ʻO ka nephropathy Diabetic ka inoa maʻamau no ka hapanui o nā maʻi ʻeha 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 maikaʻi 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.
Nā kumu no ka hoʻomohala ʻana i ka maʻi nephropathy maʻi:
- koko koko kiʻekiʻe ma ka mea maʻi;
- malū a me ka triglycerides i ke koko;
- ke koko kiʻekiʻe (heluhelu i kā mākou pūnaewele "kaikuaʻana" no hypertension);
- anemia, he “moʻo” (hemoglobin i ke koko <13.0 g / lita);
- ulaula (!).
Hoʻomaopopo o ka Diabetic Nephropathy
Hiki i ka maʻi maʻi hopena hōʻeha ma luna o nā puʻuwai no ka manawa lōʻihi loa, a hiki i 20 mau makahiki, me ka ʻole ka hoʻoluhi ʻia ʻana o nā ʻano like ʻole o ka mea maʻi. Hoʻomaka ka hōʻailona o nā nephropathy diabetes i ka wā i ulu mua ka pōʻino. Inā loaʻa i ka mea maʻi nā hōʻailona o ka hana ʻole o ka renal, a laila ʻike kēia e hōʻiliʻili nā metabolic i loko o ke koko. No ka mea, ʻaʻole i hiki i nā ʻehā i hoʻopili ʻia me kā lākou filtration.
ʻO nā maʻi nephropathy maʻi maʻi. Nā hoʻāʻo a me nā diagnostics
Ma aneane ke nānā ʻia o nā maʻi āpau i kēlā me kēia makahiki e nānā i ka hana o nā keiki. Inā ulu ka lolo nephropathy maʻi, a laila nui loa ia e ʻike i ia ma kahi hoʻomaka, ʻoiai ʻaʻoleʻike ka mea maʻi i nā hōʻailona. Hoʻomaka ka hoʻomaʻamaʻa mua loa no ka nephropathy diabetes, ʻoi aku ka nui o ka pono o ke kūleʻa, ʻo ia hoʻi, e hiki ana i ka mea maʻi ke ola me ka ʻole o ka dialysis a i ʻole kahi maʻi kidney.
I ka 2000, ua ʻae ke Kuhina o ke Ola o ka Lūkini Lūkini i ka papa helu ʻana o ka nephropathy maʻi ma o nā pae. Hoʻokomo ʻia i nā ʻōmole penei:
- hana microalbuminuria;
- pūnaehana proteinuria me ka mālama 'āina o ka nitrogen-excreting;
- ka hana o ke aʻalolo hoʻomaʻamaʻa ʻole o ka maʻi (hana me ka dialysis a i ʻole ka hoʻololi ʻana o ka pēpē).
Ma hope mai, ua hoʻomaka nā mea loea e hoʻohana i nā ʻano 'ākeʻakeʻa ʻē aʻe o ka hoʻopiʻi ʻana o nā maʻi i ka maʻi maʻi. I loko o ia mea, ʻaʻole 3, akā 5 mau hiʻohiʻona o ka nephropathy diabetes. E ʻike i nā hana o ka maʻi maʻi o ke keiki no ka nui o nā kikoʻī. ʻO ke ʻano o ka nephropathy maʻi maʻi i kahi mea maʻi e hilinaʻi nei i kāna glomerular filtration rate (ua wehewehe ʻia i ka kikoʻī pehea e hoʻoholo ai). ʻO kēia ka hōʻailona nui loa e hōʻike ana i ka maikaʻi o ka mālama ʻana i ka pēpē.
Ma ka hoʻomaka ʻana o ke kuhi maʻi nephropathy maʻi, he mea nui ia e hoʻomaopopo i ke kauka inā he hōʻeha ka maʻi o ka maʻi ma o ka maʻi a me nā kumu ʻē aʻe. Ua hana ʻia kahi ʻano maʻi like ʻole o ka nephropathy maʻi me nā maʻi ʻē aʻe:
- ka maʻi pyelonephritis (ka maʻi maʻi o nā luhi);
- ʻōpū o ka maʻi pākaukau;
- nā huehue a me ka maʻi glomerulonephritis.
Nā hōʻailona o ke pyelonephritis mau maʻi:
- nā hōʻailona o ka hoʻohālikelike (nāwaliwali, makewai, nausea, ka luaʻi, ke poʻo;);
- ʻeha i ke kua i lalo a me ka ʻōpū ma ka ʻaoʻao o ka ʻōpū i hoʻopili ʻia;
- hoʻonui i ke koko;
- i ⅓ nā mea maʻi - wikiwiki, hōʻeha ʻeha;
- hōʻike i nā hoʻokolohua o ka noho ʻana o nā keʻena koko keʻokeʻo a me nā pōʻino i loko o ka urine;
- kiʻi hiʻohiʻona me ka ultrasound o nā keiki.
ʻO nā hiʻohiʻona o ka maʻi pākīpū:
- i ka urine - leukocytes a me mycobacterium tuberkulosis;
- me ka urography excretory (x-ray o nā keiki me ka hoʻokele intravenous o kahi ʻano kūʻokoʻa) - kiʻi kiʻi.
Meaʻai no nā ʻōkuhi o nā maʻi maʻi o ka maʻi maʻi
I nā nui o nā pilikia me nā pilikia o ka maʻi diabetes, ka hoʻopololei ʻana i ka paʻakai o ka paʻakai e kōkua i ka hoʻohaʻahaʻa ʻana i ke koko, hoʻēmi ka huehue, a hoʻolohi i ka holomua o ka nephropathy maʻi. Inā maʻamau ke ʻano o kou koko, a laila ʻaʻole ʻoe eʻai ma mua o ka 5 mau grika o ka paʻakai i kēlā me kēia lā. Inā loaʻa iā ʻoe ka hypertension, a laila e kāpae i kāu paʻakai paʻakai i 2-3 pākahi i kēlā me kēia lā.
I kēia manawa ʻo ka mea nui loa. Ua hōʻike ʻia e ka lāʻau lapaʻau i kahi meaʻai "kaukau maikaʻi" no ka maʻi maʻi maʻi, a me ka hoʻohaʻahaʻa i ka haʻahaʻa o ka protein no ka nephropathy maʻi. Manaʻo mākou e noʻonoʻo ʻoe e hoʻohana i kahi meaʻai haʻahaʻa-haʻahaʻa haʻahaʻa e hoʻohaʻahaʻa i kou koko koko i ka maʻamau. Hiki i kēia ke hana i kahi helu filtration glomerular ma luna o 40-60 ml / min / 1.73 m2. Ma loko o ka ʻatikala "Diet no nā pūpū me ka maʻi maʻi," ua hōʻike nui ʻia kēia kumuhana koʻikoʻi.
Hoʻomaʻamaʻa i ka Hepropathy Diabetic
ʻO ke ala nui e pale aku ai a mālama i ka nephropathy diabetes i ka hoʻohaʻahaʻa ʻana i ke kōhi koko, a laila hoʻomau pono ia i ka maʻamau i nā kānaka olakino. I luna, ua aʻo ʻoe pehea e hana ai i kēia me kaʻai haʻahaʻa haʻahaʻa. Inā hoʻonui ʻia ka nui o ka glucose koko o ka mea maʻi a i nā manawa āpau mai kahi kiʻekiʻe a hypoglycemia, a laila liʻiliʻi ka hana a pau.
Nā lāʻau lapaʻau no ka mālama ʻana i ka nephropathy maʻi
No ka kaohi o ka hypertension arterial, me ka hypertension intracranial ma loko o ka pūpū, ka maʻi maʻamau ma mua o ka maʻi maʻamau - ACE inhibitors. ʻAʻole ʻo kēia mau lāʻau i ka hoʻohaʻahaʻa wale ʻana i ke koko, akā mālama pū ʻia hoʻi i nā naʻau a me ka puʻuwai. ʻO kā lākou hoʻohana e hoʻemi i ka pilikia o ka hiki ʻole o ka renal terminal. ʻOi paha, hana maikaʻi nā pale inhibitions ACE maikaʻi i ka captopril, a lawe ʻia iā 3-4 mau manawa i ka lā.
Inā kūkulu ka mea maʻi i kahi pāʻai maloʻo ma muli o ka lawe ʻana i ka lāʻau lapaʻau mai ka pūʻulu o nā mea hoʻopaʻa iki o ACE, a laila loli ʻia ka lāʻau lapaʻau me kahi mea hoʻonaninani receptor-II. ʻOi aku ka lāʻau ma kēia pūʻulu i ʻoi aku ka ʻoi aku ma mua o ka mea hoʻokele ACE, akā ʻoi aku ka liʻiliʻi ma nā hopena hopena. Mālama lākou i nā ʻeha a me ka puʻuwai e pili ana i ka like like.
ʻO ka pae ʻai koko pae koʻikoʻi no nā poʻe maʻi me ka maʻi diabetes is 130/80 a i lalo. ʻO ka maʻamau, i nā maʻi me ka maʻi type 2, hiki ke loaʻa i ka hui pū ʻana me nā lāʻau lapaʻau. Hiki ia i ka inhibitor ACE a me nā lāʻau lapaʻau "mai ke kaomi" o nā hui ʻē aʻe: diuretics, beta-blockers, antagonist calcium. ʻAʻohe ʻāpono ʻia nā ACE inhibitors a me angiotensin receptor blockers paʻa. Hiki iā ʻoe ke heluhelu e pili ana i nā lāʻau hoʻohui no hypertension, i ʻōlelo ʻia no ka hoʻohana ʻana i ka maʻi diabetes, ʻaneʻi. ʻO ka hoʻoholo hope loa, nā papa e kuhikuhi ai, e hana ʻia e ke kauka wale nō.
Pehea e pilikia ai ka pilikia o ka palaka ma ka mālama maʻi
Inā hōʻike kahi mea maʻi i ka nephropathy maʻi, a laila ua loli nui ke ʻano o ka mālama ʻana i ka maʻi diabetes. No ka mea pono ke hōʻemi ʻia i nā lāʻau he nui a hōʻemi ʻia kā lākou dosage. Inā hoʻemi nui ka nui o ka filtration glomerular, a laila e hoʻemi ʻia ka nui o nā insulin, no ka mea, ua hoʻomāhuahua nā maʻi palupalu.
E nānā, ʻo ka lāʻau lapaʻau kaulana no ka metformin diabetes type 2 (siofor, glucophage) hiki ke hoʻohana wale i nā kumukūʻai filomation glomerular ma luna o 60 ml / min / 1.73 m2. Inā nāwaliwali ka hana o kaʻeha o ka mea maʻi, a laila he hopena weliweli loa ka hopena o ka lactic acidosis. I kēlā mau kūlana, pau ka metformin.
Inā hōʻike nā mea noiʻi a ka mea maʻi i hōʻike i ka anemia, a laila pono e mālama ʻia, a e hoʻolohi kēia i ka hoʻomohala ʻana i ka maʻi nephropathy maʻi. Ua kuhikuhi ʻia ka mea maʻi i nā lāʻau lapaʻau e hoʻoulu ai i ka erythropoiesis, i.e., ka hana ʻana o nā ʻāpana koko ʻulaʻula i loko o ka ʻōpū o ka iwi. ʻAʻole kēia e hoʻemi wale i ka hopena o ka hikiʻole o ka pūpū, akā hoʻomaikaʻi pinepine ʻia ka maikaʻi o ke ola ma ka laulā. Inā hele ʻole ka maʻi maʻa ma ka dialysis, kuhikuhi ʻia nā mea hoʻohui lāʻau.
Inā ʻaʻole kōkua ka prophylactic lapaʻau i ka nephropathy diabetes, a laila kūkulu nā pūpū o ke akepaʻa. I kēia kūlana, pono i ka mea maʻi ke hoʻomālamalama i ka dialysis, a inā hiki, a laila e hana i kahi maʻi kidney. Ua loaʻa iā mākou kahi ʻokoʻa i ka holi o nā keiki, a e pōkole mākou e pōkole i ka hemodialysis a me ka dialysis peritoneal ma lalo iho.
Hemodialysis a me nā dialy peritoneal
I ka wā o ka kaʻina hemodialysis, hoʻokomo ʻia kahi catheter i loko o ka arteres ka mea maʻi. Ua pili pū ʻia me kahi ʻaoʻao kānana o waho e hoʻomaʻemaʻe i ke koko ma mua o nā aʻala. Ma hope o ka hoʻomaʻemaʻe, hoʻouna ʻia ke koko i ka kahe koko o ka mea maʻi. Hiki i nā Hemodialysis ke hana wale i kahi hoʻonohonoho haukapila. Hiki ke hana i kahi hāʻule o ke koko a i ʻole ka ʻeha.
ʻO ka dialisis peritoneal kahi i hoʻokomo ʻia ai ka ngongo i loko o ka lāʻau, akā i loko o ka ʻōpū o ka ʻōpū. A laila hānai ʻia ka nui o ka wai i loko o ia mea e ka hana kuʻuna. ʻO kēia ke wai kūleʻa kūikawā e huki wai. Hoʻokuʻu ʻia lākou e like me ka kahe mai ka wai mai ke ana ʻole. Pono ka dialysis peritoneal i kēlā me kēia lā. Lawe ia i ka puʻuwai o ka maʻi ma nā wahi i hoʻokomo ʻia ai ka uha i ka ʻōpū o ka ʻōpū.
Ma ka maʻi mellitus, hoʻomehana ka hū, hoʻopilikia i ka hoʻoliʻi a me ke kaulike electrolyte e hoʻonui i nā kumukūʻai filtration glomerular kiʻekiʻe. ʻO kēia ke ʻano e hoʻohuli ʻia nā maʻi me ka maʻi maʻi i ka dialysis ma mua ma mua o nā poʻe maʻi me nā pathal renal ʻē aʻe. Ke koho nei i ke ʻano ʻo ka dialysis ma mua o nā makemake o ke kauka, akā no ka mea maʻi ʻaʻole ʻokoʻa loa.
I ka manawa e hoʻomaka ai i kahi hoʻololi renal therapy (dialysis a i ʻole hoʻololi o ka kidney) i loko o nā mea maʻi me ka maʻi mellitus.
- Renal glomerular filtration rate <15 ml / min / 1.73 m2;
- ʻO nā pae kiʻekiʻe o ka pāhana i loko o ke koko (> 6.5 mmol / L), ʻaʻole hiki ke hōʻemi ʻia e nā ʻenehana conservative o ka mālama ʻana;
- ʻO ka mālama kino kino i loko o ke kino me ka hopena o ka edema pulmonary;
- ʻO nā ʻike ākea o ka palakino palekana-ikehu.
ʻO nā maka no nā hoʻokolohua koko i nā maʻi me ka maʻi maʻi e mālama ʻia me ka dialysis:
- Hemoglobin Glycated - liʻiliʻi mai ma 8%;
- Hogoglobin koko - 110-120 g / l;
- Ka hānai o ka parathyroid - 150-300 pg / ml;
- Phosporus - 1.13-1.78 mmol / L;
- Ka huina o ka calcium - 2.10-2.37 mmol / l;
- ʻO ka huahana Ca × P = Ke emi mai ka 4.44 mmol2 / l2.
Inā ulu ka lolo i ka maʻi maʻa i nā maʻi maʻi dialy diabetes, ua hoʻonoho ʻia nā stimulies erythropoiesis (epoetin alpha, epoetin beta, methoxypolyethylene glycol epoetin beta, epoetin omega, darbepoetin alpha), a me nā papa hao a i ʻole nā inikini. Ka hoʻāʻo lākou e mālama i ke koko i lalo o 140/90 mm Hg. Art., Ke pale aku ʻana o ka ACE a me nā mea hoʻoneʻe ʻekaʻawa o ka alaensensin-II e waiho nei i nā lāʻau lapaʻau ke koho pono no ka mālama ʻana i ka maʻi hypertension. Heluhelu i ka ʻatikala "Hypertension ma ka Type 1 a me ka Type 2 Diabetes" ma ka kikoʻī hou aku.
ʻO ka hemodialysis a i kēlā me kēia dialysis peritoneal e noʻonoʻo wale ʻia he hana wale nō ma ke ʻano no ka hoʻomākaukau ʻana no ka hiki ʻana i ka kidney. Ma hope o ka luhi ʻana no ka hana ʻana i ka manawa o ka lula e hana ai, hoʻōla ʻia ka mea maʻi i ka hiki ʻole o ka renal ka hana. Ke hoʻomau nei ka nephropathy diabetic, ke hoʻonui nei ka noho o ke ahonui.
Ke hoʻolālā nei i kahi hoʻololi o ka kidney no ka maʻi diabetes, ke hoʻāʻo nei nā kauka e loiloi pehea paha e loaʻa ai i ka mea maʻi ka maʻi cardiovascular (hōʻeha ka naʻau a i ʻole hōʻeha) i ka wā a ma hope o ka ʻoihana. No kēia, ʻike ʻia ka mea maʻi i nā ʻano hoʻokolohua ʻē aʻe, me kahi ECG me ka ukana.
Hoʻomaʻo pinepine nā hualoaʻa o kēia mau hoʻokolohua e ʻike ʻia nā moku e hānai ana i ka naʻau a / a i ʻole nā ʻuhane a pili ʻia i ka atherosclerosis. E nānā i ka ʻatikala "Renal Artery Stenosis" no nā kikoʻī. I kēia hihia, ma mua o ka hiki ʻana o ka hoʻololi ʻana i ka pōpoki, ua ʻōlelo ʻia e hoʻihoʻi hou i ka maʻi o nā moku.
