Matenda a impso

Matenda a impso ndi kuchepa kwa ntchito ya impso pakapita nthawi. Ntchito yayikulu ya impso ndikuchotsa zonyansa ndi madzi ochulukirapo m'thupi.

Matenda a impso (CKD) amakula pang'onopang'ono pakapita miyezi kapena zaka. Simungazindikire zizindikiro zilizonse kwakanthawi. Kutha kwa ntchito kumatha kuchepa kwambiri kotero kuti mulibe zizindikilo mpaka impso zanu zitasiya kugwira ntchito.

Gawo lomaliza la CKD limatchedwa matenda omaliza a renal (ESRD). Pakadali pano, impso sizingathenso kuchotsa zinyansi zokwanira komanso madzi owonjezera mthupi. Pakadali pano, mungafunike dialysis kapena kumuika impso.

Matenda ashuga komanso kuthamanga kwa magazi ndizomwe zimayambitsa matenda a 2 nthawi zambiri.

Matenda ndi mikhalidwe ina yambiri imatha kuwononga impso, kuphatikizapo:

• Matenda osokoneza bongo (monga systemic lupus erythematosus ndi scleroderma)
• Zofooka zobadwa za impso (monga matenda a impso a polycystic)
• Mankhwala ena oopsa
• Kuvulala kwa impso
• Impso miyala ndi matenda
• Mavuto ndi mitsempha yodyetsa impso
• Mankhwala ena, monga ululu ndi mankhwala a khansa
• Kubwerera mkodzo mu impso (Reflux nephropathy)

CKD imadzetsa kuchuluka kwa madzi ndi zinyalala m'thupi. Vutoli limakhudza machitidwe amthupi ambiri, kuphatikizapo:

• Kuthamanga kwa magazi
• Kuchuluka kwa maselo amwazi wamagazi
• Vitamini D ndi thanzi la mafupa

Zizindikiro zoyambirira za CKD ndizofanana ndi matenda ena ambiri. Zizindikirozi zitha kukhala chizindikiro chokhacho chamavuto kumayambiriro.

Zizindikiro zimaphatikizapo:

• Kulakalaka kudya
• Kumva kuwawa komanso kutopa
• Kupweteka mutu
• Kuyabwa (pruritus) ndi khungu louma
• Nseru
• Kuchepetsa thupi osayesa kuchepetsa thupi

Zizindikiro zomwe zingachitike ngati ntchito ya impso yafika poipa ndi iyi:

• Khungu lodera kapena lowala modabwitsa
• Kupweteka kwa mafupa
• Kusinza kapena mavuto owonetsetsa kapena kuganiza
• Dzanzi kapena kutupa m'manja ndi m'mapazi
• Minofu kugwedezeka kapena kukokana
• Fungo la mpweya
• Kuvulaza kosavuta, kapena magazi mu chopondapo
• Ludzu lokwanira
• Ma hiccups pafupipafupi
• Mavuto ndi magwiridwe antchito
• Kusamba kumasiya (amenorrhea)
• Kupuma pang'ono
• Mavuto ogona
• Kusanza

Anthu ambiri amakhala ndi kuthamanga kwa magazi m'magawo onse a CKD. Mukamayesa mayeso, omwe amakuthandizani azaumoyo atha kumvanso mawu osakhala achilengedwe pamtima kapena m'mapapo m'chifuwa. Mutha kukhala ndi zizindikilo za kuwonongeka kwa mitsempha panthawi yamayeso amanjenje.

Kusanthula kwamkodzo kumatha kuwonetsa mapuloteni kapena kusintha kwina mumkodzo wanu. Kusintha uku kumatha kuwonekera miyezi 6 mpaka 10 kapena kupitilira apo zizindikiro zisanachitike.

Kuyesa komwe kumayang'ana momwe impso zikugwirira ntchito ndi monga:

• Chilolezo cha Creatinine
• Magulu a Creatinine
• Magazi urea asafe (BUN)

CKD imasintha zotsatira za mayeso ena angapo. Muyenera kukhala ndi mayeso otsatirawa pafupipafupi miyezi iwiri kapena itatu iliyonse pamene matenda a impso akuipiraipira:

• Albumin
• Calcium
• Cholesterol
• Kuwerengera kwathunthu kwa magazi (CBC)
• Maelekitirodi
• Mankhwala enaake a
• Phosphorous
• Potaziyamu
• Sodium

Mayesero ena omwe angachitike pofuna kuyang'ana chifukwa kapena mtundu wa matenda a impso ndi awa:

• CT scan pamimba
• MRI ya pamimba
• Ultrasound pamimba
• Kusokoneza impso
• Kusanthula impso
• Impso ultrasound

Matendawa amathanso kusintha zotsatira za mayeso otsatirawa:

• Mpweya wambiri
• Mahomoni a Parathyroid (PTH)
• Kuyesa kachulukidwe ka mafupa
• Mulingo wa Vitamini D

Kuthamanga kwa magazi kumachepetsa kuwonongeka kwa impso.

• Angiotensin-converting enzyme (ACE) inhibitors kapena angiotensin receptor blockers (ARBs) amagwiritsidwa ntchito nthawi zambiri.
• Cholinga ndikuteteza kuthamanga kwa magazi pansi kapena pansi pa 130/80 mm Hg.

Kusintha moyo wanu kumatha kuteteza impso, komanso kupewa matenda amtima ndi sitiroko, monga:

• Osasuta.
• Idyani zakudya zopanda mafuta ambiri ndi cholesterol.
• Muzichita masewera olimbitsa thupi pafupipafupi (lankhulani ndi dokotala kapena namwino musanayambe kuchita masewera olimbitsa thupi).
• Tengani mankhwala kuti muchepetse cholesterol, ngati kuli kofunikira.
• Sungani magazi anu m'magazi.
• Pewani kudya mchere wambiri kapena potaziyamu.

Nthawi zonse lankhulani ndi katswiri wa impso musanamwe mankhwala aliwonse owonjezera. Izi zimaphatikizapo mavitamini, zitsamba ndi zowonjezera. Onetsetsani kuti onse omwe mumawachezera akudziwa kuti muli ndi CKD. Mankhwala ena atha kukhala:

• Mankhwala otchedwa phosphate binders, kuti ateteze kuchuluka kwa phosphorous
• Chitsulo chowonjezera mu zakudya, mapiritsi a ayironi, chitsulo choperekedwa kudzera mumitsempha (intravenousous iron) kuwombera kwapadera kwa mankhwala otchedwa erythropoietin, komanso kuthiridwa magazi kuti muchepetse magazi
• Kashiamu wowonjezera ndi vitamini D (nthawi zonse lankhulani ndi omwe amakupatsani musanamwe)

Wothandizira anu atha kutsatira zakudya zapadera za CKD.

• Kuchepetsa madzi
• Kudya mapuloteni ochepa
• Kuletsa phosphorous ndi ma electrolyte ena
• Kupeza zopatsa mphamvu zokwanira kuti muchepetse kunenepa

Anthu onse omwe ali ndi CKD ayenera kudziwa za katemera otsatirawa:

• Katemera wa hepatitis A.
• Katemera wa Hepatitis B
• Katemera wa chimfine
• Katemera wa chibayo (PPV)

Anthu ena amapindula chifukwa chotenga nawo mbali mgulu lothandizira matenda a impso.

Anthu ambiri sapezeka ndi CKD mpaka ataya ntchito zawo zambiri za impso.

Palibe mankhwala a CKD. Ngati zikukulirakulira ku ESRD, ndipo mwachangu bwanji, zimadalira:

• Zomwe zimayambitsa kuwonongeka kwa impso
• Mumadzisamalira bwino

Kulephera kwa impso ndiye gawo lomaliza la CKD. Apa ndi pamene impso zanu sizingathenso kuthandizira zosowa zathupi.

Wopereka wanu amakambirana za dialysis nanu musanayifune. Dialysis imachotsa zonyansa m'magazi anu pomwe impso zanu sizingagwire ntchito yawo.

Nthawi zambiri, mumapita ku dialysis mukangotsala ndi 10 mpaka 15% ya ntchito yanu ya impso.

Ngakhale anthu omwe akudikirira impso angafunike dialysis podikirira.

Zovuta zingaphatikizepo:

• Kuchepa kwa magazi m'thupi
• Kutuluka magazi m'mimba kapena m'matumbo
• Kupweteka kwa mafupa, olowa, ndi minofu
• Kusintha kwa shuga m'magazi
• Kuwonongeka kwa mitsempha ya miyendo ndi mikono (zotumphukira za m'mitsempha)
• Kusokonezeka maganizo
• Madzi amadzimadzi m'mapapo (pleural effusion)
• Matenda a mtima ndi magazi
• Maseŵera apamwamba a phosphorous
• Mlingo waukulu wa potaziyamu
• Hyperparathyroidism
• Kuchulukitsa chiwopsezo cha matenda
• Kuwonongeka kwa chiwindi kapena kulephera
• Kusowa zakudya m'thupi
• Kusokonekera komanso kusabereka
• Kugwidwa
• Kutupa (edema)
• Kufooka kwa mafupa ndi chiopsezo chowonjezeka cha mafupa

Kuchiza zomwe zikuyambitsa vutoli kungathandize kupewa kapena kuchedwetsa CKD. Anthu omwe ali ndi matenda ashuga ayenera kuwongolera shuga ndi magazi ndipo sayenera kusuta.

Impso kulephera - matenda; Aimpso kulephera - aakulu; Matenda aimpso osakwanira; Matenda a impso; Aakulu aimpso kulephera

• Matenda a impso
• Impso - kutuluka magazi ndi mkodzo
• Glomerulus ndi nephron

Christov M, Sprague SM. Matenda a impso - mchere wamfupa. Mu: Yu ASL, Chertow GM, Luyckx VA, Marsden PA, Skorecki K, Taal MW, olemba. Brenner ndi Rector a Impso. 11th ed. Philadelphia, PA: Elsevier; 2020: chap 53.

Grams INE, McDonald SP. Epidemiology ya matenda a impso ndi dialysis. Mu: Feehally J, Floege J, Tonelli M, Johnson RJ, olemba. Chachikulu Chachipatala Nephrology. Lachisanu ndi chimodzi. Philadelphia, PA: Elsevier; 2019: mutu 77.

Zolemba MW. Gawo ndi kasamalidwe ka matenda a impso. Mu: Yu ASL, Chertow GM, Luyckx VA, Marsden PA, Skorecki K, Taal MW, olemba. Brenner ndi Rector a Impso. 11th ed. Philadelphia, PA: Elsevier; 2020: chap 59.