Skrytá epidémia chronickej choroby obličiek – 1 človek z 10!

Napísal Doc. MUDr. Adrián Okša, CSc. 10. marec 2023

Chronická choroba obličiek (známa tiež pod skratkou CKD – chronic kidney disease) je častým a závažným ochorením. Postihuje približne 10% populácie vo svete, t.j. 850 miliónov ľudí. Je to 2x viac ako výskyt cukrovky a až 20x viac ako výskyt všetkých druhov rakoviny.

shutterstock_reni_1122

Zdroj foto: Shutterstock

Závažná je preto, že často prebieha nenápadne, ale pritom sa postupne zhoršuje a môže vyústiť až do nezvratného zlyhania obličiek. Vtedy je potrebná náročná a nákladná dialyzačná alebo transplantačná liečba. Okrem toho samotná prítomnosť choroby obličiek výrazne zvyšuje aj riziko kardiovaskulárnych ochorení a smrti.

Ako fungujú obličky?

Obličky sú párový orgán uložený pri zadnej stene brušnej dutiny v úrovni posledných rebier. Merajú asi 12x6x3 cm a každá váži priemerne 150 gramov. Ich hlavnou funkciou je očisťovanie krvi od splodín metabolizmu a toxínov – filtrácia a ich vylučovanie do moču. Základná  funkčná jednotka – nefrón pozostáva z mikroskopického klbka krvných kapilár – glomerulu, ktorý funguje ako filter a dômyselného systému kanálikov – tubulov, kde sa tvorí moč. V každej obličke je asi milión nefrónov.  

Obličkami denne pretečie viac ako 1700 litrov krvi, z ktorej sa v glomeruloch prefiltruje asi jedna desatina (170 l) a zvyšok sa vráti do krvného obehu. Jemný glomerulový filter prepustí len vodu, elektrolyty a látky s malou molekulou. V tubuloch sa potom 99% prefiltrovanej tekutiny vstrebá naspäť do krvi, takže definitívny moč tvorí len asi stotinu filtrátu (1,5 l).

Okrem filtračnej funkcie majú obličky aj ďalšie dôležité úlohy: udržiavajú stálosť vnútorného prostredia (vody, elektrolytov a pomeru kyslých a zásaditých látok), podieľajú sa na regulácii krvného tlaku a produkujú látky hormonálnej povahy (renín, erytropoetín, aktívny vitamín D), ktoré sú dôležité pre správnu funkciu kardiovaskulárneho systému, krvotvorbu a metabolizmus minerálov a kostí.

Ako sa prejavuje chronická choroba obličiek?

V prvých štádiách sa nemusí prejaviť žiadnymi príznakmi, s výraznejším poklesom funkcie obličiek sa môžu objaviť opuchy najmä dolných končatín, zvýšený krvný tlak, únava, slabosť, dýchavičnosť, nechutenstvo, nauzea, zvracanie, hnačky, obmedzené močenie, svrbenie tela, bledosť kože a slizníc, zvýšená krvácavosť, svalové kŕče, častejšie infekcie. 

Ako sa dá chronická choroba obličiek odhaliť?

Základná diagnostika je jednoduchá a spočíva v stanovení koncentrácie kreatinínu v krvi a vyšetrení moču na prítomnosť bielkoviny. Tieto vyšetrenia sú bežnou súčasťou preventívnej prehliadky u všeobecného lekára.

Kreatinín je produkt svalového metabolizmu, ktorý sa vylučuje do moču. Čím viac je znížená filtračná schopnosť obličiek, tým menej sa kreatinín vylučuje a jeho koncentrácia v krvi stúpa. Z koncentrácie kreatinínu v krvi vieme výpočtom odhadnúť tzv. glomerulovú filtráciu (GF), ktorá je odrazom hlavnej – filtračnej funkcie obličiek. Podľa veľkosti GF rozoznávame 5 štádií chronickej choroby obličiek: od normálnej GF (štádium 1) až po zlyhanie obličiek (štádium 5).

Bielkovina v moči môže byť prejavom poškodenia glomerulového filtra, ktorý normálne krvné bielkoviny neprepustí. Zistí sa jednoduchým testovacím papierikom vo vzorke moču. Presnejšie je stanovenie bielkoviny albumínu v moči (albuminúria), a to buď špeciálnym testovacím papierikom, alebo určením pomeru albumínu a kreatinínu v rannom moči v laboratóriu. Zvýšené množstvo albumínu v moči je často prvým príznakom poškodenia obličiek pri cukrovke.

Znížená glomerulová filtrácia alebo opakovane zvýšené vylučovanie bielkoviny (albumínu) do moču je dôvodom na podrobnejšie nefrologické vyšetrenie.

Aké sú rizikové faktory pre vznik chronickej choroby obličiek?

Vyšší vek, rodinný výskyt chorôb obličiek, nízka pôrodná hmotnosť, rasová a etnická príslušnosť sú faktory, ktoré zvyšujú vnímavosť na poškodenie obličiek. Tieto faktory ovplyvniť nevieme. Hlavnými rizikovými faktormi sú však diabetes, hypertenzia, ateroskleróza, obezita, infekcie, zápalové ochorenia, choroby močového traktu, toxíny a niektoré lieky.

Ako sa dá chronická choroba obličiek liečiť?

Chronickú chorobu obličiek vyliečiť nevieme. Ak je to možné, liečime špecifickú príčinu (základnú chorobu), ktorá chorobu obličiek vyvolala, napr. diabetes alebo hypertenziu. 

Súčasne sa snažíme ovplyvniť faktory, ktoré spôsobujú zhoršenie (progresiu) choroby a liečiť  komplikácie. Vhodnou stravou, pohybovým režimom a liekmi môžeme dosiahnuť spomalenie poklesu funkcie obličiek a oddialenie ich zlyhania, kedy je už potrebná dialyzačná liečba alebo transplantácia.

Dá sa chronickej chorobe obličiek predísť?

Áno, prevenciou a včasnou liečbou ochorení, resp. elimináciou rizikových faktorov, ktoré obličky poškodzujú:

1. kontrolou krvného cukru (glykémie) – denný príjem cukru u zdravého človeka nemá byť vyšší ako 25 gramov (5-6 čajových lyžičiek). Diabetes je najčastejšou príčinou nezvratného zlyhania obličiek!

2. kontrolou krvného tlaku – hypertenzia predstavuje vysoké riziko poškodenia obličiek, preto je dôležité mať normálny krvný tlak.

3. kontrolou hmotnosti – obezita je nezávislým rizikovým faktorom chronickej choroby obličiek, ale často sa spája s diabetom, hypertenziou a ďalšími rizikovými faktormi.

4. znížením príjmu soli – nadbytok soli zaťažuje obličky, pôsobí negatívne na cievy a zvyšuje krvný tlak. Denný príjem soli nemá byť vyšší ako 5-6 gramov (jedna čajová lyžička).

5. vyváženou a zdravou stravou – dostatok zeleniny, ovocia, celozrnných obilnín, vlákniny, strukovín, nenasýtených tukov a obmedzenie bielkovín z mäsa.

6. dostatočným príjmom tekutín – aspoň 1,5 litra nesladených tekutín za deň v bežných teplotných podmienkach.

7. pravidelnou fyzickou aktivitou – aspoň 150 minút rýchlejšej chôdze za týždeň.

8. nefajčením – fajčenie poškodzuje jemné štruktúry v obličkách a zvyšuje krvný tlak.

9. obmedzením používania liekov proti bolesti – pri častom alebo dlhodobom podávaní ibuprofénu, diklofenaku, naproxénu, nimesulidu, meloxikamu a i. sa znižuje filtračná schopnosť obličiek a zvyšuje krvný tlak.

10. pravidelnými preventívnymi prehliadkami u všeobecného lekára – v nich je zahrnuté aj základné vyšetrenie funkcie obličiek.

Doc. MUDr. Adrián Okša, CSc.

Ďalšie informácie:  

https://www.worldkidneyday.org/

https://www.era-online.org/strong-kidneys/all-about-kidneys/

https://www.theisn.org/initiatives/world-kidney-day/

 

14 komentárov

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    On the flip aspect you get people who assume tablets like Anavar are much
    less invasive and trigger much less injury.
    For example, and as we’ve already touched upon earlier on this post oral steroids can result in higher
    liver injury.
    Endeavor a strict calorie-deficit food regimen places you susceptible to muscle catabolism and
    losing energy. Oxandrolone was little question determined to be a gentle anabolic steroid means
    back then, which made it potential to be tolerated
    by feminine and youngster patients10. Anavar may supply some
    advantages, but it additionally comes with serious risks.
    Always use Anavar beneath a doctor’s steering, and by no means exceed the recommended dosage.


    It’s essential that customers comply with really helpful dosages to reduce potential
    side effects and maximize advantages. In Accordance to a 2016 study by
    McGill University, essentially the most significant adjustments within the
    physique can be seen on the 4-week mark of usage (source).
    Despite being one of many most secure anabolic steroids today,
    Anavar can nonetheless cause some issues in your physique, mainly as a
    result of Anavar is a hormone. Solely time if you don’t want a PCT after
    an Anavar cycle is when cycles last less than 4 weeks and with low doses.


    However, your dose could also be totally different depending in your individual circumstances.
    Anavar is a gentle steroid, so even if you're new to using steroids – you should be nice beginning
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    may improve your risk of coronary heart or blood vessel issues (coronary artery disease).
    Nausea, vomiting, headache, skin color modifications, increased/decreased sexual curiosity,
    oily skin, hair loss, and zits could happen.
    We may even talk about the way to cycle Anavar, as properly as provide tips about tips on how
    to reduce the chance of unwanted effects. Other medicine
    could interact with oxandrolone, together with prescription and over-the-counter medicines, nutritional vitamins, and herbal merchandise.
    Tell each of your well being care suppliers about all
    medicines you utilize now and any medicine you begin or stop utilizing.
    Older men could have an elevated threat of developing an enlarged prostate or prostate cancer whereas
    taking this drugs. You should not use oxandrolone if you have prostate cancer, advanced kidney disease, high levels of calcium in your blood, breast most cancers, or if you are pregnant.


    A beginner’s cycle often lasts between 6 to eight weeks, with a beginning dosage of
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    a lot as 50-60mg per day towards the tip of the cycle.
    By promoting muscle growth and enhancing energy levels, customers typically see important enhancements of
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    for extra intense training periods, leading to higher
    total performance in the gym. In addition to energy gains, Anavar has been linked to increased endurance and sooner recovery occasions, making it a preferred selection among athletes looking to
    enhance their physical talents.
    This is due to men producing roughly 20x extra testosterone compared to ladies (30).
    Most anabolic steroids offered on the black market are
    UGL (underground laboratories). This is actually produced in a non-certified laboratory and poses a excessive threat to the buyer,
    as there are not any regulations in place to make
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    Once again, Anavar is taken into account relatively delicate on the liver compared with other oral steroids because it passes by way of the liver faster.
    However, don’t low cost the risk – your response and sensitivity levels can vastly differ from the next user for some individuals.
    It’s worth contemplating utilizing a liver help product during your cycle.
    As A End Result Of Anavar is kind of a female-friendly steroid that ladies
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    danger of side effects, is the perfect strategy for ladies.

    Stacking Anavar will nearly exclusively be for chopping and recomposition cycles for male customers.
    Females will typically use Anavar to achieve lean mass, as women might be far
    more responsive to the anabolic results of this steroid.
    Inform your physician promptly in case you have any indicators of liver issues such as stomach/abdominal pain that's sudden or would not go
    away, yellowing eyes/skin, darkish urine or unusual tiredness.
    Bear In Mind that this medicine has been prescribed because your physician has judged that the benefit to you
    is greater than the chance of side effects. (17) Malhotra, A., Poon, E.,
    Tse, W. Y., Pringle, P. J., Hindmarsh, P. C., &
    Brook, C. G. The effects of oxandrolone on the growth hormone and gonadal axes in boys with constitutional delay of
    progress and puberty.
    This leads to infected cytokines, a gaggle of proteins produced within the kidneys
    and markers of elevated stress. Nonetheless, it isn't merely power and endurance athletes that will benefit from Anavar, with some sprinters, swimmers, and boxers also
    utilizing Anavar to gain a competitive edge.
    Anavar is a derivative of dihydrotestosterone; thus, there isn't a conversion to DHT via the 5-alpha reductase enzyme.
    Consequently, Anavar has delicate androgenic properties and
    unwanted effects. Research exhibits that 20 mg of oxandrolone causes
    72% much less sulfobromophthalein, a marker of liver stress, compared to an equal dose of fluoxymesterone (10).

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