Isifo sezintso esinganyangekiyo

Isifo sezintso esinganyangekiyo kukuphulukana nokucotha kokusebenza kwezintso ngokuhamba kwexesha. Umsebenzi ophambili wezintso kukususa inkunkuma kunye namanzi agqithisileyo emzimbeni.

Isifo sezintso esinganyangekiyo (i-CKD) ngokuthe ngcembe siba sibi ngakumbi kwiinyanga okanye kwiminyaka. Awunakuzibona naziphi na iimpawu ixesha elithile. Ukuphulukana nomsebenzi kunokucotha kangangokuba ungabi nazimpawu de izintso zakho ziphantse ziyeke ukusebenza.

Inqanaba lokugqibela le-CKD ibizwa ngokuba sisifo se-renal sokugqibela (i-ESRD). Okwangoku, izintso azisenako ukususa inkunkuma kunye nolwelo olugqithisileyo emzimbeni. Okwangoku, uya kufuna i-dialysis okanye ukufakelwa kwezintso.

Isifo seswekile kunye noxinzelelo lwegazi zizizathu ezi-2 eziqhelekileyo kunye neakhawunti yamatyala amaninzi.

Ezinye izifo kunye neemeko zinokonakalisa izintso, kubandakanya:

• Ukuphazamiseka komzimba (njenge-systemic lupus erythematosus kunye ne-scleroderma)
• Iziphene zokuzalwa kwezintso (ezinje ngesifo sezintso se-polycystic)
• Ezinye iikhemikhali eziyityhefu
• Ukwenzakala kwezintso
• Amatye eentso kunye nosulelo
• Iingxaki ngemithambo yokondla izintso
• Amanye amayeza, njengentlungu kunye neziyobisi zomhlaza
• Ukubuyela umva komchamo kwizintso (Reflux nephropathy)

I-CKD ikhokelela ekwakhiweni kolwelo kunye nemveliso yenkunkuma emzimbeni. Le meko ichaphazela uninzi lweenkqubo zomzimba kunye nemisebenzi, kubandakanya:

• Igazi elonyukayo
• Inani eliphantsi leeseli zegazi
• Vitamin D kunye nempilo yethambo

Iimpawu zokuqala zeCKD ziyafana nezinye izifo ezininzi. Ezi mpawu zinokuba kuphela kophawu lwengxaki kwinqanaba lokuqala.

Iimpawu zingabandakanya:

• Ukulahleka kokutya
• Ukugula ngokubanzi nokudinwa
• Intloko ebuhlungu
• Ukurhawuzelela (pruritus) kunye nolusu olomileyo
• Isicaphucaphu
• Ukwehla kwesisindo ngaphandle kokuzama ukunciphisa umzimba

Iimpawu ezinokuthi zenzeke xa umsebenzi wezintso uye waba nzima kubandakanya:

• Isikhumba esimnyama ngokungaqhelekanga okanye ukukhanya
• Intlungu yethambo
• Ukozela okanye iingxaki zokugxila okanye zokucinga
• Ukuba ndindisholo okanye ukudumba ezandleni nasezinyaweni
• Ukudibanisa izihlunu okanye iicramps
• Iphunga lempumlo
• Ukutyumza ngokulula, okanye igazi esitulweni
• Ukunxanwa okugqithisileyo
• Ii-hiccups rhoqo
• Iingxaki ngokusebenza ngokwesondo
• Ukuyeka ukuya exesheni (amenorrhea)
• Ukuqhawukelwa ngumphefumlo
• Iingxaki zokulala
• Ukuhlanza

Uninzi lwabantu luya kuba noxinzelelo lwegazi oluphezulu kuwo onke amabakala e-CKD. Ngexesha loviwo, umboneleli wakho wokhathalelo lwempilo unokuva ngentliziyo okanye izandi ezingaqhelekanga esifubeni sakho. Unokuba neempawu zomonakalo wemithambo-luvo ngexesha lovavanyo lweenkqubo zemithambo-luvo.

Uvavanyo lwe-urinalysis lunokubonisa iprotheni okanye olunye utshintsho kumchamo wakho. Olu tshintsho lunokubonakala kwiinyanga ezi-6 ukuya kwezi-10 okanye nangaphezulu ngaphambi kokuba kuvele iimpawu.

Uvavanyo olujonga ukuba izintso zisebenza kakuhle zibandakanya:

• Ukucoca creatinine
• Amanqanaba okudala
• Igazi urea nitrogen (BUN)

I-CKD itshintsha iziphumo zolunye uvavanyo. Uya kudinga ukuba ube novavanyo olulandelayo rhoqo kwiinyanga ezimbini ukuya kwezi-3 xa isifo sezintso sisiba mandundu:

• Ialbhamu
• Ikhalsiyam
• Icholesterol
• Gcwalisa ubalo lwegazi (CBC)
• Ii-Electrolyte
• Magnesium
• Iphosphorus
• Potassium
• Isodium

Olunye uvavanyo olunokuthi lwenziwe ukujonga unobangela okanye uhlobo lwesifo sezintso kubandakanya:

• Ukuvavanywa kwe-CT kwesisu
• I-MRI yesisu
• I-Ultrasound yesisu
• Isifo sezintso
• Ukuskena izintso
• Isifo sezintso

Esi sifo sinokutshintsha iziphumo zolu vavanyo lulandelayo:

• Erythropoietin
• Ihomoni yeParathyroid (PTH)
• Uvavanyo lokuxinana kwamathambo
• Inqanaba leVitamin D

Ulawulo lwexinzelelo lwegazi luza kuthoba ukonakala komonakalo wezintso

• I-Angiotensin-converting enzyme (ACE) inhibitors okanye ii-angiotensin receptor blockers (ARBs) zisetyenziswa rhoqo.
• Injongo kukugcina uxinzelelo lwegazi okanye ngaphantsi kwe-130/80 mm Hg.

Ukwenza utshintsho kwindlela yokuphila kunokunceda ukukhusela izintso, kunye nokuthintela isifo sentliziyo kunye nokubetha, njengale:

• Musa ukutshaya.
• Yitya izidlo ezinamafutha asezantsi kunye necholesterol.
• Yenza umthambo rhoqo (thetha nogqirha wakho okanye umongikazi ngaphambi kokuba uqale umthambo).
• Thatha iziyobisi ukunciphisa i-cholesterol yakho, ukuba iyafuneka.
• Gcina iswekile yegazi lakho iphantsi kolawulo.
• Kuphephe ukutya ityuwa eninzi okanye ipotassium.

Soloko uthetha nengcali yezintso ngaphambi kokuba uthathe naliphi na iyeza. Oku kubandakanya iivithamini, iiherbs kunye nezongezo. Qinisekisa ukuba bonke ababoneleli obandwendwelayo bayazi ukuba unayo i-CKD. Olunye unyango lunokubandakanya:

• Amayeza abizwa ngokuba yi-phosphate binders, ukunceda ukuthintela amanqanaba aphezulu enefosforasi
• Intsimbi eyongezelelweyo ekutyeni, iipilisi zentsimbi, isinyithi esinikwa ngomthambo (intravenous iron) ukudubula okukhethekileyo kweyeza elibizwa ngokuba yi-erythropoietin, kunye notofelo-gazi ukunyanga i-anemia
• I-calcium eyongezelelweyo kunye ne-vitamin D (soloko uthetha nomboneleli wakho ngaphambi kokuthatha)

Umboneleli wakho unokulandela ukutya okhethekileyo kwi-CKD.

• Ukunciphisa ulwelo
• Ukutya iiprotheyini ezimbalwa
• Ukuthintela i-phosphorus kunye nezinye ii-electrolyte
• Ukufumana iikhalori ezaneleyo ukukhusela ukunciphisa umzimba

Bonke abantu abane-CKD kufuneka babe nolwazi ngezi zitofu zilandelayo:

• Isitofu sokugonya se-Hepatitis A
• Ugonyo lwe-Hepatitis B
• Ugonyo lomkhuhlane
• Ugonyo lwepneumonia (PPV)

Abanye abantu bayazuza ngokuthatha inxaxheba kwiqela lokuxhasa isifo sesifo sezintso.

Abantu abaninzi abafunyaniswa benayo i-CKD de baphulukane nomsebenzi wabo wezintso.

Akukho lunyango lweCKD. Ukuba iya isiba mandundu kwi-ESRD, kwaye ngokukhawuleza kangakanani, kuxhomekeke:

• Unobangela womonakalo wezintso
• Uzikhathalela kakuhle kangakanani

Ukusilela kwezintso linyathelo lokugqibela le-CKD. Yilapho izintso zakho zingasakwazi ukuxhasa iimfuno zomzimba wethu.

Umboneleli wakho uya kuxoxa nge-dialysis nawe ngaphambi kokuba uyidinge. I-Dialysis isusa inkunkuma egazini lakho xa izintso zakho zingasakwazi ukwenza umsebenzi wazo.

Kwiimeko ezininzi, uya kwi-dialysis xa une-10 ukuya kwi-15% kuphela yomsebenzi wezintso oseleyo.

Nabantu abalinde ukufakelwa izintso banokufuna i-dialysis ngelixa belindile.

Iingxaki zinokubandakanya:

• Ukunqongophala kwegazi
• Ukopha esuswini okanye emathunjini
• Intlungu yethambo, edibeneyo, kunye nezihlunu
• Utshintsho kwiswekile yegazi
• Ukonakaliswa kwemithambo yemilenze kunye neengalo (peripheral neuropathy)
• Isifo sengqondo esiyingozi
• Ulwakhiwo lwamanzi olujikeleze imiphunga (ukungxola)
• Iingxaki zentliziyo kunye negazi
• Amanqanaba aphezulu e-phosphorus
• Amanqanaba aphezulu e-potassium
• Hyperparathyroidism
• Ukwanda komngcipheko wosulelo
• Ukonakala kwesibindi okanye ukusilela
• Ukungondleki
• Ukungabikho komtshato kunye nokungachumi
• Ukuxhuzula
• Ukudumba (iedema)
• Ukuncipha kwamathambo kunye nokwanda komngcipheko wokwaphuka

Ukunyanga imeko ebangela ingxaki kunokunceda ukunqanda okanye ukulibazisa i-CKD. Abantu abanesifo seswekile kufuneka balawule iswekile yegazi kunye noxinzelelo lwegazi kwaye akufuneki batshaye.

Ukungaphumeleli kwezintso - okungapheliyo; Ukusilela kwezintso - ezingapheliyo; Ukungabikho kakuhle kwezintso; Ukusilela kwezintso okungapheliyo; Ukusilela okungapheliyo kwezintso

• I-anatomy yezintso
• Izintso - ukuhamba kwegazi kunye nomchamo
• IGlomerulus kunye nephron

UChristov M, uSprague SM. Isifo esinganyangekiyo sezintso- ukungcola kwethambo kwezimbiwa. Ku: Yu ASL, Chertow GM, Luyckx VA, Marsden PA, Skorecki K, Taal MW, ii-eds. Brenner kunye noMphathi weZintso. Ngomhla we-11. IPhiladelphia, PA: Elsevier; 2020: isahluko 53.

Iigrama ME, McDonald SP. I-Epidemiology yesifo sezintso ezingapheliyo kunye ne-dialysis. Ku: Feehally J, Floege J, Tonelli M, Johnson RJ, ii-eds. I-Clinical Nephrology epheleleyo. Umhla wesi-6. IPhiladelphia, PA: Elsevier; I-2019: isahluko 77.

I-Taal MW. Ukwahlula-hlula kunye nolawulo lwezifo zezintso ezingapheliyo. Ku: Yu ASL, Chertow GM, Luyckx VA, Marsden PA, Skorecki K, Taal MW, ii-eds. Brenner kunye noMphathi weZintso. Ngomhla we-11. IPhiladelphia, PA: Elsevier; 2020: isahluko 59.