I-necrosis enamandla ye-tubular

I-acute tubular necrosis (ATN) ukuphazamiseka kwezinso okubandakanya ukulimala kwamaseli we-tubule wezinso, okungaholela ekuhlulekeni okukhulu kwezinso. Ama-tubules ayimibhobho emincane ezinso esiza ukuhlunga igazi lapho lidlula ezinso.

I-ATN ivame ukubangelwa ukungabi khona kokugeleza kwegazi ne-oxygen ezicutshini zezinso (ischemia yezinso). Kungenzeka futhi uma amangqamuzana ezinso elinyazwe ubuthi noma into eyingozi.

Izakhiwo zangaphakathi zezinso, ikakhulukazi izicubu zeshubhu sezinso, ziyalimala noma zonakaliswe. I-ATN ingenye yezinguquko zesakhiwo ezivame kakhulu ezingadala ukwehluleka okukhulu kwezinso.

I-ATN iyimbangela ejwayelekile yokuhluleka kwezinso kubantu abasesibhedlela. Izingozi ze-ATN zifaka:

• Ukusabela kokumpontshelwa igazi
• Ukulimala noma ukuhlukumezeka okulimaza imisipha
• Umfutho wegazi ophansi (hypotension) ohlala isikhathi eside kunemizuzu engama-30
• Ukuhlinzwa okukhulu kwakamuva
• Ukushaqeka kwe-Septic (isimo esibi esenzeka lapho ukutheleleka komzimba wonke kuholela ekucindezelekeni kwegazi okuyingozi)

Isifo sesibindi nokulimala kwezinso okubangelwa yisifo sikashukela (isifo sikashukela nephropathy) kungenza umuntu athambekele ekuthuthukiseni i-ATN.

I-ATN nayo ingadalwa yimithi enobuthi ezinso. Le mithi ifaka phakathi ama-antibiotic e-aminoglycoside kanye ne-antifungal drug amphotericin.

Izimpawu zingafaka noma yikuphi okulandelayo:

• Ukwehla kokuqonda, i-coma, i-delirium noma ukudideka, ukozela nokukhathala
• Ukwehla kokukhishwa komchamo noma ukungabikho komchamo
• Ukuvuvukala okujwayelekile, ukugcinwa koketshezi
• Isicanucanu, ukuhlanza

Umhlinzeki wezokunakekelwa kwempilo uzokwenza ukuhlolwa komzimba. Umhlinzeki angase ezwe imisindo engajwayelekile lapho elalele inhliziyo namaphaphu nge-stethoscope. Lokhu kungenxa yoketshezi oluningi emzimbeni.

Ukuhlolwa okungenziwa kufaka phakathi:

• I-BUN ne-serum creatinine
• Ukukhishwa kwe-sodium
• Ukucubungula izinso
• Ukuhlolwa komchamo
• I-sodium yomchamo
• Umchamo othile womchamo kanye ne-osmolarity yomchamo

Kubantu abaningi, i-ATN iyabuyiselwa emuva. Umgomo wokwelashwa ukuvimbela izinkinga ezisongela impilo zokwehluleka okukhulu kwezinso

Ukwelashwa kugxile ekuvimbeleni ukwakheka kwamanzi kanye nokungcola, ngenkathi kuvumela izinso ukuthi zelaphe.

Ukwelashwa kungafaka noma yikuphi okulandelayo:

• Ukukhomba nokwelapha imbangela yenkinga
• Ikhawulela ukungena koketshezi
• Ukuthatha imithi yokusiza ukulawula izinga le-potassium egazini
• Imithi ethathwe ngomlomo noma nge-IV ukusiza ukususa uketshezi emzimbeni

I-dialysis yesikhashana ingasusa imfucuza namanzi amaningi. Lokhu kungasiza ekuthuthukiseni izimpawu zakho ukuze uzizwe ungcono. Kungenza futhi ukwehluleka kwezinso kube lula ukulawula. I-Dialysis kungenzeka ingadingeki kubo bonke abantu, kepha ivame ukusindisa impilo, ikakhulukazi uma i-potassium iphakeme ngokuyingozi.

I-Dialysis ingadingeka kulezi zimo ezilandelayo:

• Ukwehla kwesimo sengqondo
• Ukugcwala ngokweqile
• Izinga le-potassium lenyukile
• I-Pericarditis (ukuvuvukala kwesembozo esifana nesaka nxazonke zenhliziyo)
• Ukususwa kobuthi obuyingozi ezinso
• Ukuntuleka okuphelele kokukhiqizwa komchamo
• Ukwakheka okungalawulwa kwemikhiqizo kadoti we-nitrogen

I-ATN ingahlala izinsuku ezimbalwa iye kumaviki ayisithupha noma ngaphezulu. Lokhu kungalandelwa usuku olungu-1 noma 2 lokwenza umchamo omkhulu ngokungajwayelekile njengoba izinso zilulama. Umsebenzi wezinso uvame ukubuyela kokujwayelekile, kepha kungahle kube nezinye izinkinga ezinkulu nezinkinga.

Shayela umhlinzeki wakho uma ukuphuma komchamo wakho kuncipha noma kuyeka, noma uma uthuthukisa ezinye izimpawu ze-ATN.

Ukwelapha ngokushesha izimo ezingaholela ekwehleni kokugeleza kwegazi kanye nokwehla komoya-mpilo ezinsweni kunganciphisa ubungozi be-ATN.

Ukumpontshelwa igazi kuyahlukaniswa ukuze kuncishiswe ubungozi bokungahambelani kahle.

Isifo sikashukela, ukuphazamiseka kwesibindi, nezinkinga zenhliziyo zidinga ukuphathwa kahle ukunciphisa ubungozi be-ATN.

Uma wazi ukuthi uthatha umuthi ongalimaza izinso zakho, buza umhlinzeki wakho mayelana nokuhlolwa kwezinga lakho legazi lomuthi njalo.

Phuza uketshezi oluningi ngemuva kokuthola noma iyiphi idayi yokuqhathanisa evumela ukuthi isuswe emzimbeni futhi inciphise ubungozi bokulimala kwezinso.

I-necrosis - i-tubular yezinso; I-ATN; I-Necrosis - i-tubular ebukhali

• Ukwakheka kwezinso
• Izinso - ukugeleza kwegazi nomchamo

I-Turner JM, iCoca SG. Ukulimala okunamandla kwe-tubular necrosis ye-tubular necrosis. Ku: Gilbert SJ, Weiner DE, ama-eds. I-Primer yeNational Kidney Foundation yezifo zezinso. Umhla wesi-7. IPhiladelphia, PA: Elsevier; 2018: isahluko 32.

I-Weisbord SD, iPalevsky PM. Ukuvimbela nokuphathwa kokulimala 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 29.