Uvavanyo Lokusebenza Kwezintso (KFT): Oko Kulinganiswayo, Oko Kuphoswayo, kunye nendlela Yokufunda Ingxelo Yakho

Ukuthatha okuphambili

• I-KFT iqikelela ukuhluzwa, hayi unobangela. I-creatinine ephakanyisiweyo ikuxelela ukuba ukuhluzwa kunciphile; ayikuxeleli ukuba unobangela kukuphelelwa ngamanzi emzimbeni, ukuvaleka, amayeza okanye isifo esingapheliyo.
• Uvavanyo lwegazi lodwa aluphelelanga. Umlinganiselo we-albumin-to-creatinine womchamo (i-ACR) ubona umonakalo wezintso onokuthi i-creatinine kunye ne-eGFR zingawuboni ngokupheleleyo.
• I-KFT eqhelekileyo ayikhuphi isifo sezintso. Umonakalo omkhulu kwizintso unokubakho xa i-creatinine ikwizinga eliqhelekileyo, ingakumbi kubantu abanemisipha ephantsi.
• Esinye isiphumo esingaqhelekanga asikokuxilonga. Isifo sezintso esingapheliyo sidinga ukungaqhelekanga okuhlala ubuncinane iinyanga ezintathu, okuqinisekiswa kuvavanyo oluphindaphindwayo.
• Ukutolika kufuna umxholo. Ngugqirha kuphela ocele i-KFT onokuyifunda ngokweminyaka yakho, ubunzima bemisipha, amayeza, iimpawu kunye namaxabiso akho angaphambili.

Ngokukrwaqula kanye

Kwaziwa njenge

• Uvavanyo lokusebenza kwezintso (KFT/RFT)
• Iprofayili yezintso, iprofayili yezintso, iphaneli yezintso
• "Uvavanyo lwezintso", "uvavanyo lwe-creatinine", "uvavanyo lwe-urea creatinine"
• Ukusetyenziswa kwesiHindi/kwesilwimi sasekhaya: gurde ki jaanch, kidney ki jaanch, "uvavanyo lwegazi lezintso"
• Uvavanyo lomchamo oluhambelanayo ludla ngokucwangciswa kunye: inkqubo yomchamo kunye ne-microscopy, i-urine ACR (uvavanyo lwe-urine albumin)

Yintoni uvavanyo lokusebenza kwezintso

Izintso zihluza inkunkuma kunye nolwelo olugqithisileyo oluvela egazini, zilinganise iityuwa kunye ne-asidi, zinceda ekulawuleni uxinzelelo lwegazi, zivuselele i-vitamin D kwaye zivelise i-erythropoietin, eqhuba ukuveliswa kweeseli ezibomvu zegazi. I-KFT yindlela engathanga ngqo yokujonga loo msebenzi wokucoca usebenzisa iimpawu kwigazi kunye nomchamo.

Izinto eziqhelekileyo kunye nento enegalelo kuyo nganye:

• I-creatinine ye-serum: inkunkuma evela ekujikeni kwemisipha okuqhelekileyo, esuswa kakhulu zizintso. Iyanyuka njengoko ukuhluzwa kwehla, kodwa umgangatho uxhomekeke kubunzima bemisipha, ukutya kunye nobudala.
• I-GFR eqikelelweyo (eGFR): ubalo oluvela kwi-creatinine kunye nobudala kunye nesini oluqikelela ukuhluzwa kwi-mL/min/1.73m? I-CKD-EPI 2021 creatinine equation yangoku ayisebenzisi i-race variable. I-eGFR luqikelelo, hayi umlinganiselo.
• I-urea yegazi / i-BUN: Ibonakalisa ukuqhekeka kweproteni kunye nokususwa kwezintso. Ichatshazelwa kakhulu kumanzi, iproteni yokutya, ukopha kwamathumbu kunye nee-steroids, ngoko ke iyinto ebuthathaka emele yodwa ephawula izintso.
• Ii-electrolytes kunye neeminerali: i-sodium, i-potassium, i-calcium, i-phosphate kunye ne-bicarbonate zibonisa iziphumo zokusebenza kakubi kwezintso endaweni yokuzihluza ngokwazo.
• Umlinganiselo we-albumin-to-creatinine yomchamo (ACR): ibona ukuvuza kwe-albumin kwiifilitha ezonakeleyo. I-ACR inokuba yinto engaqhelekanga ngelixa i-eGFR iseyinto eqhelekileyo, yiyo loo nto uvavanyo lwegazi lodwa lunganelanga.
• Inkqubo yomchamo kunye ne-microscopy: Ikhangela iiproteni, igazi, iiseli ezimhlophe, ii-cast, iikristale kunye neglucose, nto leyo ebonisa ukuba kukho usulelo, ukudumba okanye amatye.
• I-Cystatin C: uphawu lokucoca olungeyongozi kangako kubunzima bemisipha, olusetyenziswa xa i-eGFR esekelwe kwi-creatinine isenokungalungi. Ukufumaneka kunye neendleko ziyahluka phakathi kweelabhoratri.

Isifo sezintso esingapheliyo sichazwa kukungasebenzi kakuhle kwesakhiwo sezintso okanye umsebenzi wazo oqhubeka ixesha elingaphezu kweenyanga ezintathu, kwaye sichazwa kusetyenziswa zombini i-eGFR (izigaba ze-G) kunye ne-albuminuria (izigaba ze-A), hayi i-eGFR yodwa. [Qinisekisa uhlelo lwangoku lwesikhokelo se-KDIGO CKD, UZA KUQINISEKISWA]

Kutheni kwenziwa uvavanyo lomsebenzi wezintso

• Ukuvavanya ukuhluzwa kwezintso xa iimpawu okanye iimpawu zeklinikhi zibonisa ingxaki
• Ukuhlola abantu abasengozini enkulu, njengabo banesifo seswekile okanye uxinzelelo lwegazi
• Ukujonga isifo sezintso esingapheliyo esaziwayo kunye nesantya sotshintsho lwaso
• Ukujonga ukusebenza kwezintso ngaphambi kokujonga imifanekiso yomahluko, utyando oluthile okanye amayeza athile
• Ukubeka esweni amayeza anokuchaphazela izintso okanye afuna ukulungiswa kwedosi ngokusebenza kwezintso
• Ukuvavanya ukwenzakala kwezintso okurhanelekayo ngexesha lokugula, ukuphelelwa ngamanzi emzimbeni okanye i-sepsis
• Ukuvavanya ii-electrolytes ezingaqhelekanga, i-anemia engachazekiyo okanye uxinzelelo lwegazi oluphezulu oluxhathisayo

Ngubani ofanele afumane olu vavanyo

I-KFT idla ngokucetyiswa xa:

• Abantu abanesifo seswekile: i-eGFR yonyaka kunye ne-ACR yomchamo, okanye rhoqo ukuba sele ingaqhelekanga
• Abantu abane-hypertension, ingakumbi ukuba uxinzelelo lwegazi kunzima ukululawula
• Abantu abanesifo sentliziyo okanye ukusilela kwentliziyo
• Nabani na onembali yosapho lwakhe yesifo sezintso, i-dialysis okanye ukufakelwa i-transplant
• Abantu abanamatye ezintso aphindaphindayo okanye usulelo lomchamo oluphindaphindayo
• Abantu abasebenzisa amayeza exesha elide ezifana nee-diuretics ezithile, ii-ACE inhibitors okanye ii-ARB, i-lithium, ii-NSAIDs zexesha elide okanye iindibaniselwano ze-pain-balm/i-painkiller, okanye unyango oluchasene nesifo sephepha
• Abantu abanokuvuvukala okungaziwayo, umchamo onamagwebu, igazi kumchamo okanye ukuncipha kokuphuma komchamo
• Abantu abanesifo sokuzikhusela komzimba, i-HIV, i-hepatitis B okanye i-C, okanye i-multiple myeloma
• Abantu abadala kunye nabantu abacwangciselwe utyando olukhulu okanye imifanekiso ephuculweyo

Iimpawu ezinokukhokelela kuvavanyo ziquka ukudumba kobuso, iinyawo okanye izandla, umchamo onegwebu okanye onamafu, igazi kumchamo, ukuphuma komchamo okunciphileyo okanye okugqithisileyo, isicaphucaphu esingapheliyo, ukungabi namdla wokutya, ukurhawuzelelwa, ukudinwa okungachazekiyo okanye ukuphefumla. Abantu abaninzi abanesifo sezintso kwasekuqaleni abanazo iimpawu konke konke, yiyo loo nto ukuhlolwa kwamaqela asemngciphekweni kubalulekile.

Oko uvavanyo lomsebenzi wezintso lungenakukwazi ukukubona okanye ukungakuvumeli

• Ayinakunika isizathu. I-KFT ayikwahluli isifo sezintso seswekile kwi-glomerulonephritis, ukuvaleka kwamalungu omzimba, ukwenzakala ngamayeza okanye isifo esibangelwa kukungasebenzi kakuhle kwamalungu omzimba.
• I-creatinine eqhelekileyo ayikhuphi isifo sezintso. I-Creatinine inokuhlala ngaphakathi koluhlu lwelebhu ide ilahleke inxalenye enkulu yokuhluza, ingakumbi kubantu abanezihlunu eziphantsi, abantu abadala kunye nabasetyhini abaninzi.
• Ayinakwahlula isifo esiyingozi kwisifo esinganyangekiyo ngokuthembekileyo xa yodwa. Ngaphandle kwamaxabiso angaphambili, i-creatinine ephakanyisiweyo enye ayinakukuxelela ukuba utshintsho ludala ngeentsuku okanye ngeminyaka.
• Ayikwazi ukubona ukuvaleka, amatye, amaqhuqhuva, iithumba okanye iingxaki zesakhiwo. Oko kufuna imifanekiso efana ne-ultrasound (USG KUB) okanye i-CT.
• Ayikwazi ukufumanisa isifo esikwinqanaba lezicubu zomzimba. Kuphela yi-biopsy yezintso enokubonisa izifo ezininzi ze-glomerular kunye ne-interstitial.
• I-eGFR ayithembekanga kumazwe angaqinisekanga. Ngexesha lokusebenza kwezintso okutshintsha ngokukhawuleza, ukukhulelwa, ubungakanani bomzimba obugqithisileyo, ukunqunyulwa kwelungu, isifo sokuqina kwesibindi okanye ukungondleki kakuhle, ii-eGFR equations azisebenzi kakuhle.
• I-dipstick yomchamo engalunganga yeproteni ayikhuphi i-albuminuria. Iidipstick azinangxaki nokulahleka kwe-albumin ephantsi; kufuneka i-quantitative ACR.

Ukuba i-KFT iqhelekile kodwa iimpawu zakho ziyaqhubeka, buyela kugqirha wakho. Iziphumo eziqhelekileyo zichaza oko kwalinganiswa ngaloo mini; azibonisi ukuba akukho nto ingalunganga.

Iimviwo ezinxulumeneyo kodwa ezahlukeneyo

Ukuba loluphi uvavanyo oluza kuqala luxhomekeke kwingxaki yezonyango. Xa kuhlolwa isifo seswekile, i-eGFR kunye ne-ACR yomchamo ziza kuqala. Xa kuthathwa iintlungu zethanga, kuthathwa imifanekiso yee-leads. Xa kuthathwa umkhuhlane xa kuchama, indlela yomchamo esetyenziswa ngayo kunye ne-culture leads. Xa kuthathwa umchamo onogwebu xa uvuvukile, kuthathwa ii-proteinuria leads ezilinganisiweyo. Akukho vavanyo lubalaseleyo kwihlabathi liphela, ziphendula imibuzo eyahlukeneyo.

Ukulungiselela

Ukulungiselela kubekwa yilebhu okanye isibhedlele esenza uvavanyo kwaye kuyahluka ngokweeyunithi. Imiyalelo ebhaliweyo yeyunithi yakho ibaluleke ngaphezu kwayo nayiphi na into ekweli phepha.

• Ukuzila ukudla: I-creatinine, i-urea kunye nee-electrolytes azisoloko zifuna ukuzila ukutya. Ukuzila ukutya kunokucelwa ukuba i-glucose, ii-lipids okanye ezinye iimvavanyo zihlanganiswe ne-KFT.
• Hydration: Sela amanzi ngokwesiqhelo ngaphandle kokuba unikwe umda wolwelo. Ukuphelelwa ngamanzi emzimbeni okanye ukugcwala kwamanzi amaninzi ngequbuliso akuniki ziphumo ziyinyani.
• Amayeza kunye nezongezo: Zisa uluhlu olupheleleyo, kuquka amayeza okudambisa iintlungu, amayeza e-ayurvedic okanye e-herbal, izongezo zejimu okanye zeproteni kunye ne-creatine. Musa ukuyeka naliphi na iyeza elinikiweyo ukulungiselela i-KFT, buza ummeli kuqala.
• Iiproteni kunye ne-creatine: Ukutya okuneproteni eninzi kakhulu, inyama ephekiweyo eninzi, okanye izongezo ze-creatine ngaphambi nje kokuba uvavanyo lunyuse i-creatinine. Xela ukutya okusandul’ ukuthathwa.
• Ukuzilolonga okunzima: Ukuzilolonga okunzima kwiiyure ezingama-24 ukuya kwezingama-48 ezidlulileyo kunokunyusa i-creatinine kwaye kubangele i-transient proteinuria. Xelela ilabhoratri ukuba oku kuyasebenza.
• Isampuli yomchamo: Ukuba ufuna i-ACR ethe kratya, kudla ngokukhethwa isampuli yasekuseni. Coca indawo, ulahle inxalenye yokuqala yomjelo uze uqokelele umjelo ophakathi kwisitya esingenazintsholongwane esinikiweyo.
• Iingqokelela ezicwangcisiweyo ngexesha: Uvavanyo lomchamo lweeyure ezingama-24, lahla isithuba sokuqala sasekuseni, uze uqokelele ithontsi ngalinye kwiiyure ezingama-24 ezilandelayo kuquka nesithuba sokuqala sakusasa esilandelayo, ugcine isikhongozeli sipholile njengoko kuyalelwe.

Ukuba ukhulelwe

I-Creatinine idla ngokuwa xa ukhulelwe kwaye ii-eGFR equations eziqhelekileyo aziqinisekiswa kubafazi abakhulelweyo. Uvavanyo lwe-proteinuria xa ukhulelwe lutolikwa ngendlela eyahlukileyo ngenxa ye-preeclampsia. Xelela ilabhoratri kunye nogqirha wakho wokubelekisa.

Ukuba unesifo seswekile kunyango lokunciphisa iswekile

Ukuba uceliwe ukuzila ukutya, buza ugqirha wakho ukuba ungayiphatha njani i-insulin okanye iipilisi ezifana ne-sulfonylureas kusasa ngosuku lovavanyo, kwaye uphathe umthombo weswekile. Musa ukuzila ukutya ixesha elide ngaphandle kwengcebiso.

Ukuba unesifo sentliziyo, i-CKD eqhubele phambili okanye unciphiso lolwelo

Musa ukwandisa ulwelo olusetyenziswayo ukuze "uhlambe izintso" ngaphambi kovavanyo. Gcina umlinganiselo wolwelo olumiselweyo kwaye uxelele abasebenzi abaqokelelayo ngalo.

abantwana

Iindidi ze-creatinine zabantwana kunye nee-eGFR equations zahlukile kwezo zabantu abadala, kwaye iziphumo kufuneka zitolikwe yingcali yabantwana okanye yingcali ye-nephrologist yabantwana. Iisampuli ezincinci kunye ne-phlebotomy eqeqeshwe ngabantwana ziyakhethwa.

Abantu abadala abadala

I-eGFR iyancipha kancinci xa ukhula, kwaye ubunzima bemisipha obuphantsi bunokwenza i-creatinine ibonakale inika ithemba. I-ACR yomchamo kunye neendlela zangaphambili zibaluleke kakhulu kweli qela.

Kwenzeka ntoni ngexesha lovavanyo

• Ubhaliso kunye nokujonga: Iinkcukacha zakho, iimvavanyo eziceliweyo kunye nayo nayiphi na imiyalelo yokuzila ukutya ziyaqinisekiswa.
• Isampuli yegazi: Kusetyenziswa i-tourniquet engalweni engasentla, ulusu luyacocwa, kuze kusetyenziswe inaliti ukutsala igazi elivela kumthambo okwi-elbow crease liye kwityhubhu enye okanye ezingaphezulu. Kulandela uxinzelelo kunye ne-dressing encinci.
• Isampuli yomchamo: ziqokelelwe kwisitya esingenazintsholongwane kwigumbi lokuhlambela, okanye zilethwe zisuka kwingqokelela ebekelwe ixesha ekhaya.
• Ukuqonda: ukuhlaba okwethutyana ngexesha lokuhlatywa ngenaliti, ngamanye amaxesha ukukrweleka okuncinci emva koko.

Ixesha elithathayo le nkqubo

• Ukutsalwa kwegazi: ngesiqhelo imizuzu emi-5 ukuya kweli-10 ukusuka kwi-tourniquet ukuya kwi-dressing.
• Utyelelo lulonke: ngokuqhelekileyo imizuzu eli-15-30 kuquka ukubhalisa nokulinda.
• Umchamo onamachaphaza: imizuzu embalwa.
• Ingqokelela yomchamo weyure ezingama-24: iiyure ezingama-24 ezipheleleyo ekhaya, kunye notyelelo lokuhambisa isampuli.
• Ingxelo yokufumaneka: iyahluka ngokwelabhoratri kunye nokuba i-KFT sisicelo sesiqhelo okanye esingxamisekileyo. Buza iziko lokuqokelela ukuba ingxelo yakho iza kuba ilungile nini.

Ukuqonda ingxelo yakho ye-KFT

Funda ingxelo ngokuthelekisa uluhlu lwereferensi olushicilelwe yilabhoratri esebenza. Uluhlu lwahluka phakathi kweelabhoratri ngenxa yeendlela ezahlukeneyo zokuhlalutya, ngoko ke musa ukuthelekisa amanani akho noluhlu oluvela kwenye ilebhu okanye kwi-intanethi.

• I-creatinine ye-serum: Amaxabiso aphezulu adla ngokubonisa ukunciphisa ukuhluzwa, kodwa ubunzima bemisipha, isini, ubudala, ukutya kunye nokufakelwa kwamanzi emzimbeni konke kuyayitshintsha le nombolo. Ixabiso "eliqhelekileyo" kwindoda eselula enezihlunu linokulindeleka ngokupheleleyo; ixabiso "eliqhelekileyo" kwibhinqa elikhulileyo elibuthathaka linokufihla ukukhubazeka kokwenyani.
• i-eGFR: Kuxelwe kwi-mL/min/1.73m? Amaxabiso aphantsi abonisa ukuncipha kokuhluzwa. I-eGFR enye ephantsi ayisosifo sezintso esingapheliyo, kufuneka ihlale ixesha elide kuneenyanga ezintathu. I-eGFR ayithembeki xa umsebenzi wezintso utshintsha ngokukhawuleza.
• I-Urea / I-BUN: Inyuka xa kuhluzwa kancinci, kodwa ikwanyuka xa kuncitshiswa amanzi emzimbeni, kutyiwa iiproteni ezininzi, kuphuma igazi esiswini, kukho ii-steroids kunye nesifo se-catabolic. I-urea ephakanyisiweyo ene-creatinine eqhelekileyo idla ngokubonisa esinye sezi zifo kunokuba ibe sisifo sezintso.
• I-ACR yomchamo: Amaxabiso aphezulu abonisa ukuvuza kwe-albumin engaphezulu. Iindidi zisetyenziselwa ukulinganisa i-albuminuria, kwaye ukuqinisekiswa kwisampuli ephindaphindwayo yasekuseni kuyinto eqhelekileyo ngaphambi kokuba kubhalwe i-albuminuria engapheliyo.
• Potassium: zombini ixabiso eliphezulu neliphantsi libalulekile kwaye linokuba yinto engxamisekileyo ngokwezonyango. I-Haemolysis ngexesha lokuqokelelwa kwe-plasma inokunyusa i-potassium ngokungekho mthethweni.
• I-Trend idlula ixabiso elinye. Indlela yokutshintsha kwiingxelo ezahlukeneyo idla ngokuba luncedo ngakumbi kunalo naliphi na inani.

Ingxelo ye-KFT ayisiyonto yokuxilonga. Yiyise kugqirha ocele yona, kunye neengxelo zakho zangaphambili kunye noluhlu lwamayeza. Iziphumo ziyahluka ngokuxhomekeke kwiimeko zeklinikhi nganye.

Xa iziphumo ze-KFT zinokulahlekisa

I-Creatinine iphakanyisiwe ngokungekho mthethweni (izintso zisebenza ngcono kunokuba zibonakala)

• Ubunzima obukhulu bemisipha, ukwakha umzimba, i-creatine okanye izongezo zeproteni ezinedosi ephezulu
• Ukutya inyama eninzi okanye umthambo onzima ngaphambi nje kokuba kuthathwe isampuli
• Amayeza athintela ukukhutshwa kwe-creatinine ngaphandle kokunciphisa ukuhluzwa, njenge-trimethoprim kunye ne-cimetidine
• Ukuphelelwa ngamanzi emzimbeni okubangela ukunyuka kwangaphambi kokuchacha okulungisa ngokubuyisela amanzi emzimbeni
• Ukuphazamiseka okuthile kovavanyo, kuquka i-hyperbilirubinemia ephawulekayo okanye ezinye ii-ketones

I-Creatinine iqinisekisa ngokungeyonyani (ukusebenza kwezintso kubi kunokuba kubonakala)

• Ubunzima bemisipha obuphantsi, ubuthathaka, i-sarcopenia, ukungondleki kakuhle, ukugula okungapheliyo
• Ukunqunyulwa kwamalungu omzimba okanye ukukhubazeka komzimba
• Isifo sesibindi esiphucukileyo
• Ukutya kwemifuno okuneproteni ephantsi
• Ukukhulelwa, apho i-creatinine iwa khona ngokwe-physiologically

I-Urea/BUN ilahlekisa kwicala ngalinye

• Ukuphakama okungachanekanga: ukuphelelwa ngamanzi emzimbeni, ukutya iiproteni ezininzi, ukopha kwamathumbu, ii-corticosteroids, imeko ye-catabolic
• Iphantsi ngobuxoki: ukutya okuncinci kweproteni, isifo sesibindi, ukukhulelwa, ukopha kakhulu

I-ACR yomchamo ephakanyisiwe ngokungekho mthethweni

• Usulelo lomchamo, umkhuhlane, igazi eliphuma exesheni okanye ukungcola okuphuma kwilungu lobufazi
• Ukuzilolonga ngamandla kwiiyure ezingama-24 ezidlulileyo
• I-hyperglycemia ephawulekayo, ukusilela kwentliziyo okungekho mali, uxinzelelo lwegazi oluphezulu kakhulu
• Ukuma nkqo ixesha elide (i-orthostatic proteinuria, exhaphake kakhulu kulutsha)

Umchamo we-ACR wehliswe okanye waxutywa ngokungekho mthethweni

• Umchamo uncitshiswe kakhulu emva kokusebenzisa ulwelo oluninzi
• Ingqokelela engaphelelanga okanye engalunganga yeeyure ezingama-24, nto leyo engumthombo oqhelekileyo wempazamo kwizifundo zokucoca

Izinto zobugcisa ze-Electrolyte

• I-Potassium inyuswe ngokungekho mthethweni yi-haemolysis, ixesha elide le-tourniquet, ukuqiniswa kwesandla okanye ukucocwa kwesampuli okulibazisekileyo
• I-sodium iphantsi kakhulu xa kukho i-hyperlipidemia okanye i-paraproteinaemia kwezinye iindlela.

Iingozi kunye nokhuseleko

Isampuli yegazi (i-venepuncture)

Umngcipheko ophantsi ngokubanzi. Iziphumo ezinokubakho ziquka intlungu emfutshane, ukukrweleka, i-hematoma encinci, ukuba nentloko ekhaphukhaphu okanye ukuquleka, kunye nosulelo olungaqhelekanga lwengingqi okanye ukurhawuzelelwa yimithambo-luvo. Xelela abasebenzi ukuba uthatha amayeza okunciphisa igazi, ukukrweleka lula okanye ukhe waquleka ngexesha lovavanyo lwegazi ngaphambili.

Isampulu yomchamo

Akukho mngcipheko ngokwasemzimbeni. Ingxaki ephambili yimpazamo yesampulu, ungcoliseko okanye ukuqokelelwa okungaphelelanga ngexesha okukhokelela kwisiphumo esilahlekisayo kunye novavanyo oluphindaphindwayo olungeyomfuneko.

Uphando olunxulumeneyo oluneeprofayili ezahlukeneyo zomngcipheko

Umngcipheko awufani kuzo zonke izifundo zezintso. I-ultrasound KUB ayibandakanyi imitha. I-CT KUB ibandakanya i-ionizing radiation. Izifundo eziphuculweyo zinezinto ezinxulumene nemitha ezixhomekeke ekusebenzeni kwezintso. I-biopsy yezintso iyangena kwaye inomngcipheko obalulekileyo wokopha ofuna ukubekwa esweni. Ezi zixoxwa ngokwahlukeneyo ngugqirha ozicebisayo.

Iimeko ezikhethekileyo

Ukukhulelwa

Ukuhluzwa kwezintso kudla ngokwanda kwaye i-creatinine iyehla. Ii-eGFR equations eziqhelekileyo aziqinisekiswanga xa ukhulelwe. I-proteinuria entsha okanye uxinzelelo lwegazi emva kweeveki ezingama-20 zifuna uvavanyo olukhawulezileyo lwe-obstetric.

abantwana

Uluhlu lweereferensi zabantwana kunye nee-eGFR equations zahlukile kwezo zabantu abadala. Ukukhula, isondlo kunye nokungahambi kakuhle kwendlela yomchamo yokuzalwa kubalulekile, kwaye ukutolikwa kufanele kuxhomekeke kubantwana.

Abantu abadala abadala

Ukuncipha kwe-eGFR okuncinci kuqhelekile xa ukhula kwaye akuthethi ukuba isifo siyaqhubeka ngokuzenzekelayo. I-Albuminuria kunye nomkhwa ngokuhamba kwexesha zithwala ubunzima obungakumbi. Iidosi zamayeza zihlala zifuna ukulungiswa kokusebenza kwezintso.

Isifo seswekile kunyango lokunciphisa iswekile

I-eGFR yonyaka kunye ne-ACR yomchamo zizinto eziqhelekileyo. Amanye amayeza okwehlisa iswekile afuna uphononongo lwedosi njengoko i-eGFR itshintsha. Naluphi na utshintsho kufuneka luvele kugqirha, kungabi kwingxelo yodwa.

Izifo zesifo esingapheliyo

Ukujonga rhoqo kuxhomekeke kwinqanaba, i-albuminuria kunye nesantya sotshintsho. Ziphephe ii-NSAID ezithengiswa ngaphandle kwemvume kagqirha, amayeza emifuno angaqinisekiswanga okanye "okucoca izintso", kunye nezongezo zedosi ephezulu ngaphandle kokuxoxa ngazo nogqirha wakho wezifo zengqondo.

Ukumelwa yintliziyo

I-Creatinine kunye ne-urea zihlala zitshintshatshintsha ngokwedosi yokukhupha isisu kunye nesimo solwelo. Ukunyuka ngexesha lonyango lokukhupha isisu akuthethi ukuba izintso ziyalimala ngokuzenzekelayo kwaye kufuneka kuchazwe kunye neempawu kunye nobunzima.

Isifo esiqatha, umkhuhlane okanye ukuphelelwa ngamanzi emzimbeni

Amanani e-KFT athathwa ngexesha lokugula okukhawulezileyo asenokungabonisi ukusebenza kwezintso okusisiseko. Uvavanyo oluphindaphindwayo emva kokuchacha ludla ngokufuneka ngaphambi kokuba kubhalwe igama lesifo esinganyangekiyo.

Uvavanyo lomsebenzi wezintso kwimeko yaseIndiya

• Isigama: I-KFT kunye ne-RFT zisetyenziswa ngokutshintshana kwiilabhoratri zaseIndiya, kwaye umxholo wephaneli wahlukile kwiilabhoratri. Jonga ukuba zeziphi izinto eziqukwa yingxelo yakho, uninzi lweephaneli ze-"KFT" azibandakanyi i-urine ACR, ekufuneka icelwe ngokwahlukeneyo.
• Isifo seswekile kunye noxinzelelo lwegazi zezona zibangela isifo sezintso esinganyangekiyo eIndiya, nto leyo eyenza ukuba uvavanyo lwe-eGFR kunye nomchamo lwe-ACR lube yinto ebalulekileyo kula maqela.
• Ukwakheka komzimba waseMzantsi Asia: Isifo se-metabolic senzeka kwi-BMI ephantsi kubantu baseMzantsi Asia, kwaye ubunzima bemisipha obuphantsi kubantu abadala abaninzi buthetha ukuba i-creatinine isenokungabonisi ukukhubazeka kwezintso. I-eGFR, hayi i-creatinine yodwa, kufuneka isetyenziswe.
• Amayeza kunye nezongezo: Ukufikelela lula kwii-NSAIDs kunye neendidi zentlungu ngaphandle kwekhawuntara, amanye amalungiselelo e-ayurvedic, e-herbal kunye ne-heavy-metal, kunye ne-gym protein okanye izongezo ze-creatine zonke zibalulekile kwiziphumo zezintso. Unyango lwe-anti-tubercular kunye namanye ama-antibiotics nawo afuna idosi esekelwe kumsebenzi wezintso.
• Iintsholongwane kunye namatye: Umthwalo omkhulu wesifo samatye omchamo kwiindawo ezisemantla nasentshona yeIndiya, kunye nosulelo olushushu olunokuchaphazela izintso, kuthetha ukuba uvavanyo lomchamo kunye nemifanekiso zihlala zifuneka kunye ne-KFT yegazi.
• I-Hemoglobinopathy kunye ne-anemia: Iimpawu ze-thalassemia kunye ne-anemia yokungabikho kwesinyithi zixhaphakile kwaye zichaphazela ukutolikwa kovavanyo oluhambelanayo olufana ne-HbA1c, oluxelwe kwi-% (NGSP) kunye ne-mol/mol (IFCC), xa isifo seswekile kunye nesifo sezintso zihlolwa kunye.
• Ukukhusela idatha: Iingxelo zelebhu kunye nobhaliso lweeportal ezikwi-intanethi zibandakanya idatha yempilo yomntu ephathwa phantsi koMthetho woKhuseleko lweDatha yoBuqu yeDijithali, ka-2023. Buza ukuba idatha yengxelo yakho igcinwa kwaye yabelwana ngayo.
• Ulawulo lomfanekiso: apho i-ultrasound yongezwa kuvavanyo lwezintso kumfazi osemdala wokuzala, amaziko aseIndiya asebenza phantsi koMthetho we-PC-PNDT, ka-1994, kwaye ukuchonga isini akuvumelekanga.

Ixabiso kunye ne-inshurensi eIndiya

Iindleko zahlukile kakhulu phakathi kwezixeko, phakathi kweelabhoratri zikarhulumente nezabucala, kwaye ngokwenani labahlalutyi eliqukiweyo yiphaneli. Amanani acatshulwe naphi na kufuneka athathwe njengokubonisa kuphela; qinisekisa ixabiso langoku nelabhoratri ngaphambi kovavanyo.

Izinto ezichaphazela imali oyihlawulayo:

• Ubungakanani bePaneli: iphaneli ye-urea-creatinine-electrolyte esisiseko ixabisa ngaphantsi kuneprofayili ende yezintso
• Uvavanyo olongezelelweyo: Uvavanyo lomchamo lwe-urine ACR, i-cystatin C kunye novavanyo lomchamo oluqhutywa iiyure ezingama-24 ludla ngokuhlawuliswa ngokwahlukeneyo; i-cystatin C ibiza kakhulu kwaye ayifumaneki lula.
• Uhlobo lwelebhu: iziko likarhulumente, iziko lokuqokelelwa elizimeleyo, ilabhoratri yesibhedlele okanye ilabhoratri yokubonisa
• Ukuqinisekiswa kunye nokuguqulwa kwemisebenzi: iilabhoratri ezivunyiweyo kunye nokulungiswa okungxamisekileyo okanye kwe-STAT zihlala zibiza ngaphezulu
• Ingqokelela yasekhaya kunye neentlawulo zokuthatha iisampulu emva kweeyure zomsebenzi
• Iiphakheji zempilo ezihlanganisiweyo, ezidla ngokuquka i-creatinine kunye ne-urea kodwa zingabandakanyi i-ACR yomchamo
• Isixeko kunye nemeko yeklinikhi, kuquka ukuhlawuliswa kwezigulane ezilaliswayo xa kuthelekiswa nezigulane ezingalaliswanga

Kwi-inshorensi: uvavanyo lokuxilonga lwezigulane ezingalaliswanga ekhaya alusoloko lugutyungelwe yi-inshorensi yezempilo eqhelekileyo ngaphandle kokuba ipolisi ibandakanya i-OPD okanye inzuzo yokuxilonga. I-KFT eyenziwa njengenxalenye yenkqubo yokwamkelwa okanye yokhathalelo lwasemini idla ngokugutyungelwa kwibango lokulaliswa esibhedlele. Iinkqubo zikarhulumente kunye neenkqubo zempilo zabaqeshi zinoluhlu lwazo lwamaxabiso. Jongana ne-inshorensi yakho okanye idesika yokuhlawula isibhedlele ngaphambi kovavanyo.

Iintsomi nezibakala

Imibuzo ebuzwa qho

Ngaba kufuneka ndizile ukutya ukuze ndibe ne-KFT?

I-Creatinine, i-urea kunye nee-electrolytes azidingi kuzila ukutya. Ukuzila ukutya kudla ngokucelwa xa i-glucose okanye ii-lipids zihlanganiswe kutyelelo olunye. Ngenxa yokuba iimfuno zahlukile kwiilabhoratri, landela imiyalelo ebhaliweyo evela kwiyunithi eyenza uvavanyo lwakho endaweni yomthetho oqhelekileyo.

Ngaba i-KFT iyafana novavanyo lomchamo?

Hayi. I-KFT yegazi iqikelela ukuhluzwa nge-creatinine, i-eGFR, i-urea kunye nee-electrolytes. Uvavanyo lomchamo, i-microscopy eqhelekileyo okanye i-albumin-to-creatinine ratio, ifumanisa umonakalo, ukuvuza kweproteni, igazi kunye nosulelo. Ezi zimbini ziphendula imibuzo eyahlukeneyo, kwaye uvavanyo lwegazi lodwa lunokuphosa umonakalo wezintso kwangethuba ngokupheleleyo.

Ngaba i-creatinine yam ingaba phezulu ngaphandle kwesifo sezintso?

Ewe. Ubunzima obukhulu bemisipha, izongezo ze-creatine okanye zeproteni, ukutya inyama eninzi, umthambo onzima, ukuphelelwa ngamanzi emzimbeni, kunye namayeza anjenge-trimethoprim okanye i-cimetidine anokunyusa i-creatinine ngaphandle kokuhluzwa okuncitshisiweyo. Ugqirha wakho uhlala ephinda uvavanyo phantsi kweemeko ezizinzileyo ngaphambi kokuba enze izigqibo.

Kuthetha ukuthini ukuba i-eGFR ephantsi kwingxelo enye?

I-eGFR enye ephantsi ibonisa ukuncipha kokuhluzwa okuqikelelweyo ngaloo mini kuphela. Oku kunokubonakalisa ukugula okukhawulezileyo, ukuphelelwa ngamanzi emzimbeni okanye isiphumo seyeza. Isifo sezintso esingapheliyo sifuna ukungaqhelekanga okuhlala ixesha elingaphezu kweenyanga ezintathu, ngoko ke kufuneka uvavanyo oluphindaphindiweyo kunye nothelekiso neengxelo zangaphambili.

Yeyiphi engcono, yi-creatinine okanye yi-cystatin C?

Akukho nanye kwezi zilungileyo kuyo yonke indawo. I-eGFR esekelwe kwi-creatinine ayibizi kakhulu kwaye ifumaneka ngokubanzi. I-Cystatin C ayichaphazeleki kakhulu bubunzima bemisipha kwaye iluncedo xa i-creatinine isenokukhohlisa, njengakwimeko yobuthathaka, ukunqunyulwa kwelungu okanye ubunzima bemisipha obuphezulu kakhulu. Ukufumaneka kunye neendleko ziyahluka phakathi kweelabhoratri.

Ndifanele ndiphinde kangaphi i-KFT?

Ukuphindaphinda kuxhomekeke kwisizathu sovavanyo. Ukuhlolwa kwesifo seswekile esizinzileyo okanye uxinzelelo lwegazi oluphezulu kudla ngokwenziwa minyaka le nge-ACR yomchamo. Isifo sezintso esinganyangekiyo esikhoyo, utshintsho lwamayeza akutshanje okanye ukugula okukhawulezileyo kunokufuna uvavanyo oluqhubekayo. Ugqirha wakho onyangayo ugqiba ixesha elimiselweyo ngokusekwe kwinqanaba lakho kunye nendlela oqhuba ngayo.

Ngaba ndifanele ndiyeke amayeza am oxinzelelo lwegazi okanye eswekile ukuba i-KFT yam ayiqhelekanga?

Hayi. Musa ukuyeka okanye ukutshintsha naluphi na unyango olunikiweyo ngokusekelwe kwingxelo. Amanye amayeza akhusela izintso abangela ukunyuka okuncinci kwe-creatinine okulindelekileyo. Yisa ingxelo kugqirha, oya kugqiba ukuba ukulungiswa kwedosi, ikhefu lexeshana ngexesha lokugula, okanye akukho tshintsho lufanelekileyo.

Ngaba i-KFT ingawabona amatye ezintso?

Ayithembekanga. I-KFT ingabonisa ukuhluzwa okungasebenzi kakuhle ukuba ilitye liyavaleka, kodwa amatye ngokwawo ayinto efunyenweyo kwisakhiwo. I-Ultrasound KUB ibonisa i-hydronephrosis kunye namatye amaninzi; i-non-contrast CT KUB inovelwano kakhulu kwi-renal colic ekrokrelwayo kubantu abadala abaninzi abangakhulelwanga.

I-KFT yam iqhelekile kodwa ndisenomchamo odumbileyo nonamagwebu. Kuza kwenzeka ntoni emva koko?

Buyela kugqirha wakho. I-KFT yegazi eqhelekileyo ayikhuphi isifo sezintso, kwaye i-albuminuria inokubakho kunye ne-eGFR eqhelekileyo. Iprotheyini yomchamo okanye i-ACR elinganisiweyo, i-microscopy yomchamo, uphononongo loxinzelelo lwegazi, kwaye ngamanye amaxesha imifanekiso okanye ukudluliselwa kwingcali ngamanyathelo aqhelekileyo alandelayo.

imithombo

• Isikhokelo seKDIGO Clinical Practice soVavanyo kunye noLawulo lweSifo seNtso esiNgapheliyo [Qinisekisa uhlelo lwangoku, LUZA KUQINISEKISWA]
• U-Inker LA, u-Eneanya ND, uCoresh J, nabanye. Ii-Creatinine- kunye ne-C-Based Equations ezitsha zokulinganisa i-GFR ngaphandle kohlanga. Ijenali yezonyango yaseNew England, ngo-2021.
• I-National Kidney Foundation kunye ne-American Society of Nephrology Task Force on Reclassifying the Use of Race in eGFR, iingcebiso ezidibeneyo, 2021.
• IBhunga laseIndiya loPhando lwezoNyango, unyango oluqhelekileyo kunye nesikhokelo sokuxilonga ngesifo sezintso esingapheliyo [Qinisekisa uhlelo lwangoku, LUZA KUQINISEKISWA]
• UMthetho woBuchule bokuQondwa kwaNgaphambi kokukhulelwa kunye neendlela zokuxilonga ngaphambi kokuzalwa (uMthetho wokuThintela uKhetho lweSini), ka-1994, uRhulumente waseIndiya.
• UMthetho woKhuseleko lweDatha yoBuqu yeDijithali, ka-2023, uRhulumente waseIndiya.