Prerenal azotemia

I-prerenal azotemia yinqanaba eliphezulu ngokungaqhelekanga kwiimveliso zenkunkuma egazini.

I-prerenal azotemia ixhaphakile, ngakumbi kubantu abadala nakubantu abasesibhedlele.

Izintso zicoca igazi. Benza nomchamo ukususa iimveliso zenkunkuma. Xa isixa, okanye uxinzelelo, lokuhamba kwegazi ngokuhla kwezintso, ukucoca igazi kuyehla. Okanye ayinakwenzeka kwaphela. Iimveliso zenkunkuma zihlala egazini. Umchamo omncinci okanye awwenziwanga, nangona izintso ngokwazo ziyasebenza.

Xa iimveliso zenkunkuma ye-nitrogen, enjenge-creatinine kunye ne-urea, isakha emzimbeni, imeko ibizwa ngokuba yi-azotemia. Ezi mveliso zenkunkuma zisebenza njengetyhefu xa zisakha. Zonakalisa izicwili kwaye zinciphise amandla okusebenza kwamalungu.

I-prerenal azotemia yeyona ndlela ixhaphakileyo yokusilela kwezintso kubantu esibhedlele. Nawuphi na umqathango wokunciphisa ukuhamba kwegazi kwizintso kunokubangela, kubandakanya:

• Ukutsha
• Iimeko ezivumela ukuba ulwelo luphume kwigazi
• Ukugabha kwexesha elide, urhudo, okanye ukopha
• Ukuvezwa kobushushu
• Ukuncipha kokutya okumanzi (ukomisa)
• Ukuphulukana nomthamo wegazi
• Amayeza athile, anje nge-ACE inhibitors (amayeza anyanga ukusilela kwentliziyo okanye uxinzelelo lwegazi) kunye nee-NSAID

Iimeko apho intliziyo ingakwazi ukumpompa igazi elaneleyo okanye iimpompo zegazi ngevolumu ephantsi ikwandisa umngcipheko we-prerenal azotemia. Ezi meko zibandakanya:

• Ukumelwa yintliziyo
• Umothuko (ukothuka)

Inokubangelwa ziimeko eziphazamisa ukuhamba kwegazi kwizintso, ezinje:

• Ezinye iintlobo zotyando
• Ukwenzakala kwezintso
• Ukuvaleka komthambo obonelela ngegazi kwizintso (ukuvaleka kwemithambo yegazi)

I-prerenal azotemia ayinakuba nazimpawu. Okanye, iimpawu zezizathu ze-prerenal azotemia zinokubakho.

Iimpawu zokuphelelwa ngamanzi emzimbeni zinokubakho kwaye zibandakanya ezi zinto zilandelayo:

• Ukudideka
• Ukuncipha okanye ukungabikho kwemveliso yomchamo
• Umlomo owomileyo ngenxa yenxano
• Ukubetha ngokukhawuleza
• Ukudinwa
• Umbala wolusu oluthuthu
• Ukudumba

Uviwo lunokubonisa:

• Imithambo yentamo ewile
• Inwebu eyomileyo eyomileyo
• Umchamo omncinci okanye awukho tu kwisinyi
• Uxinzelelo lwegazi oluphantsi
• Umsebenzi wentliziyo ephantsi okanye i-hypovolemia
• Ukomelela kolusu (turgor)
• Inqanaba lentliziyo elikhawulezayo
• Ukunciphisa uxinzelelo lwe-pulse
• Iimpawu zokusilela kwezintso ezibi

Olu vavanyo lulandelayo lunokwenziwa:

• I-creatinine yegazi
• BUN
• Umchamo osmolality kunye nomxhuzulane othile
• Ukuvavanywa komchamo ukujonga amanqanaba esodium kunye ne-creatinine kunye nokujonga ukusebenza kwezintso

Eyona njongo iphambili yonyango kukulungisa ngokukhawuleza unobangela ngaphambi kokuba izintso zonakaliswe. Abantu bahlala bedinga ukuhlala esibhedlele.

Ulwelo olungena ngaphakathi (IV), kubandakanya igazi okanye iimveliso zegazi, zinokusetyenziselwa ukwandisa umthamo wegazi. Emva kokuba umthamo wegazi ubuyisiwe, amayeza anokusetyenziselwa:

• Yandisa uxinzelelo lwegazi
• Ukuphucula ukupompa kwentliziyo

Ukuba umntu uneempawu zokungaphumeleli kwezintso, unyango luya kubandakanya:

• Uxilongo
• Ukutshintsha kokutya
• Amayeza

I-prerenal azotemia inokubuyiselwa umva ukuba unobangela unokufunyanwa kwaye alungiswe kwiiyure ezingama-24. Ukuba unobangela awulungisekanga ngokukhawuleza, umonakalo unokuvela kwizintso (acute tubular necrosis).

Iingxaki zinokubandakanya:

• Ukungaphumeleli kwezintso
• I-acute tubular necrosis (ukufa kwezicubu)

Yiya kwigumbi likaxakeka okanye fowunela inombolo yongxamiseko yendawo (enje nge-911) ukuba unempawu ze-prerenal azotemia.

Ukunyanga ngokukhawuleza nayiphi na imeko ecutha umthamo okanye amandla okuphuma kwegazi kwizintso kunokunceda ukukhusela i-prerenal azotemia.

Azotemia - prerenal; IUremia; Ukunyanzeliswa kwe-renal; Ukungaphumeleli kwe-renal ngokukhawuleza - i-prerenal azotemia

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

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U-Okusa MD, uPortilla D. 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 28.

UWolfson AB. Ukusilela kwezintso. Ku: Iindonga RM, iHockberger RS, iGausche-Hill M, ii-eds. Unyango lukaRosen oluNgxamisekileyo: Iikhonsepthi kunye nokuziqhelanisa neKlinikhi. Umhla we-9. IPhiladelphia, PA: Elsevier; I-2018: isahluko 87.