Izinto okudingeka uzazi mayelana nokwehluleka kwezinso!

Wake wazibuza ukuthi lezi zinso ezimbili ezincane emzimbeni wethu zisebenza kangakanani? Ngezinye izikhathi, lezi zinso zingase zehluleke. Uma lokho kwenzeka, sikubiza ngokuthi Ukwehluleka Kwezinso. Nakuba lokhu kungaba yisihloko esesabekayo kwabanye, kubalulekile ukukuqaphela.

Kuyini Ukwehluleka Kwezinso?

Kalula nje, ukwehluleka kwezinso kuyisimo lapho eyodwa noma zombili izinso zakho zingasebenzi kahle. Lokhu kusho ukuthi azikwazi ukwenza umsebenzi wazo zodwa. Lokhu kungenzeka ngezindlela ezimbili. Enye ukwehluleka kwezinso okubukhali . Lesi yisimo esifika ngokuzumayo. Kodwa ngezinye izikhathi kuba okwesikhashana futhi singelashwa. Olunye uhlobo ukwehluleka kwezinso okungapheli . Lokhu kuwukonakala kancane kancane kwezinso ngokuhamba kwesikhathi. Lesi yisimo esivame kakhulu kubantu abaningi.

Lesi simo sokwehluleka kwezinso singaqhubekela esigabeni sokugcina, okuyiSifo Sezinso Esisesigabeni Sokuphela (ESKD) . Eqinisweni, uma singelashwa, i-ESKD ingaba yingozi empilweni. Umuntu onalesi simo angaphila izinsuku noma amasonto ambalwa kuphela ngaphandle kokwelashwa. Kodwa ungakhathazeki, ngokwelashwa okufanele, ukwehluleka kwezinso kungalawulwa futhi kuphile impilo enhle.

Kwenzekani ezinso zethu?

Manje ake sibone ukuthi lezi zitho ezibizwa ngokuthi izinso zenzani emizimbeni yethu. Izinso zakho zifana nobhontshisi ababili. Zingangesibhakela sakho. Uyazi ukuthi zikuphi? Zitholakala ngaphansi nje kwekheji lakho lezimbambo, ngasemuva. Iningi labantu linezinso ezimbili ezisebenza kahle. Kodwa uma inso eyodwa isebenza kahle, ungaphila ngokunethezeka.

Umsebenzi oyinhloko wezinso ukususa ubuthi emizimbeni yethu . Zicabange njengesihlungi. Zihlunga igazi lakho bese zisusa imfucuza engafuneki kulo njengomchamo (esiwubiza nangokuthi umchamo ).

Ngakho cabanga ngakho, kwenzekani uma lezi zinso zingasebenzi kahle? Lezo zinto ezilahliwe zinqwabelana emzimbeni. Uma lokho kwenzeka, uqala ukuzizwa ugula, futhi uma ungelashwa, ungagcina ufile. Kodwa, njengoba ngishilo ngaphambili, abantu abaningi bangalawula lesi simo ngokwelashwa okufanele.

Kuvame kangakanani ukwehluleka kwezinso?

Ake sibone ukuthi lesi simo sivame kangakanani ukubizwa ngokuthi ukwehluleka kwezinso. Ezweni elifana neMelika, lesi sifo sithinta abantu ababalelwa ku-7.5 lakh ngonyaka. Uma ubheka emhlabeni wonke, cishe abantu abayizigidi ezimbili bahlushwa yilesi sifo. Kukhona abantu abaningi abanalesi simo ezweni lethu, ikakhulukazi ngoba izifo ezifana nesifo sikashukela kanye nomfutho wegazi ophakeme zivamile.

Yiziphi izigaba ezinhlanu zesifo sezinso?

Uma sikhuluma ngezigaba zesifo sezinso, sibheka i-eGFR yakho (Isilinganiso Sokuhlunga Esilinganiselwe Se-Glomerular).Inani libizwa ngokuthi. Lokhu ukuhlolwa kwegazi.

Kalula nje, i-eGFR iyisilinganiso sokuthi izinso zakho zihlunga kahle kangakanani izinto. I-eGFR yomuntu ophilile ivame ukuba ngaphezu kwama-90. I-eGFR engu-0 isho ukuthi izinso azisebenzi nhlobo.

Kunezigaba ezinhlanu eziyinhloko zesifo sezinso:

• Isigaba I: I-GFR yakho ingaphezu kuka-90. Kuleli qophelo, izinso zakho zisebenza kahle, yize kukhona umonakalo othile.
• Isigaba II: I-GFR yakho ingaba phakathi kuka-60 no-89. Izinso zonakele kakhulu kunasesigabeni sokuqala, kodwa zisasebenza kahle.
• Isigaba III: I-GFR yakho ingaba phakathi kuka-30 no-59. Kulesi sigaba, ukusebenza kwezinso kungaba kuncane noma kube nzima.
• Isigaba IV: I-GFR yakho ingaba phakathi kuka-15 no-29. Yilapho ukusebenza kwezinso kuncipha khona kakhulu.
• Isigaba V: I-GFR yakho ingaphansi kuka-15. Lokhu kusho ukuthi izinso zakho ziseduze noma sezihlulekile ngokuphelele. Yilapho izimpawu zivame ukuqala khona ukuvela.

Yiziphi izimpawu zokuqala zokuhluleka kwezinso?

Ngokuvamile, isifo sezinso sokuqala asinazo izimpawu , noma izimpawu ezincane kuphela. Kodwa noma ungaqapheli lutho, isifo sezinso esingamahlalakhona (CKD) singabangela umonakalo ngaphakathi.

Izimpawu zokwehluleka kwezinso zingahluka kumuntu nomuntu. Uma izinso zakho zingasebenzi kahle, funa eyodwa noma ngaphezulu yalezi zimpawu ezilandelayo:

• Ukuzizwa ukhathele kakhulu (ukukhathala). Hhayi ukukhathala nje kuphela, kodwa nokukhathala okungapheli kungakhathaliseki ukuthi ulala kangakanani.
• Isicanucanu nokuhlanza. Lokhu kungase kuhambisane nokulahlekelwa yisifiso sokudla.
• Ukuzizwa udidekile noma unenkinga yokugxila. Cabanga uzizwa udidekile, ungakwazi ukugxila kokuthile.
• Ukuvuvukala (i-edema). Ukuvuvukala, ikakhulukazi ezandleni, emaqakaleni, noma ebusweni. Abanye abantu babika ukuvuvukala eduze kwamehlo abo lapho bevuka ekuseni.
• Ushintsho endleleni ochama ngayo kaningi. Kungase kudingeke ukuthi uchame kaningi noma inani lomchamo ophumayo lingase lehle. Ungase futhi ube nomchamo onegwebu.
• Ukuqaqamba kwemisipha noma ukuxhuga.
• Isikhumba esomile noma esilumayo.
• Ukulahlekelwa yisifiso sokudla, noma ukunambitheka kwensimbi emlonyeni.

Ungesabi ukuthi izinso zakho ziyahluleka ukusebenza ngoba nje unesinye noma ezimbili zalezi zimpawu. Kodwa uma lezi zimpawu ziqhubeka, kufanele nakanjani ubone udokotela .

Yiziphi izimbangela eziyinhloko zokwehluleka kwezinso?

Izimbangela ezimbili eziyinhloko zesifo sezinso esingamahlalakhona kanye nokwehluleka kwezinso isifo sikashukela kanye nomfutho wegazi ophezulu . Zombili lezi zifo zivamile ezweni lethu.

Uma unesifo sikashukela, uma singalawulwa kahle, amazinga kashukela egazini lakho azohlala ephezulu (i-hyperglycemia). Uma amazinga kashukela egazini lakho ehlala ephezulu, kungalimaza izinso zakho nezinye izitho zomzimba.

Umfutho wegazi ophakeme usho ukuthi igazi lihamba ngemithambo yegazi kanzima kakhulu, ngamandla amakhulu. Uma lingelashwa isikhathi eside, la mandla engeziwe angalimaza izicubu zezinso.

Ukwehluleka kwezinso akuyona into eyenzeka ngokuzumayo. Kunezinye izici ezingayithinta:

• Isifo Sezinso Esiyi-Polycystic (PKD): Lesi yisifo sofuzo esizuzwe komunye wabazali. Kulokhu, ama-cyst agcwele uketshezi (ama-cyst) akheka ngaphakathi kwezinso.
• Izifo ze-Glomerular: Lezi zifo zithinta ikhono lezinso lokuhlunga imfucuza.
• Izifo zezinso ezizivikela ngokuzenzakalelayo: Isibonelo, isifo esibizwa ngokuthi i-lupus . Lesi yisifo esizivikela ngokuzenzakalelayo, okusho ukuthi amasosha omzimba ahlasela amangqamuzana awo. Lokhu kungabangela ukulimala kwezitho zomzimba, ubuhlungu bamalunga, umkhuhlane kanye nezilonda zesikhumba.

Ngezinye izikhathi, ukwehluleka kwezinso kungenzeka ngokuzumayo ngesizathu esingalindelekile. Lokhu kubizwa ngokuthi i-Acute Kidney Injury . Kulesi simo, izinso zilahlekelwa amandla azo okusebenza ngokuzumayo. Lesi simo singavela ezinsukwini ezimbalwa. Kodwa isikhathi esiningi, singesesikhashana.

Izimbangela ezivamile zokwehluleka kwezinso okungazelelwe yilezi:

• Imithi ethile, ikakhulukazi imithi ethile yokudambisa izinhlungu, ingabangela lokhu.
• Ukuphelelwa amanzi emzimbeni kakhulu. Uma umzimba ungenawo amanzi anele.
• Ukuvaleka komgudu womchamo. Lokhu kungabangelwa yinto efana netshe lomchamo.
• Izifo zomzimba ezingelashwanga. Isibonelo, isifo senhliziyo noma isifo sesibindi.

Yiziphi izici eziyingozi zokwehluleka kwezinso?

Noma ubani angaba nokwehluleka kwezinso. Kodwa-ke, ungase ube sengozini enkulu uma unezinye zezici ezilandelayo:

• Uma unesifo sikashukela .
• Uma unomfutho wegazi ophakeme (umfutho wegazi ophakeme) .
• Uma unesifo senhliziyo .
• Uma othile emndenini wakho eke waba nesifo sezinso (isimo esibangelwa ufuzo).
• Uma unezinkinga zesakhiwo ezinso zakho .
• Uma umnyama (ngenxa yezizathu ezithile zofuzo).
• Uma uneminyaka engaphezu kwengu -60 ubudala .
• Uma usuthathe imithi yokubulala izinhlungu isikhathi eside , ikakhulukazi ama-NSAID (izidakamizwa ezingezona eze-steroidal Anti-inflammatory) ongazithola kalula ekhemisi.

Yiziphi izinkinga zokwehluleka kwezinso?

Izinso zenza imisebenzi eyahlukene emzimbeni wethu. Ngakho-ke uma izinso zehluleka, kungabangela izinkinga ezahlukene. Isibonelo:

• Umfutho wegazi ophezulu.
• I-anemia. Lokho kusho ukuntuleka kwegazi. Izinso zikhiqiza i-hormone esiza ekwakheni amangqamuzana abomvu egazi. Uma izinso zonakele, ziyancipha.
• Isifo samathambo.
• Uketshezi oluzungeze amaphaphu akho.
• Ukulimala kwemizwa.
• Ukungalingani kwama-electrolyte. Lokhu kusho ushintsho enanini likasawoti njenge-sodium ne-potassium egazini.

Kodwa ungacabangi ukuthi ngenxa nje yokuthi utholakale unesifo sezinso, uzofa. Uma ulandela uhlelo lokwelashwa lukadokotela wakho—olungafaka phakathi imithi, izinguquko zendlela yokuphila, kanye nokunciphisa usawoti nokudla okuthile—ungaphatha isimo sakho kahle. Kodwa-ke, uma ungamlaleli udokotela wakho, izinso zakho zingaba zimbi kakhulu futhi ungase ufe nokufa.

Ingabe ukwehluleka kwezinso esigabeni sokugcina kungadala ukufa?

Yebo, isifo sezinso esisesigabeni sokugcina (i-ESKD) singabulala. Kodwa njengoba ngishilo ngaphambili, ngokwelashwa okufanele, abantu abaningi bangaphila nokwehluleka kwezinso. Into ebaluleke kakhulu okufanele uyikhumbule ukuthi ayikho ikhambi lokwehluleka kwezinso. Lokho kusho ukuthi ngisho nangokwelashwa, izinso zakho ngeke zisebenze njengoba zazinjalo ngaphambi kokuba ube nesifo. Ukwelashwa kuhloselwe ukugcina umsebenzi osele wezinso zakho isikhathi eside ngangokunokwenzeka nokunciphisa ukuwohloka kwazo okusheshayo.

Kuhlonzwa kanjani ukwehluleka kwezinso?

Udokotela angase asebenzise izivivinyo ezahlukene zokusebenza kwezinso ukuze abone ukuthi izinso zakho zisebenza kanjani nokuthi uthola ukuthi unesifo sezinso. Uma udokotela wakho esola ukuthi usengozini yokwehluleka kwezinso, lezi yizivivinyo ezivame ukwenziwa:

• Ukuhlolwa kwegazi: Lokhu kuhlola ukuthi izinso zakho zikhipha kahle kangakanani imfucuza egazini lakho. Udokotela uthatha isampula encane yegazi emthanjeni osengalweni yakho esebenzisa inaliti encane. Isampula yegazi bese ihlolwa elabhorethri. Lokhu kuhlolwa kwegazi kusetshenziselwa futhi ukuhlola inani le-eGFR okukhulunywe ngalo ngaphambili.
• Ukuhlolwa komchamo: Lokhu kulinganisa izinto ezithile emchameni wakho, njengeprotheni noma igazi. Kuzodingeka uchamele esitsheni esikhethekile ehhovisi likadokotela noma esibhedlela. Isampula yomchamo izobe isihlolwa elabhorethri.
• Ukuhlolwa kwezithombe: Lokhu kuhlolwa kuvumela udokotela ukuthi abheke izinso zakho nendawo ezungezile ukuze abone ukuthi kukhona yini ukukhubazeka noma ukuvaleka. Ukuhlolwa okuvamile kwezithombe kuhlanganisa i-ultrasound yezinso , i-CT urogram, kanye ne -MRI .

Kulashwa kanjani ukwehluleka kwezinso?

Ukwelashwa kokwehluleka kwezinso kuncike embangela kanye nobunzima besimo. Odokotela abakwazi ukwelapha ngokuphelele ukwehluleka kwezinso, futhi kuyisimo esisongela impilo. Kodwa ukwelashwa kungakusiza uphile isikhathi eside futhi ulawule izimpawu nezinkinga.

Uma izinso zakho zihluleka kancane kancane, udokotela angasebenzisa izindlela eziningana ezahlukene ukuqapha impilo yakho nokugcina ukusebenza kwezinso isikhathi eside ngangokunokwenzeka. Lezi zindlela zingafaka:

• Ukuhlolwa kwegazi njalo.
• Ukuhlola umfutho wegazi njalo.
• Imithi.

Uma unesifo sezinso esisesigabeni sokugcina , udinga ukwelashwa ukuze uhlale uphila. Kunezindlela ezimbili zokwelapha eziyinhloko zokwehluleka kwezinso: i-dialysis kanye nokufakelwa kwezinso .

Imithi yokwehluleka kwezinso

Kuye ngembangela yesifo sakho sezinso, udokotela angase akunike umuthi owodwa noma ngaphezulu kwale mithi elandelayo:

• Ama-Angiotensin-converting enzyme (ACE) inhibitors noma ama-angiotensin II receptor blockers (ARBs): Le mithi isiza ukwehlisa umfutho wegazi.
• Ama-diuretics: Lawa asiza ekususeni uketshezi oluningi emzimbeni. Abanye abantu bawabiza nangokuthi 'amaphilisi amanzi'.
• Ama-statin: Lawa asiza ukwehlisa amazinga akho e-cholesterol.
• Ama-Erythropoietin-stimulating agents: Lawa asiza ekwakheni amangqamuzana abomvu egazi uma une-anemia.
• I-Vitamin D ne-Calcitriol: Lokhu kusiza ekuvimbeleni ukulahlekelwa amathambo.
• Izihlanganisi ze-phosphate: Lezi zisiza ukususa i-phosphorus eningi egazini lakho.

I-Dialysis

I-Dialysis iyindlela yokusiza umzimba wakho ukuhlunga igazi. Cabanga ngakho njengokunikeza izinso zakho ikhefu ukuze zingadingi ukusebenza kanzima. Kunezinhlobo ezimbili ze-dialysis:

• I-Hemodialysis: Lona umshini ohlanza igazi lakho njalo. Abantu abaningi abanenkinga yezinso baya esibhedlela noma esikhungweni se-dialysis ukuze bayohlolwa i-hemodialysis izinsuku ezintathu kuya kwezine ngesonto. Lokhu kungaba yinto ekhathazayo kancane, njengoba kufanele uxhunywe emshinini amahora amaningana ngesikhathi.
• I-dialysis ye-peritoneal:Kule nqubo, udokotela ufaka ithubhu elincane (i-catheter) ngaphansi kwesikhumba sesisu sakho bese elixhuma esikhwameni esinoketshezi lwe-dialysis. Lolu ketshezi lugeleza lusuka esikhwameni luye emgodini wesisu sakho, lapho lususa khona ukungcola kanye noketshezi olwengeziwe bese lubuyela esikhwameni. Ngezinye izikhathi, i-peritoneal dialysis ingenziwa ekhaya.

Ukufakelwa Kwezinso

Ekufakweni kwezinso, udokotela ohlinzayo ushintsha izinso zakho ezonakele ngenso enempilo. Le nso enempilo (isitho somnikeli) ingavela kumnikeli oshonile noma kumnikeli ophilayo. Ungaphila kahle ngenso eyodwa enempilo. Uma ufakwe izinso, kuzodingeka uthathe imithi impilo yakho yonke ukuze uvimbele ukulimala kwezinso ezifakwe. Le mithi isebenza ukuvimba umzimba wakho ukuthi wenqabe inso entsha.

Kungenzeka yini ukululama ekuhlulekeni kwezinso esigabeni sokugcina?

Kuncike ezintweni eziningi. Ngokwelashwa okufanele, ungaphila impilo ejabulisayo neyanelisayo. Kodwa-ke, kufanele ulindele ukuthi udinga ukwelashwa impilo yakho yonke. Khumbula, isifo sezinso noma ukwehluleka kwezinso akunakulungiswa , kungancishiswa kuphela.

Ungakuvimbela kanjani ukwehluleka kwezinso?

Nakuba ukwehluleka kwezinso kanye nesifo sezinso esingamahlalakhona (CKD) kungenakukwazi ukuguqulwa, kunezinto ongazenza ukuze uvikele ukusebenza kwezinso zakho. Imikhuba nemikhuba enempilo inganciphisa izinga lokulahlekelwa ukusebenza kwezinso zakho.

Uma une-CKD noma ukwehluleka kwezinso, kuwumqondo omuhle ukwenza lezi zinto:

• Qapha ukusebenza kwezinso zakho njalo (hlolwa njengoba udokotela wakho encoma).
• Uma unesifo sikashukela, gcina amazinga kashukela egazini lakho esezingeni elijwayelekile .
• Gcina izinga lomfutho wegazi lakho lingaphakathi kwesilinganiso esijwayelekile .
• Gwema ukusebenzisa imikhiqizo kagwayi (njengokubhema).
• Gwema ukudla okune-potassium eningi kanye ne-sodium (usawoti) . Kungcono ukubuza udokotela noma isazi sokudla okunempilo ngalokhu, njengoba ezinye izithelo nemifino nazo zino-potassium eningi.
• Qiniseka ukuthi uya kuyo yonke i-aphoyintimenti ehleliwe nodokotela wakho.

Yini ongayilindela uma unesifo sezinso?

Akukho ukwelashwa okuphelele kokwehluleka kwezinso. Kodwa-ke, ngokuxilongwa okufanele kanye nokwelashwa, ungaphila isikhathi eside ngaphandle kokushintsha okukhulu kwekhwalithi yempilo yakho.

Kufanele ubonane nini nodokotela?

Uma unezici eziyingozi zokwehluleka kwezinso, bona udokotela. Lokho kusho ukuthi:

• Uma une -high blood pressure .
• Uma ubona izinguquko endleleni yakho yokuchama (ukuchama njalo, ukuchama okuncane, umchamo onegwebu, igazi).
• Uma ubhekene nenkungu yobuchopho noma ubunzima bokugxilisa ingqondo.
• Uma unesicanucanu noma ukuhlanza .
• Uma unesifo sikashukela .
• Uma kukhona emndenini wakho oke waba nesifo sezinso .
• Uma uke waba nenkinga yezinso ngaphambilini (isib., ukwehluleka kwezinso okungazelelwe).
• Uma uthatha ama-NSAID njalo .

Uma unesifo esifana nalesi, ungasinaki. Kuwukuhlakanipha ukubona udokotela ngokushesha bese uthola iseluleko.

Yimiphi imibuzo okufanele uyibuze udokotela?

Cabanga ngokubuza udokotela wakho le mibuzo mayelana nokwehluleka kwezinso:

• Wazi kanjani ukuthi nginesifo sezinso?
• Uma ngingenaso isifo sezinso, yisiphi esinye isimo engingaba naso?
• Yini ebangela ukwehluleka kwezinso zami?
• Ingabe ngidinga i-dialysis?
• Hlobo luni lwe-dialysis oluncomayo?
• Ingabe ngifanelekile ukufakelwa izinso?
• Hlobo luni lwemithi ongincomayo?
• Ingabe kudingeka ngenze izinguquko ekudleni kwami?
• Kukangaki ngidinga ukuza ukuzokwelashwa?

Kufanele kucatshangelwe nini ukunakekelwa kwe-hospice uma kwenzeka ukwehluleka kwezinso?

Ukunquma ukuthi sekuyisikhathi sokuba wena noma othandekayo wakho nithole ukunakekelwa kwe-hospice kuyisinqumo somuntu siqu. Ithimba lakho lezokwelapha lingakusiza ukuthi unqume ukuthi yini engcono kakhulu ngesimo sakho. Umgomo wokunakekelwa kwe-hospice ukuhlinzeka ngenduduzo nokusekelwa kwabantu abanesifo esisesigabeni sokugcina, njengokwehluleka kwezinso. Ukunakekelwa kwe-hospice uma kwenzeka ukwehluleka kwezinso kuvame ukwenzeka lapho ukwelashwa okufana ne-dialysis noma ukufakelwa kwezinso kungasasebenzi noma kungenziwa.

Ngakho-ke, yiziphi izinto okudingeka sizikhumbule kukho konke lokhu?

Izinso ziyizitho ezibalulekile emzimbeni wethu. Zisusa ukungcola kanye noketshezi olwengeziwe. Uma izinso zakho zihluleka, kusho ukuthi azisebenzi kahle. Uma zingalashwa, lokhu kungabulala. Kodwa ungakhathazeki, i-dialysis noma ukufakelwa izinso kungakusiza ukuthi uqhubeke nokuphila impilo enhle. Uhlelo lwakho lokwelashwa lungafaka phakathi ukuthatha imithi nokulandela ukudla okukhethekile. Qiniseka ukuthi ugcina wonke ama-aphoyintimenti akho nodokotela wakho. Uma unemibuzo noma ukukhathazeka mayelana nokwelashwa kwakho, imithi, izinguquko zendlela yokuphila, noma yini enye ohlelweni lwakho lokwelashwa, khuluma nodokotela wakho.

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Ukwehluleka kwezinso , isifo sezinso, isifo sikashukela, umfutho wegazi ophakeme, i-dialysis, ukufakelwa kwezinso