Prerenal azotemia

I-prerenal azotemia iyizinga eliphakeme ngokungajwayelekile lemikhiqizo ye-nitrogen egazini.

I-prerenal azotemia ijwayelekile, ikakhulukazi kubantu abadala asebekhulile nakubantu abasesibhedlela.

Izinso zihluza igazi. Benza nomchamo ukukhipha imfucuza. Lapho inani, noma ingcindezi, yegazi ligeleza ngamaconsi ezinso, ukuhlunga igazi nakho kwehla. Noma kungenzeka kungenzeki nhlobo. Imikhiqizo yemfucuza ihlala egazini. Umchamo omncane noma awenziwa nhlobo, yize izinso uqobo lusebenza.

Lapho imikhiqizo yemfucumfucu ye-nitrogen, efana ne-creatinine ne-urea, yakheka emzimbeni, isimo sibizwa nge-azotemia. Le mikhiqizo yemfucumfucu isebenza njengobuthi lapho yakha. Zilimaza izicubu futhi zinciphise ikhono lezitho zokusebenza.

I-prerenal azotemia iyindlela ejwayelekile yokuhluleka kwezinso kubantu abasesibhedlela. Noma yisiphi isimo esinciphisa ukugeleza kwegazi siye ezinso singasibangela, kufaka phakathi:

• Kushe
• Izimo ezivumela uketshezi ukuba luphume egazini
• Ukuhlanza isikhathi eside, isifo sohudo, noma ukopha
• Ukuchayeka kokushisa
• Ukwehlisa uketshezi (ukoma)
• Ukulahleka kwevolumu yegazi
• Imithi ethile, efana ne-ACE inhibitors (imishanguzo elapha ukwehluleka kwenhliziyo noma umfutho wegazi ophakeme) kanye nama-NSAID

Izimo lapho inhliziyo ingakwazi ukupompa igazi elanele noma iphampa igazi ngevolumu ephansi futhi kwandisa ubungozi be-prerenal azotemia. Lezi zimo zifaka:

• Ukwehluleka kwenhliziyo
• Ukushaqeka (ukushaqeka okubucayi)

Kungabangelwa futhi yizimo eziphazamisa ukugeleza kwegazi liye ezinso, njenge:

• Izinhlobo ezithile zokuhlinzwa
• Ukulimala ezinso
• Ukuvalwa komthambo onikeza igazi ezinso (ukuvalwa komthambo we-renal)

I-prerenal azotemia kungenzeka ingabi nazimpawu. Noma, izimpawu zezimbangela ze-prerenal azotemia zingaba khona.

Izimpawu zokuphela kwamanzi emzimbeni zingaba khona futhi zibandakanya noma yikuphi okulandelayo:

• Ukudideka
• Ukwehla komkhiqizo womchamo noma cha
• Umlomo owomile ngenxa yokoma
• Ishayela okusheshayo
• Ukukhathala
• Umbala wesikhumba okhanyayo
• Ukuvuvukala

Ukuhlolwa kungakhombisa:

• Imithambo yentamo egoqekile
• Ulwelwesi lwamafinyila olomile
• Umchamo omncane noma ongekho esinyeni
• Umfutho wegazi ophansi
• Umsebenzi wenhliziyo ophansi noma i-hypovolemia
• Ubulukhuni besikhumba (turgor)
• Ukushaya kwenhliziyo okusheshayo
• Ukucindezelwa kwe-pulse okunciphile
• Izimpawu zokwehluleka okukhulu kwezinso

Ukuhlolwa okulandelayo kungenziwa:

• I-creatinine yegazi
• BUN
• I-osmolality yomchamo namandla adonsela phansi athile
• Ukuhlolwa komchamo ukuhlola amazinga e-sodium ne-creatinine nokuqapha ukusebenza kwezinso

Inhloso enkulu yokwelashwa ukulungisa imbangela ngokushesha ngaphambi kokuba izinso zonakaliswe. Abantu kaningi badinga ukuhlala esibhedlela.

Uketshezi olufakwa ngaphakathi (IV), kufaka phakathi igazi noma imikhiqizo yegazi, kungasetshenziselwa ukukhuphula umthamo wegazi. Ngemuva kokuthi ivolumu yegazi ibuyiselwe, imithi ingasetshenziselwa:

• Khulisa umfutho wegazi
• Thuthukisa ukupompa kwenhliziyo

Uma umuntu enezimpawu zokwehluleka okukhulu kwezinso, ukwelashwa kungabandakanya:

• I-Dialysis
• Izinguquko zokudla
• Imithi

I-prerenal azotemia ingaguqulwa uma imbangela ingatholakala futhi ilungiswe kungakapheli amahora angama-24. Uma imbangela ingalungisiwe ngokushesha, kungenzeka umonakalo ezinsweni (i-acute tubular necrosis).

Izinkinga zingafaka:

• Ukungasebenzi kahle kwezinso
• I-acute tubular necrosis (ukufa kwezicubu)

Iya egumbini labezimo eziphuthumayo noma ushayele inombolo yendawo ephuthumayo (njenge-911) uma unezimpawu ze-prerenal azotemia.

Ukwelapha ngokushesha noma isiphi isimo esinciphisa umthamo noma amandla okugeleza kwegazi ngezinso kungasiza ekuvimbeleni i-prerenal azotemia.

I-Azotemia - prerenal; I-Uremia; Ukungasebenzi kahle kwezinso; Ukwehluleka okukhulu kwezinso - i-prerenal azotemia

• Ukwakheka kwezinso
• Izinso - ukugeleza kwegazi nomchamo

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U-Okusa MD, uPortilla D. Pathophysiology wokulimala kanzima kwezinso. 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 28.

UWolfson AB. Ukwehluleka kwezinso. Ku: Walls RM, Hockberger RS, Gausche-Hill M, ama-eds. Imithi Ephuthumayo yaseRosen: Imiqondo kanye Nokuzijwayeza Komtholampilo. Umhlaka 9. IPhiladelphia, PA: Elsevier; 2018: isahluko 87.