko. Hiki i ka nui o nā protein albumin i loko o ka lānai ma waena o 200 a oi aku ma mua o 2000 mg / bitch. ʻO ka nephropathy diabetic o ke ʻano UIA e kū mai ana ma ka makahiki 10-15 i ke hoʻomaka ʻana o ka maʻi diabetes,
4. nephropathy haʻi. ^ E Ha yM. Hōʻano ʻia e ke aniani o ka filtration rate glomerular haʻahaʻa (GFR) a me ka hoʻolalelale ʻana o nā moku ʻōhua i nā loli sclerotic. Hiki ke mālama ʻia i kēia manawa ma hope o nā makahiki he 15 ma hope o ka hoʻololi o ka pūpū.
5. ka huaka ʻole pilikia (CRF)) ʻIke ʻia ma hope o 20-25 mau makahiki o ke ola me ka maʻi maʻi.

ʻO ka 2 mau mua o ka maʻi nephropathy maʻi (renal hyperfiltration a me microalbuminuria) i hōʻike ʻia me ka waiho ʻole o nā hōʻailona waho, ka nui o ka urine. ʻO kēia ka palena preclinical o ka nephropathy maʻi. Aia wale ma ka hopena o ke kaʻina microalbuminuria, ʻike paha kekahi mau maʻi i ka neʻe ʻana o ka paʻakikī i kēlā me kēia manawa.

I ka pae ʻana o proteinuria, ua ʻike mua ʻia nā hōʻailona o ka maʻi.

• ka puka ʻana (mai ka hā mua o ka maka a me nā wāwae i ka huki ʻana o nā ʻōpū o ke kino),
• nā makai ka nui o ke koko i mālama ʻia.
• ka hoemi nui ʻana o ka paona a me ke kuko,
• hauā, makewai,
• malaise, palupalu, luhi.

Ma nā hana hope o ke ala o ka maʻi, e hoʻomāhuahua ʻia nā hōʻailona ma luna, e hāheʻe ʻia nā koko i loko o ka urine, ke kahe ʻana o ke koko i loko o nā moku o ke akeʻa e piʻi i nā hoʻohālikelike o ka maʻi lolo.

He mea koʻikoʻi loa ia e hōʻike i kahi maʻi i ka wā mua o ka neʻe ʻana o ka hoʻomohala ʻana, aia wale nō ma o ka hele ʻana i nā hōʻike kūikawā e ʻike i ka nui o ka protein albumin i loko o ka urine.

Nā ʻ Thelelo ʻtylelo Etymological

He mea nui ia e ʻike! ʻO nā pilikia me nā haʻalulu gula ma mua o ka manawa hiki ke alakaʻi i kahi maʻi āpau āpau, e like me nā pilikia me ka hihiʻo, ka ʻili a me ka lauoho, nā ʻōpio, nā gangrene a me nā ʻeha maʻi maʻi ʻole! Ua aʻo ka poʻe i ka ʻike ʻawaʻawa e hana i nā pae holi holi ...

ʻO ka ʻoni etymological e pili ana i ka hoʻomohala ʻana o ka nephropathy i ka maʻi maʻi hānai ua ʻike ʻia:

• ʻike ka manaʻo genetic i ke kumu nui o nā maʻi keiki i ka predisposition hoʻoilina, e like me ke ʻano o ka maʻi diabetes mellitus ponoʻī, me ia ka hiki ʻana o ka hoʻomohala ʻana i ka pōʻino o ka pōʻino i loko o nā pēpē.
• ʻ sayslelo ka manaʻo o ka hemodynamic e like me ka diabetes mellitus aia ke ʻano he hypertension (kahe koko o ka maʻi i loko o nā keiki), ma muli o ke kīhaka moku ʻole ke kū i ke kahe ikaika o ka nui o nā protein albumin i hoʻokumu ʻia i loko o ka urine, hina, a me nā sclerosis (ʻeha) i nā wahi i hoʻopuni ʻia ai nā iwi.
• hoʻololi, ke kumu nui i ka luku ʻana i ka nephropathy maʻi i ka hoʻoliʻi ʻia o ka glucose kiʻekiʻe. Mai ke ʻano o nā loiloi "ʻaʻole i hiki ke hoʻomohala i nā moku ukana me ka hana filtration, ma muli o ke kaʻina hana a me ka hoʻokahe koko, pilikia nā ʻupena ma muli o ka hoʻohemo ʻana o nā momona a me ka hōʻemi o nā paʻakai sodium, a me nā hoʻonui o ke kino (hypertension).

Hiki iā ʻoe ke ʻike i nā mea e hana ai e lohi ai i ka pōʻino o ka lolo i ke diabetes mellitus ma o ka nānā ʻana i kēia wikiō.

I kēia lā, ʻo ka mea maʻamau a maʻamau e pili ana i ka hana maʻamau i nā nohona olakino o nā maʻi lapaʻau, ʻo ia ka papa o ka nephropathy maʻi, a me nā ʻano e pili ana i ka hoʻomohala ʻana o ka pathology: hyperfunction, hoʻololi i nā ʻano hana, hoʻomaka a haʻi i ka nephropathy maʻi maʻi, uremia.

He mea nui ia i ka manawa kūpono o ka hoʻokolohua ʻana i ka maʻi i kona neʻe mua ʻana i ka hoʻomohala ʻana e hiki ai ke lohi i ka hoʻomaka ʻana o ka pilikia o ka hana kino a me ka lōʻihi.

Hoʻomaopopo o ka Diabetic Nephropathy

Ke hololi nei ka helehelena - holomua ka holomua, a kau ʻia ka hōʻailona i ke kahua o ka maʻi. Hoʻonohonoho ʻia nā pae aʻe:

• ʻAno Asymptomatic - ua hōʻike ʻia nā hōʻikeʻike like ʻole, akā, ke hoʻonui nei i ka kaila filtration glomerular e hōʻike ana i ka hoʻomaka ʻana o ka hana ʻoi. Hoʻonui ʻia ke kahe koko renal a me ka hypertrophy renal. ʻAʻoleʻoi aku ka kiʻekiʻe o ka microalbumin i ka urine ma mua o 30 mg / lā.
• ʻO kahi pae o nā loli mua - ka hoʻololi mua i ka hoʻolālā o ka glomeruli kukala i ʻike ʻia (ka uhi ʻana o ka pā capillary, ka hoʻonui ʻia ʻana o ka mesangium). ʻAʻoleʻoi aku ka kiʻekiʻe o ka microalbumin i ka maʻamau (30 mg / lā) a loaʻa pū he kahe koko i loko o ka pūpū a me ia, no laila, hoʻonui ʻia ka glomerular filtration.
• ʻO ka manawa Prenephrotic - ʻoi aku ka pae o ka microalbumin ma mua o ka maʻamau (30-300 mg / lā), akā ʻaʻole hiki ke kiʻekiʻe o ka proteinuria (a i ʻole ʻeleʻele a me nā pōkole ʻo ka protein, a me ka kānana glomerular ma mua o ka maʻamau, akā hiki ke hoʻonui. Hiki ke nānā ʻia nā ʻōpū o ke koko kiʻekiʻe.
• ʻAlaʻi Neprotic - proteinuria (protein i ka urine) lilo mau. ʻO ka wā maʻamau, ʻike ʻia ka hematuria (koko i loko o ka urine) a me cylindruria. Ka hoʻemi ʻia o ke kahe koko a me ka helu filtration glomerular. Hiki ke ulu ʻia ka momona (me ke ʻano nui o ke koko). Hoʻopili ʻo Edema, ʻikea ka anemia, ka nui o nā ʻāpana o ke koko: ESR, kolamu, alpha-2 a me beta-globulins, betalipoproteins. Ua hoʻokiʻekiʻe ʻia ka levelinine a me ka urea i loko o nā palena maʻamau.
• ʻO ke ʻano kikrosclerotic (uremic) - ke kānana a me ka hana o ke kaupaona ʻana, ua hoʻemi ʻia ka nui o ke ana o ka urea a me nā mea hana i loko o ke koko. ʻO ka nui o nā protein koko ua hoʻemi nui ʻia - i hoʻokumu ʻia i ka edema. I ka ihi, proteinuria (protein i loko o ka urine), hematuria (koko i loko o ka urine), ʻike ʻia ka cylindruria. Hoʻopilikia nui kahi maʻi. E mau nei ka ulu ʻana o ka maʻi hypertension, a hiki i ke kaomi ʻana i nā helu kiʻekiʻe. I kēia manawa, ʻaʻole ʻike ka helu o ka nui o ke kō o ke koko, kaʻaʻai ma loko o ka urine. He mea kupanaha ia me ka nephrosclerotic kahi o ka maʻi nephropathy maʻi, ua emi ka nui o ka hōʻemi o ka insulin endogenous, a ua pau ka helu o ka insulin i ka pāʻai. I ka hopena, hoʻemi ʻia ka pono o ka insulin exogenous. Hiki ke emi ka pae ʻana o ke koko. Hoʻopau kēia hana me ka pani ʻole o ka renal.