Ukungaphumeleli kwe-renal ngokukhawuleza kwenzeka xa izintso zizenzeke ngokukhawuleza ukucoca ukutshabalalisa kwigazi. Kuyinto inkxalabo yeyiphi na isibalo sezifo okanye ukuphazamiseka, isiphumo saso esikhokelela ekwakheni ngokukhawuleza kweetekisi kunye nokuhlaselwa kweempawu ezivela ekunciphiseni ukuvuthwa kunye nokukhathala kwintlungu yesifuba kunye nokuthinjelwa.
Nangona ukuhluleka kwe-renal ephawulekayo kunokuvela ngaphandle kweempawu kwaye kubonakaliswe kuphela ngexesha leemvavanyo zebhabhani kwiimeko ezingahambelaniyo, amaninzi amaninzi afunyaniswa kubantu abagula kakhulu okanye bafike esibhedlele ngesifo esibi.
Ukuba ukungafuneki kwe-renal kukhankanywe, ukuhlolwa kwegazi, iimvavanyo zomchamo, i-ultrasound, kunye ne-biopsies zinokuyalelwa ukuba ziqinisekise kwaye zisezingeni lokukhubazeka. Ngokusekelwe kwiziphumo, ugqirha uya kuba nako ukubeka isifo eso kwaye athathe isenzo esifanelekileyo. Kwiimeko ezinzima kakhulu, isifo sengqondo sokuphela kwesigqibo singagunyazwa.
IiLabs kunye novavanyo
Ukungaphumeleli kwe-renal eyiyo ( ARF ), eyaziwa ngokuba yingozi yokulimala kwentso (AKI), ngokuyinhloko ifunyaniswa yigazi kunye neemvavanyo zomchamo. Phakathi kweemvavanyo ezininzi zeebhanki ezisetyenziselwa ukuhlola umsebenzi wezintso, kukho iindlela ezimbini ezibalulekileyo ekuxilongeni nasekulawuleni i-ARF.
I-Serum Creatinine
I-Serum creatinine (SCr) ilinganisa inani lezinto ezibizwa ngokuthi i- creatinine egazini. I-Creatinine yi-product-product ye-musabolism ye-muscle eyenziwa ngumchamo. Ngenxa yokuba iveliswa kwaye idityaniswe kwisilinganiselo esifanelekileyo, yindlela enokuthenjwa yomsebenzi weentso kwaye iyona mqondiso oyintloko wokwehluleka kwezintso.
Amazinga eSrr ejwayelekile kubantu abadala:
- Malunga no-0.5 ukuya ku-1.1. ii-milligrams (mg) nganye nge-deciliter (dL) kwabasetyhini
- Phantse u-0.6 ukuya ku-1.2 mg / dL kwindoda
Volume Urine
Umthamo we-Urine ulinganisa umlinganiselo we-fluid u-urinate ngexesha elithile. Njengoko i-ARF ichazwa ngokulahlekelwa kwemisebenzi yengqondo, ixabiso-elilinganiselwa kwi-milliliters (mL) ngeekhilogram zesisindo somzimba wakho (kg) ngeyure (h) -iyona nto ibalulekileyo ekuqinisekiseni ukukhubazeka kweengqondo nokulinganisa impendulo yakho kwonyango.
U-Oliguria, ukuveliswa kwemimandla encinci yomchamo, ichazwa njengento engaphantsi kwe-0.5 mL / kg / h.
Ezinye iiLabhani
Ezinye iimvavanyo zesebe ezisetyenziselwa ukuxilonga i-ARF ziquka:
- I-blood urea nitrogen (BUN) ilinganisa inani lemveliso yenkunkuma kwindawo ebizwa nge-urea nitrogen. Urea nitrojeni yenziwa xa isibindi siphula iprotheni kwaye, njenge-serum creatinine, iveliswa kwaye ikhutshwe emcini xa ihamba ngokulinganayo. Amanqanaba aphezulu e-BUN ayibonakalisa i-ARF kwaye ingaphinda ibonise isizathu esisisiseko sokungaphumeleli kwezintso (njengokwehluleka kwentliziyo, ukukhulelwa kwamanzi okanye ukukhutshwa komzila).
- Isiqalo se-Creatinine silinganisa izinga lokudala kwiisampuli zegazi kunye nesampula yomchamo eqokelelwe ngaphezu kweeyure ezingama-24. Iziphumo ezidibeneyo zingasitshela ukuba i-creatinine ichithwa kangakanani egazini ngokucoca njengoko ilinganiselwe mL ngemizuzu (mL / min). Isibonelelo esivamile sokwakha i-88% ukuya kwi-128 mL / min kubasetyhini kunye ne-97 t0 137 ml / min kumadoda.
- Isilinganisi sokuhlanjululwa kwe-glomerular (iGFR) esilinganiselweyo (i-eGFR) uvavanyo lwegazi oluqikelela ukuba igazi lidlula ngaphaya kwezihlunu zendalo ezibizwa ngokuba yi-glomeruli. Isantya esi senzekayo singasichazela ukuba zininzi kangakanani iintsholongwane ezonakaliswe kwisigaba soku-1 (ubuncinci ukuya kwintsebenzo yesifo senkunkuma) ngokukhawuleza kwisigaba 5 (ukungaphumeleli kwezintso).
- I-potassium yeSerum isetyenziselwa ukuchonga ukuba kukho i- potassium engaphezu kwegazi (imeko ebizwa ngokuba yi-hyperkalemia). I-Hyperkalemia iyimpawu ze-ARF kwaye, xa ishiywe ingakhange ilandelwe, ingakhokelela kwisifo esichengeni kunye nesifo esisongela ubomi besifo (intliziyo engavamile).
- U-urinalysis nje ukuhlalutya kwelebhu yokwenza umchamo wakho. Ingasetyenziselwa ukufumanisa ukuba kukho iprotheni engaphezulu kweminini ( proteinuria ), ithathwa njengento ebalulekileyo ye-ARF. Iyakwazi ukufumanisa igazi kumchamo (i- hematuria ) enokuthi yenzeke ukuba i-ARF ibangelwa uhlobo oluthile lomonakalo wezintso okanye isithintelo somgudu.
Iimpawu zokuxilonga
Ukungaphumeleli kwe-renal ebonakalayo kuxhomekeke kwisiphumo se-serum creatinine kunye neemvavanyo zomsindo womchamo.
Iikhrayitheriya zokuxilonga zaqulunqwa zizifo zeengxaki: Ukuphucula iziPhumo zeHlabathi (i-KDIGO), inhlangano engenzi nzuzo ejongene nokusebenzisa izikhokelo zenkcubeko yezilwanyana zesifo. Ngokutsho kwe-KDIGO, ukungaphumeleli kwe-renal ephawulekayo kunokufumanisa ukuba ngaba kukho enye yezi zinto zilandelayo:
- Ukwanda kwe-SCr ngu-0.3 mg / dL okanye ngaphezulu kweeyure ezingama-48
- Ukwanda kwe-SCr ubuncinane beepesenti ezingama-150 ngaphakathi kweentsuku ezisixhenxe
- Umthamo womchamo ongaphantsi kwe-0.5 ml / kg / h ngaphezu kweeyure ezintandathu
Uvavanyo lweemvavanyo
Ukongezelela kwiimvavanyo zegazi kunye nomchamo, iimvavanyo zengcamango zingasetyenziselwa ukubona ukuba kukho nawuphi na umonakalo wezintso okanye ukuba kukho ukuphazamiseka kwimizila yokuphuma kwegazi kwiintso okanye ukuphuma komchamo kumzimba.
Phakathi kwezinye iimvavanyo ezisetyenzisiweyo:
- I-Ultrasound yindlela ekhethiweyo yovavanyo lokucinga kunye kwaye ingasetyenziselwa ukulinganisa ubungakanani kunye nokubonakala kweentso, ukufumanisa izicubu okanye umonakalo wezintso, kwaye ufumane izibhengezo kumchamo okanye ukuhamba kwegazi. Inkqubo entsha ebizwa ngokuba ngumbala weDoppler ingasetyenziselwa ukuvavanya ama-clots, ukunciphisa okanye ukuphuka kwimida kunye neemvini zezintso.
- I-tomography ye-Computed (CT) yindlela yohlobo lwe-X-ray oluvelisa imifanekiso eqingqiweyo yelungu. Iimvavanyo ze-CT zinokuba luncedo ekufumaneni umdlavuza, izilonda, i-abscesses, izithintelo (ezifana nezitye zamatye), kunye nokuqokelelwa kwamanzi ajikelezayo. Ziyasetyenziswa ngokuqhelekileyo kubantu abagqithisileyo apho i-ultrasound ingenakho ukubonelela umfanekiso ocacileyo.
- I-imagery resonance imagination (MRI) isebenzisa amagagasi ombane ukuvelisa imifanekiso eyahlukileyo kakhulu yeentso ngaphandle kwemitha.
Iintsholongwane
I-biopsy ibandakanya ukususwa kweetyhubhu zomzimba zoviwo ngebhabhi. Uhlobo olusetyenziswa ngokutsha ukuhlola isifo sezintso lubizwa ngokuba yi- biopsy ephakathi kwendawo apho inaliti ifakwe elukhumbeni kwaye ikhokelwe kwiinjongo ukususa isampuli zeeseli.
Iimpawu ze-Biopsies zisetyenziselwa ukuba zifumane i-ARF yangaphakathi (ukungaphumeleli kwe-renal ephawulekayo eyenziwa ngumonakalo kwizintso). I-biopsy ikwazi ukufumanisa ngokukhawuleza ezinye zezizathu eziqhelekileyo zokubangela intlungu, kuquka:
- I-nephritis ye-interstitial interstitial (AIN), ukuvuvukala kwezicubu phakathi kweethambo ze-kidney
- I-tubular necrosis eqhelekileyo (ATN), imeko apho izicubu zezintso zifa ngenxa yokungabi naso oksijini
- I-Glomerulonephritis, ukuvutha kwe-glomeruli kwimigu yegazi yeentso
Ukuxilongwa ngokungafani
Njengengxaki yesifo okanye isifo, ukungaphumeleli komzimba kungabangelwa izinto ezininzi ezahlukeneyo, kubandakanyeka kwintliziyo , i- cirrhosis yesibindi , i- cancer , ukuphazamiseka kweemoto kunye nokudambiswa kwamanzi .
Ngelo xesha, kukho iimeko apho iimvavanyo zeebhabhatshini zibonisa i-ARF kodwa ezinye iimeko, ngokwenene, zibeka ityala kwizinga eliphezulu zegazi. Phakathi kwabo:
- Isifo esingasigxina sesifo (CKD) , esingaqhelekanga, singenayo yonke impawu ze-ARF kodwa zizakuqhubeka zingaphaya kweenyanga ezintathu. Nge-CKD, inkcazo yodwa ye-SCr ephakamileyo iya kuba yintlawulo yokuhlutha kwe-glomerular. Uvavanyo lwama-24 lwe-creatinine luvame ukuhluke phakathi kweemeko ezimbini.
- Amanye amayeza , njengeH2 blocker Tagamet (cimetidine) kunye ne-antibiotic Primsol (trimethoprim), inokubangela ukuphakama kwe-creinine. Ukuyeka ukukhutshwa kwesicatshulwa esikhankanywe ngokuqhelekileyo kuya kukwanela ukwenza ukwahlukana.
> Imithombo:
> Rahman, M .; Shad, F .; kunye no-Smith, M. Ulungelelaniso lweezintso eziNyango: Isikhokelo sokuLawula kunye neNgciliso. Amer Fam Phys. 2012; 86 (7): 631-9.
> Hertzberg, D .; Ryden, L .; Pickering, J. et al. Ukulimala kweentso ezinzulu-ukujonga ngokubanzi iindlela zokuxilonga kunye nokulawulwa kweeklinikhi. Iiklinikhi ze-Kidney J. 2017 10 (3): 323-331. INGXELO: 10.1093 / ckj / sfx003.