Kukundikana kwakanyanya kwekushaya renal kunoitika apo itsvo dzichibva dzisingakwanisi kuisa madota kubva muropa. Icho chirevo chemhando ipi zvayo yezvirwere kana kushungurudzika, izvo zvinoita kuti zvive nekukurumidza kuvaka-up yeaikisi uye kuputika kwezviratidzo kubva pakuderera kunonoka uye kuneta kusvika pamapfupa emvere uye kukanganisa.
Kunyange zvazvo kukundikana kwemazino kwakanyanya kunogona kuitika pasina zviratidzo uye kungoratidzwa panguva yekuongorora maitiro ehurumende isingaenderani, maitiro akawanda anoonekwa mune vanhu vane chirwere chakakomba kana vanosvika kuchipatara vane chirwere chakakomba.
Kana kukanganiswa kwemazino akaremara kunofungidzirwa, kuongororwa kweropa, urini kuongororwa, ultrasound, uye biopsies zvinogona kurayirwa kusimbisa uye kusimbisa hutachiona hwehutachiona. Maererano nemigumisiro, chiremba achakwanisa kupedza chirwere chacho uye kutora chiito chakakodzera. Mumamiriro ezvinhu akaipisisa, chirwere chepfungwa chinopera chinogona kuparidzirwa.
Labs uye Miedzo
Kukundikana kwakanyanya kwemaanal ( ARF ), inozivikanwawo sekurwadza kwepuroyo (AKI), inonyanya kuongororwa neropa uye urini kuongororwa. Pakati pemakero akawanda emarayiri anoshandiswa kuongorora basa repvo, pane zviyero zviviri zvinokosha pakati pekuongororwa uye kutungamirirwa kweArf.
Serum Creatinine
Serum creatinine (SCr) inoyera chiyero chezvinhu zvinonzi creatinine muropa. Creatinine is-a-product of muscle metabolism iyo yakanyanyisa mumugini. Nemhaka yokuti inobudiswa uye yakaderedzwa nenzira yakanyatsogadzikana, iyo inogona kuvimbika yehupi basa uye inoratidza chiratidzo chetsvo kusakundikana.
Kazhinji SCr mizinga yevanhu vakuru ndeyekuti:
- Inenge 0.5 kusvika ku1. mamiriyoni (mg) per deciliter (dL) kuvakadzi
- Inenge 0,6 kusvika ku 1.2 mg / dL kune varume
Urine Volume
Urine volume inongorongedza huwandu hwehutachiona iwe urinate pane imwe nguva yakatarwa. Sezvo ARF inotsanangurwa nekurasikirwa kwepimpidzo basa, kukosha-kuyerwa mu milliliters (mL) kilogram yehutano hwako (kg) paawa (h) -inonyanya kusimbisa kupererwa kwepfungwa uye kuenzanisa mhinduro yako mukurapa.
Oliguria, kubudiswa kwemaitiro mashoma emuti, inotsanangurwa sechinhu chipi nechipi chinopfuura 0.5 mL / kg / h.
Mamwe maTeji eBab
Mamwe mapurogiramu emakashandiswa kuongororwa ARF anosanganisira:
- Ropa urea nitrogen (BUN) inotarisa chiyero chemarara muropa anonzi urea nitrogen. Urea nitrogen yakasikwa apo chiropa chinoputsa mapuroteni uye, se serum creatinine, inobudiswa uye yakanyanyiswa mumuginha kana zvisingagadziri zvinyorwa. Nzvimbo dzeBUN dzakakwirira dzinoratidzira ARF uye dzinogonawo kuratidza chikonzero chinokonzera kukanganiswa kwepso (zvakadai sekushaya mwoyo, kupera mvura, kana kuvhiringidza urinary).
- Creatinine clearance zviyero creatinine muzinga mune zvose sveropa yeropa uye urini sampulu inounganidzwa kwemaawa makumi maviri nemaviri. Migumisiro yakabatanidzwa inogona kutiudza kuti yakawanda sei creinine iri kubviswa kubva muropa kuburikidza nekukanya sezvakayerwa mL pamaminitsi (mL / min). Chibvumirano chechisikigo chakasarudzwa chiri 88 kusvika 128 mL / min kuvakadzi uye 97 t0 137 mL / min varume.
- Inofungidzirwa glomerular filtration rate (eGFR) inopa ropa inofungidzira kuti ropa rakawanda rinopfuura sei kuburikidza nemafuta ezvimiti, anonzi glomeruli. Nhanho iyo inoitika inogona kutitaurira kuti yakawanda sei dzakatsvaga kubva pachitsauko 1 (zvishoma nezvishoma pasina kurasikirwa kwepfungwa tsvina) kusvika pachitsauko 5 (tsora kusakona).
- Serum potassium inoshandiswa kuziva kana pane potassium yakawedzerwa muropa (chirwere chinonzi hyperkalemia). Hyperkalemia inofanirwa neAARF uye, kana ikasiyiwa isingateereri, inogona kutungamirira kune zvakanyanya uye zvinogona kutyisa dysrhythmia (upenyu husina kuchena).
- Urinalysis inongova ruzha rutsva rwekuita kwemuti wako. Inogona kushandiswa kuona kana pane puroteni yakawandisa mumugini ( proteinuria ), inofungidzirwa chinhu chinokosha cheArf. Inogonawo kuona ropa mumuguta ( hematuria ) iyo inogona kuitika kana ARF inokonzerwa nedzimwe mhando dzepfungwa dzakakanganiswa kana kuvhiringidza urinary tract.
Zviratidzo Zvokuziva
Kukundikana kwakanyanya kwerealin kunoonekwa kunobva pamugumisiro we serum creatinine uye urine volume test.
Nzira yekutarisa yakave yakagadzirwa neDhinney Disease: Kuvandudza Maitiro Epasi rose (KDIGO), sangano risina purogiramu rinotarisira uye rinoshandisa mirayiridzo yekliniki yezvirwere zvepfungwa. Maererano neKDIGO, kukundikana kwemainari kunogona kuongororwa kana pane imwe yeiyo inotevera iripo:
- Kuwedzera kwe SCR ne 0.3 mg / dL kana kupfuura mukati maawa 48
- Kuwedzera kweSC yevanenge 150 muzana mukati mezuva rechinomwe
- Muyero wemvura inenge iri pasi pe 0.5 ml / kg / h pamusoro pemawa matanhatu
Kufungidzira Miedzo
Mukuwedzera kuongororwa ropa uye urini, miedzo yekufungidzira inogona kushandiswa kuona kana kune chero rudzi rwemhando yehuputsi hweimpemhi kana kana kune kuora kwekuyerera kweropa kusvika kuinso kana kubviswa kwemuti kubva mumuviri.
Pakati peimwe yedzidzo dzinoshandiswa:
- Ultrasound ndiyo nzira inoshandiswa yekufungidzira kuongorora uye inogona kushandiswa kuyera ukuru uye kuonekwa kweeitsvo, kuona maitiro kana kuora kwepvo, uye kuwana mavharogi mumuginho kana kubuda kweropa. Imwe nzira itsva inonzi Color Doppler inogona kushandiswa kuongorora mavharo, kuderedza, kana kuputika mumariti uye mitsetse yeitsvo.
- Computed tomography (CT) inoratidzira ruzivo rwe X-ray inobudisa zvikamu zvepakati pezvikamu zvenhengo. CT inoongorora inogona kubatsira pakuona kenza, zvipembenene, mabhesi, zvibvumirano (zvakadai semafuta matsvo), uye kuunganidzwa kwemvura inenge yakakomberedza itsvo. Iyo inowanzoshandiswa muvanhu vakanyanya mune iyo ultrasound haigone kupa mufananidzo wakajeka.
- Magnetic resonance imaging (MRI) inoshandisa magnetic mazai kuti abudise mifananidzo yakasiyana-siyana yeitsvo pasina mahara.
Kidney Biopsy
Bhiopsy inosanganisira kubviswa kwechigunwe chemuviri chekuongorora nebazi. Mhando iyo inowanzoshandiswa kuongorora zvirwere zvepfungwa inonzi " percutaneous biopsy" iyo inosungirirwa mucheche uye inotungamirirwa mukati mehvo kubvisa shanduro yemasero.
Mishonga inowanzoshandiswa kuongororwa kuti inonzi ARF inokonzera (kusagadzikana kwemazino zvakanyanya kunokonzerwa nekukuvadza kune itsvo). Iyo inopedzisira inogona kukurumidza kuongororodza zvimwe zvinowanzokonzera zvinokonzera zvinetso zvepvo, kusanganisira:
- Acute interstitial nephritis (AIN), kuputika kwezvisikwa pakati pemakumbo tubules
- Acute tubular necrosis (ATN), chirwere umo mafungiro etsvo anofa nekuda kwekushayikwa kweokisijeni
- Glomerulonephritis, kuvhiringidza kwemamorumusi mumidziyo yeropa yeitsvo
Kusiyanisa Kuziva
Sekunyorwa kwechirwere chepfungwa kana chirwere, kukanganisa kwakanyanya kwemazino kunogona kukonzerwa nezvinhu zvakawanda zvakasiyana, kusanganisira mwoyo kusakwanisa , chiropa chinonzi cirrhosis , kanzira , autoimmune disorders , uye kunyange kuora mvura yakaoma.
Panguva imwecheteyo, pangava nemamiriro ezvinhu apo maitiro ekuongorora mazano anoratidza ARF asi mamwe mamiriro ezvinhu, chaizvoizvo, anopomera mhosva yepamusoro yeropa. Pakati pavo:
- Chirwere chepfungwa chisingaperi (CKD) , kazhinji isingazivikanwi, inogona kunge ine zviratidzo zvose zveSERF asi zvichazoguma kwemwedzi inopfuura mitatu. NeCKD, tsanangudzo yega ye SCr yakakwirira ichave isina kukwana glomerular filtration rate. Maawa makumi maviri nemasere ekuvhenekera kuedza kunogona kusiyanisa pakati pemamiriro maviri aya.
- Mamwe mishonga , seH2 blocker Tagamet (cimetidine) uye antibiotic Primsol (trimethoprim), inogona kukonzera kukwirira kwe creatinine. Kuregererwa kwekufungidzirwa kwemishonga kunowanzove kwakakwana kuita kuti kusiyana.
> Sources:
> Rahman, M .; Shad, F .; uye Smith, M. Mutsva Yakagadzikana Kukuvadza: Nhungamiro Yekutungamira uye Kuongororwa. Amer Fam Phys. 2012; 86 (7): 631-9.
> Hertzberg, D .; Ryden, L .; Pickering, J. et al. Kuora kwepfungwa yakaoma-muongororwo wekuongorora uye nzira dzekurapa. Clin Kidney J. 2017 10 (3): 323-331. DOI: 10.1093 / ckj / sfx003.