Nephropathy ea lefu la tsoekere

Diabetes nephropathy e bua ka maqeba afe kapa afe a karolo ea lisebelisoa tsa mokokotlo tse bang teng ka lebaka la khaello ea metabolic ea lik'habohaedreite le lipids 'meleng. Liphetoho tsa methapo ea kutlo li ka ama glomeruli ea renal, tubules, arterioles le methapo ea methapo. Lefu la tsoekere lephoto le hlaha ho 70-75% ea batho ba nang le "lefu le monate".

Hangata e iponahatsa e le maemo a latelang:

• Sclerosis ea methapo ea kutlo le makala a eona.
• Sclerosis ea li-arterioles.
• Glomerulosclerosis ea mofuta oa ho nyehlisa, oa nodular le exudative.
• Pyelonephritis.
• Necrosis ea papilla e nang le mafura.
• Necrotic nephrosis.
• Sebopeho sa reubu tubules ea mucopolysaccharides, lipids le glycogen.

Sistimi ea nts'etsopele

Pathogenesis ea lefu la tsoekere lephropathy e amahanngoa le lintlha tse 'maloa tsa metabolism le hemodynamic. Sehlopha sa pele se kenyelletsa hyperglycemia (tsoekere e phahameng ea mali) le hyperlipidemia (lipilisi tse phahameng tsa lipids le / kapa lipoprotein maling a). Lintho tsa Hemodynamic li emeloa ke khatello ea mali ea methapo le khatello e eketsehileng ka hare ho glomeruli ea renal.

Bohlokoa! Ho boetse ho na le lebaka la lefutso le ke keng la fokotsoa.

Liphetoho tsa metabolism

Hyperglycemia ke sehokelo sa mantlha tlhabollong ea methapo ea methapo khahlanong le semolao sa "lefu le monate". Khahlano le semelo sa tsoekere e phahameng, e ikopanya le liprotheine le mafura a membrane ea renal, e fetohang litšobotsi tsa 'ona tsa mmele le' mele. Hape, palo e kholo ea li-monosaccharides tse nang le chefo liseleng tsa setho, se khothaletsang tlhahiso ea protheine kinase C mme se thusa ho eketsa boteng ba marako a methapo.

Hyperglycemia ke eona ntho e ka sehloohong e re thusang ho ntlafatsa mathata a lefu la tsoekere

Ts'ebetso ea methapo ea oxidation e baka ho lokolloa ha li-radicals tsa mahala tse ka bang le phello e mpe ebile e mpe ho lisele tsa setho.

Tekanyo e phahameng ea lipids le lipoprotein maling ke eona ntho e latelang ho nts'etsopele ea nephropathy. Ho beoa ka mpeng ea methapo ea methapo le li-arterioles, tsoekere e thusa ho e senya le ho eketsa boteng. Li-lipoprotein tse tlase tse seng li entsoe ka oxidation li khona ho kenella ka har'a sele e senyehileng ea methapo ea mali. Li ts'oaroa ke lisele tse ikhethileng moo metsoako e sebetsanang ea litho li qalang ho ba teng.

Hemodynamic factor

Boemo bo phahameng ba khatello ho glomeruli ea liphio ke ntho e eketsang tsoelo-pele ea psychology. Sesosa sa khatello e matla ea mali ke ts'ebetso ea ts'ebetso ea renin-angiotensin (matla a sebetsang a li-angiotensin-II).

Keketseho ea boemo ba khatello ea mali 'meleng oa motho e etsahalang ka lebaka la lintlha tsena tsohle tse ka holimo e fetoha mochine o fetolang liphetoho tsa metabolic nts'etsopeleng e tsoelang pele ea methapo ea methapo ea methapo methapong ea eona ea methapo.

Lintlha tse hloahloa

Diabetesic nephropathy (khoutu bakeng sa ICD-10 - N08.3 kapa E10-E14 leq. 2) hangata e hlaha khahlano le semelo sa lefu la tsoekere le itlamileng ka "insulin". Ke maloetse a mofuta oa 1 a hore maloetse a liphio a sebakeng sa pele har'a lisosa tsohle tsa lefu ho bakuli. Ka mofuta oa 2, nephropathy e nka sebaka sa bobeli (ea pele ke mathata a tsoang pelong le methapong ea mali).

Liphio ke sefahleho se hloekisang mali a chefo, lihlahisoa tsa metabolic, chefo. Sena sohle se pepesitsoe moroto. Glomeruli ea liphio, eo ho eona liphetoho li bang teng ho lefu la tsoekere, e nkuoa e le lifilimi. Sephetho ke tlolo ea ts'ebetso ea tlhaho le tekanyo ea li-electrolyte, ho kenella ha liprotheine mochini, tse sa bonoeng ho batho ba phetseng hantle.

Glomeruli ea liphio - mochine o ka sehloohong oa ho hlohlona mali

Sena se etsahala ho latela moralo o latelang:

• Mehato ea pele - liprotheine tse nyane haholo li kenella.
• Tsoelo-pele - limolek'hule tse kholo lia oa.
• Khatello ea mali ea eketseha, e leng ho sitisang tšebetso ea renal hape.
• Tšenyo e eketsehileng ho litho tsa eona e eketseha le ho feta BP.
• Ho haella ha protheine 'meleng ho lebisa ho edema ea bohlokoa le ho thehoa ha CKD, e bonahatsoang ke ho se sebetse hantle ha methapo.

Kahoo, re bua ka sekhahla se kotsi, sephetho sa sona ke tlhokeho ea hemodialysis, le maemong a matla, ho fetisoa ha meno.

Tlhomamiso

Ho na le likarohano tse ngata tsa lefu lena ho bana le ho batho ba baholo: tlhahlobo ea bongaka, morphological le classified ka mekhahlelo.

Tleliniki

Boteng ba protheine ka har'a moroto, maemo a creatinine maling a ikemiselitse. Ho ea pele, ho ea ka liforomo, sekhahla sa filtara ea glomerular se baloa, ho latela lipontšo tseo ho ba teng ha CKD le sethala sa eona ho ikemiselitsoeng.

Foromo ea ho hlahloba sekhahla sa ho fifala ha lintho ho batho ba baholo:
140 - lilemo (palo ea lilemo) x boima ba 'mele (in kg) x lekaneng. (monna - 1,23, basali - 1,05) / moeinine (μmol / L) = GFR (ml / min)

Foromo ea ho hlahloba GFR ea bana:
makhopho (ho latela lilemo) x bolele (cm) / creatinine (μmol / L) = GFR (ml / min)

Morphological

Ho na le mekhahlelo e mene e meholo, ho latela moo liphetoho tse boletsoeng 'meleng le' meleng oa mokuli li boletsoeng.

• Ho ts'oaroa ha membrane ea bo-renal tubules ea tlhaho e ikhethileng.
• Ho thefuleha ha lisele tsa glomerular intervascular tsa mofuta o monyane (a) kapa o boima (b).
• Sebopeho sa li-nodule ka liseleng tse sebetsanang le methapo (glomerulosulinosis).
• Sclerosis ea tlhaho e boletsoeng.

Pehelo ea methati

Mokhahlelo oa pele o tšoauoa ka tšusumetso e matla ea sesebelisoa sa filtara. E hlaha qalong ea lefu la tsoekere. Liphio li leka ho tlosa tsoekere e tsoang 'meleng kapele kamoo ho ka khonehang, ho kenyelletsa le mekhoa e tlatsetsang. Proteinuria (protheine ka har'a moroto) ha e eo, joalo ka matšoao a lefu la kelello.

Mokhahlelo oa bobeli ke lipontšo tsa pele. E hlaha lilemo tse 'maloa ka mor'a ho sibolloa ha "lefu le monate". Marako a methapo ea kutlo le arterioles a boreleli, empa ha ho na protheine ka har'a moroto, hammoho le matšoao a kalafo.

Mohato oa boraro ke mohato oa microalbuminuria. Tlhahlobo ea laboratori e lekola boteng ba protheine ka bongata ba 30 ho isa ho 300 mg / ka letsatsi. Tšenyo ea methapo e bontšoa ke keketseho ea nako le nako khatello ea mali ntle le lipontšo tse ling.

Urinalysis - motheo oa tlhahlobo ea lefu la tsoekere

Karolo ea bone - matšoao a matla a lefu la tsoekere. Palo e kholo ea protheine e tšeloa ka har'a moroto, matšoao a liprotheine tse maling a fokotseha, 'me ho hlaha puffness. Haeba boemo ba protheine bo le pakeng, edema e hlaha sefahlehong le maotong. Tabeng ea excretion ea palo e kholo ea protheine ho tsoa 'meleng, pathological exudate e bokellana ka mpeng, ka mokokotlong, ka methapo ea kutlo.

Mokhahlelo oa bohlano ke boemo bo mahlonoko bo khetholloang ke sclerosis e felletseng ea methapo ea kutlo, GFR e ka tlase ho 10 ml / min. Thuso e na le hemodialysis kapa transplantation ea setho, hobane mekhoa e meng ea kalafo ha e sa sebetsa.

Setšoantšo sa Clinical

Mehato ea lefu la tsoekere lephropathy e hokahane le lipontšo tsa bonono le tsa laboratori. Mehato ea pele e meraro e nkuoa e le ea tlhaho, kaha ha ho liponahatso tsa lefu lena. Liphetoho li ka khethoa feela ho sebelisa li-diagnostic tsa laboratori kapa nakong ea tlhahlobo ea histological ea lisele tsa renal.

Matšoao a matla a hlaha sethaleng sa bone, ha bakuli ba qala ho tletleba ka lipontšo tse latelang:

• ho ruruha ha sefahleho le likarolo tse tlaase;
• ho eketseha ha khatello ea mali;
• ho theola boima ba 'mele;
• bofokoli, ts'ebetso e fokotsehileng;
• ho nyekeloa ke pelo, ho hlatsa
• ho hloka takatso ea lijo;
• lenyora la pathological;
• cephalgia;
• ho hema hanyane
• bohloko bo ka morao ho sternum.

Matšoao a ho kena sepetlele

Phekolo ea pelehi e reretsoe joalo ka ha ho reriloe ho bakuli ba nang le nephropathy le lefu la ho emelana le nephrotic le sekhahla sa ho hlohlona kaholimo ho 65 ml / min, le lefu la renal hammoho le lefu le sa foleng la liphio la methapo ea 3 le 4.

Ho kena sepetlele ka tšohanyetso ho hlokahala maemong a latelang:

• oliguria - mofuta o fokolang oa moroto o qotsitsoeng;
• azotemia - palo e eketsehileng ea lintho tsa naetrojene maling;
• hyperhydrate - tsamaiso ea metabolism ea metsi a letsoai, e khetholloang ka ho thehoa ha edema;
• metabolic acidosis - keketseho ea acidity ea mali;
• hyperkalemia - bongata ba potasiamo e maling.

Maano a bolaoli ba mokuli le ho bona hore na tlhokahalo ea ho kena sepetlele ke tokelo ea bongaka ea ho ba teng

Tlhahlobo ea methapo ea mafu

Setsebi se hlakisa tšoaetso ea lefu la tsoekere, boemo ba khatello ea mali le phapang ea lona, ​​kholo ea ho ruruha. Ka pono e lekola boemo ba letlalo, boima ba 'mele oa mokuli, ho ba teng ha edema le ho teba ha tsona, karo-karolelano ea moroto o amoheloang le ho pepesoa ka letsatsi.

Teko e akaretsang ea mali (palo ea lintho tse thehiloeng, mmuso oa coagulation, formula ea leukocyte, ESR), biochemistry (proteni e felletseng, albin, protheine ea C-reactive) e tlameha. Melemo ea urine e ea hlahlojoa (tlhahlobo e akaretsang, microscopy ea sediment, ELISA ea liprotheine, setso sa baktheria).

Maemo a GFR, creatinine, urea, k'holeseterole, tsoekere, le lintho tse senang mohlala li ikemiselitse. Mekhoa e meng ea ho khetholla:

Lefu la Tsoekere

• Ultrasound ea liphio le mpa;
• renal tishu biopsy;
• ECG, echocardiography;
• Dopplerography ea likepe tsa renal;
• X-ray ea sefuba, mpa;
• matšoao a lihomone tsa qoqotho le tsa parathyroid.

Haeba ho hlokahala, ngaka e romela mokuli hore a fumane tumellano le setsebi sa masapo a mahlo (ho se kenyeletse lefu la tsoekere), ngaka ea methapo (ha ho bonahala matšoao a ho se sebetse ha pelo le arrhythmia), ngaka ea methapo ea kutlo (ho laola lefu le ka tlase), angiosurgeon (ho theha AV fistula joalo ka phihlello ea hemodialysis).

Phapang ea tlhahlobo ea mafu

Lefu la tsoekere le lefu la tsoekere le tlameha ho khetholloa ho lefu la nephrotic le syndrome e sa foleng ea nephritic.

Mekhoa ea ho sebetsana le mamello

Ka nts'etsopele ea methapo ea CKD ea 1 le ea 2, hammoho le keketseho ea khatello ea mali, ho ja lijo tse nang le phepo e lekaneng, protheine e lekaneng e kenella. Kh'alori ea letsatsi le letsatsi e baloa ka bonngoe ke endocrinologist kapa setsebi sa phepo. Lijo li kenyelletsa phokotso e tlamang ea letsoai le fuoang 'mele (eseng ho feta 5 g ka letsatsi).

Ho fokotsa palo ea letsoai lijong - monyetla oa ho fokotsa nts'etsopele ea puffiness

Puso ea ho ikoetlisa e behiloe halofo ea hora ho fihlela makhetlo a 5 ka beke. Ho hana mekhoa e mebe (ho tsuba le ho noa). Hang ha likhoeli tse ling le tse ling tse tharo, ho hlokahala ho tseba hore na protheine e na le moroto le ho lekanya khatello ea mali letsatsi le letsatsi.

The endocrinologist e hlahloba leano la kalafo ea insulin kapa tšebeliso ea li-hypoglycemic agents, haeba ho hlokahala, e etsa khalemelo ka ho hlakola kapa ho eketsa moriana o itseng. Sena se bohlokoa hobane hyperglycemia ke sesosa sa nts'etsopele ea lefu la tsoekere.

Phekolo ea lithethefatsi

Nako ea tlamo kalafong ea lefu la tsoekere le lefu la tsoekere ke ho fokotseha ha khatello ea mali ho lipalo tse tloaelehileng (boteng ba protheine ho moroto, khatello ea mali e lokela ho ba ka tlase ho 130/80 mm Hg). Lithethefatsi tsa khetho:

• Li-inhibitors tsa ACE (Perindopril) - ha li fokotse khatello ea mali feela, empa hape li fokotsa bongata ba liprotheine tse hlahisoang ka har'a moroto.
• Angiotensin receptor blockers (Losartan, Eprosartan) - fokotsa khatello ea mali, fokotsa ts'ebetso ea kutloelo-bohloko ea liphio.
• Thiazide diuretics (Indapamide, Clopamide) - e sebetsa mohatong oa pele, ha sekhahla sa filtara se kaholimo ho 30 ml / min.
• Liop diuretics (ethacrine acid, furosemide) - li ngotsoe ka methati ea lipontšo tse hlakileng tsa nephropathy.
• Beta-blockers (Atenolol, Metaprolol).
• Li-blocker tsa calcium calcium (Verapamil).

Ho fokotsa mats'oao a lipoproteins tse tlase, li-statins (Simvastatin, Atorvastatin) le fibrate (Ciprofibrate, Fenofibrate) li laetsoe.

Hemodialysis

Lingoliloeng tsa bongaka tsa sejoale-joale ha li na likhothaletso tsa hore na ho hlokahala neng ho qala ho hloekisoa ha mali ka hemodialysis. Ho khetholla tlhoko ke litokelo tsa setsebi se tlang. Ka 2002, ho ile ha fanoa ka tataiso ea Europe e sebetsang, e neng e na le datha e latelang.

• Ho itlhoekisa ka ho ts'oaroa ha dialysis ho lokela ho qala haeba sekhahla sa filtara ea glomerular se le tlase ho 15 ml / min se kopane le ponaletso e le 'ngoe kapa tse ngata: ho ruruha, khatello ea mali e sa laoloeng le khalemelo, pathology ea boemo ba phepo, e khetholloang ka tsoelo-pele.
• Ho hloekisoa ha mali ho lokela ho qala ka GFR ka tlase ho 6 ml / min, leha phekolo e nepahetseng e ka etsoa, ​​'me ha ho lipontšo tse ling.
• Ho daela kapele bakeng sa bakuli ba kotsing e kholo.

Litlhahiso tsa KDOQI li fana ka maikutlo a hore dialysis e lokela ho qala tlasa maemo a latelang:

• edema ea bohlokoa, e ke keng ea lokeleha ho khalemeloa ka litlhare;
• sekhahla sa filtara e ka tlase ho 15 ml / min;
• urea - 30 mmol / l le ka tlase;
• ho fokotseha ho matla ha takatso ea lijo le boemo ba mesebetsi e tloaelehileng ea 'mele;
• potasiamo ea mali e ka tlase ho 6 mmol / l.

Hemodialysis - Mokhoa oa ho itlhoekisa mali o sebelisitsoeng ho hloleha ho phekola a renal

Ho buoa

Mokuli ea nang le lefu la tsoekere o ka hloka ho buuoa ka tšohanyetso kapa ka tšohanyetso. Bakeng sa daalysis e potlakileng ntle le ho fihlella, catheter ea nakoana ea dialysis e ea hlokahala.

Ts'ebetso e reriloeng ke ho etsoa ha fistula e arteriovenous, ho kenngoa ha methapo ea methapo, e sa feleng kapa e nang le patheteral. Stinging kapa balloon angioplasty ea likepe tsa renal le eona e ka etsoa.

Mehato ea thibelo

Motheo oa thibelo ea nephropathy le mathata a mang ke puseletso bakeng sa lefu la tsoekere. Haeba lefu la kelello le se le hlahile, mme albin ka moroto e fumanoe, ho bohlokoa ho liehisa boemo ba boemo bo latelang:

• ho itlhokomela matšoao a tsoekere ea mali;
• tekanyo ea khatello ea mali ea letsatsi le letsatsi;
• khutlela ho boemo bo tloaelehileng ba mafura a mali;
• phekolo ea lithethefatsi;
• ho khomarela lijo tse nang le lik'habohaedreite tse tlase.

Ka nts'etsopele ea proteinuria e matla, likhothaletso tse latelang li lokela ho bonoa:

• phihlello ea hemoglobin e loketseng hantle (ka tlase ho 8%);
• khalemelo ea matšoao a khatello ea mali (lipalo tse phahameng tse lumelloang - 140/90 mm Hg);
• ho ja liprotheine tse ngata le lijo.

Ka bomalimabe, mokhahlelo oa pele feela oa khatello o nkuoa o le phetoho. Tse ling kaofela ha li phekolehe. Litsebi li ka fokotsa tsoelo-pele ea lefu lena, tsa boloka bophelo bo botle ba mokuli. Ho hlahlojoa ka nako le ho latela likeletso tsa ho ea lingakeng ke senotlolo sa litholoana tse ntle ho batho ba kulang.