Kodi mavuto a impso zanu angakhudze mafupa anu? Tiyeni tiphunzire za matenda a impso!

Kodi muli ndi matenda a impso, kapena omwe madokotala amati matenda a impso osatha (CKD) ? Kapena mukudziwa munthu amene ali ndi vutoli? Anthu ambiri amaganiza kuti tikamanena kuti matenda a impso, amangokhudza impso. Koma zoona zake n'zakuti, impso zathu zikapanda kugwira ntchito bwino, zimatha kukhudza kwambiri machitidwe ena ambiri m'thupi, makamaka mafupa athu . Chifukwa chake, lero tikambirana za vuto lomwe mafupa athu amafooka ndikuyamba mavuto chifukwa cha matenda a impso. Izi zimatchedwa renal osteodystrophy . Ngakhale kuti dzinali ndi lovuta pang'ono, tiyeni timvetse mosavuta.

Kodi Osteodystrophy ya Impso ndi Chiyani?

Mwachidule, matenda a impso otchedwa Osteodystrophy ndi matenda a mafupa omwe angakhudze akuluakulu ndi ana omwe ali ndi matenda a impso osatha (CKD).

Tsopano, taonani, impso zathu zili ndi ntchito yofunika kwambiri. Izi ndi kulamulira kuchuluka kwa mchere monga calcium ndi phosphorous m'magazi mwathu. Komanso, impsozo zimagwira ntchito yoyambitsa vitamini D ndikupanga mahomoni otchedwa calcitriol , omwe amathandiza kuti mafupa athu akhale olimba.

Choncho, impso zikalephera kugwira ntchito bwino kapena sizikugwira ntchito bwino, sizingathe kulamulira kuchuluka kwa mchere umenewu ndi mahomoni otchedwa calcitriol. Pamenepo ndi pamene mafupa athu amayamba kufooka pang'onopang'ono . Izi zimawonjezera chiopsezo cha mafupa kusweka mosavuta, zomwe zikutanthauza kusweka kwa mafupa .

Ndi mchere ndi mahomoni ati omwe amathandiza mafupa athu kukhala athanzi?

Pali michere ndi mahomoni ofunikira ambiri omwe amathandiza mafupa athu kukhala athanzi komanso olimba. Tiyeni tiphunzire pang'ono za iwo.

• Calcium: Ichi ndiye chinthu chachikulu chomwe chimapanga mafupa athu. Mafupa ali ngati "calcium bank" m'thupi lathu. Calcium sikuti imangolimbitsa mafupa okha, komanso ndi yofunika pazinthu zina zambiri, monga kugwira ntchito kwa mitsempha ndi minofu. Impso zathu zimathandiza kuti calcium ikhale bwino m'magazi.
• Phosphorus: Monga calcium, phosphorous ndi chinthu chofunikira kwambiri m'mafupa. Impso zathu zimachotsa phosphorous yochulukirapo yomwe thupi silifunikira ndikusunga bwino pakati pa calcium ndi phosphorous m'magazi.
• Calcitriol: Iyi ndi mtundu wa vitamini D womwe umagwira ntchito. Umapangidwa ndi impso zathu. Homoni iyi imathandiza kulamulira kuchuluka kwa calcium yomwe matupi athu amayamwa kuchokera muzakudya zomwe timadya komanso imathandizanso kuti tiziwalo ta parathyroid tizigwire ntchito.
• Fibroblast Growth Factor 23 (FGF23):Iyi ndi homoni yopangidwa ndi mafupa athu. Imathandiza kulamulira kuchuluka kwa phosphorous ndi vitamini D. Nthawi zambiri kuchuluka kwa FGF23 kumakhala kwakukulu mwa anthu omwe ali ndi matenda a impso osatha.
• Homoni ya Parathyroid (PTH): Homoni iyi imapangidwa ndi tiziwalo tinayi tating'ono tomwe timapezeka kumbuyo kwa chiwalo cha chithokomiro m'khosi mwathu. Tizilomboti timatchedwa parathyroid glands. Ntchito ya homoni iyi ya PTH ndikutulutsa calcium m'mafupa pamene thupi likufunika calcium ndikusunga calcium m'magazi kukhala yokhazikika.

Kodi mitundu ikuluikulu ya Osteodystrophy ya Impso ndi iti?

Mafupa amakula tikali aang'ono. Koma ngakhale titakula, mafupa athu samangokhala pamenepo. Amakonzedwanso nthawi zonse. Monga momwe kuchotsa njerwa zakale ndikuyika zatsopano kuti amange khoma, minofu yakale ya mafupa imasweka ndipo minofu yatsopano ya mafupa imapangidwa. Timatcha njirayi kuti "kusintha kwa mafupa."

Osteodystrophy ya impso ingachitike ngati kusintha kwa mafupa kumeneku kumachitika mofulumira kwambiri kapena pang'onopang'ono kwambiri. Pali mitundu inayi ikuluikulu:

• Osteitis Fibrosa: Imeneyi ndi matenda omwe minofu ya mafupa imasweka mofulumira kwambiri. Izi zimachitika chifukwa cha kuchuluka kwa mahomoni a parathyroid (PTH). Izi zimatchedwa hyperparathyroidism .
• Osteomalacia: Imeneyi ndi matenda omwe minofu ya mafupa imasweka, koma fupa latsopano limapangidwa pang'onopang'ono kwambiri. Mafupawo amakhala ngati siponji komanso ofooka. Izi zitha kuchitika chifukwa cha kusowa kwa vitamini D, poizoni wa zitsulo, komanso kupanga mopitirira muyeso kwa mahomoni a FGF23 chifukwa cha mitundu ina ya khansa.
• Matenda a Mafupa Osasinthasintha: Uwu ndi mkhalidwe womwe mapangidwe ndi kukonzanso minofu ya mafupa kumachepa kwambiri. Chifukwa chachikulu cha izi ndi kuchepa kwa hormone ya parathyroid (PTH).
• Matenda a Mixed Renal Osteodystrophy: Matendawa amaphatikiza zizindikiro za Osteitis Fibrosa ndi Osteomalacia.

Tsopano tiyeni tikambirane za mitundu iyi mwatsatanetsatane.

Osteitis Fibrosa

Nthawi zambiri timamva kuti anthu omwe ali ndi matenda a impso osatha amakhala ndi kuchuluka kwa parathyroid hormone (PTH). PTH ndi yomwe imatulutsa calcium kuchokera m'mafupa kupita m'magazi kuti ikhale ndi calcium m'magazi. Komabe, ngati PTH ili yokwera kwambiri, imakoka calcium yambiri m'mafupa. Izi zingayambitse kupangika kwa ma cysts a fibrous mkati mwa mafupa, zomwe zimapangitsa kuti mafupa afooke.

Pali zifukwa zingapo zomwe kuchuluka kwa PTH kungakwere:

• Kusowa kwa Calcitriol: Impso zikawonongeka, sizingathe kupanga calcitriol moyenera, zomwe zimapangitsa kuti PTH ipangidwe kwambiri.
• Kuwonjezeka kwa milingo ya FGF23:Ichi chingakhale chizindikiro choyamba cha matenda a impso. Chingakhalenso chifukwa cha mafupa omwe amachititsa kuti phosphorous m'magazi isakwere.
• Kuchuluka kwa phosphorous: Mu matenda a impso osatha, phosphorous imasonkhana m'magazi chifukwa impso sizingathe kuichotsa bwino. Izi zimathandizanso kupanga PTH.

Osteomalacia

Chifukwa chachikulu cha vutoli ndi kusowa kwa vitamini D. Izi zimachitika kawirikawiri kwa anthu omwe ali ndi matenda a impso kwa nthawi yayitali.

Komanso, zitsulo zina zingayambitse osteomalacia chifukwa cha poizoni wa zitsulo . Mwachitsanzo, zitsulo monga aluminiyamu zimasokoneza mapangidwe ndi kusamalira mafupa. Kale, mankhwala ena omwe amagwiritsidwa ntchito poletsa kuchuluka kwa phosphorous (phosphate binders) anali ndi aluminiyamu. Komabe, mankhwalawa sakuvomerezedwanso kwa anthu omwe ali ndi matenda a impso, makamaka omwe amamwa dialysis . Zomangira phosphorous zomwe si za aluminiyamu tsopano zikupezeka. Zikamwedwa ndi chakudya, zimaletsa phosphorous yomwe ili mu chakudya kuti isalowe m'magazi.

Mitundu ina ya khansa ingayambitsenso kupanga kwambiri kwa hormone ya FGF23, zomwe zingayambitse osteomalacia ndi kusweka kwa mafupa.

Matenda a Mafupa Osasinthasintha

Apa ndi pamene kupangika ndi kukonzanso minofu ya mafupa kumachepa kwambiri. Vutoli limapezeka kwambiri kwa anthu omwe ali ndi matenda oopsa a impso komanso omwe amamwa dialysis. Chifukwa chachikulu cha izi ndichakuti kuchuluka kwa calcium ndi vitamini D m'thupi kumakhala kokwera kwambiri . Pochiza matenda a impso, nthawi zina calcium ndi vitamini D wowonjezera amafunika kuperekedwa. Ngakhale izi zimathandiza kupewa osteodystrophy ya impso, yomwe imayamba chifukwa cha kusintha kwa mafupa, nthawi zina zingayambitse kuchepa kwa hormone ya parathyroid (PTH).

Pali zifukwa zina zingapo:

• Kusanthula kwa magazi kosalekeza: Uwu ndi mtundu wa dialysis. Apa, magazi amayeretsedwa mkati mwa m'mimba. Izi ndi zosiyana ndi hemodialysis , yomwe imachitika kudzera mu mtsempha womwe uli m'dzanja lanu. Madzi ena a peritoneal dialysis amakhala ndi calcium yambiri. Izi zingayambitse PTH yochepa.
• Matenda a Shuga: Mu matenda a shuga, kuchuluka kwa shuga m'magazi ndi kuchepa kwa insulin kungathenso kuchepetsa kupanga kwa PTH.

Kodi matenda a Mineral ndi Bone (Chronic Kidney Disease-associated Mineral and Bone Disorder) ndi chiyani?

Pamene kuchuluka kwa mchere ndi mahomoni m'magazi mwathu kwasokonekera, kungakhudze mtima ndi mitsempha yamagazi yathu. CKD-MBD (Chronic Kidney Disease Mineral and Bone Disorder) ndi mawu ambiri omwe amaphatikizapo matenda monga Renal Osteodystrophy ndi matenda ena okhudzana ndi mtima.

Mwachidule, pamene calcium ndi phosphorous m'magazi zichulukira, zingayambitse matenda a mtima ndi mitsempha yamagazi. Chifukwa cha izi ndi njira yotchedwa calcification . Izi zikutanthauza kuti, calcium imasonkhana ndikuyika mkati mwa mitsempha yamagazi. Izi zingayambitse makoma a mitsempha yamagazi kukhuthala ndi kuuma. Izi zimatchedwa atherosclerosis . Izi zingayambitse matenda aakulu monga kuthamanga kwa magazi, matenda a mtima, ndi sitiroko. Tangoganizirani momwe vuto la impso lingapitirire!

Kodi matenda a impso otchedwa Osteodystrophy ndi ofala bwanji?

Akuti pafupifupi 15% ya akuluakulu ku United States ali ndi matenda a impso osatha. Ambiri mwa iwo akhoza kukhala ndi vuto la impso. Kuwonongeka kwa mafupa kumeneku kumatha kukhala koopsa impso zikalephera kugwira ntchito bwino, komanso pambuyo pa dialysis yayitali. Matendawa amapezekanso ku Sri Lanka.

Kodi ndi zifukwa ziti za matenda a impso otchedwa renal osteodystrophy?

Chifukwa chachikulu ndi matenda a impso osatha (CKD) . Matenda a impso amasokoneza kuchuluka kwa mchere ndi mahomoni, komanso amasokoneza njira yokhazikika yokonzanso mafupa (kusintha kwa mafupa). Ngati kusintha kwa mafupa kumeneku kumachitika mofulumira kwambiri kapena pang'onopang'ono kwambiri, zonsezi zingayambitse mafupa ofooka.

Kodi zizindikiro za osteodystrophy ya impso ndi ziti?

Zizindikiro zazikulu ndi kupweteka kwa mafupa ndi kusweka kwa mafupa . Anthu ena sangakhale ndi zizindikiro zilizonse kumayambiriro kwa matendawa. Ndi gawo loopsa kwambiri.

Ana aang'ono omwe ali ndi matenda a impso amatha kuchedwa kukula chifukwa cha matenda a impso otchedwa osteodystrophy. Angathenso kukhala ndi mafupa opunduka otchedwa rickets . Rickets ndi matenda omwe amayamba ali ana otchedwa osteomalacia. Izi zikutanthauza kuti mafupa amakhala ofewa ndipo amatha kuwerama.

Kodi matenda a impso otchedwa osteodystrophy amachiritsidwa bwanji?

Dokotala wanu adzamvetsera mosamala zizindikiro zanu, mbiri yanu yachipatala, komanso ngati pali wina aliyense m'banja mwanu amene wakhalapo ndi matenda ofanana ndi anu. Kenako, adzakuyezani thupi.

Pali mayeso angapo omwe amagwiritsidwa ntchito pozindikira matendawa molondola:

• Mayeso a magazi: Izi zimayesa kuchuluka kwa calcium, phosphorous, vitamini D, ndi parathyroid hormone (PTH) m'magazi. Zimayesanso zizindikiro zina za kusintha kwa mafupa, monga alkaline phosphatase . Ngati muli ndi matenda a impso kwa nthawi yayitali, dokotala wanu nthawi zambiri amachita mayeso a magazi awa kuti aone ngati pali kusintha kwa kuchuluka kwa magazi.
• Kufufuza Mafupa: Izi zimaphatikizapo kutenga chidutswa cha minofu kuchokera ku fupa ndikuchiyesa mu labu. Izi zingapereke lingaliro labwino la kuchuluka ndi kapangidwe ka fupa. Komabe, iyi si mayeso ofala kwambiri.
• Kuyesa kuchuluka kwa mafupa: Kumatchedwanso DEXA scan , izi zimayesa mphamvu ya mafupa anu komanso chiopsezo chawo chosweka.
• Mayeso ojambulira: Mayeso monga X-ray , CT scans , ndi MRIs amatha kuwona kusintha kwa mafupa. Ma CT scans ndi echocardiograms ( kujambula mtima) amagwiritsidwanso ntchito pofufuza calcium deposits (calcification) m'mitsempha yamagazi.

Kumbukirani kuti si aliyense amene ayenera kuyesedwa zonsezi. Dokotala wanu adzasankha mayeso ofunikira kwambiri kutengera momwe mulili.

Kodi chithandizo cha osteodystrophy ya impso ndi chiyani?

Chithandizo chomwe mudzalandire chidzadalira kuchuluka kwa kuwonongeka kwa mafupa anu, gawo la matenda anu a impso, komanso ngati mafupa anu akusintha mofulumira kapena pang'onopang'ono. Pali njira zingapo zazikulu zochizira:

• Kusintha zakudya: Dokotala wanu angakulangizeni kudya zakudya zokhala ndi phosphorous yochepa . Izi zikutanthauza kuchepetsa zakudya zomwe zili ndi phosphorous yambiri (zakudya zopangidwa ndi kupakidwa) - monga zakudya zam'chitini, Zakudya zophikidwa nthawi yomweyo, ndi masoseji. Ngati matenda anu a impso ndi aakulu, mungafunikenso kuchepetsa zakudya zomwe zili ndi phosphorous yambiri mwachibadwa (monga mkaka, mtedza, ndi nyama ndi nsomba zouma).
• Mankhwala ndi zowonjezera: Izi zingathandize kuchepetsa kuchuluka kwa mchere ndi mahomoni. Mwachitsanzo, zowonjezera za calcium ndi vitamini D, mankhwala omwe amachepetsa kuchuluka kwa parathyroid hormone (PTH), ndi zowonjezera za phosphorous zitha kuperekedwa. Madokotala nthawi zambiri amalangiza zosakaniza zopanda calcium phosphorous chifukwa calcium yambiri ingayambitse matenda a mafupa osagwira ntchito.
• Opaleshoni ya Parathyroid: Ngati njira zina zothandizira sizinagwire ntchito, opaleshoni ikhoza kuchitidwa. Izi zimaphatikizapo kuchotsa gland imodzi kapena zingapo za parathyroid. Izi zimatchedwa parathyroidectomy . Nthawi zambiri, gland imodzi ya parathyroid imatsala. Izi zingathandize kupewa kuchuluka kwa PTH kuti kusatsike kwambiri ndikuyambitsa matenda a mafupa osasinthasintha.

Kuwonjezera pa zonsezi, dokotala wanu adzakuthandizaninso kuthana ndi matenda anu a impso. Mukatsatira ndondomeko ya chithandizo moyenera, mutha kupewa kuwonongeka kwina kwa mafupa anu.

Kodi Osteodystrophy ya Impso Ingapewedwe?

N'zovuta kupewa matenda a impso kwathunthu. Komabe, pochiza matenda a impso osatha (CKD) bwino, vutoli lingathe kuthetsedwa ndipo kupita patsogolo kwake kuchepe.Izi zikutanthauza kuti kumwa mankhwala omwe dokotala wakupatsani panthawi yake, kutsatira zakudya zomwe mwapatsidwa, komanso kuchita bwino chithandizo cha dialysis ndikofunikira kwambiri. Komanso, kuchita masewera olimbitsa thupi, kusiya kusuta fodya, komanso kuchepetsa kumwa mowa n'kothandiza kwambiri.

Kodi munthu amene ali ndi matenda a impso angayembekezere chiyani?

Palibe mankhwala ochiritsira vutoli kupatula kungomuika impso . Anthu omwe ali ndi matenda a impso kwa nthawi yayitali amataya ntchito ya impso pang'onopang'ono. Anthu ambiri pamapeto pake amalephera kugwira ntchito ya impso ndipo amafunika dialysis. Matenda a impso otchedwa Osteodystrophy ndi vuto lofala kwambiri la njirayi.

Komanso, anthu ambiri omwe ali ndi matenda a impso osatha amadwalanso matenda a mtima. Matenda a mtima ndi omwe amachititsa imfa zambiri chifukwa cha kulephera kwa impso.

Koma musadandaule. Dokotala wanu nthawi zonse amafufuza kuchuluka kwa mchere ndi mahomoni m'thupi lanu ndipo amalangiza chithandizo choteteza mafupa ndi mtima wanu.

Kodi muyenera kulankhula ndi dokotala liti?

Ngati muli ndi matenda a impso osatha (CKD), onetsetsani kuti mwadziwitsa dokotala wanu ngati mukumva kupweteka kwa mafupa kapena kuuma kwa mafupa . Izi zitha kukhala chizindikiro cha matenda a impso.

Anthu ambiri amangozindikira kuti ali ndi matenda a impso osatha akakula kale. Chifukwa chake, kukayezetsa pafupipafupi kungathandize kuzindikira matenda a impso msanga. Ngati achitika, mutha kuchitapo kanthu kuti asakule kwambiri. Izi ndizofunikira kwambiri ngati muli ndi chiopsezo cha matenda a impso (monga kunenepa kwambiri, kukhala ndi matenda a shuga, kukhala ndi mbiri ya banja la matenda a impso, matenda a mtima, kapena kuthamanga kwa magazi).

Uthenga Wopita Nawo Kunyumba

Chabwino, tiyeni tikambirane zina mwa zinthu zomwe muyenera kukumbukira kuchokera pa zomwe takambirana:

• Osteodystrophy ya impso ndi matenda a mafupa omwe amayamba chifukwa cha matenda a impso osatha (CKD).
• Impso zikalephera kugwira ntchito bwino, kuchuluka kwa calcium, phosphorous, ndi vitamini D m'magazi kumakhala kosakhazikika, ndipo mafupa amatha kufooka.
• Kupweteka kwa mafupa ndi kusweka kwa mafupa ndiye zizindikiro zazikulu, koma poyamba sizingakhale zizindikiro.
• Madokotala amazindikira vutoli kudzera mu mayeso a magazi ndi ma scan.
• Chithandizo chimaphatikizapo kuchepetsa zakudya, mankhwala, komanso nthawi zina opaleshoni.
• Njira yabwino kwambiri yothanirana ndi vutoli ndi kusamalira bwino matenda a impso.
• Ngati muli ndi matenda a impso ndipo mukumva kupweteka m'mafupa anu, pitani kwa dokotala nthawi yomweyo.
• Kupimidwa ndi dokotala nthawi zonse kungathandize kuzindikira matenda a impso msanga.

Ngakhale kuti vutoli silingathe kuchiritsidwa kwathunthu, ndi chithandizo choyenera komanso kutsatira malangizo a dokotala, mutha kukhala ndi moyo wabwino. Choncho musachite mantha, lankhulani ndi dokotala wanu, ndipo chitani zinthu zofunika.

Matenda a impso , matenda a impso, matenda a mafupa, calcium, phosphorous, vitamini D, parathyroid hormone, CKD-MBD