Ukuhluleka kwezinso ezimbi kubangelwa ukulimala ezinso, okungenzeka kube khona ngenxa yokulahleka kwegazi, ubuthi noma ukulimala ngokomzimba ezinso. Ukuhluleka kwezinso ezinzima kwenzeka ngokushesha, kubangela izimpawu ezijwayelekile, njengokulahlekelwa kwesidlo nokudideka. Kuyinto engathà sina, kodwa ingelashwa, futhi ngokuphathwa ngendlela efanele, iningi labantu lingasinda esiqenjini sokuhluleka kwezinso ezinzima ngaphandle kwemiphumela yesikhathi eside.
Izimpawu
Izinso ziqaphela inani lamanzi, i-electrolytes kanye nodoti emzimbeni, futhi ithumele izinto ezidlulele ukuze zisuswe emcinini. Izimpawu zokuhluleka kwezinso ezinzima zenzeka ngoba lezi zinto ziqoqa emzimbeni lapho izinso zingasebenzi ngendlela efanele. Amazinga avamile oketshezi kanye ne-electrolyte ayadingeka ukuze umzimba wonke usebenze kahle. Izinto zokudoba ziyingozi kulowo wonke amangqamuzana omzimba kanye nezicubu, okuholela ekuboniseni izimpawu ezibanzi. Izimpawu zokuhluleka kwezinso ezinzima zikhula ngokushesha, ngaphezu kwamahora amaningi noma izinsuku.
Izimpawu ezivame kakhulu zokuhluleka kwezinso ezimbi:
- Ukuntuleka kwamandla nokukhathala: Lokhu kungumphumela wokungasebenzi kahle kwamalungu emzimbeni wakho, ongenalo ukuhlushwa okulungile kwam electrolyte ukusebenza njengoba kufanele uma unesifo esiphuthumayo sezinso.
- Ukulahlekelwa isifiso, isicanucanu nokuhlanza: Lokhu kuzwa kwenzeka ngoba uhlelo lwakho lokugaya, oludinga ama-enzyme wokugaya, okunemisipha, nemisipha yokusebenza kahle, kunganciphisa, kungakwazi ukugcina umsebenzi ojwayelekile uma izinso zakho zingalawuli kahle izinto zakho umzimba.
- Ubukhulu obuthakathaka bomzimba: Imisipha yakho idinga ukuthi i-electrolytes ikwazi ukusebenza, futhi uma unesifo sezinso, lokhu kubangela ukuba imisipha isebenze ukuhlupheka.
- Izinhliziyo eziphuthumayo eziphuthumayo noma eziphambene: Ukushaya kwenhliziyo yakho kulawulwa imisipha yakho yenhliziyo (inhliziyo), encike ezinombolweni eziningi ezibalulekile ukusebenza kahle. Umzimba wakho uzama ukulondoloza umsebenzi wenhliziyo isikhathi eside ngangokunokwenzeka. Uma umzimba wakho ungeke uhlawulele imiphumela yokuhluleka kwezinso ezinzima, umsebenzi wakho wenhliziyo ungahlupheka, ukhiqize izilinganiso zenhliziyo ezingavamile. Lokhu kungabangela ukungabi khona kwegazi okwanele kuwo wonke umzimba.
- Ukudideka: Isibonakaliso esibucayi sokuhluleka kwezinso ezinzima, ukudideka kusho ukuthi ubuchopho bakho abuthola igazi elanele. Uma uhlangabezana nokudideka ngenxa yokuhluleka kwezinso ezinzima, ungathuthuka masinyane ekulahlekelweni kokuqwashisa noma i-coma.
- Ukulahlekelwa kokuqaphela noma i-coma: Lesi sibonakaliso sisho ukuthi ubuchopho buyakhohlwa ukunikezwa kwegazi okwanele, futhi kungabangela ukulimala okungapheli ngaphandle kokuthi uthole ukunakekelwa okuphuthumayo kwezokwelapha.
Izimbangela
Izinso zithinta izici eziningi, ezifana nokucindezelwa kwegazi, imithi, impilo yonke, ukudla, nomthamo wamanzi umuntu ophuzayo. Kunezindlela ezahlukene ezahlulekayo ukuhluleka kwezinso ezinzima . Noma yini elimaza ngokushesha izinso izokwehlisa inani lomsebenzi abakwaziyo ukuyenza. Ukuhluleka kwezinso ezinzima kungaba okwesikhashana noma kungaba uphawu lwezinkinga ezinkulu.
Kunezigaba ezintathu eziyinhloko zezimbangela zokuhluleka kwezinso ezinzima. Igama elithi renal lichaza izinso, futhi amagama lalezi zigaba yi-prerenal, intrisic kanye ne-postrenal.
I-Prerenal: Lokhu kuchaza izimbangela zokuhluleka kwezinso eziqala ngaphambi kokuba igazi lifinyelele izinso. Umfutho wegazi ophansi, isibonelo, uzokwenzeka uma inhliziyo yakho ingasebenzi ngokuphumelelayo, noma uma usuphelile amandla.
Kulokhu, izinso ngokwazo akuyona inkinga enkulu, kodwa zithinteka ukuhlinzeka ngegazi eliphansi, okwenza kube nzima izinso ukwenza umsebenzi wokuhlunga igazi.
Ukutheleleka okunzima kungathuthuka ekudumeni kwe-septic , isimo esingabangela ukulimala kanzima ngenxa yokuthi ingcindezi yegazi iwela ezingeni eliphansi kangangokuba izinso azikwazi ukusebenza kahle.
I-intrinsic: Lokhu kuchaza izimbangela zezinso ezihlulekayo lapho izinso ngokwazo zilimazwa khona. Amakhomikhali, okubandakanya amakhemikhali, izidakamizwa ezingekho emthethweni, kanye nemithi ethile enqunyiwe, kufanele adlule ezintsheni, futhi angawalimaza.
Izibonelo zemithi engase ibangele ukuhluleka kwezinso ezinzima zihlanganisa izinto ezihlukene zokuhlola izithombe. Lezi zinhlobo zemithi ayibangele wonke umuntu ozithathayo ukuba abe nokuhluleka okukhulu kwe-renal, noma ngabe akekho ongayisebenzisa. Kodwa zingabangela ukungaphumeleli kwe-renal acute kwabanye abantu, futhi kungaba nzima ukubikezela ukuthi uzothola lokhu. Ngezinye izikhathi, ungase udinge ukuhlolwa kwegazi okulinganisa umsebenzi wakho wezinso ngaphambi kokuba uthathe imithi engenzeka ukuthi ibangele ukuhluleka kwezinso.
Ezinye izimo ezingabangela ukuhluleka kwezinso ezinzima kwisigaba sangaphakathi zihlanganisa ukungabi khona kwe-oxygen egazini, ukutheleleka kwezinso, ukuvuvukala ezinso, nokugula kwezinso. Itshe elikhulu kakhulu lezinso lingabangela nokulimala kwangaphakathi ezinso.
I-Postrenal: Lokhu kuchaza izimbangela zokuhluleka kwezinso ezigxilwe emgqeni we-urinary, lapho umchamo ugeleza khona ngemva kokuba usucutshungulwe izinso. Lezi zimbangela zibandakanya izinkinga ezibandakanya ama-ureters, okuyizibhubhu ezithwala umchamo kwesinye isisu, isambiso, noma i-urethra, okuyinto ithini eliphethe umchamo kusuka esikhwameni ngaphandle komzimba.
Isiqu esikhulu sezinso noma isisu, isibonelo, singatholakala esithombeni noma i-urethra. Uma kukhulu ngokwanele ukuthi umchamo awukwazi ukudlula, umchamo ungaqala ukubuyela emuva, ekugcineni ungene ezintsheni. Lokhu kucindezela kanye nokugeleza okuqhubekayo komchamo kungabangela ukulimala kanzima ezinso.
Ukuxilongwa
Kunezinqubo zokuthola ukutholakala kwezinso ezinzima zezinso. Uma unesinye sezidingo ezintathu ezilandelayo phakathi kwamahora angu-48, lokhu kusho ukuthi unesifo esiphuthumayo sezinso.
- I-serum creatinine yindlela yokuhlolwa kwegazi eyenza umsebenzi wezinso. Uma ikhuphuka ngu-.3 mg / dl, lokhu kusho ukuthi unesifo sezinso.
- Uma i-serum creatinine yakho ikhuphuka ngama-50% noma ngaphezulu kusuka kumazinga avamile, lokhu kusho ukuthi unesifo sezinso.
- Uma umkhiqizo wakho we-urine uwela ku-.5 milliliters kilogram yesisindo somzimba ngehora kwamahora angaphezu kwama-6, khona-ke uzobe uthola ukuthi unesifo sezinso.
Ukukhiqizwa kwe-Urine
Uma unobungozi obunzima bezinso, ungase wenze okwanele umchamo noma umchamo omncane kakhulu. Ungakwazi ukunyuka okuphawulekayo ezingeni lakho le-creatinine, elibonisa ukulimala kolukhuni olunzima, kodwa okwamanje wenza izinga elijwayelekile lomchamo. Ingxenye engaphezu kwengxenye yabo bonke abantu abanokuhluleka kwezinso ezinzima bayaqhubeka benza umchamo kulokho okubonakala sengathi kuyindlela evamile.
Kubantu abadala, ukukhishwa komchamo okuvamile kumakhilomitha angu-0.5 kuya kwangu-1 ngehora ngayinye ngesisindo somzimba, noma amalitha amabili ngosuku. Kubantwana, cishe i-millilitre elilodwa ngehora ngalinye livamile, kanti izinsana, ama-milliliters amabili ngehora ngalinye ngesisindo somzimba kubhekwa njengokujwayelekile. Ukuze kubhekiswe, ama-milliliters angu-30 angaba ngu-one ounce yomchamo.
Kunemikhakha emithathu echaza inani lomkhiqizo ngesikhathi sokulimala kwe-kidney.
- Okungewona umuthi: Lokhu kuchaza isimo lapho umuntu eqhubeka nokwenza umthamo okwanele we-urine, okuvame ukuba ngaphezu kwamamithalitha angu-400 ngosuku, noma ngaphezulu, kuye ngokuthi isimo sezempilo nokudla kwamanzi.
- I-Oliguric: Lokhu kuchaza isimo lapho umuntu enza amalitha angu-400 emvini noma ngaphansi ngosuku.
- U-Anuric: Lokhu kuchaza isimo lapho umuntu enza khona ngamamitha ayizigidi ezingaphansi kuka-100 umchamo ngosuku.
Ukwelapha
Ukwelashwa kokuhluleka kwezinso ezinzima kuxhomeke ekubambeni kwenkinga, kanye nobukhulu besimo. Abantu abaningi baphuthukisa ngokwelashwa kwehluleka ukuphika kwezinso futhi abahlangabezane nezinkinga zesikhathi eside noma ukwehluleka okungenangqondo kwe-renal . Ukubona inkinga, nokuthola ukwelashwa ngokushesha, kuyindlela engcono kakhulu yokuvimbela ukulimala kwezinso okudala izinkinga zezinso zokuphila noma kudinga ukwelashwa kwe-dialysis.
- Ukwehluleka (IV) uketshezi: Umuntu onokuhluleka kwezinso ezinzima ngenxa yokuphelelwa amandla ngokweqile ngemuva kokuzwa ukushaywa kwesibindi kungathuthuka nge- IV fluids . Uma ivolumu ephansi yamanzi iyisizathu sokuhluleka kwezinso ezinzima, ukuhlinzeka umzimba ngamanzi aphuzizayo kungasiza ukubuyisela amazinga amanzi
- Ukuphathwa kwe-Electrolyte: Uma ama-fluids akho kanye nama-electrolyte engekho ebangeni elihle, odokotela bakho bangakunika ama-electrolyte supplements, noma bakunike imithi engayilahla amanye ama-electrolyte amaningi.
- Misa ukusetshenziswa kwezidakamizwa: Uma ukwehluleka kwezinso ezinzima kubangelwa imithi noma ukwesezela, ukwelashwa kufanele kufaka ukuyeka imithi.
- I-Dialysis: Uma izidakamizwa zingalindelekile ukuba ziqedwe ngokuphumelelayo uma uyeka ukuzithatha, ukwelashwa kokwehluleka kidey kudinga ukuqeda umzimba wamakhemikhali ngokushesha ngangokunokwenzeka. Ngezinye izikhathi i- dialysis iyadingeka, indlela umshini ongakwenza ngayo umsebenzi wezinso ngokususa ubuthi nokulawula ibhalansi yamanzi kanye ne-electrolyte.
Izivivinyo Zezinso Zezinso
Izivivinyo zomsebenzi wezinso ziyiqembu lezivivinyo ezihlola umsebenzi wakho wezinso. Lezi zivivinyo azisetshenziselwa ukuxilonga ukuhluleka kwezinso ezinzima, kodwa zisetshenziselwa ukuqapha ukuthi ukuhluleka kwezinso zakho kuthuthuka noma kubika. Izivivinyo zomsebenzi wezinso zingase zithole ukuthi inkinga ilukhuni kangakanani, inganikeza ukuqonda okubangela imbangela yenkinga, futhi ingabuyekezwa ukukhombisa ukuthi izinso ziyaphendula yini ukwelashwa.
Ukuhlolwa komsebenzi wezinso kuhlanganisa:
- I-Creatinine: Umkhiqizo odoti ovezwa ukuphazamiseka kwemisipha, izinga le-creatinine egazini lakho linikeza umbono wokuthi izinso zakho zisebenza kanjani kahle ngoba izinso kufanele zisuse i-creatinine egazini. Izinga elingaphezu kuka-1.21 mg / dL libhekwa njengezinga eliphezulu, futhi kubonisa ukuthi izinso azisebenzi njengoba kufanele.
- I-Blood Urea Nitrogen (BUN): I-nitrogen ye-Urea, eyalinganiswa egazini, isuswe izinso. Amazinga angaphezulu kuka-25 mg / dL abonisa ukuhluleka kwezinso.
- Isilinganiso sokuhlunga kwe-Glomerular (GFR): Le nombolo ibalwa ngokusezingeni le-creatinine egazini lakho, ngokubala okulandisa iminyaka yobudala, ukuphakama, isisindo, nezinye izici ezithinta izinguquko ngabanye. I-GFR evamile kufanele ibe ngaphezu kuka-60, kanti i-GFR engaphansi kwezingu-20 ngokuvamile ivame ukuthi umuntu unokwehluleka kwezinso.
- Ukuhlaziywa kwe-urinalysis: I-urinalysis ingakwazi ukubona igazi, amaprotheni, izifo, ukuvuvukala nezidakamizwa. Lolu lwazi lunikeza ukuqonda imbangela, futhi ngezinye izikhathi ukuthuthuka, kokuhluleka kwangempela kwamandla.
> Imithombo:
> Lavergne A, Vigneau C, uPolard E, et al. Ukulimala kwezinso ezinzima ngenkathi ukwelashwa nge-dose-cloxacillin ephezulu: Umbiko wamacala angu-23 nokubuyekezwa kwezincwadi. Ama-Int J Antimicrob Agents. 2018 Apr 14. pii: S0924-8579 (18) 30109-2. i-doi: 10.1016 / j.ijantimicag.2018.04.007. [I-Epub ngaphambi kokuphrinta]
> Qiu T, Zhou J, izidakamizwa ze-Zhang C. ezithathelwanayo kanye nengozi yesifo sezinso: Ukubuyekezwa okuhlelekile nokuhlaziywa kwemeta. J Gastroenterol Hepatol. 2018 Apr 12. i: 10.1111 / jgh.14157. [I-Epub ngaphambi kokuphrinta]