{"id":41089,"date":"2023-07-25T12:23:35","date_gmt":"2023-07-25T10:23:35","guid":{"rendered":"https:\/\/www.invarena.cz\/?p=41089"},"modified":"2023-07-25T12:23:35","modified_gmt":"2023-07-25T10:23:35","slug":"nemocne-ledviny-tise-kradou-leta-vaseho-zivota-varuji-lekari","status":"publish","type":"post","link":"https:\/\/www.invarena.cz\/?p=41089","title":{"rendered":"Nemocn\u00e9 ledviny ti\u0161e kradou l\u00e9ta va\u0161eho \u017eivota, varuj\u00ed l\u00e9ka\u0159i"},"content":{"rendered":"\n

Zpo\u010d\u00e1tku nebol\u00ed, ani pacienta neomezuj\u00ed, jen ti\u0161e ukrajuj\u00ed roky jeho zdrav\u00e9ho \u017eivota. \u0158e\u010d je o chronicky nemocn\u00fdch ledvin\u00e1ch, kter\u00e9 m\u00e1 v\u00a0\u010cesku p\u0159ibli\u017en\u011b 10\u00a0%\u00a0dosp\u011bl\u00e9 populace \u010dili t\u00e9m\u011b\u0159 milion lid\u00ed. Zhor\u0161ov\u00e1n\u00ed funkce tohoto d\u016fle\u017eit\u00e9ho org\u00e1nu se t\u00fdk\u00e1 ka\u017ed\u00e9ho druh\u00e9ho nemocn\u00e9ho s cukrovkou, stejn\u011b tak ale i lid\u00ed s\u00a0vysok\u00fdm krevn\u00edm tlakem nebo t\u011bch, co trp\u00ed ateroskler\u00f3zou \u2013 kornat\u011bn\u00edm tepen. Ledviny za\u010dnou postupn\u011b selh\u00e1vat a v nejv\u00e1\u017en\u011bj\u0161\u00edch p\u0159\u00edpadech se jejich nositel\u00e9 nevyhnou dial\u00fdze, v\u00a0p\u0159\u00edzniv\u011bj\u0161\u00edm p\u0159\u00edpad\u011b transplantaci ledviny. Ka\u017ed\u00fdm rokem v\u00a0\u010cesku nov\u011b p\u0159ibude v\u00edce ne\u017e 2 000 t\u011bch, kte\u0159\u00ed u\u017e dial\u00fdzu pot\u0159ebuj\u00ed. <\/strong><\/p>\n\n\n\n

Celkem na ni v\u00a0tuzemsku mus\u00ed zhruba 6 500 lid\u00ed a dal\u0161\u00edch p\u0159ibli\u017en\u011b 6 000 \u017eije s\u00a0funk\u010dn\u00ed transplantovanou ledvinou, tedy bez dial\u00fdzy. L\u00e9ka\u0159i varuj\u00ed, \u017ee se chronick\u00e1 nemoc ledvin v\u00a0p\u0159\u00ed\u0161t\u00edch deseti letech za\u0159ad\u00ed mezi choroby, kter\u00e9 nej\u010dast\u011bji okr\u00e1daj\u00ed pacienty o roky \u017eivota ve zdrav\u00ed a kter\u00e9 t\u00e9\u017e vedou k\u00a0\u00famrt\u00ed nemocn\u00e9ho. Pacient\u016fm s diabetem 2. typu pom\u00e1h\u00e1 l\u00e9\u010dba tzv. glifloziny, kter\u00e1 m\u016f\u017ee odd\u00e1lit selh\u00e1n\u00ed ledvin o roky.<\/strong><\/p>\n\n\n\n

\u201eNemocn\u00e9 ledviny se nejv\u00edce t\u00fdkaj\u00ed diabetik\u016f 2. typu, n\u011bjakou formou chronick\u00e9ho onemocn\u011bn\u00ed ledvin (chronic kidney disease \u2013 CKD<\/em>) trp\u00ed a\u017e 40 % z\u00a0nich. Nen\u00ed v\u0161ak v\u017edy \u00fapln\u011b snadn\u00e9 rozli\u0161it, co je prvotn\u00ed p\u0159\u00ed\u010dinou \u2013 CKD vedle diabetu \u010dasto zp\u016fsobuje vysok\u00fd krevn\u00ed tlak nebo ateroskler\u00f3za a \u0159ada pacient\u016f trp\u00ed v\u0161emi t\u011bmito chorobami najednou,\u201c <\/em>\u0159\u00edk\u00e1 MUDr. Jan \u0160oupal, v\u011bdeck\u00fd sekret\u00e1\u0159 \u010cesk\u00e9 diabetologick\u00e9 spole\u010dnosti \u010cLS JEP. Podle n\u011bj nav\u00edc diabetes 2. typu ledviny po\u0161kozuje hned zpo\u010d\u00e1tku onemocn\u011bn\u00ed, kdy o n\u011bm mnohdy pacient je\u0161t\u011b ani nev\u00ed. <\/p>\n\n\n\n

\u201eCKD se v\u011bt\u0161inou projevuje zhruba po 5\u20137 letech od diagn\u00f3zy diabetu 2. typu. St\u00e1v\u00e1 se v\u0161ak, \u017ee jej diagnostikujeme u\u017e spole\u010dn\u011b s\u00a0diabetem. Po\u0161kozen\u00ed ledvin je ov\u0161em v\u00a0drtiv\u00e9 v\u011bt\u0161in\u011b p\u0159\u00edpad\u016f nevratn\u00e9, pomoc\u00ed l\u00e9\u010dby jej m\u016f\u017eeme pouze zpomalit, a odd\u00e1lit t\u00edm v\u00e1\u017en\u00e9 n\u00e1sledky,\u201c<\/em> popisuje MUDr. \u0160oupal. Podle l\u00e9ka\u0159\u016f je chronick\u00e9 onemocn\u011bn\u00ed ledvin tak z\u00e1ludn\u00e9 pr\u00e1v\u011b proto, \u017ee se zpo\u010d\u00e1tku nijak neprojevuje. \u201eLedviny v\u00a0p\u0159\u00edpad\u011b CKD nebol\u00ed a\u00a0pacient dlouhou dobu ani nepozoruje \u017e\u00e1dn\u00e9 obt\u00ed\u017ee. Jakmile se projevovat za\u010dnou, v\u011bt\u0161inou u\u017e je po\u0161kozen\u00ed ledvin pom\u011brn\u011b pokro\u010dil\u00e9. A to je bohu\u017eel stav, ve kter\u00e9m k\u00a0n\u00e1m pacient \u010dasto doraz\u00ed poprv\u00e9,\u201c<\/em> \u0159\u00edk\u00e1 prof. MUDr. Ivan Rychl\u00edk, nefrolog a p\u0159ednosta Intern\u00ed kliniky Fakultn\u00ed nemocnice Kr\u00e1lovsk\u00e9 Vinohrady. V\u00a0pokro\u010dil\u00e9m stadiu nemoci pak podle n\u011bj doch\u00e1z\u00ed k\u00a0\u0159ad\u011b dal\u0161\u00edch probl\u00e9m\u016f, nap\u0159\u00edklad ke sn\u00ed\u017een\u00e9 tvorb\u011b \u010derven\u00fdch krvinek, zvy\u0161ov\u00e1n\u00ed krevn\u00edho tlaku nebo zadr\u017eov\u00e1n\u00ed tekutin v\u00a0t\u011ble. <\/p>\n\n\n\n

\u201eSamotn\u00e9 selh\u00e1n\u00ed ledvin p\u0159itom zab\u00edj\u00ed pom\u011brn\u011b z\u0159\u00eddka, proto\u017ee m\u00e1me k\u00a0dispozici dial\u00fdzu nebo transplantaci ledvin. CKD ale zvy\u0161uje kardiovaskul\u00e1rn\u00ed riziko, kter\u00e9 je v\u00fdrazn\u011b nebezpe\u010dn\u011bj\u0161\u00ed \u2013 jde zejm\u00e9na o srde\u010dn\u00ed infarkty, srde\u010dn\u00ed selh\u00e1n\u00ed nebo c\u00e9vn\u00ed mozkov\u00e9 p\u0159\u00edhody,\u201c<\/em> vysv\u011btluje prof. Rychl\u00edk. P\u0159\u00edpad\u016f CKD celosv\u011btov\u011b p\u0159ib\u00fdv\u00e1, podle odhad\u016f m\u00e1 ka\u017ed\u00fd des\u00e1t\u00fd dosp\u011bl\u00fd na sv\u011bt\u011b nemocn\u00e9 ledviny. Nemoc m\u00e1 tak\u00e9 na sv\u011bdom\u00ed celosv\u011btov\u011b miliony ztracen\u00fdch let \u017eivota a \u017eivota se zdravotn\u00edm posti\u017een\u00edm (tzv. DALY, disability-adjusted life year), jenom ve v\u011bkov\u00e9 skupin\u011b 60\u201364 let je jich v\u00a0d\u016fsledku CKD p\u0159es 3,5 milionu. P\u0159i l\u00e9\u010db\u011b diabetu 2. typu v\u00a0posledn\u00edch letech p\u0159ich\u00e1z\u00ed na \u0159adu modern\u00ed l\u00e9ky, tzv. glifloziny, kter\u00e9 krom\u011b l\u00e9\u010dby diabetu br\u00e1n\u00ed po\u0161kozov\u00e1n\u00ed ledvin i srdce. <\/p>\n\n\n\n

\u201ePokud jako p\u0159\u00edklad vezmeme diabetika 2.\u00a0typu, kter\u00e9mu je 60 let a m\u00e1 m\u00edrn\u00e9 po\u0161kozen\u00ed ledvin, bez l\u00e9\u010dby bych o\u010dek\u00e1val, \u017ee se dial\u00fdzy do\u010dk\u00e1 do 10\u201315 let. Pomoc\u00ed gliflozin\u016f tento bod posuneme i o 10\u201315 let d\u00e1l,\u201c<\/em> uv\u00e1d\u00ed MUDr.\u00a0\u0160oupal. D\u00edky l\u00e9k\u016fm podle n\u011bj ledviny vylou\u010d\u00ed p\u0159ebyte\u010dn\u00fd cukr do mo\u010di, co\u017e diabetikovi pom\u016f\u017ee stabilizovat hladinu cukru v\u00a0krvi, vedlej\u0161\u00edm efektem je i sn\u00ed\u017een\u00ed v\u00e1hy. Z\u00e1rove\u0148 v\u0161ak glifloziny um\u00ed sni\u017eovat tzv. filtra\u010dn\u00ed tlak v\u00a0ledvin\u00e1ch, a t\u00edm br\u00e1n\u00ed jejich po\u0161kozen\u00ed, n\u00e1sledn\u00e9mu jizven\u00ed a posl\u00e9ze ztr\u00e1t\u011b funkce. I kv\u016fli v\u010dasn\u00e9 diagn\u00f3ze a nasazen\u00ed l\u00e9\u010dby experti vyz\u00fdvaj\u00ed k\u00a0lep\u0161\u00ed prevenci a pravideln\u00fdm zdravotn\u00edm kontrol\u00e1m \u2013 prvn\u00ed sign\u00e1ly nemocn\u00fdch ledvin m\u016f\u017ee odhalit praktick\u00fd l\u00e9ka\u0159 na b\u011b\u017en\u00e9 preventivn\u00ed prohl\u00eddce. <\/p>\n\n\n\n

\u201eV\u011bt\u0161inou to b\u00fdv\u00e1 n\u00e1lez b\u00edlkoviny v\u00a0mo\u010di \u2013 to sice hned neznamen\u00e1 sn\u00ed\u017eenou kvalitu \u017eivota, ale je to varov\u00e1n\u00ed, \u017ee je pot\u0159eba dostat diabetes, krevn\u00ed tlak a dal\u0161\u00ed nemoci co nejv\u00edce pod kontrolu. Dal\u0161\u00edm d\u016fle\u017eit\u00fdm parametrem je hodnota kreatininu v krvi, ze kter\u00e9 se automaticky vypo\u010d\u00edt\u00e1 hodnota tzv. eGFR (estimated glomerular filtration rate<\/em>), je\u017e d\u00e1v\u00e1 informaci o aktu\u00e1ln\u00ed funkci ledvin,\u201c<\/em> \u0159\u00edk\u00e1 prof.\u00a0Rychl\u00edk. Podle n\u011bj by se o stav sv\u00fdch ledvin m\u011bli zaj\u00edmat jak pacienti s\u00a0diabetem, tak bez n\u011bj, p\u0159edev\u0161\u00edm tedy sledov\u00e1n\u00edm mo\u017en\u00e9 p\u0159\u00edtomnosti b\u00edlkoviny v\u00a0mo\u010di a sledov\u00e1n\u00edm hodnoty kreatininu v krvi. Rozbor obou hodnot je levn\u00fd a lehce stanoviteln\u00fd (b\u00edlkovina v\u00a0mo\u010di pap\u00edrkem ze vzorku rann\u00ed mo\u010de, kreatinin vy\u017eaduje odb\u011br krve). O tomto z\u00e1kladn\u00edm vy\u0161et\u0159en\u00ed se pacienti mohou snadno poradit se sv\u00fdm praktick\u00fdm l\u00e9ka\u0159em.<\/p>\n\n\n\n

Na onemocn\u011bn\u00ed ledvin mohou, mimo v\u00fd\u0161e uveden\u00e9, upozornit dal\u0161\u00ed zdravotn\u00ed probl\u00e9my, nap\u0159\u00edklad otoky doln\u00edch kon\u010detin, k\u0159e\u010de, zv\u00fd\u0161en\u00e1 pot\u0159eba mo\u010den\u00ed \u010di kovov\u00e1 pachu\u0165 v \u00fastech. V\u00edce informac\u00ed pacienti najdou na specializovan\u00e9m webu osladtocukrovce.cz<\/a>.<\/p>\n\n\n\n

<\/p>\n","protected":false},"excerpt":{"rendered":"

Zpo\u010d\u00e1tku nebol\u00ed, ani pacienta neomezuj\u00ed, jen ti\u0161e ukrajuj\u00ed roky jeho zdrav\u00e9ho \u017eivota. \u0158e\u010d je o chronicky nemocn\u00fdch ledvin\u00e1ch, kter\u00e9 m\u00e1 v\u00a0\u010cesku p\u0159ibli\u017en\u011b 10\u00a0%\u00a0dosp\u011bl\u00e9 populace \u010dili […]<\/a><\/p>\n<\/div>","protected":false},"author":1,"featured_media":27310,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11],"tags":[],"class_list":["post-41089","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-zdravi"],"_links":{"self":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/41089","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=41089"}],"version-history":[{"count":0,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/41089\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/media\/27310"}],"wp:attachment":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=41089"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=41089"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=41089"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}