Mayeso a Ntchito ya Impso (KFT): Zimene Zimayesa, Zimene Zimasowa, ndi Momwe Mungawerengere Lipoti Lanu

Njira zazikulu

• KFT imayesa kusefa, osati chifukwa. Kuchuluka kwa creatinine kumasonyeza kuti kusefa kwachepa; sikukuuzani ngati chifukwa chake ndi kusowa madzi m'thupi, kutsekeka kwa madzi m'thupi, mankhwala kapena matenda osatha.
• Kuyezetsa magazi kokha sikukwanira. Chiŵerengero cha albumin-to-creatinine mu mkodzo (ACR) chimazindikira kuwonongeka kwa impso komwe creatinine ndi eGFR sizingathe konse.
• Kuchiza matenda a impso (KFT) sikuchotsa matenda a impso. Kuwonongeka kwakukulu kwa impso kumatha kuchitika ndi creatinine yabwinobwino, makamaka mwa anthu omwe ali ndi minofu yochepa.
• Chotsatira chimodzi chosazolowereka si matenda. Matenda a impso osatha amafuna kuti vuto likhalepo kwa miyezi itatu kapena kuposerapo, monga momwe zatsimikizidwira poyesedwa mobwerezabwereza.
• Kutanthauzira kumafuna nkhani yeniyeni. Dokotala yekha amene anapempha KFT ndi amene angawerenge poganizira zaka zanu, minofu yanu, mankhwala anu, zizindikiro zanu, ndi zomwe munali nazo kale.

Pang'onopang'ono

Amadziwikanso monga

• KFT / RFT (kuyesa ntchito ya impso)
• Mbiri ya impso, mbiri ya impso, bolodi la impso
• "Kuyesa impso", "kuyesa creatinine", "kuyesa creatinine ya urea"
• Kagwiritsidwe ntchito ka Chihindi/Chilankhulo cha Chilankhulo: gurde ki jaanch, kidney ki jaanch, "kuyezetsa magazi a impso"
• Mayeso ofanana a mkodzo omwe nthawi zambiri amayitanidwa pamodzi ndi: ndondomeko ya mkodzo ndi microscopy, ACR ya mkodzo (mayeso a mkodzo wa albumin)

Kodi mayeso a ntchito ya impso ndi otani?

Impso zimasefa zinyalala ndi madzi ochulukirapo ochokera m'magazi, zimasunga mchere ndi asidi, zimathandiza kulamulira kuthamanga kwa magazi, zimayambitsa vitamini D ndikupanga erythropoietin, yomwe imayendetsa kupanga maselo ofiira a magazi. KFT ndi njira yosalunjika yowunikira ntchito yosefa pogwiritsa ntchito zizindikiro m'magazi ndi mkodzo.

Zigawo zachizolowezi ndi zomwe chilichonse chimathandizira:

• Seramu ya creatinine: Kutaya kwa zinthu kuchokera ku minofu yoyenda bwino, komwe kumachotsedwa makamaka ndi impso. Kumakwera pamene kusefedwa kumatsika, koma kuchuluka kwake kumadaliranso ndi kulemera kwa minofu, zakudya ndi zaka.
• Chiwerengero cha GFR (eGFR): kuwerengera kuchokera ku creatinine kuphatikiza zaka ndi kugonana komwe kumayesa kusefa mu mL/min/1.73m? CKD-EPI 2021 creatinine equation yomwe ilipo pano sigwiritsa ntchito mtundu wosinthika. eGFR ndi kuyerekezera, osati muyeso.
• Urea wa m'magazi / BUN: Zimawonetsa kusweka kwa mapuloteni ndi kuchotsedwa kwa impso. Zimakhudzidwa kwambiri ndi madzi m'thupi, mapuloteni odyetsedwa, kutuluka magazi m'mimba ndi ma steroid, kotero ndi chizindikiro chofooka cha impso.
• Ma electrolyte ndi mchere: sodium, potaziyamu, calcium, phosphate ndi bicarbonate zimasonyeza zotsatira za kulephera kwa impso m'malo mozisefa zokha.
• Chiŵerengero cha albumin-to-creatinine mu mkodzo (ACR): imazindikira kutuluka kwa albumin kudzera mu zosefera zowonongeka. ACR ikhoza kukhala yosazolowereka pomwe eGFR ikadali yabwinobwino, ndichifukwa chake kuyesa magazi kokha sikukwanira.
• Kuyeza mkodzo ndi microscopy: Amafufuza mapuloteni, magazi, maselo oyera, zinthu zopangidwa ndi ma crystals, ndi shuga, zomwe zimasonyeza matenda, kutupa kapena miyala.
• Cystatin C: njira ina yosefera yomwe simakhudzidwa kwambiri ndi minofu, yomwe imagwiritsidwa ntchito pamene eGFR yochokera ku creatinine ingasocheretse. Kupezeka ndi mtengo wake zimasiyana malinga ndi ma laboratories.

Matenda a impso osatha amadziwika ndi kusokonekera kwa kapangidwe ka impso kapena ntchito yake yomwe imachitika kwa miyezi yoposa itatu, ndipo imayikidwa pogwiritsa ntchito magawo onse a eGFR (magawo a G) ndi albuminuria (magawo a A), osati eGFR yokha. [Tsimikizirani buku la malangizo a KDIGO CKD lomwe lili pano, KUTI LITSIMIKIZIDWE]

Chifukwa chiyani mayeso a ntchito ya impso amachitidwa

• Kuwunika kusefa kwa impso pamene zizindikiro kapena zizindikiro zachipatala zikusonyeza vuto
• Kuwunika anthu omwe ali pachiwopsezo chachikulu, monga omwe ali ndi matenda a shuga kapena kuthamanga kwa magazi
• Kuwunika matenda a impso odziwika bwino komanso kusintha kwake
• Kuyang'ana momwe impso zikuyendera musanayambe kujambula zithunzi zosiyana, opaleshoni zina kapena mankhwala enaake
• Kuyang'anira mankhwala omwe angakhudze impso kapena omwe amafunika kusintha mlingo malinga ndi momwe impso zimagwirira ntchito
• Kuwunika kuvulala kwa impso komwe kukuganiziridwa kuti ndi koopsa panthawi ya matenda, kusowa madzi m'thupi kapena sepsis
• Kuyesa ma electrolyte osazolowereka, kuchepa kwa magazi kosadziwika bwino kapena kuthamanga kwa magazi kosatha

Ndani ayenera kuchita mayesowa?

KFT nthawi zambiri imalangizidwa pa:

• Anthu odwala matenda a shuga: eGFR ya pachaka ndi ACR ya mkodzo, kapena nthawi zambiri ngati yayamba kale kukhala yosazolowereka
• Anthu omwe ali ndi matenda oopsamakamaka ngati kuthamanga kwa magazi kuli kovuta kulamulira
• Anthu omwe ali ndi matenda a mtima kapena kulephera kwa mtima
• Aliyense amene ali ndi mbiri ya m'banja mwake ya matenda a impso, dialysis kapena kuikidwa kwa impso
• Anthu omwe ali ndi miyala ya impso yobwerezabwereza kapena matenda a mkodzo obwerezabwereza
• Anthu omwe akumwa mankhwala a nthawi yayitali monga mankhwala ena okodzetsa, ACE inhibitors kapena ARBs, lithiamu, NSAIDs za nthawi yayitali kapena kuphatikiza mankhwala ochepetsa ululu/mankhwala ochepetsa ululu, kapena mankhwala oletsa chifuwa chachikulu.
• Anthu omwe ali ndi kutupa kosazolowereka, mkodzo wochita thovu, magazi mu mkodzo kapena kuchepa kwa mkodzo
• Anthu omwe ali ndi matenda a autoimmune, HIV, hepatitis B kapena C, kapena multiple myeloma
• Okalamba ndi anthu omwe akukonzekera opaleshoni yayikulu kapena kujambula zithunzi zosiyanitsa mitundu

Zizindikiro zomwe zingayambitse kuyezetsa ndi monga kutupa kwa nkhope, mapazi kapena manja, mkodzo wokhala ndi thovu kapena thovu, magazi mu mkodzo, kuchepa kapena kuchuluka kwa mkodzo, nseru yosalekeza, kusafuna kudya, kuyabwa, kutopa kosadziwika bwino kapena kupuma movutikira. Anthu ambiri omwe ali ndi matenda a impso oyambilira alibe zizindikiro konse, ndichifukwa chake kuyezetsa m'magulu omwe ali pachiwopsezo ndikofunikira.

Zimene mayeso a impso sangathe kuzizindikira kapena kuzichotsa

• Sizingapereke chifukwa. KFT sisiyanitsa matenda a impso a shuga ndi glomerulonephritis, kutsekeka kwa impso, kuvulala ndi mankhwala kapena matenda apakati pa impso.
• Kuchuluka kwa creatinine m'magazi sikuchotsa matenda a impso. Creatinine ikhoza kukhalabe mkati mwa mulingo wa labotale mpaka gawo lalikulu la kusefa litatayika, makamaka mwa anthu omwe ali ndi minofu yochepa, okalamba ndi akazi ambiri.
• Sizingalekanitse matenda oopsa ndi osatha mwachisawawa pokhapokha ngati ali okha. Popanda miyezo yakale, creatinine imodzi yokha yokwezedwa singakuuzeni ngati kusinthako kuli ndi masiku kapena zaka.
• Sizingazindikire kutsekeka, miyala, ziphuphu, zotupa kapena zolakwika m'mapangidwe a ziwalo. Izi zimafuna kujambula zithunzi monga ultrasound (USG KUB) kapena CT.
• Sizingathe kuzindikira matenda omwe ali mu minofu. Kuwunika impso kokha ndi komwe kungasonyeze matenda ambiri a glomerular ndi interstitial.
• eGFR ndi yosadalirika m'maiko osakhazikika. Pa nthawi ya kusintha kwa ntchito ya impso, mimba, kukula kwa thupi kwambiri, kudula ziwalo, matenda a chiwindi kapena kusowa zakudya m'thupi kwambiri, ma equation a eGFR sagwira ntchito bwino.
• Chikhomo choyezera mapuloteni mkodzo sichichotsa albuminuria. Ma dipstick sakhudzidwa ndi kutayika kwa albumin yotsika; ACR yochuluka imafunika.

Ngati KFT ndi yabwinobwino koma zizindikiro zanu zikupitirira, pitani kwa dokotala wanu. Zotsatira zabwinobwino zimafotokoza zomwe zinayesedwa tsiku limenelo; sizikutsimikizira kuti palibe cholakwika.

Mayeso ofanana koma osiyana

Kuyeza komwe kumabwera poyamba kumadalira vuto la matenda. Poyesa matenda a shuga, eGFR pamodzi ndi mkodzo ACR ziyenera kukhala zoyambirira. Pa ululu wa m'chiuno womwe umasonyeza mwala, kujambula ma lead. Pa kutentha thupi komwe kumayaka pokodza, momwe mkodzo umakhalira komanso momwe umakulira. Pa mkodzo wokhala ndi thovu komanso kutupa, ma lead a proteinuria oyezedwa. Palibe mayeso amodzi omwe ndi abwino kwambiri padziko lonse lapansi, amayankha mafunso osiyanasiyana.

Momwe mungakonzekerere

Kukonzekera kumakhazikitsidwa ndi labotale kapena chipatala chomwe chikuchita mayeso ndipo kumasiyana malinga ndi mayunitsi. Malangizo olembedwa a yuniti yanu ndi ofunika kwambiri kuposa chilichonse chomwe chili patsamba lino.

• Kusala kudya: creatinine, urea ndi ma electrolyte nthawi zambiri safuna kusala kudya. Kusala kudya kungapemphedwe ngati shuga, mafuta kapena mayeso ena aphatikizidwa ndi KFT.
• Kuthamanga: Imwani madzi nthawi zonse pokhapokha ngati mwapatsidwa lamulo loletsa madzi. Kusowa madzi m'thupi kapena kuchuluka kwa madzi mwadzidzidzi sikupereka zotsatira zenizeni.
• Mankhwala ndi zowonjezera: Bweretsani mndandanda wonse, kuphatikizapo mankhwala ochepetsa ululu, mankhwala a ayurvedic kapena mankhwala azitsamba, masewera olimbitsa thupi kapena mapuloteni ndi creatine. Musasiye mankhwala aliwonse olembedwa kuti mukonzekere KFT, funsani kaye dokotalayo.
• Mapuloteni ndi creatine: Chakudya chokhala ndi mapuloteni ambiri, nyama yophikidwa yambiri, kapena zowonjezera za creatine nthawi yochepa mayeso asanayambe zingakweze creatinine. Tchulani zomwe munthu wadya posachedwapa.
• Kuchita masewera olimbitsa thupi kwambiri: Kuchita masewera olimbitsa thupi ochulukirapo m'maola 24-48 apitawa kungapangitse kuti creatinine ikule komanso kuyambitsa proteinuria yosakhalitsa. Uzani labotale ngati izi zikugwira ntchito.
• Chitsanzo cha mkodzo: Kuti mupeze ACR yokwanira, nthawi zambiri mumagwiritsa ntchito chitsanzo cha m'mawa kwambiri. Tsukani malowo, tayani gawo loyamba la mtsinjewo ndikusonkhanitsa pakati pa mtsinjewo mu chidebe chopanda tizilombo chomwe chaperekedwa.
• Zosonkhanitsa za nthawi: Kuti muyesedwe mkodzo kwa maola 24, tayani mkodzo woyamba m'mawa, kenako tengani dontho lililonse la maola 24 otsatira kuphatikizapo mkodzo woyamba m'mawa wotsatira, kuti chidebecho chikhale chozizira monga momwe mwalangizidwira.

Ngati muli ndi pakati

Kawirikawiri creatinine imatsika panthawi ya mimba ndipo ma equation a standard eGFR satsimikiziridwa kwa amayi apakati. Kuyezetsa kwa proteinuria panthawi ya mimba kumatanthauziridwa mosiyana chifukwa cha preeclampsia. Uzani labotale ndi dokotala wanu wa za mimba.

Ngati muli ndi matenda a shuga pa chithandizo chochepetsa shuga m'magazi

Ngati mwapempha kusala kudya, funsani dokotala wanu momwe mungagwiritsire ntchito insulin kapena mapiritsi monga sulfonylureas m'mawa wa mayeso, komanso kukhala ndi shuga. Musamale kudya kwa nthawi yayitali popanda malangizo.

Ngati muli ndi vuto la mtima, CKD yowonjezereka kapena muli ndi vuto la madzi m'thupi

Musawonjezere kuchuluka kwa madzi omwe mumamwa kuti "mutsuke impso" musanayesedwe. Sungani madzi omwe mwapatsidwa ndipo uzani ogwira ntchito yosonkhanitsa za izi.

ana

Ma range a creatinine a ana ndi ma equation a eGFR amasiyana ndi a akuluakulu, ndipo zotsatira zake ziyenera kutanthauziridwa ndi dokotala wa ana kapena katswiri wa matenda a nephrologist wa ana. Zitsanzo zochepa ndi phlebotomy yophunzitsidwa ndi ana ndizoyenera.

Achikulire achikulire

eGFR imachepa pang'ono ndi ukalamba, ndipo kuchepa kwa minofu kungapangitse kuti creatinine iwoneke yotonthoza. ACR ya mkodzo ndi zomwe zakhala zikuchitika kale ndizofunikira kwambiri m'gululi.

Chimachitika ndi chiyani panthawi ya mayeso

• Kulembetsa ndi cheke: Zambiri zanu, mayeso opemphedwa ndi malangizo aliwonse osala kudya zatsimikiziridwa.
• Chitsanzo cha magazi: Chotsukira chimayikidwa pa mkono wapamwamba, khungu limatsukidwa, ndipo singano imagwiritsidwa ntchito kutulutsa magazi kuchokera mumtsempha womwe uli m'chigongono kupita mu chubu chimodzi kapena zingapo. Kupanikizika ndi kuvala pang'ono kumatsatira.
• Chitsanzo cha mkodzo: zosonkhanitsidwa m'chidebe chopanda tizilombo m'bafa, kapena zobweretsedwa kuchokera ku zosonkhanitsira za nthawi yake kunyumba.
• Kuzindikira: kuluma kwakanthawi panthawi yobayidwa ndi singano, nthawi zina kuvulala pang'ono pambuyo pake.

Kodi njirayi imatenga nthawi yayitali bwanji

• Kutulutsa magazi: nthawi zambiri mphindi 5-10 kuchokera pa tourniquet mpaka kuvala.
• Ulendo wonse: nthawi zambiri mphindi 15-30 kuphatikizapo kulembetsa ndi kudikira.
• Mkodzo wochepa: mphindi zochepa.
• Kusonkhanitsa mkodzo wa maola 24: Kugona maola 24 athunthu kunyumba, komanso kupita kukapereka chitsanzo.
• Lipoti la kupezeka: zimasiyana malinga ndi labotale komanso ngati KFT ndi pempho lachizolowezi kapena lachangu. Funsani malo osonkhanitsira nthawi yomwe lipoti lanu lidzakonzedweratu.

Kumvetsetsa lipoti lanu la KFT

Werengani lipotilo motsutsana ndi mndandanda wa maumboni wosindikizidwa ndi labotale yomwe ikugwira ntchito. Mndandanda wa manambala umasiyana pakati pa ma labotale chifukwa cha ma analyzer ndi njira zosiyanasiyana, choncho musayerekezere manambala anu ndi mndandanda wochokera ku labotale ina kapena pa intaneti.

• Seramu ya creatinine: Kuchuluka kwa minofu nthawi zambiri kumatanthauza kuchepa kwa kusefedwa, koma kulemera kwa minofu, kugonana, zaka, zakudya ndi madzi m'thupi zonse zimasinthasintha chiwerengerocho. Kuchuluka kwa minofu mwa mnyamata kumatha kuyembekezera kwathunthu; kuchuluka kwa minofu mwa mkazi wokalamba wofooka kungabise kuwonongeka kwenikweni.
• eGFR: zomwe zanenedwa mu mL/min/1.73m? Kutsika kwa mlingo kumasonyeza kuchepa kwa kusefedwa. Kuchepa kwa eGFR imodzi si matenda osatha a impso, kuyenera kupitirira miyezi itatu. eGFR si yodalirikanso pamene ntchito ya impso ikusintha mofulumira.
• Urea / BUN: Kuchuluka kwa urea komwe kumakhala ndi creatinine wabwinobwino nthawi zambiri kumasonyeza chimodzi mwa izi osati matenda a impso.
• ACR ya mkodzo: Magulu apamwamba amasonyeza kutuluka kwa albumin kwambiri. Magulu amagwiritsidwa ntchito poyesa kuchuluka kwa albumin m'magazi, ndipo kutsimikizira pa chitsanzo chobwerezabwereza m'mawa kwambiri ndi chinthu chofunikira musanalembe albumin m'magazi osatha.
• Potaziyamu: Magazi okwera komanso otsika ndi ofunika ndipo akhoza kukhala ofunikira kuchipatala. Kuchotsa poizoni m'thupi panthawi yosonkhanitsa kungawonjezere potaziyamu molakwika.
• Zochitika zimaposa mtengo umodzi. Kuwongolera kusintha kwa malipoti angapo nthawi zambiri kumakhala kothandiza kwambiri kuposa nambala imodzi iliyonse.

Lipoti la KFT si matenda. Liperekeni kwa dokotala amene anakupemphani, pamodzi ndi malipoti anu akale ndi mndandanda wa mankhwala. Zotsatira zimasiyana malinga ndi momwe matenda alili.

Pamene zotsatira za KFT zingakhale zosokeretsa

Creatinine yokwezedwa molakwika (impso zimagwira ntchito bwino kuposa momwe zimawonekera)

• Minofu yambiri, kumanga thupi, creatine kapena mapuloteni ambiri
• Chakudya chachikulu cha nyama kapena kuchita masewera olimbitsa thupi nthawi yochepa musanatenge chitsanzo
• Mankhwala omwe amaletsa kutulutsa kwa creatinine popanda kuchepetsa kusefa, monga trimethoprim ndi cimetidine
• Kusowa madzi m'thupi komwe kumayambitsa kukwera kwa impso zomwe zimakonzedwa ndi kubwezeretsanso madzi m'thupi
• Kusokonezeka kwa mayeso ena, kuphatikizapo hyperbilirubinemia kapena ma ketone ena

Creatinine molakwika imatonthoza (ntchito ya impso imayipa kuposa momwe imawonekera)

• Kuchepa kwa minofu, kufooka, sarcopenia, kusowa zakudya m'thupi, matenda osatha
• Kudula ziwalo kapena ziwalo
• Matenda a chiwindi opitilira patsogolo
• Zakudya za anthu osadya nyama zokhala ndi mapuloteni ochepa
• Mimba, komwe creatinine imatsika mwachibadwa

Urea/BUN imasocheretsa mbali zonse ziwiri

• Kuchuluka kwa madzi m'thupi: kusowa madzi m'thupi, kudya mapuloteni ambiri, kutuluka magazi m'mimba, corticosteroids, ndi kagayidwe kachakudya m'thupi
• Kuchepa kwa ma protein: kudya mapuloteni ochepa, matenda a chiwindi, mimba, kumwa madzi ambiri m'thupi

Mkodzo wa ACR wokwezedwa molakwika

• Matenda a mkodzo, malungo, magazi a msambo kapena kumaliseche
• Kuchita masewera olimbitsa thupi mwamphamvu m'maola 24 apitawa
• Kuchuluka kwa shuga m'magazi, kulephera kwa mtima kosalipidwa, kuthamanga kwa magazi kwambiri
• Kuyimirira mowongoka kwa nthawi yayitali (orthostatic proteinuria, yomwe imapezeka kwambiri mwa achinyamata)

Mkodzo wa ACR wochepetsedwa kapena wochepetsedwa molakwika

• Kuchepetsa kwambiri mkodzo mukatha kumwa madzi ambiri
• Kusonkhanitsa kosakwanira kapena kolakwika kwa maola 24, komwe ndi gwero lofala la zolakwika pa kafukufuku wochotsa zinthu

Zinthu zopangidwa ndi electrolyte

• Potaziyamu yokwera molakwika chifukwa cha haemolysis, nthawi yayitali ya tourniquet, kugwirana mwamphamvu kapena kuchedwa kukonza zitsanzo
• Sodium yochepa kwambiri komanso hyperlipidemia yayikulu kapena paraproteinaemia pa njira zina

Zoopsa ndi chitetezo

Kuyesa magazi (venepuncture)

Nthawi zambiri chiopsezo chochepa. Zotsatira zake zingakhale kupweteka kwakanthawi, kuvulala, kutuluka magazi pang'ono, kufooka mutu kapena kukomoka, komanso matenda am'deralo kapena kukwiya kwa mitsempha. Uzani ogwira ntchito ngati mutenga mankhwala ochepetsa magazi, kuvulala mosavuta kapena munakomoka kale panthawi yoyezetsa magazi.

Chitsanzo cha mkodzo

Palibe chiopsezo chakuthupi. Vuto lalikulu ndi cholakwika cha zitsanzo, kuipitsidwa kapena kusonkhanitsa kosakwanira nthawi yomwe kumabweretsa zotsatira zosokeretsa komanso kuyezetsa kosafunikira mobwerezabwereza.

Kafukufuku wokhudzana ndi ma profiles osiyanasiyana a zoopsa

Kuopsa kwa matenda a impso sikofanana pa kafukufuku wa impso. Kuyeza kwa ultrasound KUB sikukhudza kuwala kwa dzuwa. Kuyeza kwa CT KUB kumakhudza kuwala kwa ayoni. Kafukufuku wowonjezera kusiyana kwa maselo ali ndi zinthu zokhudzana ndi kusiyana kwa maselo zomwe zimadalira momwe impso imagwirira ntchito. Kuyeza kwa impso kumawononga maselo ndipo kumakhala ndi chiopsezo chachikulu cha kutuluka magazi chomwe chimafuna kuyang'aniridwa. Izi zimakambidwa padera ndi dokotala amene amalangiza.

Zinthu zapadera

Pregnancy

Kusefa kwa impso nthawi zambiri kumawonjezeka ndipo creatinine imatsika. Ma equation a eGFR okhazikika satsimikiziridwa pa nthawi ya mimba. Ma proteinuria atsopano kapena kuthamanga kwa magazi pambuyo pa masabata 20 amafunika kuyesedwa mwachangu kwa amayi oyembekezera.

ana

Ma reference ranges a ana ndi ma equation a eGFR amasiyana ndi a akuluakulu. Kukula, zakudya, ndi zovuta za mkodzo wobadwa nazo ndizofunikira, ndipo kutanthauzira kuyenera kukhala kogwirizana ndi ana.

Achikulire achikulire

Kuchepa pang'ono kwa eGFR kumachitika kawirikawiri ndi ukalamba ndipo sizitanthauza kuti matenda amapitirira. Albuminuria ndi zomwe zimachitika pakapita nthawi zimakhala zolemera kwambiri. Mlingo wa mankhwala nthawi zambiri umafunika kusintha kuti impso zigwire bwino ntchito.

Matenda a shuga pa chithandizo chochepetsa shuga m'magazi

Mankhwala a eGFR apachaka ndi ACR a mkodzo ndi okhazikika. Mankhwala ena ochepetsa shuga amafunika kuunikanso mlingo wake pamene eGFR ikusintha. Kusintha kulikonse kuyenera kuchokera kwa dokotala, osati kuchokera ku lipoti lokha.

matenda aakulu impso

Kuyang'anira kuchuluka kwa matenda kumadalira gawo, albuminuria ndi kuchuluka kwa kusintha kwa matendawa. Pewani kumwa mankhwala oletsa kutupa (NSAIDs) osaperekedwa ndi dokotala, mankhwala azitsamba kapena "otsukira impso" osatsimikizika, komanso mankhwala owonjezera omwe ali ndi mlingo waukulu popanda kukambirana ndi dokotala wanu wa matenda a impso.

Kulephera kwa mtima

Creatinine ndi urea nthawi zambiri zimasinthasintha malinga ndi kuchuluka kwa diuretic ndi kuchuluka kwa madzi m'thupi. Kuwonjezeka kwa madzi m'thupi panthawi ya chithandizo cha diuretic sikutanthauza kuwonongeka kwa impso zokha ndipo kumafunika kutanthauzira limodzi ndi zizindikiro ndi kulemera.

Matenda aakulu, malungo kapena kutaya madzi m'thupi

Kuyeza kwa KFT komwe kumatengedwa panthawi ya matenda oopsa sikungasonyeze momwe impso zimagwirira ntchito. Kuyezanso mobwerezabwereza mukachira nthawi zambiri kumafunika musanalembe matenda osatha.

Kuyesa ntchito ya impso ku India

• Terminology: KFT ndi RFT zimagwiritsidwa ntchito mosiyana m'ma laboratories aku India, ndipo zomwe zili mu panelo zimasiyana pakati pa ma lab. Chongani zomwe zili mu lipoti lanu, ma panelo ambiri a "KFT" sakuphatikizapo mkodzo wa ACR, womwe uyenera kupemphedwa padera.
• Matenda a shuga ndi matenda oopsa Ndi omwe akutsogolera ku matenda a impso osatha ku India, zomwe zimapangitsa kuti kuyezetsa kwa eGFR ndi mkodzo wa ACR pachaka kukhale kofunika kwambiri m'magulu awa.
• Kapangidwe ka thupi la South Asia: Matenda a kagayidwe kachakudya m'thupi amapezeka pa BMI yotsika ku South Asia, ndipo kuchepa kwa minofu mwa akuluakulu ambiri kumatanthauza kuti creatinine ingayambitse vuto la impso. EGFR, osati creatinine yokha, iyenera kugwiritsidwa ntchito.
• Mankhwala ndi zowonjezera: Kupeza mosavuta mankhwala oletsa kutupa (NSAIDs) komanso mankhwala opha ululu, mankhwala ena a ayurvedic, mankhwala azitsamba komanso a heavy-metal, komanso mankhwala owonjezera a gym kapena creatine zonse ndizofunikira pa zotsatira za impso. Chithandizo choletsa chifuwa chachikulu ndi maantibayotiki ena amafunikanso kumwa mankhwala ogwiritsira ntchito impso.
• Matenda ndi miyala: Matenda ambiri a miyala ya mkodzo m'madera ena kumpoto ndi kumadzulo kwa India, komanso matenda a m'madera otentha omwe angakhudze impso, zikutanthauza kuti mayeso a mkodzo ndi zithunzi nthawi zambiri zimafunika pamodzi ndi magazi a KFT.
• Matenda a magazi m'thupi ndi kuchepa kwa magazi m'thupi: Matenda a thalassemia ndi kuchepa kwa magazi m'thupi chifukwa cha kusowa kwa ayoni ndi ofala kwambiri ndipo amakhudza kutanthauzira kwa mayeso ofanana monga HbA1c, omwe amanenedwa mu % (NGSP) ndi mmol/mol (IFCC), pamene matenda a shuga ndi matenda a impso zimayesedwa pamodzi.
• Chitetezo cha data: Malipoti a labotale ndi kulembetsa pa intaneti kumakhudza deta yaumoyo waumwini yomwe imayendetsedwa motsatira Digital Personal Data Protection Act, 2023. Funsani momwe deta yanu ya lipoti imasungidwira ndikugawidwa.
• Lamulo lojambula zithunzi: Pamene ultrasound imawonjezeredwa poyesa impso mwa mkazi wa msinkhu wobereka, malo ochitira opaleshoni ku India amagwira ntchito motsatira PC-PNDT Act, 1994, ndipo kusankha kugonana n'koletsedwa.

Mtengo ndi inshuwalansi ku India

Mitengo imasiyana kwambiri pakati pa mizinda, pakati pa ma laboratories aboma ndi achinsinsi, komanso malinga ndi kuchuluka kwa akatswiri omwe gululi likuphatikizapo. Ziwerengero zomwe zatchulidwa kulikonse ziyenera kuonedwa ngati zowonetsa zokha; tsimikizirani mtengo wapano ndi labotale musanayese.

Zinthu zomwe zimakhudza zomwe mumalipira:

• Kukula kwa Tsamba: gulu loyambira la urea-creatinine-electrolyte limawononga ndalama zochepa poyerekeza ndi mbiri yayitali ya impso
• Mayeso owonjezera: Kufufuza mkodzo wa ACR, cystatin C ndi mayeso a mkodzo a maola 24 nthawi zambiri amalipiritsa padera; cystatin C ndi yokwera mtengo kwambiri ndipo siipezeka kwambiri
• Mtundu wa Laboratory: malo a boma, malo osonkhanitsira okha, labotale yachipatala kapena labotale yowunikira
• Kuvomerezeka ndi kusintha: Ma laboratories ovomerezeka ndi kukonza mwachangu kapena STAT nthawi zambiri amawononga ndalama zambiri
• Zosonkhanitsira kunyumba ndi ndalama zolipirira zitsanzo pambuyo pa maola ola
• Maphukusi azaumoyo ophatikizidwazomwe nthawi zambiri zimakhala ndi creatinine ndi urea koma sizimaphatikizapo ACR mkodzo
• Mzinda ndi malo azachipatala, kuphatikizapo kulipira odwala omwe agonekedwa m'chipatala poyerekeza ndi omwe agonekedwa kunja kwa chipatala

Pa inshuwalansi: mayeso ozindikira matenda akunja nthawi zambiri saphimbidwa ndi inshuwalansi yazaumoyo yokhazikika pokhapokha ngati ndondomekoyi ikuphatikizapo OPD kapena phindu lozindikira matenda. KFT yochitidwa ngati gawo la njira yolandirira odwala kapena yosamalira ana masana nthawi zambiri imaphimbidwa mkati mwa pempho loti munthu agonekedwe kuchipatala. Mapulani aboma ndi mapulani azaumoyo a olemba ntchito ali ndi mndandanda wawo wamitengo. Funsani ndi kampani yanu ya inshuwalansi kapena ofesi yolipirira kuchipatala musanayese mayeso.

Nthano ndi mfundo zenizeni

MAFUNSO OFUNSIDWA KAWIRIKAWIRI

Kodi ndiyenera kusala kudya kuti ndipeze KFT?

Creatinine, urea ndi ma electrolyte nthawi zambiri safuna kusala kudya. Kusala kudya nthawi zambiri kumapemphedwa ngati shuga kapena mafuta aphatikizidwa mu ulendo womwewo. Popeza zofunikira zimasiyana malinga ndi ma laboratories, tsatirani malangizo olembedwa kuchokera ku chipangizo chomwe chikuchita mayeso anu m'malo mwa lamulo wamba.

Kodi KFT ndi yofanana ndi kuyesa mkodzo?

Ayi. KFT ya magazi imayesa kusefedwa kudzera mu creatinine, eGFR, urea ndi ma electrolyte. Kuyesa mkodzo, microscopy yachizolowezi kapena chiŵerengero cha albumin-to-creatinine, kumazindikira kuwonongeka, kutuluka kwa mapuloteni, magazi ndi matenda. Awiriwa amayankha mafunso osiyanasiyana, ndipo kuyezetsa magazi kokha kungalepheretse kuwonongeka kwa impso msanga.

Kodi creatinine yanga ingakhale yokwera popanda matenda a impso?

Inde. Minofu yambiri, creatine kapena mapuloteni owonjezera, chakudya cholemera cha nyama, kuchita masewera olimbitsa thupi kwambiri, kutaya madzi m'thupi, ndi mankhwala monga trimethoprim kapena cimetidine zimatha kuwonjezera creatinine popanda kuchepetsa kusefedwa. Dokotala wanu nthawi zambiri amabwereza mayesowo akakhala kuti ali bwino asanaganize bwino.

Kodi eGFR yotsika pa lipoti limodzi imatanthauza chiyani?

Kuchepa kwa eGFR imodzi kumasonyeza kuchepa kwa kusefedwa komwe kunaganiziridwa patsikulo lokha. Kungasonyeze matenda oopsa, kusowa madzi m'thupi kapena zotsatira za mankhwala. Matenda a impso osatha amafuna kuti vuto likhalepo kwa miyezi yoposa itatu, choncho kuyezetsa mobwerezabwereza ndi kufananiza ndi malipoti akale ndikofunikira.

Ndi chiyani chabwino, creatinine kapena cystatin C?

Palibe chimodzi mwa izi chomwe chili chabwino kuposa china chilichonse. Creatinine-based eGFR ndi yotsika mtengo komanso imapezeka paliponse. Cystatin C sikhudzidwa kwambiri ndi minofu yambiri ndipo ndi yothandiza pamene creatinine ingasocheretse, monga kufooka, kudulidwa ziwalo kapena minofu yambiri. Kupezeka ndi mtengo wake zimasiyana malinga ndi ma laboratories.

Kodi ndiyenera kubwereza kangati KFT?

Kuchuluka kwa matendawa kumadalira chifukwa choyezetsera. Kuyezetsa matenda a shuga kapena kuthamanga kwa magazi nthawi zambiri kumachitika chaka chilichonse ndi ACR ya mkodzo. Matenda a impso osatha omwe apezeka, kusintha kwa mankhwala posachedwapa kapena matenda oopsa angafunike kuyezetsa pafupipafupi. Dokotala wanu amasankha nthawi yoyezetsera malinga ndi siteji yanu komanso momwe zinthu zilili.

Kodi ndiyenera kusiya kumwa mankhwala a kuthamanga kwa magazi kapena matenda a shuga ngati KFT yanga ndi yosazolowereka?

Ayi. Musasiye kapena kusintha mankhwala aliwonse operekedwa kutengera lipoti. Mankhwala ena oteteza impso amayambitsa kuchuluka pang'ono kwa creatinine komwe kumayembekezeredwa. Perekani lipotilo kwa dokotala, yemwe adzasankha ngati kusintha kwa mlingo, kuyimitsa kwakanthawi panthawi ya matenda, kapena kusasintha kulikonse ndikofunikira.

Kodi KFT imatha kuzindikira miyala ya impso?

Sizodalirika. KFT ingasonyeze kusasefa bwino ngati mwala ukutsekeka, koma miyala yokha ndi yomwe imapezeka m'mapangidwe ake. Ultrasound KUB imasonyeza hydronephrosis ndi miyala yambiri; non-contrast CT KUB imakhala yothandiza kwambiri m'matenda a impso omwe akuganiziridwa kuti ndi otupa mwa akuluakulu ambiri omwe si apakati.

KFT yanga ndi yabwinobwino koma ndili ndi mkodzo wotupa komanso wotulutsa thovu. Kenako, ndi chiyani?

Bwererani kwa dokotala wanu. Kuyeza magazi bwino (KFT) sikuchotsa matenda a impso, ndipo albuminuria ikhoza kupezeka ndi eGFR yachibadwa. Mapuloteni a mkodzo kapena ACR oyezedwa, microscopy ya mkodzo, kuwunika kuthamanga kwa magazi, komanso nthawi zina kujambula zithunzi kapena kutumiza kwa akatswiri ndi njira zina zomwe zimachitika nthawi zonse.

magwero

• Malangizo a KDIGO Clinical Practice for Evaluation and Management of Chronic Impso Disease [Tsimikizirani kope lamakono, KUTI LITSIMIKIZIDWE]
• Inker LA, Eneanya ND, Coresh J, ndi ena. Ma equation atsopano a Creatinine- ndi Cystatin C kuti ayese GFR popanda mtundu. New England Journal of Medicine, 2021.
• National Kidney Foundation ndi American Society of Nephrology Task Force on Reclassifying Use of Race in eGFR, malangizo ogwirizana, 2021.
• Bungwe la India la Kafukufuku Wachipatala, chithandizo chokhazikika ndi malangizo ozindikira matenda a impso osatha [Tsimikizirani kope lamakono, KUTI LITSIMIKIZIDWE]
• Lamulo Loletsa Kusankha Amuna ndi Akazi Asanatenge Mimba, 1994, Boma la India.
• Lamulo la Chitetezo cha Deta Yaumwini pa Intaneti, 2023, Boma la India.