Ukuhluleka okunamandla okweqileko kwenzeka uma izinso ngokungazelelwe zingakwazi ukuhlunga ama-waste avela egazini. Kuyinkimbinkimbi yanoma yiliphi inani lezifo noma izinkinga, umphumela oholela ekutheni ukwakhiwa okusheshayo kwezinto ezibangelwa ubuthi kanye nokuhlaselwa kwezimpawu kusukela ekunciphiseni ukugcoba nokukhathala emathunjini esifubeni nokuqothulwa.
Ngenkathi ukuhluleka kwe-renal ejwayelekile kungase kwenzeke ngaphandle kwempawu futhi kubonakaliswe ngesikhathi sokuhlolwa kwelebhu ngesimo esingavumelani, amacala amaningi atholakele kubantu abagula kakhulu noma abafika esibhedlela ngesifo esibi kakhulu.
Uma ukuhluleka kwe-renal okusobala kusolakala, ukuhlolwa kwegazi, ukuvivinya kwe-urine, i-ultrasound, ne-biopsies kungalawulwa ukuqinisekisa nokwenza izinga lokukhubazeka. Ngokusekelwe emiphumeleni, udokotela uzokwazi ukusungula lesi sifo futhi athathe isinyathelo esifanele. Esimweni esinzima kunazo zonke, isifo sezinso sokuphela kwezinso singasakazwa.
Ama-Labs nezivivinyo
Ukuhluleka okunamandla okweqileko ( ARF ), owaziwa nangokuthi ukulimala kwezinso ezinzima (AKI), ngokuyinhloko kutholakala ukuhlolwa kwegazi kanye nomchamo. Phakathi kokuhlolwa okuningi kwelebhu okusetshenziselwa ukuhlola umsebenzi wezinso, kunezinyathelo ezimbili eziyinhloko ezibhekene nokuxilongwa nokuphathwa kwe-ARF.
I-Serum Creatinine
I-Serum creatinine (SCr) ilinganisa inani lezinto ezibizwa ngokuthi i- creatinine egazini. I-Creatinine iwumkhiqizo we-metabolism we-muscle ekhishwa emcinini. Ngenxa yokuthi ikhiqizwa futhi igxiliwe ngokwezinga elilinganiselwe, kuyindlela enokwethenjelwa yokusebenza kwezinso futhi kuyisibonakaliso esiyinhloko sokuhluleka kwezinso.
Amazinga e-SCr avamile kubantu abadala:
- Cishe ngo-0.5 ukuya ku-1.1. ama-milligram (mg) nge-deciliter ngayinye (dL) kwabesifazane
- Cishe u-0.6 kuya ku-1.2 mg / dL kubesilisa
I-Urine Volume
Ivolumu ye-urine imane ilinganise inani lomkhuhlane owuvuthayo ngesikhathi esithile esinikeziwe. Njengoba i-ARF ichazwa ngokulahlekelwa kwezinso zezinso, inani-elilinganiselwa ku-milliliters (mL) kilogremu yesisindo somzimba wakho (kg) ngehora (h) -kuyisisekelo sokuqinisekisa ukukhubazeka kwezinso nokulinganisa impendulo yakho ekwelapheni.
U-Oliguria, ukukhiqizwa kwemifino encane engavamile, ichazwa njengento engaphansi kuka-0.5 mL / kg / h.
Ezinye izivivinyo zeLebhu
Ezinye izivivinyo zelabhu ezisetshenziselwa ukuxilonga i-ARF zifaka:
- I-blood urea nitrogen (BUN) ilinganisa inani lemfucuza egazini elibizwa nge-urea nitrogen. I-nitrogen ye-Urea idalwa lapho isibindi siphula phansi amaprotheni futhi, njenge-serum creatinine, ikhiqizwa futhi igxiliwe emcimbini uma kunezinhlobo ezingapheliyo. Izinga eliphezulu ze-BUN libonisa i-ARF futhi lingase liphakamise imbangela eyinhloko yokwehluleka kwezinso (njengokuhluleka kwenhliziyo, ukuphelelwa amandla kwamanzi noma ukuvinjelwa kwe-urinary).
- I-Creatinine imvume yokulinganisa izinyathelo zokudala kokubili isampula ye-sampuli yegazi ne-urine eqoqwe amahora angaphezu kwangu-24. Imiphumela ehlangene ingasitshela ukuthi i-creatinine isuswe kangakanani egazini ngokucibungula njengoba kulinganiswa nge-ML ngamaminithi (mL / min). Imvume evamile yokudala i-creatinine i-88 kuya ku-128 mL / iminithi kubesifazane kanye ne-97 t0 137 mL / min emadodeni.
- Isilinganiso sokuhlunga kwe-glomerular (i-eGFR) esilinganiselwe ukuhlolwa kwegazi esilinganisa ukuthi igazi lidlula kangakanani izihlungi zemvelo zezinso, okuthiwa i-glomeruli. Isivinini esenzeke kulo lokhu singasitshela ukuthi izinso zonakaliswe kanjani kusukela esiteji soku-1 (okuncane kakhulu kuya ekulahlekelweni kwezinso zezinso) kuze kube sigaba 5 (ukwehluleka kwezinso).
- I-potassium ye-serum isetshenziselwa ukunquma ukuthi kukhona yini i- potassium engaphezu kwegazi (isimo esibizwa ngokuthi i-hyperkalemia). I-Hyperkalemia isici se-ARF futhi, uma ishiywe ingalashwa, ingaholela ekudleni okukhulu okungenzeka kusongela impilo (izinga elingavamile lenhliziyo).
- Ukuhlaziywa kwe- urinal kuphela kuhlaziywa kwelebhu kokwenza umchamo wakho. Ingasetshenziselwa ukuthola ukuthi kukhona yini amaprotheni okweqile emcimbini ( proteinuria ), ebhekwa njengesici esibalulekile se-ARF. Ingabuye ibone igazi emcimbini (i- hematuria ) engenzeka uma i-ARF ibangelwa uhlobo oluthile lokulimala kwezinso noma ukuvinjelwa kwamagciwane.
Imfuneko Yokuthola
Ukuhluleka okunamandla kokuthola izinso kutholakala ngokususelwa kumphumela we-serum creatinine nokuhlolwa kwevolumu yomchamo.
Indlela yokuxilongwa yasungulwa yizifo zezinso: Ukuthuthukisa Imiphumela Yomhlaba Wonke (i-KDIGO), inhlangano engenzi inzuzo eqondisa futhi isebenzise iziqondiso zomtholampilo zesifo sezinso. Ngokusho kwe-KDIGO, ukwehluleka okukhulu kwe-renal kungatholakala uma kukhona okulandelayo okukhona:
- Ukwanda kwe-SCr ngu-0.3 mg / dL noma ngaphezulu kwamahora angu-48
- Ukwanda kwe-SCr okungenani ngamaphesenti angu-150 phakathi nosuku lwesikhombisa
- Ivolumu yomchamo engaphansi kwe-0.5 ml / kg / h ngaphezu kwesikhathi sehora lesithupha
Ukuhlolwa kwezilingo
Ngaphezu kokuhlolwa kwegazi kanye nomchamo, ukuhlolwa kwe-imaging kungasetshenziswa ukubona ukuthi kunoma yiluphi uhlobo lokulimala kwezinso noma uma kunokukhubazeka kokugeleza kwegazi kuya ezinso noma ukuphuma komchamo emzimbeni.
Phakathi kwezinye izivivinyo ezisetshenzisiwe:
- I-Ultrasound yindlela ekhethwa yokuhlola i-imaging futhi ingasetshenziswa ukukala usayizi nokubukeka kwezinso, ukuthola izicubu noma ukulimala kwezinso, futhi thola amabhulogi emgqeni noma ukugeleza kwegazi. Inqubo entsha ebizwa ngokuthi i-Color Doppler ingasetshenziselwa ukuhlola ama-clots, ukunciphisa noma ukuphuka emithanjeni nasemithanjeni yezinso.
- I-tomography ehlanganisiwe (CT) iyinhlobo ye-X-ray inqubo eyenza izithombe ezithintekayo zesitho. Ukuhlolwa kwe-CT kungasiza ekutholeni umdlavuza, izilonda, ama-abscesses, ukuvimbela (njengezinso zezinso), nokuqoqa oketshezi ezizungezile izinso. Zijwayele ukusetshenziselwa abantu abakhulu kakhulu lapho i-ultrasound ingase ingahlinzeki isithombe esanele.
- I-imagery resonance magnetic (MRI) isebenzisa amagagasi amakhulu ukukhiqiza izithombe eziphambene kakhulu nezinso ngaphandle kwemisebe.
I-Kidney Biopsy
I-biopsy ihilela ukususwa kwezitho zomzimba zokuhlolwa ngelebhu. Uhlobo oluvame ukusetshenziselwa ukuhlola isifo sezinso lubizwa ngokuthi i- biopsy ngayinye lapho inaliti ifakwe esikhumbeni futhi iqondiswe zibe izinso ukususa isampuli yamaseli.
I-Biopsies ivame ukusetshenziselwa ukuthi ihlolwe i-ARF yangaphakathi (ukungaphumeleli okukhulu kwe-renal okubangelwa ukulimala kwezinso). I-biopsy ingasheshe ihlolisise ezinye zezimbangela ezivame kakhulu zokulimala kwezinso, kuhlanganise:
- I-nephritis yangaphakathi ye-interstitial (AIN), ukuvuvukala kwezicubu phakathi kwe-tubules yezinso
- I-necrosis ye-tubular enamandla (i-ATN), isimo lapho izicubu zezinso zifa ngenxa yokungabi khona kwe-oxygen
- I-Glomerulonephritis, ukuvuvukala kwe-glomeruli emithanjeni yegazi yezinso
Ukuhlonza okuhlukile
Njengengcindezi yesifo esiyinhloko noma isifo, ukwehluleka okukhulu kwe-renal kungabangelwa izinto eziningi ezihlukene, kuhlanganise nokuhluleka kwenhliziyo , i- cirrhosis yesibindi , i- cancer , ukuphazamiseka kwe-autoimmune , ngisho nokuphela kwamanzi okuphela kwamanzi .
Ngesikhathi esifanayo, kungase kube khona izimo lapho ukuhlolwa kwebhu kuphakamisa i-ARF kodwa ezinye izimo zisola amazinga egazi aphakeme. Phakathi kwazo:
- Isifo esiphelele sezinso (CKD) , ngokuvamile esingaziwa, singase sibe nazo zonke izimpawu ze-ARF kodwa zizoqhubeka ziqhubeka izinyanga ezingaphezu kwezintathu. Nge-CKD, incazelo ecacile ye-SCr ephakeme izoba ngesilinganiso sokuhlunga kwe-glomerular engafanelekile. Ukuhlolwa kwe-creativeinine yamahora angu-24 kungavamile phakathi kwezimo ezimbili.
- Imithi ethile , njenge-H2 yokuvimba i-Tagamet (cimetidine) kanye ne-Primsol (trimethoprim) yama-antibiotic, ingabangela ukuphakama kwe-creatinine. Ukuqedwa kwesidakamizwa esicatshangelwayo kuyokwanela ngokwanele ukwenza umehluko.
> Imithombo:
> Rahman, M .; Shad, F .; no-Smith, M. Ukulimala Kwezinso: Umhlahlandlela Wokuphathwa Nokuhlolwa. Amer Fam Phys. 2012; 86 (7): 631-9.
> Hertzberg, D .; Ryden, L .; Pickering, J. et al. Ukulimala okusobala kwezinso-ukubuka kabanzi ngezindlela zokuxilonga nokuphathwa kwemitholampilo. Clin Kidney J. 2017 10 (3): 323-331. I-DOI: 10.1093 / ckj / sfx003.