Ọrịa mamịrị nephropathy: atụmatụ nke ọrịa na usoro ọgwụgwọ na-abịaru nso

Nkọwa nke "ọrịa mamịrị nephropathy" bụ echiche mkpokọta nke jikọtara ọrịa dị iche iche na-ebute mmerụ akwara na akụrụ megide nzụlite ọrịa shuga mellitus.

A na-ejikarị okwu ahụ bụ "Kimmelstil-Wilson syndrome" maka ọrịa a, n'ihi na a na-eji echiche nke nephropathy na glomerulosclerosis dịka otu.

Maka ICD 10, a na-eji koodu 2 maka ọrịa nephropathy mamịrị. Yabụ, koodu nephropathy nke ọrịa mamịrị dịka ICD 10 nwere ike inwe ma ọ bụrụ na E.10-14.2 (ọrịa shuga nwere mmerụ akụrụ) yana N08.3 (ọnya na-arịa ọrịa shuga). Ọtụtụ mgbe, a na-ahụkarị ọrụ ezumike n’akụkụ insulin na-adabere, ụdị nke mbụ - 40-50%, na ụdị nke abụọ ka ịgbasa nephropathy bụ 15-30%.

Ihe kpatara mmepe

Ndị dọkịta nwere echiche atọ bụ́ isi banyere ihe na-akpata nephropathy:

mgbanwe. Ihe ebum n’uche n’echiche bụ na eburu oke ọrụ mbibi ahụ ka ọ bụ n’ọbara glucose dị n’ọbara, n’ihi na ọbara ọbara akwara na-agbagha, a na-etinyekwa abụba n’ime arịa, nke na-eduga na nephropathy,
mkpụrụ ndụ ihe nketa. Nke ahụ bụ, ọrịa ga - ekesa ọrịa ahụ. Ebumnuche nke echiche a bụ na ọ bụ usoro mkpụrụ ndụ ihe nketa na-akpata ọrịa dị ka ọrịa shuga na ọrịa nephropathy na ụmụaka.
hemodynamic. Ozizi ahụ bụ na na ọrịa shuga enwere mmebi nke hemodynamics, ya bụ, mgbasa ọbara na akụrụ, nke na-ebute mmụba na ọkwa nke albumin na mmamịrị - protein na-emebi arịa ọbara, mmebi nke ọ na-egbu (sclerosis).

Na mgbakwunye, ihe kpatara mmepe nke nephropathy dịka ICD 10 na-agụnyekarị:

ise siga
ọbara mgbali elu
ọbara mgbali elu
ogbenye triglycerides na cholesterol
anaemia

Ọtụtụ mgbe, a na-achọpụta ọrịa ndị na-esonụ na ìgwè nephropathy:

ọrịa shuga glomerulosclerosis,
gbasara akwara akwara atherosclerosis,
gbasara akwara nke obere akwara,
abụba na-abanye n'ọwa akụrụ,
pyelonephritis.

Nke mbu, okwesiri ikwu na oria mamiri nwere ike imebi akwara nke onye ọrịa rue oge di anya, onye ọrịa agaghị enwe mmetuta ojoo obula.

Ọtụtụ mgbe, a na-ahụ ihe mgbaàmà nke ọrịa mamịrị nephropathy ugbua n'oge nsogbu akwara malitere.

N'oge usoro a kara aka, ndị ọrịa nwere ike ịnwe mmụba n'ọbara, proteinuria, yana mmụba nwatakịrị 15-25%. Na ọkwa dị elu, ndị ọrịa na-enwe ọrịa diphtic nephrotic syndrome, ọbara mgbali elu, na mbelata ọnụego filtration glomerular. Akara nke agba - ọrịa akụrụ na - adịghị ala ala - bụ nke ọnụnọ nke azotemia, osteodystrophy nke akwara, ọbara mgbali elu na ọnụnọ nke edematous syndrome.

Na ọkwa niile nke ọrịa, a na-achọpụta neuropathy, hypertrophy ventricular left, retinopathy na angiopathy.

Kedu ka esi achọpụta ya?

Iji chọpụta nephropathy, a na-eji akụkọ ihe mere eme nke onye ọrịa na nyocha ụlọ nyocha. Mainzọ kachasị na usoro ahụ bụ ịchọpụta ọkwa nke albumin na mmamịrị.

Enwere ike iji usoro ndị a iji chọpụta ọrịa mamịrị nephropathy dị ka ICD 10:

mkpebi siri ike nke GFR site na iji ule Reberg.
biopsy.
Dopplerography nke akụrụ na arịa arịa (ultrasound).

Na mgbakwunye, ophthalmoscopy ga - enyere aka ikpebi ọdịdị na ogbo nke retinopathy, na electrocardiogram ga - enyere aka ịchọpụta hypertrophy nke aka ekpe.

Ọrịa shuga na-atụ egwu ọgwụgwọ a, dị ka ọkụ!

Naanị ịchọrọ itinye ...

N'ime ọgwụgwọ ọrịa akụrụ, ọnọdụ kachasị bụ ọgwụgwọ mmado nke ọrịa shuga. A na-arụ ọrụ dị mkpa site na nhazi nke metabolism lipid na mmezi nke ọbara mgbali. A na-agwọ Nephropathy na ọgwụ na-echebe akụrụ na ala ọbara mgbali elu.

Ihe atụ nke ihe oriri nwere carbohydrates dị mfe

Otu n'ime ụzọ ịgwọ ọrịa bụ nri. Nri maka nephropathy kwesiri ibu oke oriri nke carbohydrates di nfe ma nwee otutu protein achọrọ.

Mgbe ị na-eri nri, ọnye mmiri anaghị amachọ ya; ọzọkwa, mmiri mmiri ahụ kwesiri ịnwe potassium (dịka ọmụmaatụ, mmiri ọweetụweetụ). Ọ bụrụ na onye ọrịa ebelatala GFR, nri nwere protein dị ala, mana n'otu oge ahụ nwere ọtụtụ calorie achọrọ. Ọ bụrụ na jikọtara nephropathy onye ọrịa na ọbara mgbali elu, a na-atụ aro nri nwere nnu dị obere.

Palliative gbasara akwara ọgwụgwọ

Ọ bụrụ na onye ọrịa ahụ na-agbadata etu esi agbaze ụwa dị ka ihe na-egosi na mmiri dị n'okpuru 15 mil / min / m2, dibịa na-aga elekere na-ekpebi ịmalite usoro nnọchi, nke enwere ike ịnọchite anya hemodialysis, ọgwụ mgbapụta ma ọ bụ ntụgharị.

Ihe di omimi banyere ihe banyere akwara bu osachapu obara site na iji “ngwaa akuru”. Ekwesịrị ịme usoro ahụ ugboro atọ n'izu, ihe dịka awa 4.

Mgbatị akwara azụ na-agụnye ịsacha ọbara site na peritoneum. Kwa ubochi, ugboro ugboro 3-5 onye ọrịa ka a na-eji ọgwụ oji akara n’ime akpịrị nwa. N'adịghị ka usoro akụrụngwa dị n'elu, a nwere ike ịme mgbapụta ụlọ n'ụlọ.

Ọkpụkpụ akụrụ na inye onyinye bụ usoro dị oke njọ iji luso ọgụ nephropathy. N'okwu a, onye ọrịa ahụ kwesịrị ị medicationsụ ọgwụ ndị na-egbochi usoro ahụ ji alụso ọrịa ọgụ iji gbochie mgbochi ntụgharị.

Threezọ atọ iji gbochie

Thezọ kachasị ntụkwasị obi iji gbochie mmepe nke nephropathy bụ ụgwọ a na-anabata maka ọrịa shuga:

Ihe mgbochi bụ mgbochi nke microalbuminuria. Isi ihe maka mmepe nke microalbuminuria bụ: oge afọ nke ọrịa shuga site na afọ 1 ruo afọ 5, ihe nketa, ise anwụrụ, retinopathy, hyperlipidemia, na enweghị ebe obibi na-arụ ọrụ na ya,
Ihe mgbochi nke abụọ gụnyere imebi mmepe nke ọrịa ahụ na ndị ọrịa nwetụrụla GFR ma ọ bụ ọkwa albumin na mmamịrị dị elu karịa ka ọ dị. Usoro a bụ mgbochi: nri nwere protein dị ala, njikwa ọbara mgbali elu, mmezi nke profaịlụ lipid n'ọbara, njikwa glycemia na nhazi nke ọbara ịba ọcha n'anya.
A na - egbochi mgbochi na ngalaba nke proteinuria. Ebumnuche ebumnuche dị na mbido ahụ bụ iwelata ihe ize ndụ nke ọganihu nke akụrụngwa na-akpata nnukwu nsogbu, nke, n'aka nke ya, ọbara mgbali elu, akwụghị ụgwọ maka metabolism metabolism, protein na-adịghị ala ala na hyperlipidemia.

Vidiyo ndị metụtara

N'elu ihe ndị na-akpata na ọgwụgwọ nke nephropathy na ọrịa shuga na TV show "Bie ahụike!" Na Elena Malysheva:

N'agbanyeghi eziokwu na n'etiti nsogbu ojoo niile nke ọrịa shuga mellitus, nephropathy bụ otu n'ime ebe ndị a na - eduga, iji nlezianya debe ihe mgbochi na njikọta na nyocha oge kwesịrị ekwesị ga - enyere aka kwụsịtụ mmepe nke ọrịa a.

Ederede nke ọrụ sayensị na isiokwu ya "Ọrịa mamịrị nephropathy: usoro ọgwụgwọ ọhụụ dị nso maka ọgwụgwọ"

UDC 616.61 -08-02: 616.379-008.64.001

DIABETIC NEPHROPATHY: MODSERR AP ỌGW TOGW TO TOM TAKA

Ngalaba Propaedeutics nke ciki, St. Petersburg State Medical University Acad. I.P. Pavlova, Russia

Okwu gbara ọkpụrụkpụ: mellitus ọrịa shuga, nephropathy na-arịa ọrịa shuga, ọgwụgwọ.

Ọrịa mamịrị nepropathy (DN) bụ ugbu a bụ ihe kachasị na-ebute mmepe nke ọdịda ọdịda renal ọdịda (PN). Mmụba nke ọnụ ọgụgụ ndị ọrịa ụdị a dị egwu - na 1984, nke ndị ọrịa ọhụrụ chọrọ ọgwụgwọ nnọchi ezigharị, 11% na Europe na 27% na USA bụ ndị nwere DN, na 1993 ọnụọgụ ndị a 17% na 36%, karị 46 , 47. Mmụba nke ihe kpatara nkụda obi na ogbo nke ọrịa akwara na-adịghị ala ala jikọtara ya na mmụba ugboro ugboro nke ọrịa shuga mellitus (DM) n'onwe ya, ọkachasị n'ụdị nke II n'ihi oke ịba ụba nke ọha mmadụ na mbelata ọnụ ọgụgụ nke nsogbu ọrịa obi. Dịka ọmụmaatụ, enwere ike ịkọtara ọnụ ọgụgụ ndị a: site na 1980 ruo 1992, ọnụ ọgụgụ ndị ọrịa ọhụụ na-arịa ọrịa shuga na PN mgbe afọ 25 ruo 44 mụbara ugboro abụọ, n'otu oge ahụ, ọnụ ọgụgụ ndị ọrịa nwere afọ 65 gbagoro ugboro 10. Ebe ọ bụ na nkezi oge dị n'etiti nchoputa nke ọrịa shuga na mmepe nke proteinuria na-adịgide adịgide bụ ihe dị ka afọ 20, ọnụ ọgụgụ ndị a dị n'elu na-egosi na n'ime afọ 10 ruo 15, ebili mmiri nke ndị ọrịa shuga chọrọ ọgwụgwọ nnọchi ezigharị - usoro akwara, ịtụgharị akụrụ - na nsonaazụ niile, nwere ike imeri Europe. n'ihi ya nsonaazụ akụ na ụba na ọgwụ. Ọzọkwa, lanarị ọrịa nke ndị ọrịa na-arịa ọrịa shuga na usoro ọgwụgwọ ndị a dị obere karịa na ọrịa ndị ọzọ gbasara akụrụ, ọkachasị n'ihi ọgbụgba akwara ọbara 20,23. Ihe omuma a di elu nke oria a emeela ka ihe di iche na oganihu na nlebara anya nke DN

ugbu a bụ ihe nlebara anya sitere n'aka ndị ọkà mmụta ọrịa gburugburu ụwa.

Usoro ọgwụgwọ iji gbochie ma mee ka ọ ghara ịdị na-aga n'ihu nke DN dabere n'echiche ọhụụ banyere usoro pathogenetic dị iche iche nke ọrịa, n'etiti ndị na-ezughị oke nchịkwa glycosylation, mgbali elu hyperension-hyperfiltration megide ndabere nke mmụba ọbara mgbali elu na mmegharị nke sistemụ sistemụ akụrụ. .

Njikwa glycemic

Nchịkwa zuru oke nke ọbara glucose na ọrịa shuga, yana akara ya, mmụba nke ọbara mgbatị glycosylated, nwere njikọ chiri anya na mmepe nke microansopathies n'ụdị m na ụdị shuga II na, karịsịa, na mmalite nke mmalite nke DN. Usoro ogwu nke hyperglycemia na-agbagha site n'ọtụtụ usoro, gụnyere ịba ụba nke ngwaahịa na-abụghị enzymatic glycosylation, mejupụtara myoinositol metabolism, mụbara de novo syntheis nke diacylglycerol na mmegharị nke protein kinase C, yana mgbanwe nke homonụ na ihe ndị na-eto eto, ọkachasị, egwuregwu na-agbanwe mgbanwe (PG nke ọrụ dị mkpa na mmepe nke hypertrophy glomerular 22, 52. Agbanyeghị, egosiputara na njikwa glycemic siri ike, site na ya onwe ya, na -ebelata ọnụego nke ntolite nke ezughi oke gbasara akụrụ. atochnosti na ọrịa na-arịa ọrịa shuga pịnye m na proteinuria. Agbanyeghị, ọ dị ka ọ bụrụ na-eleba anya n'ọrịa shuga bidoro tupu mmepe nsogbu nke akụrụ, yabụ nke a nwere ike igbochi mmepe ha n'ọdịniihu. Yabụ, ọmụmụ DCCT gosipụtara

mbelata nke ugboro ole ọ bụghị naanị proteinuria na PN megide ndabere nke ọgwụgwọ kpụ ọkụ n'ọnụ hyperglycemia, kamakwa mbelata nke ukwuu na microalbuminuria, akara nke mmalite nke DN. Mbelata ihe ọghọm nke nkụda obi sitere na 40% ruo 60%. Ileba anya na glycemia na-eduga na mmụba na mbelata nke ịba ụba na mbụ, yana gbochiekwa ịpụta mgbanwe mgbanwe nke akụrụngwa na akụrụ. Ya mere, ịchịkwa ọkwa nke glycemia site na mmalite nke ọrịa shuga dị oke mkpa iji gbochie mmepe nke nsogbu ndị gbasara akpịrị.

Uru nke ngwaahịa bara ụba

glycosylation na mgbazi ha

N'ụzọ doro anya, mmetụta hyperglycemia na akụrụ bụ n'ụzọ dị ukwuu na ngwaahịa nke ụba glycosylation protein (BCP). Egosiputara ya na ngwaahịa nke ọgwụ ike nke enzymatic na - egbochi na glucose na - agbakọ na anụ ahụ nke ndị ọrịa nwere ọrịa shuga, na - emebi ihe owuwu nke matriks extracellular, na - ebute oke ngụgụ nke okpuru ulo na mmụba nke obere lipoprbgeids na immunoglobulin c. Na mgbakwunye, PPG na-ebute ọtụtụ mgbanwe nke mkpụrụ ndụ na-eduga na nsị akwara, mmụba nke mmepụta matriks extracellular, yana glomerulosclerosis. Mgbanwe na arụ ọrụ nke mkpụrụ ndụ PPG na-agbagha site na mgbakwunye nnabata nke dị n’elu ala ha. Achọpụtala ya na ụdị sel dị iche iche - prieloid, lymphoid, monocyte-macrophage, endothelial, muscular soft, fibroblasts, i.e. n'ahụ sel ndị metụtara aka na mmepe nke ọrịa gbasara akwara. Ihe mgbakwunye nke PPG na ọdịbendị nke sel sel mesangial na-eduga na mmụba na mRNA na mmụba nke mmepụta fibronectin, ụdị collagen laminin IV na isi uto platelet (ROOP), isi ihe na glomerulosclerosis 14, 47.

Egosiputara ebumnuche nke BCP n'ihe omume na ntopute nke DN na-egosipụta site na nchịkwa ụmụ anụmanụ na-enweghị ihe ịrịba ama nke ọrịa shuga. Na-emegide usoro iji PPG ruo ogologo oge, eserese morphological na akara ụlọ ọgwụ nke DN na-etolite. N'otu oge

nchịkwa nke aminoguanidine, ọgwụ na-ebelata nguzobe nke BCPs, ma ọ bụ nchịkwa nke ọgwụ mgbochi monoclonal na glycosylated albumin na-ebelata ogo mgbanwe mgbanwe ọrịa 15, 47. Ọnwụnwa nke ọgwụ aminoguanidine na ndị ọrịa emechabeghị. Ugbu a, a na-eme usoro nke atọ nke ụdị maka ọrịa shuga m na DN na ogbo nke proteinuria, nke ga-egosi ma ọ̀ ga-agbasa ma ọrịa ahụ ga-agbada site na iji amino1uanidine n'ime mmadụ.

Uru nke ọbara ọgbụgba dị elu / hyperfiltration na ọganihu nke DN na ụzọ ndị bụ isi nke mgbazi ya

Na 80s, e gosipụtara mmekọrịta chiri anya, nke ahụ yiri nke metụtara mmụba nke ọbara ọgbụgba ọbara na mgbanwe nhazi nke arterioles, mana maka mmetụta ọbara mgbali elu dịpụrụ adịpụ na hyperfiltration na proliferation, mbibi endothelial, microccrombosis capillary, na glomerulosclerosis 49, 50. Isi ihe nke nsogbu nke intracubular hemodynamics bụ afferent arteriole n'ihi arụmọrụ autoregulation na spasm nke efferent arteriole megidere ndabere nke ịbawanyewanye na ndị ọrụ mgbasa ozi - angiotens na, - noradrenaline, vasopressin, 3, 5, bụ nke na-eduga na ụba intra-glomerular nsogbu. Mmetụta arụmọrụ dị na mgbidi nke glomerular capillary na-eme ka mmụba na njikọ nke ụdị I na IV nke collagen, laminin, fibronectin, na TCR- (3, nke, n'ikpeazụ, ọ na-eduga na mmụba nke matrix extracellular, na mgbe ahụ gaa na glomerulosclerosis 16, 28.) na mmepe nke usoro ọbara mgbali intracubic hyperfiltration, o doro anya, ihe ndị a dị mkpa: sistemu ọbara mgbali elu (site na ịba ụba n'ọnụ ụzọ nke glomerulus), ịgbalite usoro nke renal-renin-angiotensin na mmepe nke spasm nke efferent arteriole, hypergly Kemia na ngafe protein.

Nchịkwa mgbochi na nri

Afọ iri atọ ahụmihe eji nri nke nwere obere protein na-egosi nsonaazụ bara uru ọ na-ebelata ọganihu nke ọrịa akụrụ, gụnyere

na NAM. O di nwute, otu n’ime ihe omumu kasịnụ banyere mmetụta nri nwere protein dị ala na mbelata nke PN (M01J) agunyeghi ndị ọrịa nwere ọria mamịrị na DM. Agbanyeghị, na ọrụ mechara, enwere mmetụta dị mma nke igbochi oriri protein na ọnụego mbelata ọrụ ezumike na ndị ọrịa nwere DN na ụdị ọrịa shuga na PN gosipụtara. Nri protein kwa ubochi n’ime ihe omumu a bu 0.6 g / kg. Ọ dị mkpa ịmara na mmachi ụdị mgbochi nke protein ahụ ogologo oge (ruo afọ 5) edugaghị nsonaazụ ọ bụla dị mkpa - nleghara anya na nri nri, mgbanwe mgbanwe profaịlụ nke ọbara, ma ọ bụ njikwa njikwa glycemia. Enwere ike ịnweta nsonaazụ dị mma nke nri a n'ihe banyere ichekwa ọrụ na-arụ ọrụ ọbụna na ndị ọrịa nwere nsogbu mbụ ya na GFR nke ihe karịrị 45 ml / min. Yabụ, ka amachibido ịmịnye protein ga-adịrị na nrịba ama mbụ nke PN.

A na-akọwa mmetụta ọgwụgwọ nke nri nwere protein dị ala site n'eziokwu ahụ na ọ na-eduga n'ịbelata hyperfiltration na nephrons ndị ọzọ, nke bụ otu n'ime usoro ndị isi pathophysiological na-eduga na mmepe nke sclerosis glomerular.

Usoro nchịkwa ọbara mgbali

Onu ogugu omumu emere gosiputara na ndi oria nwere oria insulin na aru mmadu na aru oru ha, mbelata ihe banyere onodu obara n’enweghi ike nke PN 11, 31.33. Ekwesịrị iburu n'uche na n'ọrụ ndị e zoro aka, ọkwa ọbara mgbali elu dị elu ma rụpụtaghị mmezi ya zuru oke. N'agbanyeghi nke a, mmetụta nke ọgwụ antihypertensive n'ihe banyere ichekwa ọrụ akụrụngwa dị iche, ya mere enwere ike ịtụ anya na njikwa zuru oke nke ọbara mgbali elu ga-akachasị nwee ike. N’ezie, ọmụmụ emere n’oge na-adịbeghị anya gosipụtara na inweta ọnụ ọgụgụ dị ala nke ọbara mgbali n’òtù ndị ọrịa nwere PN, gụnyere DN, na-eduga n’inwekwu nkwupụta nke mbelata nke GFR yana mbelata proteinuria. Ọzọkwa, ka ọ dị n’usoro ọkwa mbụ nke proteinuria, ka enwekwu ike ibelata ọkwa ọbara ọgbụgba bara uru.

Họrọ nlezianya ịhọrọ ọgwụgwọ antihypertensive dị mkpa ugbua na ọdụ mbụ nke NAM, dịka ndị ọrịa nwere microalbuminuria, njikwa ọbara mgbali na-eduga na mbelata urinary albumin excretion, mmetụta nke ọgwụ antihypertensive na-ebelata ka albuminuria na-aga n'ihu.

Ọtụtụ nnyocha achọpụtala mmetụta dị ala nke ọbara mgbali na MD n'oge ọrịa shuga typedị. Enwere ike ịtụ anya ụdị usoro a maka ọrịa shuga na-abụghị insulin, ebe ọ bụ na ọkwa nke ọbara mgbali ọbara na nke a na-adaba na ogo albuminuria. A na - eme nnyocha pụrụ iche ugbu a (ABCS), ọrụ bụ nke ka amachara nke ọma oke ọrụ ọbara ọgbụgba na mmepe nke nsogbu metụtara ọrịa shuga II.

N'ụzọ doro anya, usoro nke uru bara uru iji belata ọbara mgbali sistemu na ndị ọrịa nwere DN metụtara mbelata ọbara mgbali intra-glomerular na mbelata mgbali na mgbidi nke okpu ọchịchị ụwa.

Ihe mgbochi nke usoro renin-angiotensin (RAS)

Ọtụtụ usoro nke usoro nje na-ekpebi mmepe na ọganihu nke DN na-emetụta ASD. Ejikọtara ha na usoro nke ọbara mgbali elu usoro, ọbara mgbali intracranial, ịba ụba nke macromolecules n'ime mesangium na mmepe nke mgbanwe na -akpata mkpụrụ ndụ mesangium na matrix extracellular na-eduga na glomerulosclerosis, yana mkpali kpọmkwem nke mmepụta nke ndị mgbasa ozi nke glomerulosclerosis, akpan akpan TOR- | 3.

Ihe kpatara iji duzie nnwale nke ụlọ ọgwụ angiotensin-na-agbanwe enzyme inhibitors (ACE inhibitors) bụ ọtụtụ ọmụmụ ụmụ anụmanụ nke gosipụtara mmetụta nchebe nke otu ọgwụ a na njikọta ọrịa morphology na ọrụ ezumike. Na oke maka iji ogologo oge nke ndị na - egbochi ACE, ngosipụta nke ọrụ na arụmọrụ nke DN belatara, yana mbelata nke nrụgide ọchịchị ụwa. Ọgwụ ndị ọzọ enweghị mmetụta yiri nke ahụ.

Na-ebute mbelata hyperfiltration na mbido (microalbumin-uric) nke DN na anụmanụ, ebumnuche

Ndị na - egbochi ACE belata ma ọ bụ dozie microalbuminuria ma gbochie mmalite nke foto 3.4. Mmetụta pụrụ iche nke ụlọ ọrụ iji ACE inhibitors na-aga n'ihu na ọkwa dị elu nke DN. Onu ogugu nke ndi oria nke oria nke oria nke oria m na ihe iriba ama nke ihe banyere nephropathy nke nwetagoro akuko gosiputara 48.5% n'ihe onodu dabere na mmepe nke PN mbu ma mbelata 50.5% n'ihe banyere ihe ikpeazu ya, ya bu, onwonye ya, na onwu.

N'ime ndị ọrịa nwere ọrịa shuga nke II, a nwalere usoro ọgwụgwọ nke ACE inhibitor mmetụta n'ihe banyere mmepe nke proteinuria na PN. Ihe omumu nke enalapril gosiputara ezigbo ogwu nke ogwu ahu, mejuputara ibelata ogo microalbuminuria, igbochi mmepe nke proteinuria na PN.

Eziokwu nke mbelata proteinuria n'oge eji AC Inhibitors dị mkpa na onwe ya, ebe ọnụọgụ bụ ihe nnwere onwe ga - eme maka DN na ndị ọzọ glomerulopathies 1, 13, 37. Mbelata proteinuria site na iji ACE nwere ike nweta ya ọbụna na ọkwa dị elu nke DN na mmepe nke nephrotic syndrome, mbelata ọnwụ nke protein na mmamịrị na-esonyere njikwa arụ ọrụ akụrụ.

Ekwesiri ime ka ọ pụta ìhè na mmetụta antiproteinuric na mbelata na mmepe nke ọrụ renal na-adalata n'iji ACE ndị na-egbochi ACE anaghị adabere na nsonaazụ ha na ọbara mgbali. Nke a gosipụtara site na iji meta-nyocha nke ọnụọgụ ọmụmụ banyere ọgwụ ọgwụ antihypertensive na DN ma nwee uru ọgwụgwọ dị mkpa - ndị na-egbochi ACE nwere ikike nchedo ọ bụghị naanị na njikọta nke DN na ginertzheniyu, kamakwa na ndị ọrịa nwere DN nwere ọbara mgbali nkịtị 35, 39.

Mmetụta nrụghachi nke ndị na-egbochi ACE bụ n'ihi ọtụtụ ihe, n'etiti nke bụ normalization nke intra-tubular hemodynamics, ihe mgbochi maka trophic mmetụta nke angiotensin II jikọtara ya na mkpali nke cellulite na glomerular hypertrophy 9,17,18, na mwepu nke mkpokọta nke mesangial matrix. Na mgbakwunye, ndị na - egbochi ACE na - ebelata ịdị njọ nke mgbanwe nke ọrịa na podocytes, nke na - ebelata oke nke isi ala ma,

N'ụzọ doro anya, ọ bụ ntọala nke ihe mgbochi proteinuric dịka ihe onwunwe nke otu ọgwụ a.

Ojiji nke ndị na-emegide calcium

Calcium intracellular na-arụ ọrụ dị mkpa na pathophysiology nke DN, ebe ọ bụ na mmetụta metụtara hemodynamic nke ọtụtụ cytokines, gụnyere angiotensia II, na-agbagha site na mmụba nke ọdịnaya calcium intracellular. Nke a na-egosi na mmetụta nzipụta nke ACE inhibitors na calcium antagonists nwere ike ịdị otu a, ebe ọ bụ na nke ikpeazụ na-ebelata vasoconstriction ma gbochie mmetụta hypertrophic na hyperplastic mmetụta nke angiotensin II na migogenes ndị ọzọ na sel sel na ahụ dị mma 5, 43. Agbanyeghị, naanị nkwadebe nonhydropyridine nwere mmetụta a. - verapamil na diltiazem, o doro anya n'ihi mmetụta pụrụ iche ha na glomeular permeability. Ọ bụ ezie na enweghị ọmụmụ ogologo oge nke ndị na-emegide calcium na ndị ọrịa nwere DN, enwetara nsonaazụ na-agba ume n'oge na-adịbeghị anya - calcium antagonists, dị ka lisinopril, belatara mkpịsị albumin dị ukwuu ma belata mbenata mmiri zuru ụwa ọnụ na ndị ọrịa nwere DN. Ọ ga - ekwe omume na njikọta ọgwụ na ndị na - egbochi ACE na ndị na - emegide calcium nwere ike inwe mmetụta ndị ọzọ na - enyere ha aka iji nwayọọ nwayọọ na - agbasa DN.

Site na hyperglycemia, glucose na-amalite ịkwatu n'okporo ụzọ sorbitol, "nke na-eduga n'ịba ụba nke ọdịnaya sorbitol na mbelata ego nke myoinositol na glomeruli, irighiri akwara na oghere. E bipụtabeghị ọnwụnwa na-aga n'ihu na ọgwụ ndị ọrịa aldose reductase.

Ihe omuma a gosiputara anyi ka anyi kwuo na uzo ọgwụgwọ DN, o kwere omume iji nweta oganihu di nkpa banyere ọrịa shuga na onwu a, ma enwere ike

na igbochi mmepe nke PN. N'agbanyeghị eziokwu ahụ na ntinye ahụ na-arụ ọrụ nke ọma na mbido - microalbuminuric - phase nke DN, a nwekwara ike ịmalite ọgwụgwọ dị mma n'ọnọdụ ndị dị elu, ọbụlagodi ọnụnọ nke nephrotic syndrome na PN.

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Etiology na pathogenesis

Ọrịa ọgbụgba na-adịghị ala ala, ọbara mgbali intracubic na sistemụ, mkpụrụ ndụ ihe nketa

A na-ekpebi Microalbuminuria na 6-60% nke ndị ọrịa nwere ụdị ọrịa shuga 1 mgbe afọ 5-15 gasịrị gasịrị. Site na CD-2, DNF na-etolite na 25% nke agbụrụ Europe yana na 50% nke agbụrụ Eshia. Ngụkọta ọnụ ọgụgụ DNF na CD-2 bụ 4-30%

Isi ngosiputa nke ulo ogwu

Na mbido mmalite adịghị. Ọbara mgbali akwara, ọrịa nephrotic, akụrụ gbasara akwara na-adịghị ala ala

Microalbuminuria (albumin excretion 30-300 mg / ụbọchị ma ọ bụ 20-200 μg / min), proteinuria, mụbaa ma belata ọnụego filtration glomerular, ihe ịrịba ama nke ọrịa nephrotic na ọrịa akwara na-adịghị ala ala

Ọrịa akụrụ na ọrịa ndị ọzọ na-akpata ọdịda akwara afọ n’ala

Ikwụghachi ụgwọ ndị ọrịa shuga na ọbara mgbali elu, ndị na - egbochi ACE ma ọ bụ ndị na - egbochi angiotensin na - egbochi usoro site na microalbuminuria, protein dị ala na nri nnu dị ala. Na mmepe nke odida akwara na-adịghị ala ala - akwara hemodialysis, akwara peritoneal, mmegharị akụrụ

Na 50% nke ndị ọrịa nwere ụdị shuga 1 na 10% nke ụdị shuga 2 bụ ndị achọpụtara proteinuria, CRF na-etolite n'ime afọ 10 sochirinụ. 15% nke ọnwụ niile dị na ndị ọrịa nwere ụdị oria 1 n'okpuru afọ 50 na-esonyere ụkọ akwara na-adịghị ala ala n'ihi DNF