Okufanele ukwazi ngesifo sezinso esingapheliyo (nokuthi ungasivimbela kanjani)

Imfundo Yezempilo

Uzibonile izinguquko emchameni wakho — njengokuguquka kombala nokugqwala amagwebu — futhi ubusuvuvukala muva nje, ikakhulukazi maqondana namaqakala akho. Ezinye zezimpawu zakho zingachazwa kalula ngezimo ezijwayelekile, ezinjengokuxineka, ukukhulelwa, kanye nokutheleleka, kepha le nkanyezi yezimpawu nayo ingasolwa ngesifo esingapheliyo sezinso (CKD).

Siyini isifo sezinso esingalapheki?

Ihlukaniswe njengomonakalo ezinsweni zakho osekudlule izinyanga eziningi, isifo sezinso esingalapheki senzeka lapho izinso zakho ziyeka ukusebenza njengohlelo lokuhlunga oluhlelwe kahle igazi elihambayo, uketshezi kanye nodoti ngomzimba wakho 24/7).

Isifo sezinso esibi, noma ukulimala okuncane nokwenzekile muva nje, kungaguqulwa uma odokotela besithola ngesikhathi. Isifo sezinso esibucayi bese kuba yisifo sezinso esingalapheki. Kepha isifo sezinso esingalapheki kunzima ukuselapha — futhi ukulimala kwezinso imvamisa kuyinto ongase ungazi ukuthi unayo kuze kwephuze ukungenelela.

Isifo sezinso esingapheli empeleni sivame kakhulu kunendlela ocabanga ngayo. Ngokwe-nephrologist yase-University of Missouri Health Care uKunal Malhotra, MD, izibalo zikazwelonke zibonisa ukuthi ama-14% aseMelika anaso, kufaka phakathi umuntu oyedwa kwabathathu onesifo sikashukela, kanye nesiguli esisodwa kwabahlanu abane-high blood pressure. Ukuba neyodwa — noma zombili — zalezo zimo kukwenza ube sethubeni lokuba nesifo esingapheliyo sezinso, njengoba kuba nomlando womndeni wezinkinga zezinso, isifo semithambo yegazi , noma ongowokuzalwa e-Afrika eMelika.

Izigaba zesifo esingapheliyo sezinso

Kunezigaba ezinhlanu zesifo sezinso esingalapheki. Nakhu ukuthi bahlukana kanjani:

• Isigaba 1: Ungaba nezimpawu zokulimala kwezinso, njengeprotheni noma igazi emchameni wakho, kodwa okwamanje akuthinti ukusebenza kwezinso zakho ngokuphelele.
• Isigaba 2: Uqala ukuhlangabezana nokulahlekelwa okuthile kokusebenza, kodwa kungenzeka kungatholakali okwamanje ngaphandle kokuthi udokotela wakho avivinye i-GFR yakho, noma isilinganiso sokuhlunga se-glomerular, okuyingxenye yelabhorethri ejwayelekile ye-electrolyte okungukuthi, iphaneli eyisisekelo yemetabolism (BMP). Kubantu abadala abaphilile, I-GFR kufanele okungenani ibe ngu-90 .
• Isigaba 3: Umsebenzi wakho wezinso wehlela ku-40% noma ku-50%. Usuqala ukuqoqa ama-electrolyte noketshezi, kepha izinso zakho zisasebenza ukukhokhela ngokweqile ukulahleka komsebenzi — ngakho-ke kungenzeka ukuthi awukabi nawo umonakalo okwamanje.
• Isigaba 4: Njengoba umsebenzi wakho wezinso uqhubeka ukwehla, awusakwazi ukufihla imizamo yawo yokusebenza ngempumelelo. Uqala ukubona izimpawu njengokuvuvukala njengoba umzimba wakho uqoqa usawoti ne-potassium. Ngalesi sikhathi, ungazizwa ukhathele futhi ukhathele.
• Isigaba 5: Kamuva kulesi sifo, uma ukusebenza kwehle ngaphansi kuka-30%, ungahle ulahlekelwe isifiso sokudla, ukukhathala noma ukuqwasha, isikhumba esomile nesilumayo, ukuvuvukala kwamehlo, ukuvuvukala kwemilenze, amaqakala nezinyawo, ukuqunjelwa yimisipha, ukuchama kaningi, kanye umchamo ogqamile noma onamagwebu (izimpawu zokwanda kwamaprotheni noma igazi emchameni). Lapho izinso zakho zisebenza ku-15% (noma ngaphansi) komsebenzi ojwayelekile, ungadinga ukufakelwa izinso noma dialysis ukuvimbela ukwehluleka kwezinso.

Into ekhohlisa kakhulu ngesifo esingapheliyo sezinso, kusho uDkt Malhotra, ukuqhubeka kwaso buthule.

Uqala ukulahlekelwa ngumsebenzi esigabeni sesibili, kepha izinso zinendlela yokunqoba lezo zithiyo, kusho uDkt Malhotra. Kukhasa kubantu… ingxenye enkulu, kuze kube isigaba sesine lapho uzibona khona izimpawu. Ngamanye amagama, kuvame ukungabonakali kuze kube yilapho sekwephuze kakhulu ukumisa noma ukuguqula umonakalo. Kunezimpawu ezimbalwa kakhulu zokuxwayisa ezigabeni zokuqala ohlangabezana nokusebenza okuncishisiwe.

Akuzona zonke izindaba ezimbi, noma kunjalo: Kunezinto ongazenza ukubambezela ukukhula kwesifo esingapheliyo sezinso uma unaso futhi, ngokubonga, izindlela zokusivimba ukuthi singenzeki kwasekuqaleni.

Ukuhlonza isifo sezinso esingalapheki

Odokotela abasola ukuthi isifo sesifo esingapheliyo sezinso ezigulini zabo bazojwayela ukusebenzisa ukusebenza kwegazi ukuhlola i-GFR nokwenza i-urinalysis ukukala uhlobo oluthile lwamaprotheni abizwa i-albhamuin . Bangalinganisa futhi amazinga e-creatinine ; i-creatinine, umkhiqizo odoti ohlungwe izinso, uvame ukuqoqeka lapho umsebenzi wezinso wehliswa. Njengoba ileveli ejwayelekile ye-creatinine iyehluka ngokobulili, ubudala, nobukhulu bemisipha, amazinga e-creatinine kuphela awakwazi ukuxilonga isifo sezinso, noma singasetshenziswa ngokuhlanganyela nokuhlolwa komchamo nokuhlolwa kwe-GFR.

Lezi zivivinyo zebhu, ngaphezu kwe ama-ultrasound futhi ama-biopsies wezinso, kungasiza odokotela ukuxilonga ubukhona bomonakalo.

Ukwelapha isifo sezinso esingalapheki

Ngokuqondene nokwelashwa, okuningi kuncike ekuguqulweni kwempilo enempilo. Kubalulekile ukulungisa izinto eziyingozi, njengokuqinisekisa ukuthi isifo sikashukela silawulwa kahle, kanye nokwenza ushintsho ekudleni, kusho uDkt Malhotra.

Uyanezela ukuthi ukunciphisa ukusetshenziswa kwakho kwezithako ezingadingekile nemithi (ikakhulukazi imishanguzo yokulwa nokuvuvukala efana ne-ibuprofen, engakwazi kubangele ukulimala kwezinso futhi kubhebhethekise izimpawu zesifo esingapheliyo sesifo sezinso), kanye nokuyeka ukubhema nokuvivinya umzimba njalo kungavimbela nokuthi kulimale ezinye izinso.

Ngokusho kukaDkt Robert Greenwell, isikhulu se-nephrology eMercy Medical Center eBaltimore, ukwelapha umfutho wegazi ophezulu kungenye indlela yokuvikela izinso zakho ekulimaleni okungaphezulu. Ukulawula umfutho wegazi lakho nge I-ACE inhibitor noma izidakamizwa ezifana losartan noma lisinopril ingakusiza ugcine ukusebenza kwezinso futhi wehlise inani lamaprotheni emchameni wakho.

Ungasigwema kanjani isifo sezinso

UDkt. Greenwell uphinda kabili ukuxhumana phakathi kwesifo esingapheliyo sezinso nokukhetha indlela yokuphila — ikakhulukazi njengoba kuhlobene nokuvinjelwa.

Lapho sithola ukulimala, [kwesikhathi eside] kwezinso, amathuba okuthi sikubuyise lokho kuphansi, usho kanje. Kepha uma sibheka izinto ezinkulu ezidala ukuthi umuntu adinge i-dialysis, lezo zici imvamisa zihlobene nendlela yokuphila.

Ubuye akhombe esigabeni esiphezulu sesifo sezinso esingalapheki ezigulini ezinesifo sikashukela, umfutho wegazi ophakeme, isifo senhliziyo, i-HIV, kuma-counter ama-NSAID nokusetshenziswa kwezidakamizwa njalo: Izinto eziningi ezidala isifo sezinso ezingamahlalakhona eziholela ekulimaleni unomphela noma kudinga i-dialysis 'ngeke zilungiswe - kepha besingabavimbela eminyakeni eyi-15 edlule ngokukhetha indlela yokudla nendlela yokuphila.

Ngakho-ke yini ongayenza manje, ngaphambi kokuba ube nesifo esingapheliyo sezinso, ukugcina izinso zakho ziphilile?

1. Phatha isisindo sakho kanye namazinga kashukela egazini. Ukukhuluphala ngokweqile, ukumelana ne-insulin, kanye nomfutho wegazi ophezulu kuvame ukuholela kusifo sikashukela, okuyimbangela ehamba phambili yezifo ezingamahlalakhona zezinso. Uma isifo sikashukela singalawulwa ngeHemoglobin A1c esekuyisikhathi eside ingaphezu kuka-8.0%, kufanele ufune isazi sikashukela esifana nodokotela we-endocrinologist ukuze akusize ngesifo sakho sikashukela ngoba siyimbangela ehamba phambili yokuhluleka kwezinso okungamahlalakhona e-United States.
2. Ukuzivocavoca umzimba. Olunye ucwaningo lukhombisa ukuthi ukuzivocavoca umzimba kunganciphisa ukuqhubeka wesigaba sesithathu nesigaba sesine sesifo sezinso.
3. Yeka ukubhema. Ukubhema hhayi kuphela kwandisa ingozi yokuba nesifo esingapheliyo sezinso , inegalelo ekushayeni umfutho wegazi ophakeme, ukuqina kwemithambo yezinso, neproteinuria. Kubuye kube yingcuphe isifo sesifo sesigaba sokugcina (ESRD).
4. Yidla kahle. TO sezinso-friendly Ukudla okunothile okusanhlamvu okuphelele, amaprotheni ezilwane ezinomzimba omncane namaprotheni asuselwa ezitshalweni, amafutha e-monounsaturated, izithelo, imidumba nemifino kungavimbela ukulimala kwezinso, njengoba kunganciphisa nosawoti, utshwala, namafutha agcwele. INational Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) ibuye yeluleke abantu abanezifo ezingamahlalakhona zezinso ukuthi baqaphe ingakanani i-phosphorus ne-potassium ekudleni kwabo , ngoba zombili zingakha kalula egazini lakho. Lokho kusho ukuthi: Gwema ukudla ubisi oluningi, ubhontshisi omningi, imidumba, iziphuzo ezinombala omnyama, ubhanana namawolintshi, phakathi kokunye ukudla. Khetha ukudla okuphansi kwe-phosphorus kanye ne-potassium ephansi njengama-apula, izaqathe, ubisi lwelayisi, ipasta emhlophe, neziphuzo ezicacile uma kungenzeka.
5. Phatha izimo zezempilo ezikhona. Uma unesifo sikashukela, umfutho wegazi ophakeme, noma i-HIV, qiniseka ukuthi udokotela wakho uhlola njalo ukusebenza kwezinso zakho ngoba lezo zifo zandisa amathuba okuba nesifo sezinso.
6. Nciphisa ukusetshenziswa kwemithi. Abantu bathatha ama-NSAID ngenxa yezinhlungu nezinhlungu kodwa abaqapheli ukuthi leyo mithi iyimbangela evame kakhulu yokulimala kwezinso okubangelwa izidakamizwa, kusho uDkt Malhotra. Zingalimaza izinso ngezindlela eziningi, zidale isimo sokuvuvukala ukuthi can buyiselwa emuva — ngaphandle kokuthi uyithathe isikhathi eside kangaka ubangele isibazi esingalungiseki. Uncoma kuphela ukuthatha izinhlungu zokunciphisa izinhlungu ze-NSAID, njenge-naproxen noma ibuprofen, lapho kudingeka kakhulu-futhi njalo ngaphansi kokuqondisa kukadokotela.
7. Yiba ngummeli oqinile wakho. Uma unesifo sikashukela noma umfutho wegazi ophakeme, udokotela wakho kufanele ngabe ubheka ukusebenza kwezinso zakho kakade… futhi uma kungenjalo, kufanele ubuze udokotela wakho ukuthi izinso zakho zihamba kanjani, kusho uDkt Greenwell. Ngamanye amagama, uma wazi ukuthi usengozini enkulu yokulimala kwezinso ngenxa yesimo sangaphambilini, ungabi namahloni ngokuqinisekisa ukuthi udokotela wakho unake umsebenzi wakho wezinso.
8. Thatha uvithamini wezinso. Ngokusho kweNational Kidney Foundation, isifo sezinso esingalapheki singadala ukuthi unciphise ukudla okuthile noma amaqembu okudla, okusho ukuthi ungaba njalo kushoda amavithamini namaminerali abalulekile . Ukuthatha i- i-vitamin yezinso ingaqinisekisa ukuthi uthola izakhi zomzimba ezifanele — njenge-iron, i-calcium, no-B amavithamini ayinkimbinkimbi - nsuku zonke. Lokho kusho ukuthi, abantu abanesifo esingapheliyo sezinso kufanele futhi bagweme ukuba nezakhi eziningi ngokweqile, ngakho-ke kufanele uhlale ukhuluma nodokotela wakho ngaphambi kokuthatha noma iziphi izithasiselo.

Ungakwazi ukuguqula ukulimala kwezinso?

Imvamisa awukwazi ukuguqula isifo sezinso esingalapheki ngoba umonakalo nesibazi kukhulu kakhulu. Ezinye izinhlobo zesifo esibucayi sezinso, njengohlobo olubangelwa ukusetshenziswa ngokweqile kwemithi, zingaguqulwa uma zibanjwe kusenesikhathi ngokwanele.

Uma [ngibona izimpawu zomonakalo], ngicabanga ukuthi kungenzeka yini ukuthi kubangelwe imbangela ebucayi futhi engahle iguqulwe kuqala, kusho uDkt. Greenwell. Uma umonakalo usanda kwenzeka — njengokuthi umsebenzi wakho ubujwayelekile enyangeni edlule futhi manje akunjalo — ngithole ithuba elingcono lokukusiza ukuthi ululame kunokuthi ube nomonakalo osekukudala ukhona.

Ngaleso sikhathi, uDkt.Greenwell uyachaza, ukugxila okuncane kufanele kubekwe ekuzameni ukulungisa noma ukwelapha umonakalo nokunye mayelana nokuthi ungawunciphisa kanjani. Kungaleso sikhathi lapho usebenza cishe u-10% osebenza khona lapho udinga i-dialysis noma ukufakelwa kabusha, usho kanjalo. Ngakho-ke ungaba nesifo esingapheliyo sezinso nezinga [elingavamile] le-creatinine ezintathu, kepha ungakwazi ukuhlala kulolo hlu isikhathi eside. Singazama ukunciphisa umonakalo, ngakho-ke amazinga akho e-creatinine aya ngokuya eba ngaphezulu kweminyaka engu-15 esikhundleni semithathu.

Khuluma nomhlinzeki wakho wezokunakekelwa kwezempilo ngezindlela ezinhle zokunciphisa ukuqhubeka kwezinkinga zakho zezinso.