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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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  • Komentár Merry %PM, %24 %873 %2025 %19:%mar napísal Merry

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    By altering your training variables, you will
    stress your muscles in different methods. Grinds are slow and managed movements that promote most pressure and time
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    So, this mix might help stimulate muscle growth
    and maintain your exercises various and challenging. The major distinction with the floor press is that
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    That means you're taking three seconds to lower the load, pause for one
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    the load back up. The pectoralis minor is a a lot smaller muscle that runs above the pectoralis main and
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    this is a unilateral exercise that will work the pecs in a different position and identify potential imbalances.

    Use free weights, and as a warning, only one set may have your chest fatigued.

    In regular dumbbell curls, you carry each dumbbells simultaneously, however with alternating dumbbell curls, you raise one dumbbell at a
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    The brachialis and brachioradialis may not get
    the glory like the biceps. Nonetheless, they play an essential position in ensuring you'll be able to lift,
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    The degree of higher chest involvement will depend on how a lot you’re leaning again when pressing.
    Your chest muscular tissues are one of the main muscle groups of your higher body.

    In this text, we evaluation, critique, and expand on Jeff Nippard's guide to the most effective chest workout routines for muscle progress.
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    If you’re doing split routines, throw in some chest flyes on the days whenever you wish to give your chest
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    To avoid straining your decrease back, hold your back flat against the pad.
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  • Komentár Monika %AM, %24 %379 %2025 %08:%mar napísal Monika

    The other distinction between the three- and six-day variants is that you only
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    Deadlifts tax your nervous system, and most of the people profit from only doing them once, particularly as part of a demanding six-day workout plan for the complete physique.

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    A place for for people who imagine that correct food plan and intense training are all you want to construct a tremendous physique.

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    For that cause, apply progressive overload to all workouts in this system.
    There’s nothing worse than getting began on a heavy set of bench press and pulling
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    you but these secondary days function extra compound than isolation workouts,
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    The 12 week program is a variation on an Upper-Lower break up, with the higher body divided into Shoulders, and Chest-Back.
    "They're positively not sufficient to make you robust." Consider it or not, an in-depth analysis discovered that push-ups and bench presses
    are related in each muscle activation and total muscle gains.
    This doesn't mean push-ups should be all you do,
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    It ensures consistent muscle stimulation and helps monitor progress over time.
    Below is a breakdown of an optimized weekly training plan to prioritize strength and muscle progress whereas minimizing fats gain. If
    you might have been following our four day break up Intermediate
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    your power. Say your program calls for three units of 10 to 12 reps
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    The concepts for back day additionally apply to your chest exercise.
    You’ll hit slightly traps at the end (kind of like you hit slightly quads after back).
    There are 2 core explanation why you go to the fitness center
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    After protein, we’ll be filling up our plate with calories from carbs (and fats).
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    A Push/Pull/Legs break up is usually considered more environment
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    Nonetheless, a Bro Cut Up can nonetheless be effective if coaching intensity and volume are high sufficient.
    The best option depends on individual objectives, recovery, and training consistency.

    It refers to the total quantity of work carried out, usually measured in sets and reps.
    Different splits require different quantity methods to be effective.
    If you find that you’re constantly sore or not recovering nicely, consider adjusting your
    break up. You may need to include extra rest days or cut back the
    number of sets per session. Discovering the proper training frequency is essential for
    muscle development.
    In order to optimize muscle protein synthesis, plant-based eaters may
    very well need MORE grams of protein per day (~1.0g/lb of body weight).

    As Coach Matt says, if you do a ton of long-distance cardio, it’s hard to eat sufficient energy to develop bigger.
    You’re also training for effectivity quite than measurement, which stimulates
    a unique sort of diversifications in your muscle tissue.
    By slimming down first, whereas building muscle, you don’t have to worry about shopping for BIGGER
    garments first, only to then need smaller clothes when you start cutting the fat.


    If you practice a muscle group too regularly, you threat overtraining.

    If you do have to do the job your self, make it quick then get back under
    the bar. Now pump out one other 10 reps. Then perform another
    50% weight drop and rep out with a last 10 reps.
    That implies that your final two units may have you
    doing 30 reps per set. That will be sure that
    every single muscle fiber is on fire by the time you stroll away from the incline bench.
    You can follow this 8-week bodybuilding workout program religiously, however when you don’t give your
    muscles what they want to recuperate, they merely will not develop.

    But should you play your playing cards right, there isn't any reason to suspect that you simply can’t place within the
    prime range of the muscle acquire rates above. Moreover, including "drop sets"
    and "negative sets" assist increase energy and muscle acquire, and
    quite often can utterly rework a exercise for the better.
    Or others, that don't give your muscle tissue sufficient time to
    relaxation between exercises thus resulting in over-training.
    As I have mentioned, the aim is to give you the most effective muscle
    building program. A exercise program that delivers results and can be used for years, and years.
    While this may look like a small amount, the outcomes may be dramatic
    over time. With just a few years of consistent coaching, you can achieve 20–40 kilos (9–18 kg) of muscle,
    which might be a dramatic physique change for just about
    anybody beginning a resistance training program.

    It’s additionally going to permit you to develop
    true energy and muscularity simply because of
    your psychological approach, which leads to the finest way
    you’re going to perform each exercise.

    An effective exercise with the least variety of totally different workout routines would
    wish to incorporate an train from most (but not essentially all) of these classes.
    The program additionally involves different workouts for each muscle group, which has
    a variety of benefits. Purpose for round 0.7 grams of protein per pound, or 1.6 grams
    per kilogram, of bodyweight each day.
    You don’t essentially have to apply all of these weight training ways in the same
    or every exercise. You can select which of them you need
    to do and you can alternate them. That’s one other factor about building muscle at any age; it’s always good to alter
    up your exercises every so often, even if they’re simply refined modifications (anywhere from each
    4-8 weeks). Full-body exercises may be made to work for newbie, intermediate and
    advanced trainees alike. In truth, some superior lifters favor a
    high-frequency (4-5 times per week) full body exercise plan over extra standard physique part break up routines.
    As a rule, I’d suggest resting for longer between sets of compound workout routines that work a large amount of muscle mass, such as squats,
    rows, deadlifts, leg presses and so on. Suppose of it as
    a online game; you want to degree up to make your stats enhance.


    A calorie surplus of 250–500 calories is the sweet spot
    for most individuals. If you’re naturally skinny, you possibly can go for the higher end of that interval, but if
    you discover yourself gaining fats easily, it’s higher to aim
    for the decrease end. Rest days aren't lazy days – they’re your muscles’ chance to repair,
    rebuild, and are available again stronger. If you notice tell-tale signs of
    overtraining, in the discount of on your intensity and quantity or take every week off to allow
    your body to recuperate.
    The research suggests that you’ll promote more muscle mass lifting three,200 kg than you'll say 1,300 kg.
    Be Taught why density sets, dropsets, and double rest-pause units may be great training tools.
    You may be shocked to see that you’re not straying away from free-weight workout routines
    in this routine. Some of the so-called consultants could inform folks over forty to do extra
    machines as a end result of free-weights can cause damage.

    Creatine works by rising the stores of creatine phosphate in your muscular tissues, which
    is used as a quick power source when training.
    It has been studied in additional than a thousand scientific trials and has consistently been proven to increase performance in excessive
    depth activities, such as resistance coaching or sprints.
    The most basic "muscle-building zone" is to use a weight where you can do about 8–15 reps per set.


    Your last 4 weeks are going to shift slightly into gaining
    more muscle definition while sustaining the mass you’ve gained and maybe gaining much more measurement.
    But if you want to hold it hardcore you'll have the ability to
    go for the complete 12 weeks and not utilizing a deload –
    however focus on as a lot leisure as attainable in your days off.
    They change in every workout and assist to keep your smaller muscle tissue progressing… and to keep
    you interested too. It’s presently thought that quantity triggers protein synthesis rather more
    effectively then depth – and that results in larger muscle
    cell ranges. That’s as a result of your muscles are composed of various varieties of muscle fibers.

    However as increasingly research comes out although, we’re realizing
    that you could create an adaptation at just about every rep vary – from heavy to mild.

    Cardio acceleration actions must be used between occasions of supersets,
    or as a replacement of supersets between workouts. This will
    help optimize your body composition, even further in between your supersets.
    The coaching triggers growth, but your food provides the
    means. If you don’t eat sufficient, your body won’t have the constructing blocks to add muscle dimension.
    As for health stage, obviously the extra skilled you're and the better shape
    you're in, the extra your muscle tissue can deal with.
    Every day, we burn a certain variety of energy just existing, which known as our BMR
    (basal metabolic rate). We then think about our every day activity stage, and get a number that known as our "total daily vitality expenditure." You can calculate yours
    below. As we mentioned above, gaining weight comes right down to thermodynamics and science.
    No have to call for help to get that 50lb bag of pet
    food off the highest shelf, or carrying an air conditioner unit up a flight of stairs.
    Break this down into simple steps and goals that aren’t scary, and get started.
    If you struggle to get enough calories in your system, spacing out your meals may assist you to feel less full, or provide you with extra opportunities to succeed in your calorie aim for the day.
    I hate to say it, however building endurance and getting larger simultaneously
    is brutally tough.
    For me, it occurs very first thing in the morning as a end result of that’s once I
    train. And I’m going to give you a quick ritual to follow as a guide.
    So you should just bear in mind to have the proper intent before stepping foot into the health
    club. In truth, the lads were able to crank out, on common,
    three additional reps on the leg extension machine when they did leg curls immediately, 30 seconds or 60 seconds earlier.

    Finally, it’s the lying EZ bar extension, which is a little easier on the elbows compared to a straight bar.
    In the beginning place, your arms should be at a slight angle.

    The idea behind steady-state cardio is to work at
    about 60-70% of your maximum heart fee for an prolonged interval of time—anywhere from 20 minutes to an hour.
    Over the years, this has been referred to as the "fat-burning zone," but that’s not why you
    need to be doing this type of work. If your type isn’t perfect utilizing the load you
    selected, decide a lighter weight.
    Non-training days require slightly larger fats as there's much less want for carbs.
    If your physique responds nicely to fat go for the
    higher finish of the ranges prescribed under and vice versa if it performs
    higher on carbs. You will learn to measure progress and reply to
    plateaus, so you can proceed to enhance nicely beyond
    Week 12. Exercise splits range in frequency, depth, and recovery
    calls for. Push/Pull/Legs balances frequency and recovery properly, while Bro
    Splits allow high-volume concentrate on individual muscle groups but with decrease frequency.

    This program is designed to construct muscle &
    strength, with an emphasis on building muscle. We're now going by
    way of the workout routine including the push pull legs workout routines in addition to the rep scheme.
    In laymen’s terms, you’ll begin your exercise with an isolation train before doing a compound train (the reverse of any regular exercise routine).

    At a look this will seem counterproductive for constructing muscle.
    Nevertheless, you’d be surprised at how shortly your body
    adapts to this. And doing cardio first could give you much
    more power on your weight coaching exercise as your body is warmed up and
    your blood is flowing.
    When you’re motivated, you’re more likely to push by way of those last
    reps that really flip up the heat on your muscle-building machinery.
    In addition, correct type ensures that every rep
    counts and every drop of sweat is invested wisely. Like
    a savvy businessperson, you need the best returns in your effort, and an excellent lifting
    approach maximizes muscle engagement and minimizes wasted vitality.
    It’s like squeezing each final drop of juice out of
    an orange – however in this case, the orange is your
    exercise, and the juice is your features. Monitoring your progress is crucial to
    keep your gains coming.
    I assume committing to a year-long bulking workout plan for newbies or advanced lifters is more effective.
    It allows for regular muscle development without the drastic yo-yo effects of frequent bulking and slicing.
    Our corrective exercise choice goes to be my favourite of the higher body workouts, the Face Pull.