Isifo se-hepatorenal

I-Hepatorenal syndrome yisimo lapho kunokuhluleka kwezinso okuqhubekayo okwenzeka kumuntu one-cirrhosis yesibindi. Kuyinkinga enkulu engaholela ekufeni.

I-Hepatorenal syndrome yenzeka lapho izinso ziyeka ukusebenza kahle kubantu abanezinkinga ezinkulu zesibindi. Kususwa umchamo omncane emzimbeni, ngakho-ke imikhiqizo emfucuza equkethe i-nitrogen iyakhiwa egazini (i-azotemia).

Lesi sifo senzeka kubantu abafinyelela kwabangu-1 kwabayishumi abasesibhedlela abanesibindi. Kuholela ekuhlulekeni kwezinso kubantu abane:

• Ukwehluleka okukhulu kwesibindi
• Isifo sokusha kwesibindi esidakayo
• Isifo sokuqina kwesibindi
• Uketshezi lwesisu oluthelelekile

Izici zobungozi zifaka:

• Umfutho wegazi owela lapho umuntu ephakama noma eshintsha ngokungazelelwe isikhundla (i-orthostatic hypotension)
• Ukusetshenziswa kwemithi ebizwa nge-diuretics ("amaphilisi amanzi")
• Ukopha emathunjini
• Ukutheleleka
• Ukususwa kwakamuva kwesisu esiswini (paracentesis)

Izimpawu zifaka:

• Ukuvuvukala kwesisu ngenxa yoketshezi (okubizwa nge-ascites, uphawu lwesifo sesibindi)
• Ukudideka kwengqondo
• Imisipha iqhuma
• Umchamo onombala omnyama (uphawu lwesifo sesibindi)
• Ukwehla kokukhishwa komchamo
• Isicanucanu nokuhlanza
• Ukuzuza kwesisindo
• Isikhumba esiphuzi (i-jaundice, uphawu lwesifo sesibindi)

Lesi simo sitholakala ngemuva kokuhlolwa ukukhipha ezinye izimbangela zokuhluleka kwezinso.

Ukuhlolwa komzimba akukutholi ukwehluleka kwezinso ngqo. Kodwa-ke, ukuhlolwa kuzovame ukukhombisa izimpawu zesifo esingapheli sesibindi, njenge:

• Ukudideka (imvamisa ngenxa ye-hepatic encephalopathy)
• Uketshezi oluningi esiswini (ascites)
• I-jaundice
• Ezinye izimpawu zokwehluleka kwesibindi

Ezinye izimpawu zifaka:

• Izimo ezingejwayelekile
• Amasende amancane
• Umsindo omfushane endaweni yesisu lapho uthepha ngamathiphu weminwe
• Izicubu zesifuba ezandisiwe (gynecomastia)
• Izilonda (izilonda) esikhunjeni

Okulandelayo kungaba yizimpawu zokuhluleka kwezinso:

• Okuncane kakhulu noma akukho okukhipha umchamo
• Ukugcina uketshezi esiswini noma emaphethelweni
• Ukwandiswa kwe-BUN namazinga egazi e-creatinine
• Ukwandisa amandla adonsela phansi womchamo kanye ne-osmolality
• I-sodium ephansi yegazi
• Umchamo ophansi kakhulu we-sodium

Okulandelayo kungaba yizimpawu zokuhluleka kwesibindi:

• Isikhathi esingajwayelekile se-prothrombin (PT)
• Izinga le-ammonia yegazi elandisiwe
• I-albhamu ephansi yegazi
• I-Paracentesis ikhombisa ama-ascites
• Izimpawu ze-hepatic encephalopathy (i-EEG ingenziwa)

Inhloso yokwelashwa ukusiza isibindi sisebenze kangcono nokuqinisekisa ukuthi inhliziyo iyakwazi ukupompa igazi elanele emzimbeni.

Ukwelashwa kucishe kufane nokuhluleka kwezinso nganoma yisiphi isizathu. Kubandakanya:

• Ukumisa yonke imithi engadingekile, ikakhulukazi ibuprofen namanye ama-NSAID, ama-antibiotic athile, kanye ne-diuretics ("amaphilisi amanzi")
• Ukuba ne-dialysis ukwenza ngcono izimpawu
• Ukuthatha imithi yokwenza ngcono umfutho wegazi nokusiza izinso zakho zisebenze kangcono; ukumnika i-albumin nakho kungasiza
• Ukubeka i-shunt (eyaziwa njenge-TIPS) ukuqeda izimpawu ze-ascites (lokhu kungasiza nokusebenza kwezinso, kepha inqubo ingaba yingozi)
• Ukuhlinzwa ukubeka i-shunt kusuka esikhaleni sesisu kuya emthanjeni we-jugular ukukhulula ezinye izimpawu zokwehluleka kwezinso (le nqubo iyingozi futhi ayivamisile ukwenziwa)

Umphumela uvame ukuba mubi. Ukufa kuvame ukwenzeka ngenxa yokutheleleka noma ukopha kakhulu (ukopha).

Izinkinga zingafaka:

• Ukopha
• Ukulimala, nokwehluleka, kwezinhlelo eziningi zomzimba
• Isifo sezinso sokugcina
• Ukugcwala ngokweqile kokwehluleka kwenhliziyo
• I-Coma ebangelwa ukwehluleka kwesibindi
• Izifo zesibili

Lesi sifo sivame ukutholakala esibhedlela ngesikhathi sokwelapha isifo sesibindi.

Ukuqina kwesibindi - hepatorenal; Ukwehluleka kwesibindi - hepatorenal

UFernandez J, Arroyo V. Hepatorenal syndrome. Ku: Feehally J, Floege J, Tonelli M, Johnson RJ, abahleli. I-Nephrology Yomtholampilo Ephelele. Umhlaka 6. IPhiladelphia, PA: Elsevier; 2019: isahluko 73.

IGarcia-Tsao G. Cirrhosis nokulandelana kwayo. Ku: IGoldman L, iSchafer AI, ama-eds. Imithi yeGoldman-Cecil. Umhla ka-26. IPhiladelphia, PA: Elsevier; 2020: isahluko 144.

Mehta SS, Fallon MB. I-hepatic encephalopathy, i-hepatorenal syndrome, i-hepatopulmonary syndrome, nezinye izinkinga zesistimu yesifo sesibindi. Ku: Feldman M, Friedman LS, Brandt LJ, ama-eds. Sleisenger kanye neFordtran's Gastrointestinal and Liver Disease. Umhla ka-11. IPhiladelphia, PA: Elsevier; 2021: isahluko 94.