Prerenal azotemia

Prerenal azotemia ndimitundu yayikulu kwambiri yazinyalala zama nitrojeni m'magazi.

Prerenal azotemia ndi wamba, makamaka okalamba komanso anthu omwe ali mchipatala.

Impso zimasefa magazi. Amapanganso mkodzo wochotsa zonyansa. Kuchuluka, kapena kuthamanga, kwa magazi kumadutsa m'madontho a impso, kusefa kwamagazi kumatsikanso. Kapena mwina sizingachitike konse. Zonyansa zimakhala m'magazi. Mkodzo wawung'ono kapena wopanda pake umapangidwa, ngakhale impso yomwe ikugwira ntchito.

Zinthu zonyansa za nayitrogeni, monga creatinine ndi urea, zikamakula mthupi, vutoli limatchedwa azotemia. Zinthu zonyansazi zimakhala ngati ziphe zikamakula. Amawononga minofu ndikuchepetsa kuthekera kwa ziwalo kugwira ntchito.

Prerenal azotemia ndiye mtundu wambiri wa impso kulephera kwa anthu omwe ali mchipatala. Chikhalidwe chilichonse chomwe chimachepetsa magazi kupita ku impso chimatha kuyambitsa, kuphatikiza:

• Kutentha
• Zinthu zomwe zimalola kuti madzimadzi atuluke m'magazi
• Kusanza kwa nthawi yayitali, kutsegula m'mimba, kapena kutuluka magazi
• Kutentha
• Kuchepetsa kumwa kwamadzimadzi (kuchepa madzi m'thupi)
• Kutaya magazi
• Mankhwala ena, monga ACE inhibitors (mankhwala omwe amathandizira kulephera kwa mtima kapena kuthamanga kwa magazi) ndi ma NSAID

Zinthu zomwe mtima sungapope magazi okwanira kapena kupopa magazi motsika kwambiri kumawonjezeranso chiopsezo cha prerenal azotemia. Izi ndi monga:

• Mtima kulephera
• Shock (septic mantha)

Zitha kuyambidwanso chifukwa cha zinthu zomwe zimasokoneza magazi kupita ku impso, monga:

• Mitundu ina ya opaleshoni
• Kuvulala kwa impso
• Kutsekedwa kwa mtsempha womwe umapereka magazi ku impso (kutsekeka kwamitsempha yamagazi)

Prerenal azotemia sangakhale ndi zizindikilo. Kapena, zizindikiro za zomwe zimayambitsa prerenal azotemia zitha kupezeka.

Zizindikiro zakusowa kwa madzi m'thupi zitha kupezeka ndikuphatikizira izi:

• Kusokonezeka
• Kuchepetsa kapena kusapanga mkodzo
• Pakamwa pouma chifukwa cha ludzu
• Kutentha kwambiri
• Kutopa
• Mtundu wa khungu wotumbululuka
• Kutupa

Kufufuza kungawonetse:

• Mitsempha yokhotakhota
• Ziwalo zam'mimba zowuma
• Mkodzo wochepa kapena wopanda chikhodzodzo
• Kuthamanga kwa magazi
• Ntchito ya mtima wotsika kapena hypovolemia
• Khungu lokhazikika (turgor)
• Kuthamanga kwa mtima mwachangu
• Kuchepetsa kuthamanga kwa kugunda
• Zizindikiro za pachimake impso kulephera

Mayesero otsatirawa akhoza kuchitika:

• Mlengi wamagazi
• BUNI
• Mkodzo osmolality ndi mphamvu yokoka
• Kuyesa kwamikodzo kuti muwone kuchuluka kwa sodium ndi creatinine ndikuwunika momwe impso imagwirira ntchito

Cholinga chachikulu cha mankhwala ndikuthetsa vutoli impso isanawonongeke. Nthawi zambiri anthu amafunika kukhala mchipatala.

Madzi amkati (IV), kuphatikiza magazi kapena zinthu zamagazi, atha kugwiritsidwa ntchito kuwonjezera kuchuluka kwamagazi. Pambuyo pobwezeretsa kuchuluka kwamagazi, mankhwala atha kugwiritsidwa ntchito:

• Onjezani kuthamanga kwa magazi
• Limbikitsani kupopera kwa mtima

Ngati munthuyo ali ndi zizindikiro zakusowa kwa impso, chithandizo chingaphatikizepo:

• Dialysis
• Zakudya zimasintha
• Mankhwala

Prerenal azotemia imatha kusinthidwa ngati chifukwa chake chingapezeke ndikukonzedwa mkati mwa maola 24. Ngati chifukwa chake sichinakonzedwe mwachangu, kuwonongeka kungachitike ku impso (pachimake tubular necrosis).

Zovuta zingaphatikizepo:

• Pachimake impso kulephera
• Pachimake tubular necrosis (kufa kwa minofu)

Pitani kuchipinda chodzidzimutsa kapena itanani nambala yadzidzidzi yakomweko (monga 911) ngati muli ndi zizindikiro za prerenal azotemia.

Kuchiza mwachangu chilichonse chomwe chimachepetsa kuthamanga kapena kuthamanga kwa magazi kudzera mu impso kungathandize kupewa prerenal azotemia.

Azotemia - prerenal; Uremia; Kuponderezedwa kwaimpso; Pachimake aimpso kulephera - prerenal azotemia

• Matenda a impso
• Impso - kutuluka magazi ndi mkodzo

Haseley L, Jefferson JA. Pathophysiology ndi etiology yovulala kwambiri kwa impso. Mu: Feehally J, Floege J, Tonelli M, Johnson RJ, olemba. Chachikulu Chachipatala Nephrology. Lachisanu ndi chimodzi. Philadelphia, PA: Elsevier; 2019: chap 66.

Okusa MD, Portilla D. Pathophysiology yovulala kwambiri kwa 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: mutu 28.

Wolfson AB. Aimpso kulephera. Mu: Makoma RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018: mutu 87.