Wahi a nā helu honua, i kēia lā e pili ana i ka 8.5% o ka lehulehu ka maʻi i ka maʻi diabetes.
ʻO ka nui o nā poʻe e predisposed i ka maʻi diabetes a i ʻole me kahi maʻi maʻi undiagnosed he nui ka nui. A ke hoʻomau nei kēia mau helu.
Eia naʻe, ke hoʻonui nei ka paʻakikī o nā hoʻopiʻi i ka maʻi diabetes, ʻo ia ke kumu o ka pilikia a me ka make ma mua o nā maʻi. ʻO kekahi o nā hōʻike koʻikoʻi nui loa ka maʻi glomerulosclerosis, kahi mea hoʻoweliweli i ka ola.
ʻO ka maʻi glomerulosclerosis maʻi a me glomerulopathy: he aha ia?
ʻO ka maʻi maʻi maʻi palaka uhi ʻia kēlā mau loli pathological he nui i loaʻa i ka vascular origin (microangiopathy) a loaʻa i kahi kikoʻī no ka maʻi maʻi (metabolism impaired i loko o nā lau o nā pūlima).
Ke noʻonoʻo nei ʻaʻole i nā mea hoʻonani glomerular wale nō, akā hoʻopilikia wale ʻia nā hale hoʻohuli ʻē aʻe, ua inoa ʻia ka inoa - nephropathy diabetic.
Me nā maʻi diabetes e hilinaʻi ʻia ana, ʻoi aku ka nui o nā maʻi āpau ma mua o ka maʻi like ʻole o ka insulin (30% a 20%). ʻO ka hoʻomohala ʻana o ka glomerulosclerosis e pili pū me nā hōʻailona iki o ka maʻi mellitus maʻi diabetes. Hōʻaia nā hōʻailona hōʻailona o ka maʻi (proteinuria, hypertension) ma ke ʻano he kānāwai, ma hope o 15 mau makahiki mai kona neʻe ʻana.
Akā ʻo nā loli mua - he piʻi nui o ke kaomi i ka glomeruli a me ka hoʻonui ʻana o ka huina filtration glomerular e hele kokoke i ka manawa like me ka maʻi maʻi. ʻO ka nalowale o ka albumin (microalbuminuria) e hoʻomaka i ka hala ma hope o 5 mau makahiki, akā paʻa mau ia i nā hoʻokolohua maʻamau.
Ka hana i hoʻomohala ʻia (proteinuria, paʻakikī, paʻa i ka hana filomation glomerular gla) i ʻike ʻia ma hope o 5 mau makahiki hou. Kūkulu ʻia ʻo Uremia ma hope o 5 mau makahiki mai ka hoʻomau ʻana i ka nalowale ʻana o ka protein huna.
ʻO nā kumu kumu no ka hoʻomohala ʻana i nā pathology
I ka hoʻomehana maʻi, ʻo ka etiopathogenesis o ka pōʻino o ka pōʻino e hui pū ʻia me ʻelua mau kaola a me nā mea holo a ʻelua.
- nā pono kīkē (hoʻololi);
- nā haunaele hemodynamic.
Hoʻemi ʻia ka paukū, ka mea mua loa, i hoʻonui i ka glycosylation o nā huahana hope ma muli o ka nele o ka insulin.
ʻO ia ka mea, he nui ka hoʻohui ʻana o ke kō i nā molekala, e hoʻolōʻihi ana iā lākou a me nā deform. Ke alakaʻi nei kēia i kahi e hoʻonui i ka membrane nui o nā capillaries o ka glomerular a me ka hoʻonui i ka pae intervascular (mesangial matrix).
Hoʻopilikia ka mea hemodynamic i ka hoʻonui ʻana i ka hoʻonuiʻana filtration glomerular a me ka hoʻolaha o kona wahi, kahi mea e kū ana i ka pane o ka hypoxia kiko.
A ke hopena, hoʻonui ʻia ke kaomi i loko o nā capillaries o ka mana o ka glomeruli, e hoʻoiho ai i ka glomerular hypertrophy. Hoʻonui ka hanalela maʻi vascular i ka komo ʻana o nā protein pathological, lipids a me nā molekue hou i loko o ka mesangium matrix.
Nui nō hoʻi nā ʻano hypotheses e ʻimi e wehewehe i ka pathogenesis o kaʻeha o ka maʻi ma ka maʻi maʻi:
- immunological, e wehewehe ana i ka hōʻeha o nā angiopathies e ka neʻe ʻana o nā mea hōʻeha kino i hiki ke hōʻino i nā kahe koko;
- neuroendocrine, e hoʻopili ai i ka angathyathy me ka hoʻonui ʻana i nā hormones o nā kohu adrenal, hypothalamus, adenohypophysis;
- ka genetic, ka pilina o nā maʻi metabolic i ka maʻi diabetes me ka neʻe ʻana o kekahi mau loci i nā ʻano gena.
Nā maʻi maʻi ma ka maʻi maʻi
Hāʻawi ʻia nā pōʻino i ka maʻi diabetes i ka nānā ʻana ma muli o ka hoʻomohala lōʻihi ʻana o nā loli, ka makemake i ke kala ʻole, a me ka ʻole o nā hōʻike o waho.
Mālama ʻia ka maʻi ma ke ʻano o nā hōʻike kikoʻī.
- hypoproteinemia;
- albuminuria;
- ʻano momona hypertension (ma ka pae mua);
- retinopathy
- hawewe kūpono.
ʻO kahi hōʻailona nui o ka hōʻino o ka maʻi hakahaka o ka maʻi retinopathy, ka mea i ʻike ʻia ma ka 90% o ka hilinaʻi i ka insulin a me 60% o nā mea maʻi ole-insulin.
ʻO nā loli i loko o ka waihona kālā he ʻano maʻamau (microaneurysms, exudative spot around the vessel, macula, hemorrhages in the form of redots in the retina) that diabetic glomerulopathy is most suspect to suspect.
Ua mahele ʻia ke ʻano o ke kūkulu ʻana o ka maʻi.
- ka hoʻomaka (me nā mea hōʻike liʻiliʻi);
- transient (me ka ʻike maka proteinuria);
- ka hope (me ka maikaʻi ʻole o ka hana).
Me nā nephropathy maʻi maʻi lolo, ʻike ʻia nā ʻano like ʻole e hoʻohālikelike ai i ka maʻi diabetes.
Ma nā hihia koʻikoʻi, ʻo ka alakaʻi koʻikoʻi i ke kiʻi o ka maʻi ka maʻi mōʻala, a ke waiho nei nā luhi o nā maʻi maʻi maʻi i ka kua.
Aia paha ke ʻike ʻia ka hoʻomaikaʻi ʻana i nā maʻi maʻi maʻi (hoʻemi ʻia ka glucose i loko o ka urine a me ke koko, e hoʻemi ʻia ka pono o ka insulin). ʻO ka holomua o ka nephropathy hiki i nā maʻi nephrotic, pono ka hopena i ka maʻi ʻokoʻa me ka glomerulonephritis a me nā ʻōnaehana renal a me nā ʻōnaehana.
Nā Kūlā Kūʻai
ʻAʻole hiki ke ʻike i nā hōʻailona mua i nā loli o ka maʻi hakahaka ma o nā ʻano lāʻau lapaʻau maʻamau. He mea nui ka pono no ka maʻi ʻaila, ʻoiai ke ʻike pono i ka manawa hiki iā ʻoe ke hoʻomaka i ka lapaʻau a pale i ka hoʻomohala ʻana o ka maʻi.
Ma mua o ka puka ʻana o nā hōʻailona lapaʻau o ka glomerulopathy, ʻo ia hoʻi nā ʻano hana no ka nānā ʻana i nā patology:
- ka hopena o ka kānana glomerular (e hoʻēmi ana i nā mahina mua o ka maʻi);
- ka hoʻoholo ʻana i ka ʻenehana magnesium (kahi e hoʻokaʻawale ʻia ke ala ʻana);
- aʻoi ʻo radionuclide;
- ka hoʻomalu o ka albumin me ka mea hana i loko o ka pihi o ka wana kakahiaka (ua ʻike ʻia ka nalowale o ka albumin).
ʻO ka pono o kahi biopsy mua e ʻike i kahi lesion kūikawā i loko o nā moku ʻauhi. Ua lawe ʻia kahi ʻāpana ma kahi no ka mōʻaukala.
ʻO ka hoʻonui ʻana ma lalo o kahi microscope e hōʻike ana i ka nunui o ke membement basement o nā capomaries glomeruli i nā makahiki mua o 1-2 mai ka hoʻomaka ʻana i ka maʻi maʻi. Ua hōʻike ʻia nā pathology hou aʻe i ka hoʻonui ʻia o ka mānoanoa o nā pono o ka ukana, ka nalowale o ka mesangium.
Hōʻike ʻia nā hoʻololi o ka makahiki Moronae e 4 mau ʻano:
- ʻolio:
- māhule;
- exudative;
- huiia.
ʻO Nodular ka mea maʻamau. Hōʻike ʻia ia e ka hoʻokumu ʻana o nā nodules poepoe i loaʻa ke kiʻekiʻe molopolysaccharides kiʻekiʻe, a me nā mea momona momona.
Hoʻopiha lākou i kekahi mahele a i ʻole ka glomerulus holoʻokoʻa, e hoʻopiʻi ana i nā loiloi capillary. ʻIke ʻia ka aneurysms i loko o nā moku, paʻapū ka membrane nui.
Me kahi ʻano pālahalaha, kahi loli homogeneous ma ke ʻano intervascular e hele me ka hoʻokumu ʻia o nā hanana like ʻole me ka membrane i loko. ʻO nā membal basal o nā moku e hoʻonui ai i ka mānoanoa. Hoʻokuʻu ʻia ka hoʻouluulu ʻana o ka leo vascular glomerular.
ʻO ke kiʻi exudative pinepine pinepine me nā kūlana koʻikoʻi, wikiwiki ka holomua. ʻO nā "fibrinoid caps" ma waena o ka endothelium a me ka membrane capillary kumu nui, i hōʻike ʻia ma ka micropreparation, nona nā hoʻohui me ka hoʻohui ʻana i nā immunoglobulins (antigen-antibody complex), ʻaʻole ia i kikoʻī no ka maʻi maʻi. E ʻike ʻia nā “Capsule droplets” i loko o ke kaekeke Bowman.
ʻO ka hui pū ʻana o nā nodules me kahi loli kūlike i ka layer mesangial he ʻano hiʻohiʻona o kahi ʻano kāwili. ʻIke ʻia nā membran lau o ka capillary i nā ʻano morphological a pau. ʻO ka ulu ʻana o nā loli morphological e alakaʻi i ke manawa ma kahi o kahi puʻupuʻu puʻu.
Ua hōʻike ʻia kahi hoʻololi o ka anatomy nephropathy maʻi i ka wehewehe o ka macrodrug:
- ʻokiʻoki ka nui o ka pūpū;
- ma muli o ka hiki i ka hoʻopili ʻana o ka kiko, ua hoʻonui ʻia ke kumu;
- piliki cortical layer;
- ke helehelena maikaʻi ka maka.
Hiki i nā hoʻopiʻi ka hopena o ka nephropathy diabetes
ʻO nā hoʻololi o nā puʻuwai me ka maʻi diabetes ka kumu maʻamau loa o ka make i nā mea maʻi. Hiki i nā hōʻeha ke nephropathy ma waena o nā makahiki mua a ma hope o ka manawa nui.
ʻO nā ʻōpiopio ka:
- anemia
- ka ulu ʻana o ka hoʻoikaika;
- loli;
- ka hoʻomohala ʻana o nā puʻuwai naʻau a me nā hōʻeha.
Me ka hoʻomohala ʻana o ka proteinuria mau loa, he hopena ʻole ka hopena o ka maʻi. ʻO ka hoʻolālāʻana o ka hana hāpau i alakaʻi i ka uremia me ka make kiʻekiʻe.
Nā lāʻau lapaʻau
ʻO ka mālama ʻana, ʻo ka mea mua, pono e kuhikuhi i ka hoʻoponopono ʻana i nā maʻi ma lalo.
ʻO nā mea kumu o ke kuʻuna no ka nephropathy penei:
- kahi papa me kahiʻuʻuku haʻahaʻa o nā kāloli māmā, me ka hoʻohaʻahaʻa o nā kānana kānana - ka nui o ka protein;
- ke kaua aku i ka anemia;
- ka hoʻōho maʻamau a ka hoʻohana ʻana i nā lāʻau lapaʻau (ACE inhibitors);
- hana maʻamau o ka lipid metabolism;
- nā angioprotectors;
- me ka hoʻomohala ʻana o nā hōʻailona o ka pilikia o ka renal - ka hoʻololi ʻana i ka insulin;
- me nā hōʻailona o ka uremia - hemodialysis.
ʻO ka wānana a me ke kālai
Nā hōʻailona nui no ka kūkulu ʻana i kahi wanana nā:
- ka pae pae albuminuria-proteinuria;
- he pili koko
- hoʻomehana maʻi maʻi.
ʻO ka ʻike ʻana i ka microalbuminuria a me proteinuria me ka holomua i hiki mai, e hiki iā mākou ke nānā i ke kiʻekiʻe o ka hopena o ka hopena hōʻeha.
Hōʻalo ʻia ka pale ʻana o ka nephropathy i nā ʻano aʻe:
- huki a me nā pulima;
- hakakā me ke kaumaha nui;
- inu ʻoki;
- hana kino kino;
- kāohi ʻia e nā poʻe akamai.
Nā wikiō pili
Nā kikoʻī e pili ana i ka nephropathy maʻi i ka wikiō:
