Kuedzwa kweKushanda kweItsvo (KFT): Zvainoyera, Zvainoshaya, uye Maitiro ekuverenga Mushumo Wako

Key tora kutora

• KFT inofungidzira kusefa, kwete chikonzero. Kuwanda kwekriatinine kunokuudza kuti kusefa kwaderera; hakukuudze kana chikonzero chiri kupera mvura mumuviri, kuvharika kweropa, mishonga kana chirwere chisingaperi.
• Kuongororwa kweropa chete hakuna kukwana. Chiyero che albumin-to-creatinine weti (ACR) chinoona kukuvara kweitsvo uko creatinine ne eGFR zvinogona kutadza kushanda zvachose.
• Kuvhiyiwa kweKFT kwakajairika hakubvisi chirwere cheitsvo. Kukuvara kukuru kweitsvo kunogona kuitika kana creatinine iri mumuviri wakajairika, kunyanya kuvanhu vane tsandanyama shoma.
• Chimwe mhedzisiro isingawanzoitiki haisi kuongororwa kwechirwere. Chirwere cheitsvo chisingaperi chinoda kuti chirwere chacho chirambe chisina kujairika kwemwedzi mitatu, zvichisimbiswa pakuongororwazve.
• Kududzira kunoda mamiriro ezvinhu. Chiremba akakumbira KFT chete ndiye anogona kuiverenga zvichienderana nezera rako, tsandanyama, mishonga, zviratidzo uye kukosha kwawakaita kare.

Pakuona

Uyewo anozivikanwa se

• Kuongororwa kwebasa reitsvo (KFT / RFT)
• Mbiri yeitsvo, nhoroondo yeitsvo, panel yeitsvo
• "Kuongororwa kweitsvo", "kuongororwa kwecreatinine", "kuongororwa kweurea creatinine"
• Mashandisirwo echiHindi/mutauro wemuno: gurde ki jaanch, kidney ki jaanch"kuongororwa kweropa reitsvo"
• Kuongororwa kweweti kwakafanana kunowanzoitwa pamwe chete: maitiro ekuita weti ne microscopy, urine ACR (urine albumin test)

Chii chinonzi bvunzo yekushanda kweitsvo?

Itsvo dzinosefa tsvina nemvura yakawandisa kubva muropa, dzinoenzanisa munyu neasidhi, dzinobatsira kudzora BP, dzinoita kuti vhitamini D ishande uye dzinogadzira erythropoietin, iyo inosimudzira kugadzirwa kwemasero matsvuku eropa. KFT inzira isina kunanga yekutarisa kushanda kwesefa uchishandisa zviratidzo muropa nemuweti.

Zvinhu zvakajairika uye zvinopa chimwe nechimwe:

• Creatinine muropa: tsvina inobva mukubuda kwetsandanyama kwakajairika, inobviswa zvakanyanya neitsvo. Inokwira kana kusefa kuchiderera, asi huwandu hwayo hunoenderanawo nehuremu hwetsandanyama, kudya uye zera.
• Inofungidzirwa GFR (eGFR): kuverenga kubva kucreatinine pamwe nezera uye murume kana mukadzi kunofungidzira kusefa mu mL/min/1.73m? CKD-EPI 2021 creatinine equation yazvino haishandisi race variable. eGFR ifungidziro, kwete chiyero.
• Urea yeropa / BUN: Inoratidza kuputsika kwemapuroteni uye kubviswa kweitsvo. Inokanganiswa zvakanyanya nekunyoroveswa kwemvura mumuviri, mapuroteni ekudya, kubuda ropa mudumbu uye masteroids, saka chiratidzo cheitsvo chisina kusimba.
• Maelectrolyte nemaminerari: sodium, potassium, calcium, phosphate uye bicarbonate zvinoratidza mhedzisiro yekusashanda zvakanaka kweitsvo pane kuti zvisasefe zvoga.
• Chiyero cheweti che albumin-to-creatinine (ACR): inoona kubuda kwe albumin kuburikidza nemafirita akakuvara. ACR inogona kunge isina kujairika nepo eGFR ichiri yakajairika, ndosaka kuongororwa kweropa chete kusina kukwana.
• Maitiro ekuita weti uye microscopy: Inotsvaga mapuroteni, ropa, masero machena, masimbi, makristaro uye glucose, zvichiratidza hutachiona, kuzvimba kana matombo.
• Cystatin C: imwe nzira yekusefa isinganyanyi kukanganiswa nekukora kwetsandanyama, inoshandiswa kana eGFR yakavakirwa pacreatinine ingangokanganisa. Kuwanikwa uye mutengo zvinosiyana zvichienderana nemarabhoritari.

Chirwere cheitsvo chisingaperi chinotsanangurwa nekusarongeka kwechimiro cheitsvo kana mashandiro azvo kwemwedzi inopfuura mitatu, uye chinoongororwa uchishandisa ese ari maviri eGFR (G stages) uye albuminuria (A stages), kwete eGFR chete. [Simbisa gwara reKDIGO CKD riripo, KUTI RISIMBISWE]

Nei bvunzo yekushanda kweitsvo ichiitwa?

• Kuongorora kusefa kweitsvo kana zviratidzo kana zviratidzo zvekiriniki zvichiratidza dambudziko
• Kuongorora vanhu vari panjodzi huru, vakaita seavo vane chirwere cheshuga kana BP
• Kutarisa chirwere cheitsvo chisingaperi chinozivikanwa uye mwero wekuchinja kwacho
• Kuongorora mashandiro eitsvo usati watora mifananidzo yekuenzanisa, mamwe maoparesheni kana mimwe mishonga
• Kutarisa mishonga inogona kukanganisa itsvo kana inoda kugadziriswa kwemushonga zvichienderana nekushanda kweitsvo
• Kuongorora kukuvara kweitsvo panguva yekurwara, kushaya mvura mumuviri kana sepsis
• Kuongorora ma electrolytes asina kujairika, anemia isina tsananguro kana kuti BP yakakwira inoramba

Ndiani anofanira kuongororwa uku?

KFT inowanzo kurudzirwa kune:

• Vanhu vane chirwere cheshuga: eGFR yegore negore uye ACR yeweti, kana kakawanda kana zvatove zvisina kujairika
• Vanhu vane BPkunyanya kana BP yakaoma kudzora
• Vanhu vane chirwere chemwoyo kana kutadza kushanda zvakanaka kwemoyo
• Munhu wese ane nhoroondo yemhuri yechirwere cheitsvo, dialysis kana kuisirwa nhengo yemuviri
• Vanhu vane matombo eitsvo anodzoka kana hutachiona hweweti hunodzoka
• Vanhu vari pamishonga yenguva refu zvakaita semamwe mishonga inobvisa mvura mumuviri, mishonga inodzivirira ACE kana maARB, lithium, mishonga yeNSAID yenguva refu kana mishonga inosanganiswa ne pain-balm/ painkiller, kana mishonga yekurwisa TB.
• Vanhu vane kuzvimba kusingatsananguriki, weti ine furo, ropa muweti kana kuti weti shoma inobuda
• Vanhu vane chirwere che autoimmune, HIV, hepatitis B kana C, kana multiple myeloma
• Vakuru nevanhu vakarongerwa kuvhiyiwa kukuru kana mifananidzo ye contrast-enhanced

Zviratidzo zvinogona kukonzera kuongororwa zvinosanganisira kuzvimba kwechiso, tsoka kana maoko, weti ine furo kana furo, ropa muweti, weti shoma kana yakawandisa, kuda kurutsa kunogara kuripo, kushaya chido chekudya, kuvaviwa, kuneta kusingatsananguriki kana kutadza kufema. Vanhu vazhinji vane chirwere cheitsvo chepakutanga havana zviratidzo zvachose, ndosaka kuongororwa mumapoka ari panjodzi kuchikosha.

Izvo zvisingakwanise kuonekwa kana kusaonekwa nebvunzo yekushanda kweitsvo

• Hazvigone kupa chikonzero. KFT haisiyanise chirwere chetsvo chine chirwere cheshuga ne glomerulonephritis, kuvharika kwetsinga, kukuvara kwemishonga kana chirwere chemukati metsinga.
• Creatinine yakajairika haibvisi chirwere cheitsvo. Creatinine inogona kuramba iri murabhoritari kusvika chikamu chakakura chekusefa charasika, kunyanya kuvanhu vane tsandanyama dzisina kusimba, vakuru nevakadzi vazhinji.
• Hazvigone kuparadzanisa chirwere cheacute kubva kune chisingaperi zviri zvega. Pasina kukosha kwekare, creatinine imwe chete yakakwira haigone kukuudza kana shanduko yacho yave yemazuva kana makore.
• Haikwanise kuona kuvharika, matombo, mavanga, bundu kana kusagadzikana kwemaumbirwo emuviri. Izvi zvinoda mifananidzo yakaita se ultrasound (USG KUB) kana CT.
• Haikwanise kuongorora chirwere chemuviri. Kuongororwa kweitsvo chete ndiko kunogona kuratidza zvirwere zvakawanda zve glomerular uye interstitial.
• eGFR haina kuvimbika munyika dzisina kugadzikana. Munguva yekushanda kweitsvo kuri kuchinja nekukurumidza, pamuviri, kukura kwakanyanya kwemuviri, kugurwa nhengo, cirrhosis kana kushaya chikafu chakakwana, eGFR equation haishande zvakanaka.
• Chidzitiro cheweti chisina kunaka cheprotein hachibvisi albuminuria. Zvidzitiro zveDipstick hazvinzwisisi kurasikirwa kwealbumin muropa; ACR inodiwa kuti iongororwe.

Kana chirwere cheKFT chiri chenguva dzose asi zviratidzo zvako zvikaramba zvichienderera mberi, dzokera kuna chiremba wako. Mhinduro yakajairika inotsanangura zvakayerwa pazuva iroro; hazviratidzi kuti hapana chakaipa.

Bvunzo dzakabatana asi dzakasiyana

Kuongororwa kupi kunotanga zvichienderana nedambudziko rechirwere. Pakuongorora chirwere cheshuga, eGFR pamwe neACR yemuweti zvinotanga. Pakurwadziwa kwechiuno zvinoratidza dombo, kufungidzira matinji. Pakupisa nekutsva kweweti, maitiro eweti uye culture lead. Paweti ine furo nekuzvimba, matinji eproteinuria akayerwa. Hapana bvunzo imwe chete iri nani pane dzese, inopindura mibvunzo yakasiyana.

Maitiro ekugadzirira

Kugadzirira kunorongwa nerabhoritari kana chipatara chinoita bvunzo uye kunosiyana zvichienderana nezvikamu. Mirayiridzo yakanyorwa yeyuniti yako ndiyo inonyanya kukosha pane chero chinhu chiri papeji rino.

• Kutsanya: creatinine, urea uye electrolytes hazvidi kutsanya. Kutsanya kunogona kukumbirwa kana glucose, lipids kana mimwe miedzo yakabatanidzwa neKFT.
• Hydration: Inwa mvura nguva dzose kunze kwekunge warambidzwa kushandisa mvura yakawanda. Kushaya mvura yakakwana kana kuti kuwanda kwemvura kamwe kamwe hazvipe mhedzisiro yechokwadi.
• Mishonga uye zvinowedzera: Uyai nerunyorwa rwakazara, kusanganisira mishonga inoderedza marwadzo, mishonga yeAyurvedic kana yemishonga yemishonga, mishonga yekurovedza muviri kana yemapuroteni uye creatine. Musarega chero mushonga wakanyorwa kuti mugadzirire KFT, tangai mabvunza chiremba.
• Mapuroteni uye creatine: Kudya zvine mapuroteni akawanda, nyama yakabikwa yakawanda, kana zvimwe zvinowedzera creatine nguva pfupi bvunzo isati yaitwa zvinogona kuwedzera creatinine. Taura nezvekudya kwazvino uno.
• Kurovedza muviri kwakasimba: Kurovedza muviri nesimba mumaawa 24-48 apfuura kunogona kuwedzera creatinine uye kukonzera proteinuria yekufamba kwenguva pfupi. Udza rabhoritari kana izvi zvichibvira.
• Muenzaniso weti: Kuti uwane ACR, sampuli yemangwanani ndiyo inonyanya kufarirwa. Chenesa nzvimbo yacho, rasa chikamu chekutanga cherukova wounganidza pakati perukova mumudziyo usina utachiona wakapihwa.
• Kuunganidzwa kwenguva yakatarwa: Kuti uongorore weti kwemaawa makumi maviri nemana, rasa chinhu chekutanga chemangwanani, wozounganidza donhwe rega rega kwemaawa makumi maviri nemana anotevera kusanganisira chinhu chekutanga chemangwanani anotevera, uchichengetedza mudziyo uchitonhorera sezvakarayirwa.

Kana iwe uri nepamuviri

Creatinine inowanzo donha panguva yekuzvitakura uye zviyero zve eGFR zvakajairwa hazviongororwe kuvakadzi vane pamuviri. Kuongororwa kweproteinuria panguva yekuzvitakura kunonzwisiswa zvakasiyana nekuda kwe preeclampsia. Udza rabhoritari nechiremba wezvekubereka.

Kana uine chirwere cheshuga uri pakurapwa kuderedza shuga yeropa

Kana wakambokumbira kutsanya, bvunza chiremba wako kuti ungashandisa sei insulin kana mapiritsi akadai sesulfonylureas mangwanani ebvunzo, uye kuti une shuga yakawanda sei. Usatsanye kwenguva yakareba usina kupiwa mazano.

Kana uine chirwere chemwoyo, CKD yakanyanya kana kuti une dambudziko remvura mumuviri

Usawedzera mvura inonwiwa kuti "ugeze itsvo" usati waongororwa. Ramba wakadzikama kusvika padanho rawakarairwa uye udza vashandi vekutora nezvazvo.

Children

Kuyera kwecreatinine muvana uye equations dze eGFR zvakasiyana nedzevakuru, uye mhedzisiro inofanira kududzirwa nachiremba wevana kana chiremba wezveuropi hwevana. Sample volumes diki uye phlebotomy yakadzidziswa nevana ndiyo inonyanya kufarirwa.

Vakuru vakuru

eGFR inoderera zvishoma nekukura, uye tsandanyama shoma dzinogona kuita kuti creatinine iite seine nyaradzo. ACR yeweti uye maitiro ekare zvakakosha zvikuru muboka iri.

Chii chinoitika panguva yebvunzo

• Kunyoresa uye cheki: Ruzivo rwako, bvunzo dzakumbirwa uye chero mirairo yekutsanya zvasimbiswa.
• Muenzaniso weropa: tourniquet inoiswa paruoko rwepamusoro, ganda rinocheneswa, uye tsono inoshandiswa kubvisa ropa kubva mutsinga iri mugokora ichienda muchubhu imwe kana kupfuura. Zvinotevera kumanikidzwa uye jira diki.
• Muenzaniso weti: zvinounganidzwa mumudziyo usina utachiona muimba yekugezera, kana kuunzwa kubva muunganidzwa wakatarwa nenguva kumba.
• Kunzwa: kuruma kwenguva pfupi panguva yekubaiwa netsono, dzimwe nguva maronda madiki mushure mezvo.

Zvinotora nguva yakareba sei kuti maitiro acho aite

• Kutorwa kweropa: kazhinji maminetsi mashanu kusvika gumi kubva pakupfeka jira kusvika pakupfeka.
• Kushanya kwose: kazhinji maminetsi gumi nemashanu kusvika makumi matatu kusanganisira kunyoresa nekumirira.
• Weti ine madonhwe: kwemaminitsi mashoma.
• 24-awa yekuunganidza weti: kugara kumba kwemaawa makumi maviri nemana, pamwe nekushanya kunosiya muenzaniso.
• Bika kuwanikwa: Zvinosiyana zvichienderana nerabhoritari uye kana KFT iri chikumbiro chenguva dzose kana chekukurumidzira. Bvunza nzvimbo yekuunganidza kuti mushumo wako uchagadzirwa riini.

Kunzwisisa mushumo wako weKFT

Verenga mushumo uchienzanisa nehuwandu hwemareferensi akadhindwa nerabhoritari iri kushanda. Mhando dzakasiyana dzemarabhoritari nekuda kwemhando dzakasiyana dzeanalyzers uye nzira, saka usaenzanisa nhamba dzako nehukuru hwerabhoritari kana kubva paindaneti.

• Creatinine muropa: Kuyera kwakakwirira kunowanzo ratidza kudzikira kwekusefa kwemasero, asi huremu hwetsandanyama, murume kana mukadzi, zera, kudya uye kunyorova kwemuviri zvese zvinochinja huwandu hwetsandanyama. Kuyera "kwakajairika" mumurume wechidiki ane tsandanyama kunogona kutarisirwa zvachose; kuyera "kwakajairika" mumukadzi mukuru asina simba kunogona kuvanza kuremara chaiko.
• eGFR: yakataurwa mu mL/min/1.73m? Kuderera kwehuwandu hwemasero kunoratidza kudzikira kwekusefa. Kuderera kwe eGFR kamwe chete hakusi chirwere cheitsvo chisingaperi, chinofanira kugara kwenguva refu kupfuura mwedzi mitatu. eGFR haivimbikewo kana mashandiro eitsvo achichinja nekukurumidza.
• Urea / BUN: Inokwira kana muviri ukasasefa, asiwo kana muviri ukadzikira, ukawana mapuroteni akawanda, kubuda ropa mudumbu, ma steroid uye chirwere che catabolic. Kuwanda kweurea ine creatinine yakajairika kunowanzo ratidza chimwe chezvirwere izvi kwete chirwere cheitsvo.
• Weti ACR: Zviyero zvepamusoro zvinoratidza kubuda kwe albumin yakawanda. Mapoka anoshandiswa kuenzanisa albuminuria, uye kusimbiswa kwemuenzaniso wemangwanani-ngwanani kunowanzoitwa usati wanyora kuti albuminuria inogara iripo.
• Potassium: zvose zviri zviviri zvakakosha uye zviri pasi uye zvinogona kukurumidza kurapwa. Kubviswa kweropa mumuviri panguva yekuunganidza kunogona kuwedzera potassium zvisiri izvo.
• Trend inodarika kukosha kumwe chete. Kutungamira kweshanduko mumishumo yakati wandei kunowanzova neruzivo rwakawanda kupfuura chero nhamba imwe chete.

Mushumo weKFT hausi wekuongorora chirwere. Uendese kuna chiremba akakukumbira, pamwe chete nemishumo yako yekare uye runyorwa rwemishonga. Mhedzisiro yacho inosiyana zvichienderana nemamiriro ekurapa emunhu mumwe nemumwe.

Kana mhedzisiro yeKFT inogona kutsausa

Creatinine yakasimudzwa zvisirizvo (itsvo inoshanda zviri nani kupfuura zvainotaridzika)

• Tsandanyama hombe, kuvaka muviri, creatine kana kuti mapuroteni akawanda
• Kudya nyama yakawanda kana kurovedza muviri kwakaoma nguva pfupi usati watora sampuli
• Mishonga inovhara kuburitswa kwe creatinine pasina kuderedza kusefa, senge trimethoprim uye cimetidine
• Kushaya mvura mumuviri zvichikonzera kukwira kwemuviri usati watanga itsvo uko kunogadziriswa nekuwedzera mvura mumuviri
• Kumwe kukanganiswa kwekuyedza, kusanganisira hyperbilirubinemia yakanyanya kana mamwe ma ketones

Creatinine inonyaradza zvenhema (kushanda kweitsvo kwakaipa kupfuura zvainoita)

• Tsandanyama dzakaderera, kushaya simba, sarcopenia, kushaya chikafu zvinovaka muviri, chirwere chisingaperi
• Kuchekwa kwemakumbo kana kuoma mitezo
• Chirwere chechiropa chakakura
• Kudya kwevasina miriwo kunosanganisira kudya mapuroteni mashoma
• Pamuviri, apo creatinine inodonha mumuviri

Urea/BUN inotsausa munzira dzese dziri mbiri

• Kukwira kweropa zvisina kunaka: kushaya mvura mumuviri, kudya mapuroteni akawanda, kubuda ropa mudumbu, corticosteroids, mamiriro ekuchinja kwemuviri
• Zvisirizvo: kudya mapuroteni mashoma, chirwere chechiropa, pamuviri, mvura yakawandisa mumuviri

Weti ACR yakasimudzwa zvisiri pamutemo

• Kutapukirwa nehutachiona hwemudumbu, fivha, ropa rinobuda panguva yekuenda kumwedzi kana kubuda ropa kubva munhengo yemukadzi
• Kurovedza muviri nesimba mumaawa makumi maviri nemana apfuura
• Kuwanda kweglucose mumuviri, kutadza kushanda kwemoyo, BP yakanyanya kukwira
• Kugara wakatwasuka kwenguva yakareba (orthostatic proteinuria, inowanzoonekwa muvechiri kuyaruka)

Weti ACR yakaderedzwa kana kuderedzwa zvisizvo

• Weti inonyungudika zvakanyanya mushure mekunwa mvura yakawanda
• Kuunganidzwa kwemaawa makumi maviri nemana kusina kukwana kana kuti kwakaitwa zvisina kururama, izvo zvinowanzokonzera kukanganisa muzvidzidzo zvekubviswa kwemafuta

Zvinhu zveElectrolyte

• Potassium inowedzerwa zvisiri izvo nekubvisa ropa, nguva yakareba ye tourniquet, kubata chibhakera kana kunonoka kugadzira sampuro.
• Sodium shoma inoratidzika kunge ine hyperlipidemia yakanyanya kana paraproteinaemia pane dzimwe nzira

Njodzi nekuchengetedzeka

Muenzaniso weropa (venepuncture)

Kazhinji njodzi shoma. Migumisiro inogona kuitika inosanganisira kurwadziwa kwenguva pfupi, mavanga, kubuda ropa diki, kuchembera kana kufenda, uye kazhinji hutachiona hwepanzvimbo kana tsinga dzinorwadza. Udza vashandi kana uchitora mishonga inobvisa ropa, yakakuvara zviri nyore kana kuti wakambofenda panguva yekuongororwa ropa kare.

Weti muenzaniso

Hapana njodzi yemuviri. Dambudziko guru nderekukanganisa kwemuenzaniso, kusvibiswa kana kuunganidzwa kwakakwana kwenguva zvichikonzera mhedzisiro inotsausa uye kuongororwa kusingakoshi.

Kuferefeta kwakabatana nemaitiro akasiyana enjodzi

Njodzi hadzina kufanana pakuongororwa kweitsvo. Ultrasound KUB haishandisi mwaranzi. CT KUB inosanganisira mwaranzi ionizing. Zvidzidzo zvakavandudzwa zvine zvinhu zvine chekuita nekusiyana kweitsvo zvinoenderana nekushanda kweitsvo. Kuongororwa kweitsvo kunokuvadza uye kune njodzi huru yekubuda ropa inoda kuongororwa. Izvi zvinokurukurwa zvakasiyana nachiremba anovakurudzira.

Mamiriro ezvinhu anokosha

Kuberekwa

Kusefa kweitsvo kunowanzowedzera uye creatinine inodzikira. Maequation eGFR akajairwa haaonekwe panguva yekuzvitakura. Mapuroteni matsva kana BP mushure memavhiki makumi maviri zvinoda kuongororwa nekukurumidza kwekuzvitakura.

Children

Mareferensi evana uye eGFR equations akasiyana neevanhu vakuru. Kukura, kudya kunovaka muviri uye kusagadzikana kwemunzira yeweti yekuzvarwa nayo kunokosha, uye dudziro inofanira kunge yakanangana nevana.

Vakuru vakuru

Kudzikira kweGFR kudiki kunowanzoitika nekukura uye hazvirevi kuti chirwere chinoenderera mberi. Albuminuria uye mafambiro echirwere nekufamba kwenguva zvinorema zvakanyanya. Mishonga inowanzoda kugadziriswa kuti ishande zvakanaka sei.

Chirwere cheshuga chiri pakurapa kuderedza shuga yeropa

EGFR yegore negore uye ACR yemuweti ndizvo zvakajairika. Mimwe mishonga inoderedza shuga inoda kuongororwa kwemuyero sezvo eGFR ichichinja. Chero shanduko inofanira kubva kune anoinyora, kwete kubva kumushumo chete.

Chirwere chisingaperi chepfungwa

Kuongororwa kwehuwandu hwechirwere kunoenderana nedanho, albuminuria uye mwero wekuchinja kwechirwere. Dzivisa mishonga yeNSAID inotengeswa pasina kunyorerwa chiremba, mishonga yemishonga yemishonga kana "yekuchenesa itsvo" isina kusimbiswa, uye mishonga yekuwedzera mishonga ine mwero mukuru usina kukurukura nezvayo nachiremba wezvirwere zvepfungwa.

Heart failure

Creatinine neurea zvinowanzochinja-chinja zvichienderana nehuwandu hwemvura inobuda mumuviri uye mamiriro emvura mumuviri. Kuwedzera kwemvura panguva yekurapwa nemhepo inobuda mumuviri hazvirevi kuti itsvo dzakuvara uye zvinoda kutsanangurwa pamwe chete nezviratidzo nehuremu.

Kurwara zvakanyanya, fivha kana kupera mvura mumuviri

Kuongororwa kweKFT kunotorwa panguva yekurwara kwakanyanya kunogona kusaratidza mashandiro eitsvo pakutanga. Kuongororwazve mushure mekupora kunowanzo dikanwa usati wanyora kuti chirwere chisingaperi.

Kuongororwa kwebasa reitsvo muIndia

• Terminology: KFT neRFT zvinoshandiswa zvakasiyana mumarabhoritari ekuIndia, uye zviri muzvikamu zvakasiyana mumarabhoritari. Tarisa kuti ndezvipi zvikamu zvakanyorwa mumushumo wako, akawanda mapaneru e "KFT" haana urine ACR, ayo anofanira kukumbirwa zvakasiyana.
• Chirwere cheshuga uye hypertension Ndivo vanotungamira mukuwedzera chirwere cheitsvo chisingaperi muIndia, zvichiita kuti kuongororwa kwegore negore kwe eGFR pamwe ne ACR yemuwedzero kuve kwakakosha zvikuru mumapoka aya.
• Kuumbwa kwemuviri wekuSouth Asia: Chirwere chemetabolism chinoitika paBMI yakaderera muvanhu vekuSouth Asia, uye huwandu hwetsandanyama hushoma muvanhu vakuru vazhinji zvinoreva kuti creatinine inogona kusaratidza kutadza kweitsvo. eGFR, kwete creatinine chete, ndiyo inofanira kushandiswa.
• Mishonga uye zvinowedzera: Kuwana nyore nyore mishonga yeNSAIDs uye musanganiswa wemarwadzo usingabhadhariswi, mimwe mishonga yeAyurvedic, yemishonga yemishonga yemishonga yemishonga yemishonga yemishonga yemishonga yemishonga yemishonga yemishonga yemishonga yemishonga yemishonga yemishonga yekurapa chirwere ichi, pamwe nemishonga yemishonga yemishonga yemishonga yekurapa inonzi heavy-metal, pamwe nemishonga yekurovedza muviri kana ye creatine, zvese zvine chekuita nemigumisiro yeitsvo. Kurapa kweTB nemamwe mishonga yekuuraya utachiona kunodawo kupihwa mushonga unoenderana nekushanda kweitsvo.
• Utachiona nematombo: Dambudziko guru rechirwere chematombo emuweti munzvimbo dziri kuchamhembe nekumadokero kweIndia, pamwe nehutachiona hwenzvimbo dzinopisa hunogona kukanganisa itsvo, zvinoreva kuti kuongororwa kweweti nemifananidzo zvinowanzodiwa pamwe chete neropa reKFT.
• Hemoglobinopathy uye anemia: Zviratidzo zveThalassemia uye anemia yekushaikwa kwesimbi zvakanyanya uye zvinokanganisa kududzirwa kwemiedzo yakafanana neHbA1c, yakashumwa mu % (NGSP) uye mmol/mol (IFCC), kana chirwere cheshuga nechirwere cheitsvo zvikaongororwa pamwe chete.
• Dziviriro yedata: Mishumo yerabhoritari uye kunyoreswa kwepaindaneti zvinosanganisira ruzivo rwehutano hwemunhu rwunobatwa pasi peMutemo weDhijitari weDziviriro yeData reMunhu, 2023. Bvunza kuti ruzivo rwemushumo wako runochengetwa uye runogovaniswa sei.
• Mutemo wemifananidzo: uko ultrasound inowedzerwa pakuongororwa kweitsvo mumukadzi asvika zera rekubereka, nzvimbo dzekuIndia dzinoshanda pasi pePC-PNDT Act, 1994, uye kusarudzwa kwebonde hakubvumidzwe.

Mutengo neinishuwarenzi muIndia

Mitengo inosiyana zvakanyanya pakati pemaguta, pakati pemarabhoritari ehurumende neevanhu, uye zvichienderana nekuti boka rinosanganisira vaongorori vangani. Nhamba dzakataurwa chero kupi dzinofanira kutorwa sedzinoratidza chete; simbisa mutengo uripo nerabhoritari usati waedza.

Zvinhu zvinokanganisa mari yaunobhadhara:

• Saizi repaneru: panel ye urea-creatinine-electrolyte inodhura zvishoma pane profile yakareba yeitsvo
• Miedzo yekuwedzera: Kuongororwa kweweti yeACR, cystatin C uye weti yemaawa makumi maviri nemana zvinowanzo kubhadhariswa zvakasiyana; cystatin C inodhura zvakanyanya uye haiwanikwe zvakanyanya
• Rudzi rwemurabhoritari: nzvimbo yehurumende, nzvimbo yekuunganidza yakazvimiririra, rabhoritari yechipatara kana rabhoritari yekutarisa
• Kubvumidzwa uye kugadziriswa kwemabasa: marabhoritari ane mvumo uye kugadziriswa kwekukurumidzira kana STAT zvinowanzodhura zvakanyanya
• Muunganidzwa wepamba uye muripo wekutora sampuli mushure memaawa ebasa
• Mapakeji ehutano akaunganidzwa, izvo zvinowanzo sanganisira creatinine neurea asi zvisingasanganisi urine ACR
• Guta nenzvimbo yekiriniki, kusanganisira kubhadhara muri muchipatara kana muri kunze kwechipatara

Painishuwarenzi: bvunzo dzekuongorora varwere vasiri muchipatara kazhinji hadzifukidzwe neinishuwarenzi yehutano inotsiva kunze kwekunge mutemo wacho uine OPD kana rubatsiro rwekuongorora. KFT inoitwa sechikamu chekubvumidzwa kupinda muchipatara kana kutarisirwa kwevana inowanzo kuvharwa mukati mekukumbira kugara muchipatara. Zvirongwa zvehurumende nezvirongwa zvehutano zvevashandirwi zvine runyorwa rwazvo rwemitengo. Tarisa neinishuwarenzi yako kana dhipatimendi rekubhadhara zvipatara usati waongororwa.

Ngano nezvokwadi

Mibvunzo inowanzobvunzwa

Ndinofanira kutsanya kuti ndiwane KFT here?

Creatinine, urea uye electrolytes hazvidi kutsanya. Kutsanya kunowanzo kumbirwa kana glucose kana lipids zvabatanidzwa muongororo imwe chete. Nekuti zvinodiwa zvinosiyana pakati pemarabhoritari, tevera mirairo yakanyorwa kubva kuchikamu chiri kuita bvunzo yako pane mutemo wakajairika.

Ko KFT yakafanana neyekuongorora weti here?

Kwete. Kuongororwa kweropa kweKFT kunotarisa kusefa kuburikidza necreatinine, eGFR, urea uye electrolytes. Kuongororwa kweweti, microscopy yenguva dzose kana kuti albumin-to-creatinine ratio, kunoona kukuvara, kubuda kweprotein, ropa uye hutachiona. Vaviri ava vanopindura mibvunzo yakasiyana, uye kuongororwa kweropa chete kunogona kukanganisa kukuvara kweitsvo zvachose.

Creatinine yangu inogona kukwira pasina chirwere cheitsvo here?

Ehe. Tsandanyama dzakakura, creatine kana mapuroteni, kudya nyama yakawanda, kurovedza muviri kwakasimba, kushaya mvura mumuviri, uye mishonga yakaita setrimethoprim kana cimetidine zvinogona kuwedzera creatinine pasina kuderedzwa kwekusefa. Chiremba wako anowanzo dzokorora bvunzo iyi mumamiriro ezvinhu akagadzikana asati awana mhedziso.

Zvinorevei kuti eGFR yakaderera pamushumo mumwe chete?

Kuderera kwe eGFR kunoratidza kudzikira kwefungidziro yekusefa pazuva iroro chete. Izvi zvinogona kuratidza kurwara kwakanyanya, kushaya mvura mumuviri kana mhedzisiro yemushonga. Chirwere cheitsvo chisingaperi chinoda kuti chigare chisina kujairika kwemwedzi inopfuura mitatu, saka kuongororwazve uye kuenzanisa nemishumo yapfuura kunodiwa.

Chii chiri nani, creatinine kana cystatin C?

Hapana chimwe chazvo chiri nani pasi rose. Creatinine-based eGFR haina mari yakawanda uye inowanikwa zvakanyanya. Cystatin C hainyanyi kukanganiswa nekukora kwetsandanyama uye inobatsira kana creatinine ichigona kukanganisa, senge mukushaya simba, kuchekwa kwenhengo kana tsandanyama dzakanyanya kukora. Kuwanikwa uye mutengo zvinosiyana pakati pemarabhoritari.

Ndinofanira kudzokorora KFT kangani?

Kuwanda kwechirwere kunoenderana nechikonzero chekuongororwa. Kuongororwa kwechirwere cheshuga chakagadzikana kana BP kunowanzoitwa gore rega rega neACR yemuweti. Chirwere cheitsvo chisingaperi chakaonekwa, shanduko dzemushonga dzichangobva kuitika kana chirwere chakanyanya chingada kuongororwa kakawanda. Chiremba wako anokurapa ndiye anosarudza nguva yacho zvichienderana nedanho rako uye mafambiro aunoita chirwere.

Ndorega here kushandisa mushonga wangu weBP kana chirwere cheshuga kana KFT yangu isina kunaka?

Kwete. Musamisa kana kuchinja chero mushonga wamakanyorerwa zvichibva pane mushumo. Mimwe mishonga inodzivirira itsvo inokonzera kuwedzera kudiki kwe creatinine. Endesai mushumo wacho kumunyoreri, uyo achasarudza kana kugadziriswa kwemushonga, kumbomira kwenguva pfupi panguva yekurwara, kana kusachinja kwakakodzera.

KFT inogona kuona matombo eitsvo here?

Hazvina kunyatsovimbika. KFT inogona kuratidza kusashanda zvakanaka kwesefa kana dombo richivharika, asi matombo pachawo ndiwo anowanikwa. Ultrasound KUB inoratidza hydronephrosis nematombo akawanda; non-contrast CT KUB inonyanya kubatwa nechirwere cheitsvo chinofungidzirwa kuti chinokonzerwa necolic muvanhu vakuru vakawanda vasina pamuviri.

KFT yangu yakajairika asi ndichiri nekuzvimba uye weti ine furo. Chii chinotevera?

Dzokera kuna chiremba wako. Kuongororwa kweropa kwakajairika hakubvisi chirwere cheitsvo, uye albuminuria inogona kuwanikwa neGFR yakajairika. Mapuroteni emuweti akayerwa kana ACR, microscopy yeweti, kuongorora BP, uye dzimwe nguva mifananidzo kana kutumira kune nyanzvi ndiwo matanho akajairika anotevera.

Sources

• Gwaro reKDIGO Clinical Practice rekuongorora nekutarisira chirwere cheitsvo chisingaperi [Simbisa chinyorwa chiripo, CHICHASIMBISWA]
• Inker LA, Eneanya ND, Coresh J, nevamwe. Maequations matsva eCreatinine- neCystatin eC-Based Equations ekuongorora GFR isina Rudzi. New England Journal of Medicine, 2021.
• National Kidney Foundation neAmerican Society of Nephrology Task Force pamusoro peKugadzirisa Kushandiswa kweRudzi muGFR, mazano akabatanidzwa, 2021.
• Dare reIndia reKutsvagurudza Kwezvokurapa, kurapwa kwakajairika uye gwara rekuongorora chirwere cheitsvo chisingaperi [Simbisa chinyorwa chiripo, CHICHASIMBISWA]
• Mutemo weKurambidza Kusarudza Bonde (Prohibition of Bonde Selection) Act, 1994, Hurumende yeIndia.
• Mutemo weDhijitari weDziviriro yeData reMunhu, 2023, Hurumende yeIndia.