Ingabe izinkinga zakho zezinso zingathinta amathambo akho? Ake sifunde nge-Renal Osteodystrophy!

Unesifo sezinso, noma lokho thina odokotela esikubiza ngokuthi isifo sezinso esingamahlalakhona (CKD) ? Noma ingabe uyamazi umuntu ohlushwa yilesi simo? Abantu abaningi bacabanga ukuthi uma sithi isifo sezinso, sithinta izinso kuphela. Kodwa iqiniso liwukuthi, lapho izinso zethu zingasebenzi kahle, zingaba nomthelela omkhulu kwezinye izinhlelo eziningi emzimbeni, ikakhulukazi uhlelo lwethu lwamathambo, okungukuthi, amathambo ethu . Ngakho-ke, namuhla sizokhuluma ngesimo lapho amathambo ethu eba buthakathaka futhi abangele izinkinga ngenxa yesifo sezinso. Lokhu ngokwezokwelapha kubizwa ngokuthi i-renal osteodystrophy . Nakuba igama liyinkimbinkimbi kancane, masiliqonde kalula.

Kuyini i-Renal Osteodystrophy?

Kalula nje, i-Renal Osteodystrophy yisifo samathambo esingathinta abantu abadala nezingane ezinesifo sezinso esingamahlalakhona (CKD).

Manje, bheka, izinso zethu zinendima ebaluleke kakhulu. Lokho ukulawula amazinga amaminerali afana ne -calcium ne -phosphorus egazini lethu. Futhi, izinso zinesibopho sokusebenza kwe -vitamin D nokukhiqiza i-hormone ebizwa ngokuthi i-calcitriol , esiza ukugcina amathambo ethu eqinile.

Ngakho-ke, lapho izinso zihluleka noma zingasebenzi kahle, azikwazi ukulawula inani lala maminerali kanye ne-hormone calcitriol. Yilapho amathambo ethu eqala ukuba buthaka kancane kancane . Lokhu kwandisa ingozi yokuthi amathambo aphuke kalula, okusho ukuthi aqhekeke .

Yimaphi amaminerali nama-hormone asiza ukugcina amathambo ethu ephilile?

Kunezinhlobo eziningana zamaminerali nama-hormone abalulekile asiza ukugcina amathambo ethu ephilile futhi eqinile. Ake sifunde kancane ngawo.

• I-Calcium: Lena yingxenye eyinhloko yamathambo ethu. Amathambo afana "nebhange le-calcium" emzimbeni wethu. I-Calcium ayigcini nje ngokuqinisa amathambo, kodwa futhi ibalulekile kwezinye izinto eziningi, njengokusebenza kwesimiso sezinzwa kanye nokusebenza kwemisipha. Izinso zethu zisiza ukulinganisela amazinga e-calcium egazini.
• I-Phosphorus: Njenge-calcium, i-phosphorus nayo iyinto ebaluleke kakhulu emathanjeni. Izinso zethu zisusa i-phosphorus eningi ongayidingi umzimba futhi zigcine ibhalansi efanele phakathi kwe-calcium ne-phosphorus egazini.
• I-Calcitriol: Lena yindlela esebenzayo ye-vitamin D. Yenziwa yizinso zethu. Le hormone isiza ukulawula ukuthi ingakanani i-calcium emuncwa yimizimba yethu ekudleni esikudlayo futhi isiza nezindlala zethu ze-parathyroid ukuthi zisebenze.
• I-Fibroblast Growth Factor 23 (FGF23):Lena yi-hormone ekhiqizwa amathambo ethu. Isiza ekulawuleni amazinga e-phosphorus kanye ne-vitamin D. Amazinga e-FGF23 avame ukuphakama kubantu abanesifo sezinso esingamahlalakhona.
• I-Parathyroid Hormone (PTH): Le hormone ikhiqizwa yizindlala ezine ezincane ezitholakala ngemuva kwe-thyroid gland entanyeni yethu. Lezi zibizwa ngokuthi izindlala ze-parathyroid. Umsebenzi wale hormone ye-PTH ukukhipha i-calcium emathanjeni lapho umzimba udinga i-calcium nokugcina izinga le-calcium egazini lizinzile.

Yiziphi izinhlobo eziyinhloko ze-Renal Osteodystrophy?

Amathambo ayakhula lapho sisebancane. Kodwa ngisho nalapho siba ngabantu abadala, amathambo ethu awahlali nje lapho. Ahlala evuselelwa futhi elungiswa. Njengokususa izitini ezindala nokufaka ezintsha ukuze kwakhiwe udonga, izicubu ezindala zamathambo ziyaqhekeka futhi kwakheka izicubu ezintsha zamathambo. Sibiza le nqubo ngokuthi "ukuguquka kwamathambo."

I-Osteodystrophy yezinso ingenzeka uma lokhu kuguquka kwamathambo kushesha kakhulu noma kuhamba kancane kakhulu. Kunezinhlobo ezine eziyinhloko:

• I-Osteitis Fibrosa: Lesi yisimo lapho izicubu zamathambo ziphuka khona ngokushesha okukhulu. Lokhu kubangelwa ukwanda kwamazinga e-parathyroid hormone (PTH). Lokhu kubizwa ngokuthi i-hyperparathyroidism .
• I-Osteomalacia: Lesi yisimo lapho izicubu zamathambo ziphuka khona, kodwa amathambo amasha akheka kancane kakhulu. Amathambo aba yi-sponge futhi abe buthakathaka. Lokhu kungabangelwa ukuntuleka kwe-vitamin D, ubuthi bensimbi, kanye nokukhiqizwa ngokweqile kwe-hormone i-FGF23 ngenxa yezinhlobo ezithile zomdlavuza.
• Isifo Samathambo Esishintshashintshayo: Lesi yisimo lapho ukwakheka nokulungiswa kwezicubu zamathambo kuncipha kakhulu. Imbangela eyinhloko yalokhu amazinga aphansi e-parathyroid hormone (PTH).
• I-Mixed Renal Osteodystrophy: Lesi simo sihlanganisa izimpawu ze-Osteitis Fibrosa kanye ne-Osteomalacia.

Manje ake sixoxe ngalezi zinhlobo ngemininingwane ethe xaxa.

I-Osteitis Fibrosa

Sivame ukuzwa ukuthi abantu abanesifo sezinso esingamahlalakhona banezinga eliphezulu le-parathyroid hormone (PTH). I-PTH inesibopho sokukhipha i-calcium emathanjeni iye egazini ukuze ilinganise izinga le-calcium egazini. Kodwa-ke, uma izinga le-PTH liphezulu kakhulu, lidonsa i-calcium eningi emathanjeni. Lokhu kungaholela ekwakhekeni kwama-cyst e-fibrous ngaphakathi kwamathambo, okwenza amathambo abe buthaka.

Kunezizathu eziningana zokuthi kungani amazinga e-PTH angakhuphuka:

• Ukuntuleka kwe-Calcitriol: Uma izinso zonakele, azikwazi ukukhiqiza i-calcitriol ngendlela efanele, okwandisa ukukhiqizwa kwe-PTH.
• Amazinga e-FGF23 akhuphukile:Lokhu kungaba uphawu lokuqala lwesifo sezinso. Kungaba futhi impendulo evela emathanjeni ukuvimba amazinga e-phosphorus egazini ukuthi angakhuli.
• I-phosphorus eyandayo: Esifweni sezinso esingamahlalakhona, i-phosphorus iqoqana egazini ngoba izinso azikwazi ukuyisusa kahle. Lokhu kukhuthaza nokukhiqizwa kwe-PTH.

I-Osteomalacia

Imbangela eyinhloko yalesi simo ukuntuleka kwevithamini D. Lokhu kuvamile kubantu abanesifo sezinso sesikhathi eside.

Futhi, ezinye izinsimbi zingabangela i-osteomalacia ngenxa yobuthi bensimbi . Isibonelo, izinsimbi ezifana ne-aluminium ziphazamisa ukwakheka nokugcinwa kwamathambo. Esikhathini esidlule, eminye imithi eyayisetshenziswa ukulawula amazinga e-phosphorus (ama-phosphate binders) yayine-aluminium. Kodwa-ke, le mithi ayisanconywa kubantu abanesifo sezinso, ikakhulukazi labo abasebenzisa i-dialysis . Ama-non-aluminium phosphorus binders aseyatholakala manje. Uma ethathwa nokudla, avimbela i-phosphorus ekudleni ukuthi ingamuncwa egazini.

Ezinye izinhlobo zomdlavuza zingabangela nokukhiqizwa ngokweqile kwehomoni i-FGF23, okungaholela ku-osteomalacia kanye nokuqhekeka kwamathambo.

Isifo Samathambo Esishintshashintshayo

Yilapho ukwakheka nokulungiswa kwezicubu zamathambo kuncipha kakhulu. Lesi simo sivame kakhulu kubantu abanesifo sezinso esibi kakhulu nalabo abasebenzisa i-dialysis. Isizathu esiyinhloko salokhu ukuthi inani le-calcium ne-vitamin D emzimbeni liphezulu kakhulu . Lapho welapha isifo sezinso, ngezinye izikhathi kudingeka unikezwe i-calcium ne-vitamin D eyengeziwe. Nakuba lokhu kusiza ukuvimbela i-osteodystrophy yezinso, ebangelwa ukushintshashintsha kwamathambo okuphezulu, ngezinye izikhathi kungabangela amazinga e-parathyroid hormone (PTH) ukuba ehle kakhulu.

Kunezinye izizathu eziningana:

• I-Continuous Peritoneal Dialysis: Lolu uhlobo lwe-dialysis. Lapha, igazi lihlanzwa ngaphakathi kwesisu. Lokhu kuhlukile kwi -hemodialysis , eyenziwa ngomthambo ongalweni yakho. Ezinye iziphuzo ze-peritoneal dialysis zino-calcium eningi. Lokhu kungabangela amazinga aphansi e-PTH.
• Isifo Sikashukela: Kusifo sikashukela, amazinga kashukela egazini akhuphukile kanye namazinga e-insulin anciphile nakho kunganciphisa ukukhiqizwa kwe-PTH.

Kuyini i-CKD-MBD (Chronic Kidney Disease-associated Mineral and Bone Disorder)?

Uma ibhalansi yamaminerali nama-hormone egazini lethu iphazamiseka, ingathinta inhliziyo nemithambo yegazi yethu. I-CKD-MBD (Isifo Sezinso Esingapheli Esibangelwa Amaminerali Namathambo) yigama elibanzi elihlanganisa izimo ezifana ne-Renal Osteodystrophy kanye nesifo senhliziyo esihlobene naso.

Kalula nje, uma i-calcium ne-phosphorus egazini ziphezulu kakhulu, kungaholela ezifweni zenhliziyo nemithambo yegazi. Isizathu salokhu inqubo ebizwa ngokuthi i-calcification . Okusho ukuthi, i-calcium iyanqwabelana futhi ibeke ngaphakathi kwemithambo yegazi. Lokhu kungabangela ukuthi izindonga zemithambo yegazi ziqine futhi ziqine. Lokhu kubizwa ngokuthi i-atherosclerosis . Lokhu kungaholela ezimweni ezibucayi njengomfutho wegazi ophakeme, ukuhlaselwa yinhliziyo, kanye nesifo sohlangothi. Cabanga ukuthi inkinga yezinso ingahamba ibanga elingakanani!

Ivame kangakanani i-Renal Osteodystrophy?

Kulinganiselwa ukuthi cishe abantu abadala abangu-15% e-United States banesifo sezinso esingamahlalakhona. Abaningi babo bangase babe nezinga elithile le-osteodystrophy yezinso. Lo monakalo wamathambo ungaba mubi kakhulu ngemva kokuba izinso sezihlulekile ngokuphelele, futhi ngemva kokuhlinzwa isikhathi eside. Lesi simo sivamile naseSri Lanka.

Yiziphi izimbangela ze-Renal Osteodystrophy?

Imbangela eyinhloko yisifo sezinso esingamahlalakhona (CKD) . Isifo sezinso siphazamisa amazinga amaminerali nama-hormone, futhi siphazamisa inqubo evamile yokulungiswa kwamathambo (ukuguquka kwamathambo). Uma lokhu kuguquka kwamathambo kushesha kakhulu noma kuhamba kancane kakhulu, kokubili kungaholela emathanjeni abuthakathaka.

Ziyini izimpawu ze-Renal Osteodystrophy?

Izimpawu eziyinhloko ubuhlungu bamathambo kanye nokuphuka kwamathambo . Abanye abantu bangase bangabi nazo nhlobo izimpawu ezigabeni zokuqala zalesi sifo. Leyo yingxenye eyesabekayo kakhulu.

Izingane ezincane ezinesifo sezinso zingase zibhekane nokukhubazeka kokukhula ngenxa ye-renal osteodystrophy. Zingase futhi zibe nokukhubazeka kwamathambo okubizwa ngokuthi ama-rickets . Ama-rickets uhlobo lwesifo se-osteomalacia ebuntwaneni. Lokhu kusho ukuthi amathambo ayathamba futhi angase agobe.

I-Renal Osteodystrophy ihlolwa kanjani?

Udokotela wakho uzolalela ngokucophelela izimpawu zakho, umlando wakho wezokwelapha, nokuthi ngabe kukhona yini emndenini wakho oke waba nezifo ezifanayo. Ngemuva kwalokho, bazokwenza ukuhlolwa ngokomzimba.

Kunezinhlobo eziningana zokuhlolwa ezisetshenziselwa ukuxilonga lesi simo ngokunembile:

• Ukuhlolwa kwegazi: Lokhu kuhlola amazinga e-calcium, i-phosphorus, i-vitamin D, kanye ne-parathyroid hormone (PTH) egazini. Kuphinde kulinganise nezinye izimpawu zokuguquka kwamathambo, njenge -alkaline phosphatase . Uma unesifo sezinso sesikhathi eside, udokotela wakho uvame ukwenza lokhu kuhlolwa kwegazi ukuhlola izinguquko kula mazinga.
• I-Bone Biopsy: Lokhu kuhilela ukuthatha ingxenye encane yezicubu ethanjeni bese uyihlola elebhu. Lokhu kunganikeza umbono omuhle ngobuningi kanye nesakhiwo sethambo. Kodwa-ke, lokhu akulona ukuhlolwa okuvamile kakhulu.
• Ukuhlolwa kokuqina kwamathambo: Okubizwa nangokuthi i-DEXA scan , lokhu kulinganisa amandla amathambo akho kanye nengozi yawo yokuphuka.
• Ukuhlolwa kwezithombe: Ukuhlolwa okufana ne -X-ray , i-CT scan , kanye ne-MRI kungabheka izinguquko emathanjeni. Ukuhlolwa kwe-CT kanye ne-echocardiograms ( ukuskena kwenhliziyo) nakho kusetshenziselwa ukubheka ama-calcium deposits (i-calcification) emithanjeni yegazi.

Khumbula, akuwona wonke umuntu okudingeka enze zonke lezi zivivinyo. Udokotela wakho uzonquma ukuthi yiziphi izivivinyo ezibaluleke kakhulu kuye ngesimo sakho.

Yiziphi izindlela zokwelapha i-Renal Osteodystrophy?

Ukwelashwa okutholayo kuzoncika ekutheni umonakalo ongakanani owenzekile emathanjeni akho, esigabeni sesifo sakho sezinso, nokuthi ukuguquka kwamathambo akho kuyashesha noma kuhamba kancane. Kunezindlela eziningana zokwelapha eziyinhloko:

• Izinguquko ekudleni: Udokotela wakho angase akuncome ukudla okune-phosphorus ephansi . Lokhu kusho ukunciphisa ukudla okune-phosphorus eningi (ukudla okucutshunguliwe nokupakishwe) - njengokudla okusemathinini, ama-noodle asheshayo, namasoseji. Uma isifo sakho sezinso sibi kakhulu, kungadingeka futhi unciphise ukudla okune-phosphorus eningi ngokwemvelo (isib. eminye imikhiqizo yobisi, amantongomane, nenyama nezinhlanzi ezomisiwe).
• Imithi kanye nezithasiselo: Lokhu kungasiza ekulinganiseni amazinga amaminerali nama-hormone. Isibonelo, izithasiselo ze-calcium ne-vitamin D, imithi ehlisa amazinga e-parathyroid hormone (PTH), kanye nezithasiselo ze-phosphorus zingase zinikezwe. Odokotela manje bavame ukuncoma izithasiselo ze-non-calcium phosphorus ngoba i-calcium eningi kakhulu ingaholela esifweni samathambo esingaguquki.
• Ukuhlinzwa kwe-Parathyroid: Uma ezinye izindlela zokwelapha zingasebenzi, ukuhlinzwa kungenziwa. Lokhu kuhilela ukususa i-parathyroid gland eyodwa noma ngaphezulu. Lokhu kubizwa ngokuthi i-parathyroidectomy . Ngokuvamile, kusala okungenani i-parathyroid gland eyodwa. Lokhu kungasiza ekuvimbeleni amazinga e-PTH ukuthi ehle kakhulu futhi kubangele isifo samathambo esingaguquki.

Ngaphezu kwakho konke lokhu, udokotela wakho uzokusiza futhi ukuphatha isifo sakho sezinso. Ngokulandela uhlelo lokwelashwa kahle, ungavimbela ukulimala okwengeziwe emathanjeni akho.

Ingabe i-Renal Osteodystrophy ingavinjelwa?

Kunzima ukuvimbela ngokuphelele i-Renal Osteodystrophy. Kodwa-ke, ngokuphatha kahle isifo sezinso esingamahlalakhona (i-CKD), lesi simo singalawulwa futhi ukuqhubekela phambili kwaso kwehle.Lokho kusho ukuthi ukuthatha imithi oyinikezwe udokotela ngesikhathi, ukulandela ukudla okunikezwe udokotela, kanye nokwenza ukwelashwa nge-dialysis ngendlela efanele kubaluleke kakhulu. Futhi, ukuzivocavoca umzimba, ukuyeka ukubhema, kanye nokunciphisa ukusetshenziswa kotshwala nakho kuyasiza.

Yini umuntu one-Renal Osteodystrophy angayilindela?

Akukho ukwelashwa okuhlala njalo kwalesi simo ngaphandle kokufakelwa izinso . Abantu abanesifo sezinso sesikhathi eside balahlekelwa ukusebenza kwezinso kancane kancane. Abantu abaningi bagcina sebehluleka ngokuphelele ukusebenza kwezinso futhi badinga i-dialysis. I-Renal Osteodystrophy iyinkinga evamile yale nqubo.

Futhi, abantu abaningi abanesifo sezinso esingamahlalakhona nabo banesifo senhliziyo. Isifo senhliziyo siyimbangela yokufa okuningi ngenxa yokwehluleka kwezinso.

Kodwa ungakhathazeki. Udokotela wakho uzohlola njalo amazinga akho amaminerali nama-hormone futhi ancome ukwelashwa ukuze avikele amathambo nenhliziyo yakho.

Kufanele ukhulume nini nodokotela?

Uma unesifo sezinso esingamahlalakhona (CKD), qiniseka ukuthi utshela udokotela wakho uma uzwa ubuhlungu noma ukuqina kwamathambo . Kungaba uphawu lwe-osteodystrophy yezinso.

Abantu abaningi bathola ukuthi banesifo sezinso esingamahlalakhona uma sesivele sithuthukile. Ngakho-ke, ukuhlolwa njalo kwezokwelapha kungasiza ekutholeni isifo sezinso kusenesikhathi. Uma kwenzeka, ungathatha izinyathelo zokuvimbela ukuthi singabi sibi kakhulu. Lokhu kubaluleke kakhulu uma unesifo sezinso (isib. ukukhuluphala ngokweqile, ukuba nesifo sikashukela, ukuba nomlando womndeni wesifo sezinso, isifo senhliziyo, noma umfutho wegazi ophakeme).

Umlayezo Wokuya Nawe Ekhaya

Kulungile, ake siphinde sixoxe ngezinye zezinto okudingeka uzikhumbule kulokho esikhulume ngakho:

• I-Renal Osteodystrophy yisifo samathambo esibangelwa yisifo sezinso esingamahlalakhona (CKD).
• Uma izinso zingasebenzi kahle, amazinga e -calcium, i-phosphorus, kanye ne-vitamin D egazini ayaphazamiseka, futhi amathambo angaba buthakathaka.
• Ubuhlungu bamathambo kanye nokuphuka yizimpawu eziyinhloko, kodwa kungase kungabi khona zimpawu ekuqaleni.
• Odokotela baxilonga lesi simo ngokuhlolwa kwegazi kanye nokuskena.
• Ukwelashwa kuhlanganisa ukulawula ukudla, imithi, futhi ngezinye izikhathi nokuhlinzwa.
• Indlela engcono kakhulu yokulawula lesi simo ukuphatha kahle isifo sezinso.
• Uma unesifo sezinso futhi uzwa ubuhlungu emathanjeni akho, bonana nodokotela ngokushesha.
• Ukuhlolwa njalo kwezokwelapha kungasiza ekutholeni isifo sezinso kusenesikhathi.

Nakuba lesi simo singelapheki ngokuphelele, ngokwelashwa okufanele nangokulandela iseluleko sezokwelapha, ungalondoloza impilo enhle. Ngakho-ke ungesabi, khuluma nodokotela wakho, bese wenza izinto ezidingekayo.

I- osteodystrophy yezinso, isifo sezinso, isifo samathambo, i-calcium, i-phosphorus, i-vitamin D, i-parathyroid hormone, i-CKD-MBD