Nephropathie Ya Diabete (Indwara Y'Impyiko)

Diabetic nephropathy ni ingaruka ikomeye y'igisukari cya type 1 na type 2. Iyi ndwara izwi kandi nka indwara y'impyiko iterwa na diyabete. Muri Leta Zunze Ubumwe za Amerika, hafi umuntu umwe kuri batatu bafite diyabete arwaye diabetic nephropathy.

Mu myaka myinshi, diabetic nephropathy ihita yangiza gahoro gahoro urwego rw'impyiko rushinzwe gukora isuku y'amaraso. Ivuriro hakiri kare rishobora gukumira iyi ndwara cyangwa kuyigabanya umuvuduko ndetse no kugabanya ibyago by'ingaruka mbi.

Indwara y'impyiko iterwa na diyabete ishobora gutera gucika intege kw'impyiko. Ibi bizwi kandi nka gucika intege kw'impyiko mu buryo bukomeye. Gucika intege kw'impyiko ni indwara ikomeye ishobora kwica. Uburyo bwo kuvura gucika intege kw'impyiko ni dialyse cyangwa kubaga kugira ngo bashyiremo impyiko.

Kimwe mu bikorwa by'ingenzi by'impyiko ni ukweza amaraso. Uko amaraso agenda anyura mu mubiri, ajyana amazi y'umubiri, ibintu by'imiti n'ibisasira. Impyiko zitandukanya ibi bintu mu maraso. Bijyanwa hanze y'umubiri mu nshinge. Niba impyiko zitabasha gukora ibi kandi iyi ndwara ntitivurwe, haboneka ibibazo bikomeye by'ubuzima, kugeza ubwo umuntu apfa.

Mu ntangiriro z'indwara y'impyiko iterwa na diyabete, bishobora kuba nta bimenyetso. Mu bihe bikurikiyeho, ibimenyetso bishobora kuba birimo:

• Kubyimba kw'ibirenge, ibibero, amaboko cyangwa amaso.
• Inkari zifite amafuro.
• Ubwenge buke cyangwa kugorana gutekereza.
• Guhumeka bugufi.
• Kubura ubushake bwo kurya.
• Kwicuza no kuruka.
• Gukorora.
• Umunaniro n'intege nke.

Suzuguramo umwanya ubone umuganga niba ufite ibimenyetso by'indwara y'impyiko. Niba urwaye diyabete, sura umuganga wawe buri mwaka cyangwa kenshi uko babikubwiye kugira ngo bakore ibizamini byerekana uko impyiko zawe zikora.

Diabetic nephropathy ibaho iyo diyabete yangije udukora tw'amaraso n'utundi turemangingo mu mpyiko.

Impyiko zikuraho imyanda n'amazi y'umubiri arenze mu maraso binyuze mu bice bito bita nephrons. Buri nephron igira umucunga, witwa glomerulus. Buri mucunga ugira imiyoboro y'amaraso mito cyane yitwa capillaries. Iyo amaraso yinjiye muri glomerulus, ibice bito cyane, byitwa imyunyu y'amazi, amabuye y'agaciro n'ibiribwa, n'imyanda bicamo inkuta za capillary. Imvunyu nini, nka poroteyine n'utubuto tw'amaraso, ntibicamo. Igice cyacunguwe kigenda mu kindi gice cya nephron kitwa tubule. Amazi, ibiribo n'amabuye y'agaciro umubiri ukeneye bisubizwa mu maraso. Amazi arenze n'imyanda iba umushishi ujya mu kibuno.

Impyiko zigira za miriyoni z'utugari tw'impyiko tw'imikororo y'amaraso duto cyane twitwa glomeruli. Glomeruli zicunga imyanda mu maraso. Kwangirika kw'iyi miyoboro y'amaraso bishobora gutera diabetic nephropathy. Kwangirika bishobora gutuma impyiko zitakora nk'uko bikwiye kandi bigatuma impyiko zidakorera neza.

Diabetic nephropathy ni ikibazo gisanzwe cy'indwara ya diyabete yo mu bwoko bwa mbere n'iya diyabete yo mu bwoko bwa kabiri.

Niba ufite diabete, ibi bikurikira bishobora kongera ibyago byo kurwara indwara y'impumyi z'amateraniro ya diabete:

• Isura y'isukari y'amaraso idakozwe, izwi kandi nka hyperglycémie.
• Kunywa itabi.
• Cholesterol nyinshi mu maraso.
• Gutakaza ibiro.
• Amateka y'umuryango wa diabete n'indwara z'impyiko.

Ingaruka z'indwara y'impyiko iterwa na diyabete zishobora kuza buhoro buhoro mu mezi cyangwa imyaka. Zirimo:

• Izamuka ry'urwego rw'umunyungugu wa potasiyumu mu maraso, bita hyperkalemie.
• Indwara y'umutima n'imijyana y'amaraso, bita kandi indwara z'umutima n'imijyana y'amaraso. Ibi bishobora gutera umuvuduko w'amaraso mu bwonko.
• Kugabanuka kw'utubuto tw'amaraso dutwara umwuka. Iyi ndwara ikunze kwitwa anemia.
• Ingaruka ku nda zikomeye ku mugore utwite n'umwana uri mu nda.
• Kwangirika kw'impyiko kutakira. Bita indwara y'impyiko igeze ku ntambwe ya nyuma. Umuti ni dialyse cyangwa kubyaza impyiko.

Kugira ngo ugabanye ibyago byo kwibasirwa na diabetic nephropathy:

• Jya uba uganira n'abaganga bawe buri gihe kugira ngo mumenye uko uburwayi bwa diabete buhagaze. Komeza kujya kubagana kugira ngo barebe uko uburwayi bwa diabete buhagaze kandi barebe niba hari ibindi bibazo byaba biriho. Ushobora kujya kubagana buri mwaka cyangwa kenshi kurushaho.
• Vura indwara ya diabete. Iyo uvuye diabete neza, ushobora kugira igipimo cy'isukari mu maraso kiri mu rwego rwiza uko bishoboka kose. Ibi bishobora gukumira cyangwa kugabanya umuvuduko wa diabetic nephropathy.
• Fata imiti utabona ku rupapuro rw'abaganga gusa nkuko byategetswe. Soma ibyanditse ku miti y'ububabare ufata. Ibi bishobora kuba harimo aspirine n'imiti igabanya ububabare, nka naproxen sodium (Aleve) na ibuprofen (Advil, Motrin IB, n'izindi). Ku bantu barwaye diabetic nephropathy, ubu bwoko bw'imiti y'ububabare bushobora gutera ibibazo by'impyiko.
• Komeza urebe ko ibiro byawe bihagaze neza. Niba ibiro byawe bihagaze neza, komeza ugerageze kubigumishaho ukoresha imbaraga umubiri wawe buri munsi. Niba ukeneye kugabanya ibiro, vugana n'umwe mu baganga bawe ku buryo bwiza bwo kugabanya ibiro.
• Ntukore. Itabi rishobora kwangiza impyiko cyangwa kurushaho kwangiza impyiko. Niba uri umunywa itabi, vugana n'umwe mu baganga bawe ku buryo bwo kureka. Amatsinda y'ubufasha, inama n'imiti imwe ishobora kugufasha.

Mu gihe cyo gupima impyiko, umukozi w’ubuzima akoresha igikombe cyo gukuramo igice gito cy’umwijima w’impyiko kugira ngo ucukumbuzwe muri laboratwari. Igikombe cyo gupima impyiko gishyirwa mu ruhu kugera ku mpyiko. Iyi nzira ikunze gukoresha igikoresho cyo kubona ishusho, nka ultrasound transducer, kugira ngo kiyobore igikombe.

Nephropathy ya diyabete isanzwe imenyekana mu bipimo bisanzwe bigize igice cyo gucunga diyabete. Supimisha buri mwaka niba ufite diyabete yo mu bwoko bwa 2 cyangwa ufite diyabete yo mu bwoko bwa 1 imaze imyaka irenga itanu.

Ibizamini byo gusuzuma bisanzwe bishobora kuba birimo:

• Isuzuma ry’albumin mu mpisi. Iki kizamini gishobora kumenya poroteyine y’amaraso yitwa albumin iri mu mpisi. Ubusanzwe, impyiko ntizisukura albumin mu maraso. Albumin nyinshi mu mpisi yawe bishobora gusobanura ko impyiko zidakora neza.
• Igipimo cya Albumin/creatinine. Creatinine ni imyanda y’ibinyabutabire impyiko nzima zisukura mu maraso. Igipimo cya albumin/creatinine gipima ubwinshi bwa albumin ugereranyije na creatinine biri mu mpisi. Bigaragaza uko impyiko zikora neza.
• Igipimo cyo gusimbura glomerular (GFR). Igipimo cya creatinine kiri mu kizamini cy’amaraso gishobora gukoreshwa kugira ngo turebe uburyo impyiko zisukura amaraso vuba. Ibi bita igipimo cyo gusimbura glomerular. Igipimo gito bisobanura ko impyiko zidakora neza.

Ibindi bipimo byo kuvura bishobora kuba birimo:

• Ibizamini byo kubona ishusho. X-rays na ultrasound bishobora kwerekana imiterere n’ubunini bw’impyiko. CT na MRI scans bishobora kwerekana uko amaraso agenda neza mu mpyiko. Ushobora kuba ukeneye ibindi bizamini byo kubona ishusho, kimwe.
• Gupima impyiko. Iyi ni inzira yo gufata igice cy’umwijima w’impyiko kugira ngo ucukumbuzwe muri laboratwari. Irimo imiti yo kubabara yitwa anesthésique locale. Igikombe gito gikoreshwa mu gukuramo ibice bito by’umwijima w’impyiko.

Mu ntangiriro z'uburwayi bwa diyabete bwangiza impyiko, ubuvuzi bwawe bushobora kuba burimo imiti yo gucunga ibi bikurikira:

• Isuka ry'amaraso. Imiti ishobora gufasha kugenzura isuka ryinshi ry'amaraso mu bantu barwaye diyabete yangiza impyiko. Irimo imiti ya kera yo kuvura diyabete nka insuline. Imiti mishya irimo Metformin (Fortamet, Glumetza, n'izindi), imiti igira uruhare rwa glucagon-like peptide 1 (GLP-1) receptor agonists na SGLT2 inhibitors.

  Baza umuganga wawe niba imiti nka SGLT2 inhibitors cyangwa GLP-1 receptor agonists yakugirira akamaro. Ubu buvuzi bushobora kurinda umutima n'impyiko kwangirika bitewe na diyabete.

• Kolesterol nyinshi. Imiti igabanya kolesterol yitwa statins ikoreshwa mu kuvura kolesterol nyinshi no kugabanya umubare wa poroteyine mu mpiswi.

• Ukwangirika kw'impyiko. Finerenone (Kerendia) ishobora gufasha kugabanya udukoko mu mpyiko mu burwayi bwa diyabete bwangiza impyiko. Ubushakashatsi bwerekanye ko iyi miti ishobora kugabanya ibyago byo kunanirwa kw'impyiko. Ishobora kandi kugabanya ibyago byo gupfa bitewe n'indwara z'umutima, kugira ibitero by'umutima no kujya kwa muganga kuvurwa indwara z'umutima mu bantu barwaye indwara z'impyiko zidakira zifitanye isano na diyabete yo mu bwoko bwa 2.

Isuka ry'amaraso. Imiti ishobora gufasha kugenzura isuka ryinshi ry'amaraso mu bantu barwaye diyabete yangiza impyiko. Irimo imiti ya kera yo kuvura diyabete nka insuline. Imiti mishya irimo Metformin (Fortamet, Glumetza, n'izindi), imiti igira uruhare rwa glucagon-like peptide 1 (GLP-1) receptor agonists na SGLT2 inhibitors.

Baza umuganga wawe niba imiti nka SGLT2 inhibitors cyangwa GLP-1 receptor agonists yakugirira akamaro. Ubu buvuzi bushobora kurinda umutima n'impyiko kwangirika bitewe na diyabete.

Niba ufashe iyi miti, uzakenera gupimwa buri gihe. Ibizamini bikorwa kugira ngo turebe niba indwara y'impyiko yawe ihora kimwe cyangwa irushaho kuba mbi.

Mu gihe cy'ubugingo bw'impyiko, impyiko y'umuntu utanze impyiko ishyirwa mu gice cyo hasi cy'inda. Udukoko tw'amaraso tw'impyiko nshya duhuzwa n'udukoko tw'amaraso mu gice cyo hasi cy'inda, hejuru gato y'umuguru umwe. Umuyoboro mushya w'impyiko aho umushishi uca ugana mu kibuno, witwa ureter, uhuzwa n'ikibuno. Keretse iyo bitera ibibazo, izindi mpyiko zisigara aho ziri.

Ku kunanirwa kw'impyiko, bitwa kandi indwara z'impyiko zidakira, ubuvuzi buhingamiye ku gusimbuza akazi k'impyiko zawe cyangwa kukugira amahoro. Amahitamo arimo:

• Gucukura impyiko. Ubu buvuzi bukuraho ibintu byangiza n'amazi menshi mu maraso. Hemodialysis icukura amaraso hanze y'umubiri ikoresheje imashini ikora akazi k'impyiko. Kuri hemodialysis, ushobora kuba ukeneye kujya mu kigo kivura impyiko inshuro eshatu mu cyumweru. Cyangwa ushobora gucukura impyiko iwawe n'umuntu watojwe. Buri cyiciro gifata amasaha 3 kugeza kuri 5.

  Peritoneal dialysis ikoresha uruhu rw'imbere rw'inda, bitwa peritoneum, gucukura ibintu byangiza. Amazi yo gukuraho umwanda anyura mu muyoboro ugana kuri peritoneum. Ubu buvuzi bushobora gukorwa iwawe cyangwa ku kazi. Ariko siko buri wese ushobora gukoresha ubu buryo bwo gucukura impyiko.

• Gusimbuza impyiko. Rimwe na rimwe, gusimbuza impyiko cyangwa gusimbuza impyiko n'umwijima ariyo nzira nziza yo kuvura kunanirwa kw'impyiko. Niba wowe n'itsinda ryawe ry'abaganga mufata icyemezo cyo gusimbuza impyiko, uzapimwa kugira ngo bamenye niba ushobora kubagwa.

• Guhagarara ibimenyetso. Niba ufite kunanirwa kw'impyiko kandi ntushaka gucukura impyiko cyangwa gusimbuza impyiko, ushobora kubaho amezi make gusa. Ubuvuzi bushobora kugufasha kugira amahoro.

Gucukura impyiko. Ubu buvuzi bukuraho ibintu byangiza n'amazi menshi mu maraso. Hemodialysis icukura amaraso hanze y'umubiri ikoresheje imashini ikora akazi k'impyiko. Kuri hemodialysis, ushobora kuba ukeneye kujya mu kigo kivura impyiko inshuro eshatu mu cyumweru. Cyangwa ushobora gucukura impyiko iwawe n'umuntu watojwe. Buri cyiciro gifata amasaha 3 kugeza kuri 5.

Peritoneal dialysis ikoresha uruhu rw'imbere rw'inda, bitwa peritoneum, gucukura ibintu byangiza. Amazi yo gukuraho umwanda anyura mu muyoboro ugana kuri peritoneum. Ubu buvuzi bushobora gukorwa iwawe cyangwa ku kazi. Ariko siko buri wese ushobora gukoresha ubu buryo bwo gucukura impyiko.

Mu gihe kizaza, abantu barwaye diyabete yangiza impyiko bashobora kungukirwa n'ubuvuzi burimo gukorwa hakoreshejwe ubuhanga bufasha umubiri kwiyubaka, bita regenerative medicine. Ubu buhanga bushobora gufasha gusubiza inyuma cyangwa kugabanya kwangirika kw'impyiko.

Kurugero, bamwe mu bashakashatsi batekereza ko niba diyabete y'umuntu ishobora kuvurwa n'ubuvuzi bw'igihe kizaza nko gusimbuza uturemangingo tw'umwijima cyangwa ubuvuzi bw'uturemangingo, impyiko zishobora gukora neza. Ubu buvuzi, kimwe n'imiti mishya, buracyiga.

• Kwihagarika isukari y'amaraso yawe. Itsinda ry'abaganga bazakubwira ukuntu ugomba kenshi gusuzuma urwego rw'isukari y'amaraso kugira ngo ugume mu rugero rwawe. Urugero, ushobora kuba ukeneye kuyisuzuma rimwe ku munsi mbere cyangwa nyuma yo gukora imyitozo ngororamubiri. Niba ufashe insuline, ushobora kuba ukeneye gusuzuma urwego rw'isukari y'amaraso yawe inshuro nyinshi ku munsi.
• Kora imyitozo ngororamubiri hafi iminsi yose y'icyumweru. Intego ni ugukora byibuze iminota 30 cyangwa irenga imyitozo ngororamubiri ikomeye cyangwa irutaho iminsi myinshi. Genda byibuze iminota 150 mu cyumweru. Ibikorwa bishobora kuba birimo kugenda wihuta, koga, gusiganwa ku magare cyangwa kwiruka.
• Funga indyo yuzuye. Funga indyo ifite ibinyamisogwe byinshi, imbuto nyinshi, imboga zitari ibinyamisogwe, ibinyampeke byuzuye n'ibinyampeke. Kora ku ruhande amavuta yuzuye, inyama zitunganyije, ibinyobwa byinshi n'umunyu.
• Reka kunywa itabi. Niba unywa itabi, vugana n'umuganga wawe ku buryo bwo kureka.
• Guma ufite ibiro bikwiye. Niba ukeneye kugabanya ibiro, vugana n'umuganga wawe ku buryo bwo kubikora. Kuri bamwe, kubagwa kugira ngo bagabanye ibiro ni igisubizo.
• Fata aspirine buri munsi. Vugana n'umuganga wawe niba ukwiye gufata aspirine ya buri munsi kugira ngo ugabanye ibyago by'indwara z'umutima.
• Vugana n'itsinda ry'abaganga bawe. Kora uburyo abaganga bawe bose bazi ko ufite indwara y'impyiko iterwa na diyabete. Bashobora gufata ingamba zo kurinda impyiko zawe ibindi byangiza batakora ibizamini by'ubuvuzi bikoresha ibara ry'umukara. Ibi birimo angiograms na computerized tomography (CT) scans.

Niba ufite indwara y'impyiko iterwa na diyabete, ibi bintu bishobora kugufasha guhangana:

• Huza n'abandi bantu bafite diyabete n'indwara y'impyiko. Baza umwe mu itsinda ry'abaganga bawe ku matsinda y'ubufasha mu karere kawe. Cyangwa hamagara amatsinda nka American Association of Kidney Patients cyangwa National Kidney Foundation kugira ngo ubone amatsinda mu karere kawe.
• Komeza gahunda yawe isanzwe, uko bishoboka. Gerageza gukomeza gahunda yawe isanzwe, ukora ibikorwa ukunda kandi ukora, niba ubuzima bwawe bubikwemerera. Ibi bishobora kugufasha guhangana n'ibyiyumvo by'agahinda cyangwa igihombo ushobora kugira nyuma yo kuvurwa.
• Vugana n'umuntu wizeye. Kubaho ufite indwara y'impyiko iterwa na diyabete bishobora gutera umunaniro, kandi bishobora kugufasha kuvugana ku byiyumvo byawe. Ushobora kugira inshuti cyangwa umuryango wumva neza. Cyangwa ushobora kubona ko ari ingirakamaro kuvugana n'umuyobozi w'idini cyangwa undi muntu wizeye. Baza umwe mu itsinda ry'abaganga bawe izina ry'umukozi w'imibereho rusange cyangwa umujyanama.