Isifo sezinso esingalapheki

Isifo esingapheliyo sezinso ukulahleka kancane kokusebenza kwezinso ngokuhamba kwesikhathi. Umsebenzi omkhulu wezinso ukukhipha imfucuza namanzi amaningi emzimbeni.

Isifo sezinso esingalapheki (i-CKD) siya ngokuya siba sibi ngaphezu kwezinyanga noma iminyaka. Ungahle ungaboni zimpawu okwesikhashana. Ukuphela komsebenzi kungahle kuhamba kancane uze ungabi nezimpawu kuze kube yilapho izinso zakho sezicishe zayeka ukusebenza.

Isigaba sokugcina se-CKD sibizwa ngokuthi isifo se-end-stage renal disease (ESRD). Kulesi sigaba, izinso azisakwazi ukususa imfucuza eyanele noketshezi oluningi emzimbeni. Kuleli qophelo, uzodinga i-dialysis noma ukufakelwa izinso.

Isifo sikashukela nomfutho wegazi ophezulu yizimbangela ezi-2 ezivame kakhulu kanye ne-akhawunti yamacala amaningi.

Ezinye izifo nemibandela eminingi ingalimaza izinso, kufaka phakathi:

• Ukuphazamiseka okuzenzakalelayo (njenge-systemic lupus erythematosus ne-scleroderma)
• Ukukhubazeka kokuzalwa kwezinso (njengesifo sezinso se-polycystic)
• Amanye amakhemikhali anobuthi
• Ukulimala ezinso
• Amatshe ezinso nokutheleleka
• Izinkinga ngemithambo yokondla izinso
• Eminye imithi, njengezinhlungu kanye nemithi yomdlavuza
• Ukugeleza emuva komchamo ungene ezinso (i-reflux nephropathy)

I-CKD iholela ekwakhiweni komkhiqizo oketshezi nodoti emzimbeni. Lesi simo sithinta kakhulu izinhlelo zomzimba nemisebenzi, kufaka phakathi:

• Umfutho wegazi ophezulu
• Isibalo samaseli egazi aphansi
• Uvithamini D nempilo yethambo

Izimpawu zokuqala ze-CKD ziyefana nezinye izifo eziningi. Lezi zimpawu zingaba ukuphela kophawu lwenkinga ezigabeni zokuqala.

Izimpawu zingafaka:

• Ukulahleka kwesifiso
• Ukugula okujwayelekile nokukhathala
• Ukuphathwa ikhanda
• Ukulunywa (pruritus) nesikhumba esomile
• Isicanucanu
• Ukwehla kwesisindo ngaphandle kokuzama ukunciphisa umzimba

Izimpawu ezingase zivele lapho ukusebenza kwezinso sekukubi kakhulu zifaka:

• Isikhumba esimnyama ngokungajwayelekile noma esikhanyayo
• Ubuhlungu bamathambo
• Ukozela noma izinkinga zokugxila noma ukucabanga
• Ukuba ndikindiki noma ukuvuvukala ezandleni nasezinyaweni
• Ukudikiza kwemisipha noma amajaqamba
• Iphunga lokuphefumula
• Ukulimala okulula, noma igazi esitokisini
• Ukoma ngokweqile
• Ama-hiccups avamile
• Izinkinga ngomsebenzi wezocansi
• Isikhathi sokuya esikhathini siyayeka (amenorrhea)
• Ukuphelelwa umoya
• Izinkinga zokulala
• Ukuhlanza

Iningi labantu lizoba nomfutho wegazi ophakeme kuzo zonke izigaba ze-CKD. Ngesikhathi sokuhlolwa, umhlinzeki wakho wezokunakekelwa kwempilo angase ezwe nemisindo yenhliziyo noma yamaphaphu engajwayelekile esifubeni sakho. Ungaba nezimpawu zokulimala kwemizwa ngesikhathi sokuhlolwa kwesistimu yezinzwa.

Ukuhlolwa kwe-urinalysis kungakhombisa amaprotheni noma olunye ushintsho kumchamo wakho. Lezi zinguquko zingavela ezinyangeni eziyisithupha kuya kweziyishumi noma ngaphezulu ngaphambi kokuba kuvele izimpawu.

Ukuhlolwa okubheka ukuthi izinso zisebenza kahle kangakanani kufaka:

• Imvume ye-Creatinine
• Amaleveli we-Creatinine
• Igazi urea nitrogen (BUN)

I-CKD ishintsha imiphumela yezinye izivivinyo eziningana. Uzodinga ukuvivinywa okulandelayo kaningi njalo ezinyangeni ezimbili kuya kwezi-3 lapho isifo sezinso siba sibi kakhulu:

• I-albhamuin
• I-calcium
• Cholesterol
• Qedela ukubalwa kwegazi (CBC)
• Ama-electrolyte
• Magnesium
• I-Phosphorus
• I-potassium
• Sodium

Okunye ukuhlolwa okungenziwa ukubheka imbangela noma uhlobo lwesifo sezinso kufaka:

• I-CT scan yesisu
• I-MRI yesisu
• I-Ultrasound yesisu
• Ukucubungula izinso
• Ukuskena izinso
• Izinso ultrasound

Lesi sifo singashintsha nemiphumela yokuhlolwa okulandelayo:

• I-Erythropoietin
• I-Parathyroid hormone (PTH)
• Ukuhlolwa kwesisindo samathambo
• Izinga likavithamini D

Ukulawulwa kwengcindezi yegazi kuzonciphisa okunye ukulimala kwezinso.

• Ama-angiotensin-converting enzyme (ACE) inhibitors noma ama-angiotensin receptor blockers (ARBs) asetshenziswa kakhulu.
• Inhloso ukugcina umfutho wegazi ungaphansi noma ngaphansi kuka-130/80 mm Hg.

Ukwenza izinguquko endleleni yokuphila kungasiza ekuvikeleni izinso, futhi kuvimbele isifo senhliziyo nesifo sohlangothi, njenge:

• UNGABHALI.
• Yidla ukudla okunamafutha amancane ne-cholesterol.
• Vivinya umzimba njalo (khuluma nodokotela wakho noma unesi ngaphambi kokuqala ukuzivocavoca).
• Thatha izidakamizwa ukwehlisa i-cholesterol yakho, uma kudingeka.
• Gcina ushukela wegazi lakho ulawulwa.
• Gwema ukudla usawoti omningi noma i-potassium.

Hlala ukhuluma nodokotela wakho wezinso ngaphambi kokuthatha noma imuphi umuthi ongawuzuzi. Lokhu kufaka amavithamini, amakhambi nezithako. Qiniseka ukuthi bonke abahlinzeki obavakashelayo bayazi ukuthi une-CKD. Ezinye izindlela zokwelashwa zingafaka:

• Imithi ebizwa nge-phosphate binders, ukusiza ukuvimbela amazinga aphezulu we-phosphorus
• Insimbi eyengeziwe ekudleni, amaphilisi ensimbi, i-ayoni enikezwa ngomthambo (insimbi efakwa emithanjeni) isibhamu esikhethekile somuthi obizwa nge-erythropoietin, nokumpontshelwa igazi ukwelapha i-anemia
• I-calcium eyengeziwe novithamini D (khuluma njalo nomhlinzeki wakho ngaphambi kokuthatha)

Umhlinzeki wakho kungenzeka ukuthi ulandele ukudla okukhethekile kwe-CKD.

• Kukhawulela uketshezi
• Ukudla amaprotheni amancane
• Ikhawulela i-phosphorus namanye ama-electrolyte
• Ukuthola amakhalori anele ukuvimbela ukulahleka kwesisindo

Bonke abantu abane-CKD kufanele babe sesikhathini ngemigomo elandelayo:

• Umuthi wokugomela i-Hepatitis A.
• Umuthi wokugomela i-Hepatitis B
• Umuthi wokugomela umkhuhlane
• Umuthi wokugomela i-pneumonia (PPV)

Abanye abantu bayasizakala ngokubamba iqhaza eqenjini elisekela isifo sezinso.

Abantu abaningi abatholakali ukuthi bane-CKD kuze kube yilapho belahlekelwe umsebenzi wabo wezinso.

Alikho ikhambi le-CKD. Uma iba kubi ku-ESRD, futhi ngokushesha kangakanani, kuya ngo:

• Imbangela yokulimala kwezinso
• Uzinakekela kahle kangakanani

Ukuhluleka kwezinso yisigaba sokugcina se-CKD. Yilapho izinso zakho zingasakwazi ukuxhasa izidingo zomzimba wethu.

Umhlinzeki wakho uzoxoxa nawe nge-dialysis ngaphambi kokuthi uyidinge. I-Dialysis isusa imfucuza egazini lakho lapho izinso zakho zingasakwazi ukwenza umsebenzi wazo.

Ezimweni eziningi, uzoya ku-dialysis uma ususele ku-10 kuya ku-15% kuphela womsebenzi wakho wezinso.

Ngisho nabantu abalinde ukufakelwa izinso bangadinga i-dialysis ngenkathi belindile.

Izinkinga zingafaka:

• Ukushoda kwegazi
• Ukopha esiswini noma emathunjini
• Ubuhlungu bamathambo, obuhlangene nobomzimba
• Izinguquko kushukela wegazi
• Ukulimala kwemizwa yemilenze nezingalo (i-peripheral neuropathy)
• Ukuwohloka komqondo
• I-fluid buildup ezungeze amaphaphu (i-pleural effusion)
• Izinkinga zenhliziyo negazi
• Izinga eliphezulu le-phosphorus
• Amazinga aphezulu e-potassium
• Hyperparathyroidism
• Ingozi eyengeziwe yokutheleleka
• Ukulimala kwesibindi noma ukwehluleka
• Ukungondleki
• Ukuphuphuma kwesisu nokungazali
• Ukuquleka
• Ukuvuvukala (i-edema)
• Ukuncipha kwamathambo kanye nengozi eyengeziwe yokwaphuka

Ukwelapha isimo esidala inkinga kungasiza ukuvimbela noma ukubambezela i-CKD. Abantu abanesifo sikashukela kufanele balawule ushukela wegazi nomfutho wegazi labo futhi bangabhemi.

Ukwehluleka kwezinso - okungapheli; Ukwehluleka kwezinso - okungapheli; Ukungasebenzi kahle kwezinso; Ukwehluleka kwezinso okungamahlalakhona; Ukwehluleka kwezinso okungamahlalakhona

• Ukwakheka kwezinso
• Izinso - ukugeleza kwegazi nomchamo
• I-Glomerulus nephron

UChristov M, uSprague SM. Isifo esingapheliyo sezinso - i-mineral bone disorder. Ku: Yu ASL, Chertow GM, Luyckx VA, Marsden PA, Skorecki K, Taal MW, ama-eds. IBrenner neRector's The Kidney. Umhla ka-11. IPhiladelphia, PA: Elsevier; 2020: isahluko 53.

Izinsimbi ME, McDonald SP. I-Epidemiology yesifo esingapheliyo sezinso ne-dialysis. Ku: Feehally J, Floege J, Tonelli M, Johnson RJ, abahleli. I-Nephrology Yomtholampilo Ephelele. Umhlaka 6. IPhiladelphia, PA: Elsevier; 2019: isahluko 77.

I-Taal MW. Ukwahlukaniswa kanye nokuphathwa kwesifo esingapheliyo sezinso. Ku: Yu ASL, Chertow GM, Luyckx VA, Marsden PA, Skorecki K, Taal MW, ama-eds. IBrenner neRector's The Kidney. Umhla ka-11. IPhiladelphia, PA: Elsevier; 2020: isahluko 59.