Yintoni oyaziyo ngesifo sezintso ezingapheliyo (kunye nendlela yokuzikhusela)

Imfundo yezeMpilo

Uqaphele utshintsho kumchamo wakho-njengokutshintsha kombala kunye nokugungxeka kwegwebu-kwaye ubusuke uvuvuka mva nje, ngakumbi ngeenxa zonke emaqatheni. Ezinye zeempawu zakho zinokuchazwa ngokulula ziimeko eziqhelekileyo, ezinje ngoxinzelelo, ukukhulelwa kunye nosulelo, kodwa eli qela leempawu linokubekwa ityala kwizifo zezintso ezingapheliyo (CKD).

Yintoni isifo esinganyangekiyo sezintso?

Ichongwe njengomonakalo kwizintso zakho eziye zaqhubeka kangangeenyanga ezininzi, isifo esinganyangekiyo sezintso senzeka xa izintso zakho ziyeka ukusebenza njengenkqubo yokucoca kakuhle elungisiweyo ( igazi elihambayo, ulwelo kunye nenkunkuma ngomzimba wakho 24/7).

Isifo sezintso esibuhlungu, okanye umonakalo omnene nowenzekileyo kutshanje, unokubuyiselwa umva ukuba oogqirha bayasifumana kwangexesha. Isifo sezintso esibuhlungu emva koko siba sisifo sezintso esinganyangekiyo. Kodwa isifo esinganyangekiyo sezintso kunzima ukunyanga-kwaye ukonzakala kwezintso kuhlala kuyinto onokungazi ukuba unayo kude kube lixesha lokungenelela.

Isifo sezintso esinganyangekiyo siqhelekile kunokuba ucinga. Ngokwe-University of Missouri Health Care nephrologist Kunal Malhotra, MD, manani kazwelonke abonisa ukuba i-14% yabantu baseMelika banayo, kubandakanya umntu omnye kwabathathu abanesifo seswekile, kunye nesigulana esinye kwabahlanu abanexinzelelo lwegazi. Ukuba nokuba-okanye zombini — kwezi meko kukwenza ukuba ube sesichengeni sezintso, njengokuba kunjalo ngembali yosapho yeengxaki zezintso, isifo semithambo , okanye ukuba ungowenzala yase-Afrika yaseMelika.

Amanqanaba esifo esinganyangekiyo sezintso

Kukho amanqanaba amahlanu esi sifo esinganyangekiyo sezintso. Nantsi indlela abachitha ngayo:

• Inqanaba 1: Unokuba neempawu zomonakalo wezintso, njengeprotein okanye igazi kumchamo wakho, kodwa ayikachaphazeli ukusebenza kweentso zakho ngokubanzi.
• Inqanaba 2: Uqala ukufumana ukulahleka komsebenzi, kodwa akunakufunyanwa okwangoku ngaphandle kokuba ugqirha wakho avavanye i-GFR yakho, okanye inqanaba lokuhluza i-glomerular, eliyinxalenye yelabhoratri eqhelekileyo ye-electrolytes okt, iphaneli yemetabolism esisiseko (BMP). Kubantu abadala abasempilweni, I-GFR kufuneka okungenani ibe ngama-90 .
• Inqanaba 3: Umsebenzi wezintso uhla uye kwi-40% okanye kwi-50%. Uqala ukuqokelela i-electrolyte kunye ne-fluid, kodwa izintso zakho zisasebenza ukugqithisa ngokulahleka komsebenzi-ngoko ungeke uqaphele okwangoku ngomonakalo.
• Inqanaba 4: Njengokuba umsebenzi wakho wezintso uqhubeka nokuhla, awusayi kuphinda uyifihle imizamo yawo yokusebenza ngokufanelekileyo. Uqala ukuqaphela iimpawu ezinjengokudumba njengoko umzimba wakho uqokelela ityuwa kunye ne potassium. Okwangoku, unokuziva udiniwe kwaye udiniwe.
• Inqanaba 5: Kamva kwesi sifo, xa ukusebenza kuye kwehla ngaphantsi kwe-30%, unokufumana ukulahlekelwa ngumdla, ukukhathala okanye ukulala, ulusu olomileyo nolurhawuzayo, ukudumba kwamehlo, ukudumba kwemilenze, amaqatha, kunye neenyawo, izihlunu zemithambo, ukuchama rhoqo, kunye umchamo odayiweyo okanye onogwebu (imiqondiso yokunyuka kweprotein okanye igazi kumchamo). Xa izintso zakho zisebenza nge-15% (okanye ngaphantsi) komsebenzi oqhelekileyo, unokufuna ukufakelwa kwezintso okanye dialysis ukunqanda ukusilela kwezintso.

Eyona nto inamaqhinga ngesifo sezintso esinganyangekiyo, utshilo uGqirha Malhotra, kukuqhubeka kwaso kuthule.

Uqala ukuba nelahleko yomsebenzi kwinqanaba lesibini, kodwa izintso zinendlela yokoyisa le miqobo, utshilo uGqirha Malhotra. Iyangena ebantwini… ubukhulu becala, kude kube kwinqanaba lesine ukuba uqaphele iimpawu. Ngamanye amagama, kuhlala kungabonakali de kube semva kwexesha ukuyeka okanye ukuguqula umonakalo. Zimbalwa kakhulu iimpawu ezilumkisayo kumanqanaba okuqala ohlangabezana nokusebenza okuncitshisiweyo.

Ayizizo zonke iindaba ezimbi, nangona: Kukho izinto onokuzenza ukunciphisa isantya sezintso ukuba unaso kwaye, ngombulelo, iindlela zokuthintela ukuba zenzeke kwasekuqaleni.

Ukuchonga isifo sezintso ezingapheliyo

Oogqirha abarhanela isifo esinganyangekiyo sezintso kwizigulana zabo baya kuqhuba umsebenzi wegazi ukujonga i-GFR kunye nokwenza uvavanyo lokuchama ukulinganisa uhlobo oluthile lweprotheni ebizwa ialbin . Banokulinganisa amanqanaba e-creatinine ; I-creatinine, imveliso yenkunkuma ehluzwe zizintso, ihlala iqokelela xa umsebenzi wezintso uthotyiwe. Kuba inqanaba eliqhelekileyo le-creatinine lihluka ngokwabelana ngesondo, ubudala, kunye nobunzima bemisipha, amanqanaba e-creatinine kuphela awakwazi ukufumanisa isifo sezintso, nangona inokusetyenziswa ngokudibeneyo kunye novavanyo lwe-urinal kunye novavanyo lwe-GFR.

Olu vavanyo lwelebhu, ukongeza kwi Imitha yesandi kwaye iibhayopsies sezintso, kunokunceda oogqirha bafumane ubukho bomonakalo.

Ukunyanga isifo sezintso ezingapheliyo

Ngokuphathelele kunyango, uninzi lwayo luxhomekeke kutshintsho lwendlela yokuphila esempilweni. Kubalulekile ukulungisa iimeko ezinobungozi, njengokuqinisekisa ukuba isifo seswekile silawulwa kakuhle, kunye nokwenza utshintsho kwindlela otya ngayo, utshilo uGqirha Malhotra.

Wongeza ukuba ukunciphisa umda ekusebenziseni kwakho izongezo ezingeyomfuneko kunye namayeza (ngakumbi amayeza angaphaya kokunganyangeki njenge-ibuprofen, enokuthi kubangele ukulimala kwezintso kunye nokwandisa iimpawu zesifo sezintso ezingapheliyo), kunye nokuyeka ukutshaya kunye nokuzilolonga rhoqo kunokuthintela ukonzakala okungakumbi kwezintso.

NgokukaGqirha Robert Greenwell, inkosi ye-nephrology kwiziko lonyango iMercy eBaltimore, ukunyanga uxinzelelo lwegazi yenye indlela yokukhusela izintso zakho ekonakaleni okungaphaya. Ukulawula uxinzelelo lwegazi nge Isithintelo se-ACE okanye iziyobisi ezinje losartan okanye lisinopril inokukunceda ugcine ukusebenza kwezintso kunye nokunciphisa isixa seprotein kumchamo wakho.

Indlela yokuthintela isifo sezintso

UGqirha Greenwell uyaphindaphinda kabini kunxibelelwano phakathi kwesifo sezintso ezingapheliyo kunye nokukhetha indlela yokuphila-ngakumbi ngokunxulumene nokuthintela.

Xa sifumanisa umonakalo [wexesha elide] kwizintso, amathuba okuguqula loo nto iphantsi, utshilo. Kodwa xa sijonga izinto ezinkulu ezibangela ukuba umntu afune i-dialysis, ezo zinto zihlala zinxulumene nendlela yokuphila.

Ukwalatha kwizigulo eziphezulu zesifo sezintso kwizigulana ezinesifo seswekile, uxinzelelo lwegazi, isifo sentliziyo, i-HIV, kwiikhawuntari ze-NSAID kunye nokusetyenziswa gwenxa kweziyobisi: Izinto ezininzi ezibangela isifo sezintso ezingapheliyo kwaye zikhokelela kumonakalo osisigxina okanye ukufuna i-dialysis 'Azinakulungiswa-kodwa ngekhe sabathintela kwiminyaka eli-15 eyadlulayo ngokukhetha ukutya kunye nendlela yokuphila.

Ke unokwenza ntoni ngoku, ngaphambi kokuba ube nesifo sezintso ezingapheliyo, ukugcina izintso zakho zisempilweni?

1. Lawula ubunzima bakho kunye namanqanaba eswekile yegazi. Ukutyeba kakhulu, ukunganyangeki kwi-insulin, kunye noxinzelelo oluphezulu lwegazi zihlala zikhokelela kwisifo seswekile, nesona sizathu siphambili sesifo sezintso esinganyangekiyo. Ukuba isifo sakho seswekile asilawulwa yi-Hemoglobin A1c ekudala ikho ngaphezulu kwe-8.0%, kuya kufuneka ufumane ingcali yeswekile enje nge-endocrinologist ukunceda kwisifo seswekile njengoko sisona sizathu siphambili sokungaphumeleli kwezintso e-United States.
2. Zilolonge. Olunye uphononongo lubonisa ukuba umthambo unokuyicotha inkqubela phambili Kwinqanaba lesithathu kunye nesigaba sesine sezintso.
3. Yeka ukutshaya. Ukutshaya hayi kuphela kwandisa umngcipheko wesifo sezintso ezingapheliyo , inegalelo kuxinzelelo lwegazi, ukuqina kwemithambo yegazi, kunye neproteinuria. Ikwayingxaki yomngcipheko isifo sesibindi sokugqibela (ESRD).
4. Yitya kakuhle. UKUYA Impilo ifanelekile ukutya okunotye ukutya okuziinkozo, iiprotein zezilwanyana ezingenamafutha kunye neprotein esekwe kwizityalo, amafutha e-monounsaturated, iziqhamo, iimbotyi kunye nemifuno zinokuthintela ukonzakala kwezintso, njengoko kunokunciphisa ityiwa, utywala, kunye namafutha. I-National Institute of Diabetes kunye neZifo zeDigestive kunye neZintso (NIDDK) icebisa abantu abanezifo ezingapheliyo zezintso ukuba bajonge ingakanani i-phosphorus kunye ne-potassium ekudleni kwabo , kuba zombini zinokwakha ngokulula egazini lakho. Oko kuthetha ukuba: Kuphephe ukutya kakhulu ubisi, iimbotyi ezininzi, iimbotyi, iziselo ezinombala omnyama, iibhanana kunye neeorenji, phakathi kwezinye izinto zokutya. Khetha ukutya okuphantsi kwe-phosphorus kunye ne-potassium ephantsi njengee-apile, iminqathe, ubisi lwerayisi, ipasta emhlophe, kunye neziselo ezicacileyo xa kunokwenzeka.
5. Lawula iimeko ezikhoyo zempilo. Ukuba unesifo seswekile, uxinzelelo lwegazi, okanye i-HIV, qiniseka ukuba ugqirha wakho uhlala ejonga ukusebenza kwezintso kuba ezo zifo zonyusa umngcipheko wokuba nesifo sezintso.
6. Ukunciphisa ukusetyenziswa kwamayeza. Abantu bathatha ii-NSAIDs zeentlungu kunye neentlungu kodwa abayiqondi loo mayeza ngoyena nobangela wokulimala kwezintso okubangelwa ziziyobisi, utshilo uGqirha Malhotra. Banokonakalisa izintso ngeendlela ezininzi, zibangele imeko yokuvuvukala unako buyiselwa umva-ngaphandle kokuba uyithathile ixesha elide ubange isikrelemnqa esingenakulungiseka. Ucebisa kuphela ukuthatha iintlungu ze-NSAID, njenge-naproxen okanye ibuprofen, xa kunyanzelekile-kwaye uhlala phantsi kweliso likagqirha.
7. Yiba ngummeli oqinileyo kuwe. Ukuba unesifo seswekile okanye uxinzelelo lwegazi, ugqirha wakho kufuneka abe ujonga ukusebenza kwezintso zakho ... kwaye ukuba azikho, kuya kufuneka ubuze ugqirha wakho ukuba ziqhuba njani izintso zakho, utshilo uGqirha Greenwell. Ngamanye amagama, ukuba uyazi ukuba usemngciphekweni omkhulu wokonzakala kwezintso ngenxa yemeko yangaphambili, ungabi nazintloni ngokuqinisekisa ukuba ugqirha wakho ujonge umsebenzi wezintso.
8. Thatha i-vitamin yezintso. Ngokwe-National Kidney Foundation, isifo sezintso esinganyangekiyo sinokubangela ukuba unciphise ukutya okuthile okanye amaqela okutya, oko kuthetha ukuba unokuba njalo ukunqongophala kweevithamini kunye neeminerals . Ukuthatha iivithamini zezintso unokuqinisekisa ukuba ufumana izondlo ezichanekileyo-njenge-iron, i-calcium, kunye ne-B iivithamini ezinzima-imihla ngemihla. Oko kwathethi, abantu abanesifo sezintso esinganyangekiyo kufuneka bakuphephe ukuba nokugqitha kwizondlo ezithile, ke kuya kufuneka uthethe nogqirha wakho ngaphambi kokuba uthathe naziphi na izongezo.

Ungawutshintsha umonakalo wezintso?

Ngokwesiqhelo awukwazi ukuguqula isifo sezintso ezingapheliyo ngenxa yokuba umonakalo kunye nokuqhekeka kukhulu kakhulu. Ezinye iintlobo zesifo sezintso ezibi, njengohlobo olubangelwa kukusetyenziswa gwenxa kwamayeza, zinokubuyiselwa umva ukuba zibanjwe kwangethuba.

Kanye [ndibona imiqondiso yomonakalo], ndicinga ukuba ingaba isuka kwinto ebukhali nenokubuyisa umva kuqala, utshilo uGqirha Greenwell. Ukuba umonakalo wenziwe kutsha nje-njengokusebenza kwakho kwakuqhelekile kwinyanga ephelileyo kwaye ngoku akunjalo-ndinethuba elingcono lokukunceda ukuba uphinde ubuye kunokuba unomonakalo ekudala umi.

Ngelo xesha, uGqirha uGreenwell uyacacisa, kugxilwe kancinci ekubekeni ukuzama ukulungisa okanye ukunyanga umonakalo kunye nendlela yokuwucothisa. Kuphela kuxa uhle malunga nokusebenza kwe-10% apho ufuna i-dialysis okanye ukufakelwa, utshilo. Ke unokuba nesifo sezintso esinganyangekiyo kunye nenqanaba le-creatinine [engaqhelekanga] yesithathu, kodwa unokukwazi ukuhlala kolo luhlu ixesha elide. Singazama ukuwucotha umonakalo ezantsi, ke amanqanaba akho e-creatinine aya esiba mandundu ngaphezulu kweminyaka eli-15 endaweni yesithathu.

Thetha nomboneleli wakho wezempilo malunga nezona ndlela zokucotha ukuqhubela phambili kwengxaki yakho yezintso.