Ukwehluleka kwezinso ezinjeni

Izimpawu zesifo

Imisebenzi yezinso emzimbeni ihlukahlukene - ayihlanganisi indima yokukhipha kuphela, kodwa futhi nokubamba iqhaza kumetabolism yamaprotheni, ama-carbohydrate kanye ne-lipids, ukulawulwa kwebhalansi ye-acid-base, umfutho we-osmotic, ibhalansi yamanzi, umfutho wegazi, njll. Ngakho-ke, ngokukhula kwesifo kuMzimba uphazanyiswa izinqubo eziningi, futhi izimpawu zezinkinga zezinso ezinjeni zingahlukahluka kakhulu. Isibonelo, lezi zingaba izimpawu zesifo sesisu, isifo sikashukela, urolithiasis, isifo sezinsini, kwezinye izimo, ungasola ngisho nokuba khona komzimba wangaphandle esiswini noma emathunjini.

Izimpawu eziyinhloko zokuhluleka kwezinso ezinjeni zihlanganisa:

• ukwenqaba ukudla noma ukulahlekelwa isifiso sokudla;

• ukuhlanza;

• ukukhathala, ukudangala;

• iphunga elibi eliphuma emlonyeni;

• ukoma okwandayo;

• ukuchama njalo;

• ukuncipha komzimba.

Njengoba sibona, izimpawu zesifo ziyisici sezinhlobonhlobo ze-pathologies, ngakho-ke ukuxilongwa kufanele kuqinisekiswe ngokuhlolwa. Emtholampilo, kufanele wenze ukuxilongwa okulandelayo:

• thatha ukuhlolwa kwegazi jikelele kanye ne-biochemical;

• yenza ukuhlolwa komchamo jikelele;

• ukwenza i-ultrasound yomgodi wesisu;

• ukukala umfutho wegazi (tonometry);

• ukukhipha ezinye izifo ezinezimpawu ezifanayo, kuyinto efiselekayo ukwenza i-x-ray yomgodi wesisu.

Ngokusekelwe emiphumeleni yokuhlolwa, izimpawu ezilandelayo zokuhluleka kwezinso ezinjeni zingabonakala:

• ukwanda kwe-urea, i-creatinine, i-phosphorus ku-biochemistry;

• i-anemia ngokusho kokuhlolwa kwegazi okujwayelekile;

• i-proteinuria, i-hematuria, ukuncipha kokuxineka komchamo;

• ukwanda komfutho wegazi ku-tonometry.

Njengoba kunikezwe umthamo obalulekile wezinso, okungenani u-60-70% wezicubu zezinso kufanele zife ukuze kuthuthukiswe izimpawu zalesi sifo, futhi kuze kube yileso sikhathi inja ingase ingabi nazo izimpawu zokuba khona kwalesi sifo. Ezigabeni zokuqala zesifo sezinso, inani lama-nephron afile lingafinyelela ku-75%! I-prognosis embi yesifo ihlotshaniswa nalesi sici - ngesikhathi isilwane sinezimpawu zesifo futhi kungenzeka ukwenza ukuxilongwa, njengomthetho, akukho lutho olungenziwa ukusiza. Okunye okubangela umphumela ongemuhle ukuthi ngokuvamile abanikazi bawo abaqapheli ngisho nokuthi inja inezinkinga zezinso, bacime zonke izimpawu zokuguga futhi bangayi emtholampilo wezilwane.

Ukuhluleka kwe-renal acute (ARF)

Ukuhluleka kwe-renal acute ezinjeni yi-syndrome eqala ngenxa yokungasebenzi kahle kwezinso futhi ihambisana ne-azotemia (okungukuthi, ukwanda kwe-urea ne-creatinine ekuhlolweni kwegazi), ukuphazamiseka kwebhalansi ye-fluid ne-electrolyte kanye nebhalansi ye-acid-base.

Izizathu zokuthuthukiswa kwe-OPN zifaka:

• ukwephulwa kwesimiso sokujikeleza kwegazi ngenxa yokushaqeka, ukulahlekelwa igazi, isifo senhliziyo, i-renal vascular thrombosis nezinye izimo ezinzima;

• ukusetshenziswa kwezidakamizwa ze-nephrotoxic, njengama-antibiotics athile, izidakamizwa ezingezona ukuvuvukala, izidakamizwa ze-immunosuppressive kanye ne-chemotherapy, noma ubuthi bezinto ze-nephrotoxic, njenge-ethylene glycol;

• ukutholakala kwe-pathologies enzima ye-systemic, ukuphazamiseka kwe-autoimmune, izifo ezithathelwanayo (isibonelo, i-leptospirosis), njll.

Ukuxilongwa kuyinkimbinkimbi ngokusekelwe kulokhu:

1. Umlando wesici (ukuphuza imithi noma ezinye izinto ze-nephrotoxic, ukuhlinzwa, ukuhlukumezeka, njll.);

2. Izimpawu eziqondile (ukwenqaba ukudla kungazelelwe, ukunganaki, ukuhlanza, isifo sohudo, umoya omubi, ukudlikizeka, ukungakwazi ukusebenza kahle emkhathini kanye nokuncipha kwenani lokubunjwa komchamo kuze kube yilapho ukuchama kungasekho);

3. Ngokuxilonga elabhorethri:

   • ukuhlolwa kwegazi kungabona ukwanda kwe-hematocrit, ukwanda kwenani lama-leukocyte nge-lymphopenia;

   • ngokusho kwe-biochemistry yegazi, ukwanda okuqhubekayo kokuqukethwe kwe-urea, i-creatinine, i-phosphorus, i-potassium ne-glucose kuyaphawulwa;

   • i-urinalysis inquma ukwehla komthamo womchamo, i-proteinuria, i-glucosuria;

   • imiphumela ye-X-ray kanye ne-ultrasound ekuthuthukisweni okunamandla kwenqubo, njengomthetho, ayishintshile. 

Ukuthi inja isalelwe isikhathi esingakanani ukuthi iphile uma izinso zayo zihluleka kuncike ezingeni lomonakalo wazo, isivinini sokuthintana nomtholampilo kanye nokunemba kokwelashwa okunqunyiwe.

Ukwehluleka kwezinso okungapheli (CRF) ezinjeni

Ukwehluleka kwezinso okungapheli kuyisimo somzimba somzimba esibonakala ngokulimala okungenakulungiseka ezinso, ukwephulwa kokuphuma kwemikhiqizo ye-nitrogen metabolism emzimbeni kanye nokuphazamiseka kwezinhlobo eziningi ze-homeostasis (okungukuthi, ukungaguquguquki kwemvelo yangaphakathi umzimba).

Lesi sifo singabhekwa njengesigaba sokugcina sokuqhubeka kwezifo ezihlukahlukene zezinso: ukukhubazeka kokuzalwa, i-glomerulonephritis, i-amyloidosis, i-pyelonephritis, i-nephrolithiasis, isifo se-polycystic nabanye abaningi. Iningi lalokhu kuxilongwa kungenziwa kuphela nge-biopsy (ukuthatha ucezu lwesitho se-histology), ngakho-ke, ezimweni eziningi, bakhuluma nge-nephropathy yezinhlangothi zombili engapheli njengesiphetho.

Njengoba kushiwo ngenhla, ukulimala okungaphezu kuka-75% wesisindo sezinso kuholela ekuphazamisekeni kwezinso: umsebenzi wokuhlushwa uyancipha (okuholela ekwehleni komthamo womchamo), kukhona ukubambezeleka ekukhishweni kwe-nitrogen. imikhiqizo ye-metabolism (lesi yisigaba sokugcina se-protein metabolism emzimbeni), futhi ekugcineni i-CRF ezinjeni iba ne-uremia - ubuthi emzimbeni ngemikhiqizo ebolayo. Futhi, izinso zikhiqiza i-hormone erythropoietin, ebhekele ukuhlanganiswa kwamangqamuzana abomvu egazi - ngakho-ke, lapho izinso zihluleka, ukuhlanganiswa kwe-hormone kuncipha futhi i-anemia ikhula kancane kancane.

Njengasendabeni ye-acute pathology, ukuxilongwa kokwehluleka kwezinso okungapheli kwenziwa ngesisekelo se-anamnesis kanye nemiphumela yokuhlolwa kwesici: i-hypoplastic anemia, ukwanda kwe-creatinine ne-urea nitrogen yegazi, i-hyperphosphatemia, i-acidosis, i-hyperkalemia itholwa. Ukunciphisa ukuminyana komchamo (ezinjeni ezingaphansi kuka-1,025 hl), i-proteinuria emaphakathi nayo ingenzeka (iphrotheni emchameni iyanda).

Ku-radiograph uma kwenzeka ukwehluleka kwezinso ezinjeni kungatholwa ukwakheka okungalingani kwezinso kanye nokuncipha kosayizi wazo, ngokusho kwe-ultrasound - isakhiwo esingafani, i-sclerosis ye-parenchyma, ukulahlekelwa okuphelele kwezingqimba (ukuhlukaniswa okukhubazekile kwe-cortico-medullary). ), ukuncipha kobukhulu besitho.

Ngokusekelwe enanini lokuhlushwa kwe-creatinine ku-serum yegazi, izigaba ezi-4 ze-CRF ezinjeni ziyahlukaniswa:

1. isigaba se-nonazotemic - lokhu kungabandakanya noma yikuphi ukwephulwa kwezinso ngaphandle kwesizathu esihlonziwe esihlotshaniswa nokuba khona kwe-nephropathy. Izinguquko zokuqala ezinsweni nge-ultrasound zingabonakala, emcinini - ukwanda kwenani lamaprotheni kanye nokuncipha kobuningi. Ngokusho kwe-biochemistry yegazi, ukwanda okuqhubekayo kokuqukethwe kwe-creatinine kuyaphawulwa (kodwa ngaphakathi kwebanga elijwayelekile).

2. I-azotemia ye-renal encane - Amanani e-Serum creatinine angama-125-180 μmol. Umkhawulo ophansi wamanani we-creatinine uXNUMXbuXNUMXbkungaba okuhlukile kwejwayelekile, kepha kulesi sigaba, noma yikuphi ukuphazamiseka ekusebenzeni kohlelo lokuchama sekuvele kubonwe ezifuyweni. Izimpawu zokwehluleka kwezinso ezinjeni zingase zibe mnene noma zingabikho.

3. I-azotemia ye-renal emaphakathi - Amanani e-Serum creatinine angama-181-440 μmol. Kulesi sigaba, njengomthetho, izimpawu ezihlukahlukene zomtholampilo zesifo sezivele zikhona.

4. I-azotemia enkulu yezinso - amanani e-creatinine angaphezu kwama-441 μmol. Kulesi sigaba, ukubonakaliswa okunzima kwesistimu yesifo kanye nezimpawu ezishiwo zokudakwa ziyabonwa.

Ukwelashwa kokwehluleka kwezinso ezinjeni

Ngakho, uma inja inokwehluleka kwezinso, ingabe ingelapheka? Amaqhinga okwelapha kanye namathuba okuqeda ukwehluleka kwezinso ezinjeni ahluka kakhulu kuye ngohlobo lwazo.

Ukwelashwa kokuhluleka kwe-renal acute kwenziwa kuphela esibhedlela ngaphansi kokuqondiswa njalo kukadokotela. Ukwelashwa okuqondile (i-pathogenetic) kunqunyelwe, okuhloswe ngayo ukuqeda imbangela yalesi sifo. I-symptomatic therapy nge-intravenous yenziwa njalo ukuze kujwayelekile ibhalansi yamanzi-electrolyte kanye nebhalansi ye-acid-base, kanye nokukhipha ubuthi. Ukuhlolwa kwegazi, isimo esijwayelekile sesiguli, inani lomchamo elihlukanisiwe libhekwa nsuku zonke - kulokhu, i-catheterization yesinye kanye nokufakwa komchamo kuyimpoqo.

Lapho ulondoloza ukudla, ukudla okukhethekile kunqunyelwe ukwehluleka kwezinso ezinjeni, ngokuhlanza nokuntula ukudla - izakhi eziyinhloko kufanele zinikezwe nge-intravenously noma ngamashubhu akhethekile (i-nasoesophageal probe, njll.).

Esimeni sokudakwa okunzima, ukungabikho noma ukucishe kuqedwe ngokuphelele ukukhiqizwa komchamo kanye nokungasebenzi kokwelashwa okuqinile ezinsukwini zokuqala eziyi-1-3 zokulaliswa esibhedlela, i-dialysis iyanconywa (lena inqubo yokukhipha udoti okwenziwa ngokwenziwa kanye noketshezi oluningi oluvela esikhumbeni. umzimba).

Ngokuthuthukiswa kokuhluleka kwe-renal acute kwanoma iyiphi i-etiology, umnikazi wesilwane kufanele aqonde ukuthi ukubikezelwa kwalesi sifo kuqaphile kuze kube kubi, izinkinga ezihlukahlukene zingenzeka ngesikhathi sokwelashwa. Kudingeka futhi ulungiselele ukulaliswa esibhedlela ezibizayo isikhathi eside - lapho uzama ukwelapha isilwane esifuywayo esisesimweni esibucayi ekhaya, ungalahlekelwa isikhathi, bese amathuba okuthola kabusha ancishiswa kakhulu. Kodwa ngokwelashwa okufanele nangesikhathi esifanele, inja inawo wonke amathuba okuthola kabusha nokululama okugcwele.

Ukwelashwa kokwehluleka kwezinso okungapheli ezinjeni kungaba yizimpawu kuphela. Kulokhu, kubalulekile ukuqaphela iqiniso lokuthi i-CRF iyisifo esiqhubekayo, esingenakuhlehliswa esinomphumela obulalayo: uma isilwane sasekhaya sanikezwa isigaba se-4 (terminal), khona-ke cishe ngeke siphile isikhathi esingaphezu kwenyanga.

Nakuba ulondoloza isifiso sokudla esilwaneni esifuywayo esine-CRF, into eyinhloko ukulandela ukudla okukhethekile (izimiso esizoxoxa ngazo ngezansi) nokuhlola ukuhlolwa kwegazi ngokuhamba kwesikhathi.

Lapho kukhona ukuhlanza nokwenqaba ukudla, kusetshenziswa izidakamizwa ze-antiemetic (njenge-maropitant, metoclopramide), kanye nezidakamizwa ze-gastroprotective (sucralfate) kanye ne-H2 receptor antagonists (ranitidine).

Ngokunyuka kwenani le-phosphorus egazini le-biochemistry, izidakamizwa ezibopha i-phosphorus emathunjini, okuthiwa ama-phosphate binders (isibonelo, ipakitine), zinqunyiwe.

Ngokwenqaba okuphikelelayo kokudla, ukuhlanza okungalawuleki, nezinye izimpawu zokudakwa kwe-uremic, ukwelashwa kwesiguli ngokwelashwa ngomjovo nokuqapha ukuhlolwa kwegazi kuyadingeka ukuze kuqiniswe isilwane esifuywayo.

Futhi, ngokuthuthukiswa kwe-CRF ezifuyweni ezifuywayo, ukwanda komfutho wegazi kuvame ukubonwa, ukuze kulawulwe lapho i-angiotensin-converting enzyme inhibitors (ACE inhibitors) inqunywa ngokulawulwa okuphoqelekile kwe-proteinuria ne-azotemia (ngoba le mithi ingaba yimbi kakhulu ubunzima be-CRF).

Lapho isimo sesilwane esifuywayo sizinzile, inkambo yesifo kanye nempumelelo yokwelashwa kuhlolwa ngezikhathi ezithile. Ngenkambo elinganiselwe yesifo, kuhle ukuhlola inja kanye njalo ezinyangeni ezingu-1.

Ukuthi izinja ezine-CRF ziphila isikhathi esingakanani kuya ngezinga kanye nesimo sokuqhubeka kwesifo. I-prognosis yesikhathi eside ayilungile, lesi sifo sidlulela esigabeni sokugcina ezinyangeni ezimbalwa noma iminyaka.

Ukudla

Ake sikhulume ngomsoco ekuhlulekeni kwezinso. Ukudla kungenye yezindlela ezibaluleke kakhulu zokugcina umzimba nokunciphisa ukuthuthukiswa kwezimpawu zesifo sezinso esingamahlalakhona, futhi ekuhlulekeni kwezinso okukhulu kungenye yezingxenye ezibaluleke kakhulu zokwelashwa. Ngaphezu kwalokho, impendulo yombuzo wokuthi inja enesifo sezinso izophila isikhathi esingakanani incike ekudleni okuhlanganiswe kahle.

Imigomo yokwelashwa kokudla kokwehluleka kwezinso ezinjeni ihlanganisa:

• ukunikeza umzimba amandla aphelele;

• ukukhululeka kwezimpawu zesifo sezinso kanye nokudakwa kwe-uremic;

• ukunciphisa okukhulu okungenzeka kokwephulwa kwamanzi, i-electrolyte, i-vitamin, amaminerali kanye ne-acid-base balance;

• ukunciphisa ukuqhubeka kokuhluleka kwezinso.

Okulandelayo, sizogxila ezicini eziyinhloko zokudla kokwehluleka kwezinso.

Ukunciphisa ingozi yokuwohloka kwamaprotheni emzimbeni, okuholela ekwehleni kwesisindo futhi kubhebhethekise ukudakwa, kuyadingeka ukunikeza isilwane inani elanele lamandla agayeka kalula. Kufanele kukhunjulwe ukuthi izingxenye zamandla angewona amaprotheni zifaka ama-carbohydrate namafutha. Lapho kwakhiwa ukudla kwezinja ezinesifo sezinso, ngokuvamile kuvame ukungezwa amafutha amaningi, okwandisa amandla okudla, athuthukise ukuthakazelisa nokuthakazelisa kwawo.

Ngenxa yokuthi ukudla okunamaprotheni amaningi kukhulisa ubunzima be-nephropathy, amaprotheni ekhwalithi ephezulu kufanele asetshenziswe ngokulinganisela lapho kuthuthukiswa ukudla. Kufakazelwe ukuthi ukuncipha kwenani lamaprotheni ngokunciphisa ukuthathwa kwama-amino acid angabalulekile kunganciphisa ukuqoqwa kwemikhiqizo ye-nitrogen metabolism futhi, ngenxa yalokho, kunciphise ukubonakaliswa kwesifo somtholampilo.

Okubaluleke kakhulu ukwehla kwenani le-phosphorus ekudleni, okuthi (kufakazelwe) kukhulisa izinga lokusinda kwezinja, kuvimbela ukwehla kwenani le-calcium emzimbeni (ngenxa yokuthuthukiswa kwe-hyperparathyroidism yesibili) futhi, ngenxa yalokho. , ibambezela ukuthuthukiswa kwe-osteodystrophy nokubala kwezicubu ezithambile.

Kubalulekile futhi ukunciphisa i-sodium (okuyingxenye kasawoti wetafula) ekudleni ukuze unciphise umfutho wegazi ophakeme (okuwumphumela wezinso ezinesifo).

Kufanele kukhunjulwe ukuthi amavithamini ancibilikayo emanzini akhishwa emchameni, ngakho-ke, nge-polyuria ngokumelene nesizinda sesifo sezinso, ukuntuleka kwawo kungenzeka. Lokhu kulahlekelwa kwamavithamini kungabangela i-anorexia, ngakho-ke ukudla kufanele kufakwe ngamavithamini ancibilikayo emanzini.

Ukwengezwa kwenani elikhulayo le-fiber yokudla kuboniswa ezifweni zezinso, njengoba zihambisana nokwehla kwe-intestinal motility, futhi i-fiber yokudla ingathuthukisa isimo kanye ne-motility ye-gastrointestinal tract.

Ngakho-ke, uma inja yondliwe kahle lapho kukhona ukwehluleka kwezinso, ukwelashwa kokudla kuyindlela eyinhloko ephumelelayo yokukhulula izimpawu zomtholampilo ze-uremia ezilwaneni. Futhi uchwepheshe wezokudla kwezilwane angakhetha ukudla okufanele ngenxa yokwehluleka kwezinso: ngaphezu kwalokho, kungaba ukudla kwasembonini osekwenziwe kakade (okufana neRoyal Canin Renal, i-Hill's K/d, iPurina NF), noma ukudla okulungiselelwe okukodwa kwasekhaya (ngokuvamile okusekelwe phezu kwenkomo, amazambane kanye namafutha yemifino).

I-athikili ayikona ukubizela esenzweni!

Ukuze uthole ukucwaninga okuningiliziwe kwenkinga, sincoma ukuthi uxhumane nochwepheshe.

Buza udokotela wezilwane

Okthoba 8 2020

Kubuyekezwe: February 13, 2021