Ukuhlolwa Kokusebenza Kwezinso (KFT): Lokho Okukalayo, Lokho Okuphuthelwa Yikho, kanye Nokuthi Ungawufunda Kanjani Umbiko Wakho

Ukuthatha okhiye

• I-KFT ilinganisela ukuhlunga, hhayi imbangela. I-creatinine ephakanyisiwe ikutshela ukuthi ukuhluzwa kunciphile; ayikutsheli ukuthi imbangela iwukuphelelwa amanzi emzimbeni, ukuvaleka, imithi noma isifo esingamahlalakhona.
• Ukuhlolwa kwegazi kuphela akuphelele. Isilinganiso se-albumin-to-creatinine yomchamo (i-ACR) sithola umonakalo wezinso ongaphuthelwa yi-creatinine kanye ne-eGFR ngokuphelele.
• I-KFT evamile ayikukhiphi isifo sezinso. Umonakalo omkhulu wezinso ungaba khona nge-creatinine evamile, ikakhulukazi kubantu abanemisipha ephansi.
• Umphumela owodwa ongavamile awukona ukuxilongwa. Isifo sezinso esingamahlalakhona sidinga ukungajwayelekile okuqhubeka okungenani izinyanga ezintathu, okuqinisekiswa ekuhlolweni okuphindaphindiwe.
• Ukuhumusha kudinga umongo. Udokotela kuphela ocele i-KFT ongayifunda ngokweminyaka yakho, ubunzima bemisipha, imithi, izimpawu kanye namanani akho angaphambilini.

Nge-shazi

Obeye aziwe njengo

• Ukuhlolwa kokusebenza kwezinso kwe-KFT / RFT (i-renal function test)
• Iphrofayili yezinso, iphrofayili yezinso, iphaneli yezinso
• "Ukuhlolwa kwezinso", "ukuhlolwa kwe-creatinine", "ukuhlolwa kwe-urea creatinine"
• Ukusetshenziswa kwesiHindi/kwesilungu: gurde ki jaanch, kidney ki jaanch, "ukuhlolwa kwegazi lezinso"
• Ukuhlolwa komchamo okuhlobene kuvame uku-oda kanye: inqubo yomchamo kanye ne-microscopy, i-urine ACR (ukuhlolwa kwe-urine albumin)

Kuyini ukuhlolwa kokusebenza kwezinso

Izinso zihlunga imfucuza kanye noketshezi oluningi oluvela egazini, zilinganise usawoti kanye ne-asidi, zisize ekulawuleni umfutho wegazi, zisebenze i-vitamin D futhi zikhiqize i-erythropoietin, eqhuba ukukhiqizwa kwamangqamuzana abomvu egazi. I-KFT iyindlela engaqondile yokuhlola lowo msebenzi wokuhlunga usebenzisa izimpawu egazini nasemchameni.

Izingxenye ezivamile kanye nalokho okunikelwa yizo ngayinye:

• I-creatinine ye-serum: umkhiqizo ongcolile ovela ekuguqukeni kwemisipha okuvamile, osuswa kakhulu yizinso. Uyakhuphuka njengoba ukuhlunga kwehla, kodwa izinga libuye lincike ebunzini bemisipha, ukudla kanye nobudala.
• I-GFR elinganiselwe (eGFR): ukubalwa okuvela ku-creatinine kanye nobudala nobulili okulinganisa ukuhluzwa ku-mL/min/1.73m? I-CKD-EPI 2021 creatinine equation yamanje ayisebenzisi i-race variable. I-eGFR iyisilinganiso, hhayi isilinganiso.
• I-urea yegazi / i-BUN: Kubonisa ukuwohloka kwamaprotheni kanye nokuhlanzwa kwezinso. Kuthonywa kakhulu ngamanzi, iphrotheni yokudla, ukopha kwamathumbu kanye nama-steroid, ngakho-ke kuyisibonakaliso sezinso esibuthakathaka esizimele.
• Ama-electrolyte namaminerali: i-sodium, i-potassium, i-calcium, i-phosphate kanye ne-bicarbonate kubonisa imiphumela yokusebenza kwezinso okungasebenzi kahle kunokuba kube ukuhlunga ngokwako.
• Isilinganiso se-albumin-to-creatinine yomchamo (ACR): ithola ukuvuza kwe-albumin ngezihlungi ezonakele. I-ACR ingaba yinto engajwayelekile kuyilapho i-eGFR isajwayelekile, yingakho ukuhlolwa kwegazi kuphela kunganele.
• Indlela yomchamo kanye ne-microscopy: ifuna amaprotheni, igazi, amangqamuzana amhlophe, ama-cast, amakristalu kanye ne-glucose, okunikeza izinkomba zokutheleleka, ukuvuvukala noma amatshe.
• I-Cystatin C: uphawu lokuhlunga oluhlukile olungathinteki kakhulu yisisindo semisipha, olusetshenziswa lapho i-eGFR esekelwe ku-creatinine ingase idukise. Ukutholakala kanye nezindleko kuyahlukahluka phakathi kwama-laboratory.

Isifo sezinso esingamahlalakhona sichazwa ukungalingani kwesakhiwo sezinso noma ukusebenza kwazo okuhlala isikhathi esingaphezu kwezinyanga ezintathu, futhi sihlukaniswa ngezigaba kusetshenziswa i-eGFR (izigaba ze-G) kanye ne-albuminuria (izigaba ze-A), hhayi i-eGFR yodwa. [Qinisekisa uhlelo lwamanje lwesiqondiso se-KDIGO CKD, KUZOQINISEKISWA]

Kungani kwenziwa ukuhlolwa kokusebenza kwezinso

• Ukuhlola ukuhluzwa kwezinso uma izimpawu noma izimpawu zomtholampilo ziphakamisa inkinga
• Ukuhlola abantu abasengozini enkulu, njengalabo abanesifo sikashukela noma umfutho wegazi ophakeme
• Ukuqapha isifo sezinso esingamahlalakhona esaziwayo kanye nezinga lokushintsha kwaso
• Ukuhlola ukusebenza kwezinso ngaphambi kokuthatha izithombe ezibonisa umehluko, ukuhlinzwa okuthile noma imithi ethile
• Ukuqapha imithi engathinta izinso noma edinga ukulungiswa komthamo ngokusebenza kwezinso
• Ukuhlola ukulimala okusolwayo kwezinso ngesikhathi sokugula, ukuphelelwa amanzi emzimbeni noma i-sepsis
• Ukuhlola ama-electrolyte angajwayelekile, i-anemia engachazeki noma umfutho wegazi ophakeme omelana nawo

Ubani okufanele athole lolu vivinyo

I-KFT ivame ukwelulekwa uma:

• Abantu abanesifo sikashukela: i-eGFR yonyaka kanye ne-ACR yomchamo, noma kaningi uma kakade kungavamile
• Abantu abanomfutho wegazi ophakeme, ikakhulukazi uma umfutho wegazi kunzima ukuwulawula
• Abantu abanesifo senhliziyo noma ukwehluleka kwenhliziyo
• Noma ubani onomlando womndeni wesifo sezinso, i-dialysis noma ukufakelwa
• Abantu abanamatshe ezinso aphindaphindayo noma izifo zomchamo eziphindaphindayo
• Abantu abasebenzisa imithi yesikhathi eside njengemithi ethile yokukhipha isisu, ama-ACE inhibitors noma ama-ARB, i-lithium, ama-NSAID esikhathi eside noma inhlanganisela ye-pain-balm/painkiller, noma ukwelashwa okulwa nesifo sofuba
• Abantu abanokuvuvukala okungachazeki, umchamo onegwebu, igazi emchameni noma ukwehla kokukhishwa komchamo
• Abantu abanesifo sokuzivikela komzimba, i-HIV, i-hepatitis B noma i-C, noma i-multiple myeloma
• Abantu abadala kanye nabantu abahlelelwe ukuhlinzwa okukhulu noma izithombe ezithuthukisiwe

Izimpawu ezingase zibangele ukuhlolwa zifaka phakathi ukuvuvukala kobuso, izinyawo noma izandla, umchamo onegwebu noma onamagwebu, igazi emchameni, ukuphuma komchamo okunciphile noma okweqile, isicanucanu esiqhubekayo, ukungakuthandi ukudla, ukulunywa, ukukhathala okungachazeki noma ukuphelelwa umoya. Abantu abaningi abanesifo sezinso ekuqaleni abanazo nhlobo izimpawu, yingakho ukuhlolwa emaqenjini asengozini kubalulekile.

Lokho ukuhlolwa kokusebenza kwezinso okungenakukwazi ukukubona noma ukukukhipha

• Akunakunikeza isizathu. I-KFT ayihlukanisi isifo sezinso esinesifo sikashukela ne-glomerulonephritis, ukuvaleka kwemithambo yegazi, ukulimala kwezidakamizwa noma isifo esithinta izinso.
• I-creatinine evamile ayikuvimbeli ukugula kwezinso. I-Creatinine ingahlala ngaphakathi kwebanga lelabhorethri kuze kube yilapho ingxenye enkulu yokuhlunga ilahlekile, ikakhulukazi kubantu abanemisipha ephansi, abantu abadala kanye nabesifazane abaningi.
• Ayikwazi ukuhlukanisa isifo esiyingozi nesingapheli ngokuthembekile uma ihlukanisiwe. Ngaphandle kwamanani angaphambilini, i-creatinine eyodwa ephakanyisiwe ayikwazi ukukutshela ukuthi ushintsho luyizinsuku noma iminyaka.
• Ayikwazi ukubona ukuvinjelwa, amatshe, ama-cyst, amathumba noma izinkinga zesakhiwo. Lokho kudinga izithombe ezifana ne-ultrasound (USG KUB) noma i-CT.
• Ayikwazi ukuxilonga isifo esisezingeni lezicubu. Ukuhlolwa kwezinso kuphela okungachaza izifo eziningi ze-glomerular kanye ne-interstitial.
• I-eGFR ayithembekile ezimweni ezingazinzile. Ngesikhathi sokusebenza kwezinso okushintsha ngokushesha, ukukhulelwa, ubukhulu bomzimba obukhulu, ukunqunywa kwezicubu, isifo sokuqina kwesibindi noma ukungondleki kahle okukhulu, izibalo ze-eGFR azisebenzi kahle.
• I-dipstick yomchamo engalungile yeprotheni ayikususi i-albuminuria. Izinti zokuhlola azinandaba nokulahlekelwa yi-albumin ezingeni eliphansi; kudingeka i-ACR eningi.

Uma i-KFT ijwayelekile kodwa izimpawu zakho ziqhubeka, buyela kudokotela wakho. Umphumela ojwayelekile uchaza ukuthi kwalinganiswa ini ngalolo suku; awufakazeli ukuthi akukho okungahambi kahle.

Ukuhlolwa okuhlobene kodwa okuhlukile

Ukuthi yikuphi ukuhlolwa okuza kuqala kuncike enkingeni yezokwelapha. Ukuhlolwa kwesifo sikashukela, i-eGFR kanye ne-ACR yomchamo kuza kuqala. Ubuhlungu bethanga obusikisela itshe, ukuthathwa kwezithombe zama-lead. Umkhuhlane ohambisana nokuchama okushisayo, inqubo yomchamo kanye ne-lead yokukhulisa. Ukuhlolwa komchamo onamagwebu okuhambisana nokuvuvukala, ama-lead e-proteinuria alinganisiwe. Akukho ukuhlolwa okukodwa okuphakeme kakhulu emhlabeni wonke, baphendula imibuzo ehlukene.

Ungalungiselela kanjani

Ukulungiselela kusethwa yilabhorethri noma isibhedlela esenza ukuhlolwa futhi kuyahlukahluka phakathi kwamayunithi. Imiyalelo ebhaliwe yeyunithi yakho iza kuqala kunanoma yini ekuleli khasi.

• Ukuzila ukudla: I-creatinine, i-urea kanye nama-electrolyte ngokuvamile akudingi ukuzila ukudla. Ukuzila ukudla kungacelwa uma i-glucose, amafutha noma ezinye izivivinyo zihlanganiswa ne-KFT.
• Ukuhambisa amanzi: phuza amanzi njalo ngaphandle kokuthi unikezwe imikhawulo yoketshezi. Ukuphelelwa amanzi emzimbeni noma ukugcwala kwamanzi amaningi ngokuzumayo akunikezi umphumela oyiqiniso.
• Imithi nama-supplements: Letha uhlu oluphelele, okuhlanganisa imithi yokubulala izinhlungu, imithi ye-ayurvedic noma ye-herbal, izithasiselo zejimu noma zeprotheyini kanye ne-creatine. Ungayeki noma yimuphi umuthi onikezwe udokotela ukuze ulungiselele i-KFT, buza udokotela kuqala.
• Amaprotheni kanye ne-creatine: Ukudla okunamaphrotheni amaningi kakhulu, inani elikhulu lenyama ephekiwe, noma izithasiselo ze-creatine ngaphambi nje kokuhlolwa kungakhuphula i-creatinine. Yisho ukudla okudliwe muva nje.
• Ukuzivocavoca okunzima: Ukuzilolonga okunzima emahoreni angu-24-48 adlule kungakhuphula i-creatinine futhi kubangele i-proteinuria yesikhashana. Tshela ilabhorethri uma lokhu kusebenza.
• Isampula yomchamo: Ukuze uthole i-ACR eqondile, isampula yasekuseni ivame ukukhethwa. Hlanza indawo, ulahle ingxenye yokuqala yomfudlana bese uqoqa umfula ophakathi nendawo esitsheni esihlanzekile esinikeziwe.
• Amaqoqo aphelelwe yisikhathi: Ukuze uthole ukuhlolwa komchamo kwamahora angama-24, lahla indawo yokuqala yokuphuma kwamanzi ekuseni, bese uqoqa yonke ithonsi emahoreni angama-24 alandelayo kufaka phakathi indawo yokuqala yokuphuma kwamanzi ekuseni ngakusasa, ugcine isitsha sipholile njengoba kuyalelwe.

Uma ukhulelwe

I-Creatinine ivame ukwehla ngesikhathi sokukhulelwa futhi izibalo ezijwayelekile ze-eGFR aziqinisekiswa kwabesifazane abakhulelwe. Ukuhlolwa kwe-proteinuria ngesikhathi sokukhulelwa kuhunyushwa ngendlela ehlukile ngenxa ye-preeclampsia. Tshela ilabhorethri kanye nodokotela wakho wezifo zokubelethisa.

Uma unesifo sikashukela ekwelashweni kokwehlisa i-glucose

Uma kucelwe ukuzila ukudla, buza udokotela wakho ukuthi ungayiphatha kanjani i-insulin noma amaphilisi afana ne-sulfonylureas ekuseni ngosuku lokuhlolwa, futhi uphathe umthombo kashukela. Ungazili ukudla isikhathi eside ngaphandle kweseluleko.

Uma unesifo senhliziyo, i-CKD ethuthukile noma uketshezi oluncishisiwe

Ungandisi umthamo woketshezi ukuze "ugeze izinso" ngaphambi kokuhlola. Gcina umkhawulo wakho woketshezi onqunyiwe bese utshela abasebenzi abaqoqayo ngakho.

Izingane

Amabanga e-creatinine ezingane kanye nezibalo ze-eGFR ahlukile kwezabantu abadala, futhi imiphumela kumele ihunyushwe ngudokotela wezingane noma udokotela wezinzwa wezingane. Amasampula amancane kanye ne-phlebotomy eqeqeshwe yizingane kungcono.

Abantu abadala abadala

I-eGFR yehla kancane ngokweminyaka, futhi isisindo semisipha esiphansi singenza i-creatinine ibukeke iduduza. I-ACR yomchamo kanye nemikhuba yangaphambilini kubaluleke kakhulu kuleli qembu.

Kwenzekani ngesikhathi sokuhlolwa

• Ukubhalisa nokuhlola: Imininingwane yakho, izivivinyo eziceliwe kanye nanoma yimiphi imiyalelo yokuzila ukudla kuyaqinisekiswa.
• Isampula yegazi: Kufakwa i-tourniquet engalweni engenhla, isikhumba siyahlanzwa, bese kusetshenziswa inaliti ukukhipha igazi emthanjeni osekugoqweni kwendololwane liye epayipini elilodwa noma ngaphezulu. Kulandela ukucindezela kanye nebhandeji elincane.
• Isampula yomchamo: ziqoqwe esitsheni esingenamagciwane endlini yokugezela, noma zilethwe zisuka eqoqweni elihleliwe ekhaya.
• Isinxephezelo: ukuhlaba isikhashana ngesikhathi sokuhlaba inaliti, ngezinye izikhathi ukushaqeka okuncane ngemva kwalokho.

Inqubo ithatha isikhathi esingakanani

• Ukudonswa kwegazi: ngokuvamile imizuzu emi-5-10 kusukela ku-tourniquet kuya ekugqokeni.
• Ukuvakasha okuphelele: ngokuvamile kuthatha imizuzu eyi-15-30 kufaka phakathi ukubhalisa nokulinda.
• Umchamo onamachashaza: imizuzu embalwa.
• Ukuqoqwa komchamo wamahora angu-24: amahora angu-24 agcwele ekhaya, kanye nokuvakashela ukuyokhipha isampula.
• Bika ukutholakala: kuyahlukahluka kuye ngelebhu nokuthi i-KFT iyisicelo esijwayelekile noma esiphuthumayo. Buza isikhungo sokuqoqa ukuthi umbiko wakho uzolunga nini.

Ukuqonda umbiko wakho we-KFT

Funda umbiko uqhathaniswe nobubanzi bereferensi obunyatheliswe yilabhorethri esebenza. Ububanzi buyahluka phakathi kwamalabhorethri ngenxa yabahlaziyi nezindlela ezahlukene, ngakho-ke ungaqhathanisi izinombolo zakho nobubanzi obuvela kwenye ilabhorethri noma kwi-inthanethi.

• I-creatinine ye-serum: amanani aphezulu ngokuvamile asikisela ukuncipha kokuhluzwa, kodwa isisindo semisipha, ubulili, ubudala, ukudla kanye nomswakama konke kushintsha inani. Inani "elijwayelekile" kumuntu osemusha onemisipha lingalindelwa ngokuphelele; inani "elijwayelekile" kowesifazane osekhulile obuthakathaka lingafihla ukukhubazeka kwangempela.
• i-eGFR: Kubikwe ku-mL/min/1.73m? Amanani aphansi asikisela ukuhlunga okuncishisiwe. I-eGFR eyodwa ephansi ayisona isifo sezinso esingamahlalakhona, kumele iqhubeke isikhathi esingaphezu kwezinyanga ezintathu. I-eGFR ayithembekile futhi lapho ukusebenza kwezinso kushintsha ngokushesha.
• I-Urea / I-BUN: Kukhuphuka ngokuncipha kokuhluzwa, kodwa futhi nangokuphelelwa amanzi emzimbeni, ukudla amaprotheni amaningi, ukopha kwamathumbu, ama-steroid kanye nesifo sokugaya ukudla. I-urea ephakanyisiwe ene-creatinine evamile ivame ukukhomba esinye salezi zifo kunesifo sezinso.
• I-ACR yomchamo: amanani aphezulu abonisa ukuvuza okwengeziwe kwe-albumin. Izigaba zisetshenziselwa ukulinganisa i-albuminuria, futhi ukuqinisekiswa kwesampula ephindaphindwayo ekuseni kuyinto ejwayelekile ngaphambi kokufaka ilebula ku-albuminuria eqhubekayo.
• I-Potassium: kokubili amanani aphezulu naphansi abalulekile futhi angaba yingozi emtholampilo. I-Haemolysis ngesikhathi sokuqoqwa kwayo ingakhuphula i-potassium ngamanga.
• Ithrendi idlula inani elilodwa. Indlela yokushintsha kwemibiko eminingana ivame ukuba nolwazi oluningi kunanoma iyiphi inombolo eyodwa.

Umbiko we-KFT awuyona inkinga yokuxilonga. Yiyise kudokotela owucelile, kanye nemibiko yakho yangaphambilini kanye nohlu lwemithi. Imiphumela iyahlukahluka kuye ngezimo zomtholampilo ngazinye.

Uma imiphumela ye-KFT ingadukisa

I-Creatinine ephakanyisiwe ngokungeyikho (izinso zisebenza kangcono kunalokho ezibukeka ngakho)

• Imisipha emikhulu, ukwakha umzimba, i-creatine noma izithasiselo zamaprotheni ezinomthamo ophezulu
• Ukudla inyama enkulu noma ukuzivocavoca okunzima ngaphambi nje kwesampula
• Imithi evimba ukukhishwa kwe-creatinine ngaphandle kokunciphisa ukuhlunga, njenge-trimethoprim kanye ne-cimetidine
• Ukuphelelwa amanzi emzimbeni okubangela ukunyuka kwangaphambi kwezinso okulungisa ngokubuyisela amanzi emzimbeni
• Ukuphazamiseka okuthile kokuhlolwa, okuhlanganisa i-hyperbilirubinemia ephawulekayo noma amanye ama-ketone

I-Creatinine iqinisekisa ngamanga (ukusebenza kwezinso kubi kakhulu kunalokho okubukeka)

• Imisipha ephansi, ubuthakathaka, i-sarcopenia, ukungondleki kahle, ukugula okungapheli
• Ukunqunywa kwezitho noma ukukhubazeka
• Isifo sesibindi esithuthukile
• Ukudla kwemifino okune-protein ephansi
• Ukukhulelwa, lapho i-creatinine yehla khona ngokomzimba

I-Urea/BUN idukisa kunoma iyiphi indlela

• Okuphezulu ngamanga: ukuphelelwa amanzi emzimbeni, ukudla amaprotheni amaningi, ukopha kwamathumbu, ama-corticosteroids, izimo ze-catabolic
• Okuphansi ngamanga: ukudla amaprotheni aphansi, isifo sesibindi, ukukhulelwa, amanzi amaningi ngokweqile

I-ACR yomchamo ephakanyisiwe ngokungeyikho

• Ukutheleleka komgudu womchamo, umkhuhlane, igazi lokuya esikhathini noma ukungcola koketshezi lwesitho sangasese sowesifazane
• Ukuzivocavoca okunamandla emahoreni angama-24 adlule
• I-hyperglycemia ephawulekayo, ukwehluleka kwenhliziyo okungenamholo, umfutho wegazi ophakeme kakhulu
• Ukuma okuqondile isikhathi eside (i-orthostatic proteinuria, evame kakhulu entsheni)

I-ACR yomchamo yehliswe noma ihlanjululwe ngamanga

• Nciphisa umchamo kakhulu ngemva kokuphuza uketshezi oluningi
• Ukuqoqwa okungaphelele noma okungahleliwe ngesikhathi esifanele, okuwumthombo ovamile wamaphutha ezifundweni zokususa imfucuza

Izinto zobuciko ze-Electrolyte

• I-Potassium ekhuliswe ngamanga yi-haemolysis, isikhathi eside se-tourniquet, ukugoqa ngenqindi noma ukucutshungulwa kwesampula okulibazisekile
• I-sodium ephansi ngokusobala ene-hyperlipidemia enzima noma i-paraproteinaemia kwezinye izindlela

Izingozi nokuphepha

Isampula yegazi (ukufakwa kwe-venepuncture)

Ngokuvamile ingozi iphansi. Imiphumela engaba khona ihlanganisa ubuhlungu obufushane, ukudumba, i-hematoma encane, ikhanda elikhanyayo noma ukuquleka, kanye nokutheleleka okuvamile kwendawo noma ukucasuka kwemizwa. Tshela abasebenzi uma uthatha imithi yokunciphisa igazi, ukhubazeka kalula noma uke waquleka ngesikhathi sokuhlolwa kwegazi ngaphambilini.

Isampula yomchamo

Akukho bungozi obungokomzimba. Inkinga enkulu iphutha lesampula, ukungcola noma ukuqoqwa okungaphelele ngesikhathi okuholela emiphumeleni edukisayo kanye nokuhlolwa okuphindaphindiwe okungadingekile.

Uphenyo oluhlobene namaphrofayili ahlukene engozi

Ingozi ayifani kuzo zonke izivivinyo zezinso. I-ultrasound KUB ayibandakanyi imisebe. I-CT KUB ihilela ukushiswa kwemisebe nge-ionizing. Izifundo ezithuthukisiwe ngokuqhathanisa zinezinto ezihlobene nokuqhathanisa ezincike ekusebenzeni kwezinso. I-biopsy yezinso iyahlasela futhi inengozi enengqondo yokopha edinga ukubhekwa. Lokhu kuxoxwa ngakho ngokwahlukana ngudokotela okukhuthazayo.

Izimo ezikhethekile

ukukhulelwa

Ukuhlunga kwezinso kuvame ukwanda futhi i-creatinine yehla. Izilinganiso ezijwayelekile ze-eGFR aziqinisekiswa ekukhulelweni. I-proteinuria entsha noma umfutho wegazi ophakeme ngemva kwamasonto angama-20 kudinga ukuhlolwa okusheshayo kokubeletha.

Izingane

Amabanga okubhekisela ezinganeni kanye nezibalo ze-eGFR ahlukile kwezabantu abadala. Ukukhula, ukudla okunomsoco kanye nokukhubazeka komgudu womchamo wokuzalwa kubalulekile, futhi ukuchazwa kufanele kuqondene nezingane.

Abantu abadala abadala

Ukwehla okuncane kwe-eGFR kuvamile ngokweminyaka futhi akusho ukuthi isifo esiqhubekayo ngokuzenzakalelayo. I-Albuminuria kanye nomkhuba ngokuhamba kwesikhathi kuthwala isisindo esikhulu. Imithamo yemithi ivame ukudinga ukulungiswa kokusebenza kwezinso.

Isifo sikashukela ekwelashweni kokwehlisa ushukela

I-eGFR yonyaka kanye ne-ACR yomchamo kuyizinto ezijwayelekile. Eminye imithi yokwehlisa ushukela idinga ukubuyekezwa komthamo njengoba i-eGFR ishintsha. Noma yiluphi ushintsho kumele luvele kudokotela, hhayi embikweni kuphela.

Isifo sezinso ezingapheli

Ukuqapha imvamisa kuncike esigabeni, i-albuminuria kanye nezinga lokushintsha. Gwema ama-NSAID athengiswa ngaphandle kwemithi kadokotela, amalungiselelo ezitshalo angaqinisekisiwe noma "okuhlanza izinso", kanye nezithasiselo ezinomthamo ophezulu ngaphandle kokuxoxa ngazo nodokotela wakho wezinso.

Ukuhluleka kwenhliziyo

I-Creatinine ne-urea zivame ukushintshashintsha kuye ngomthamo wokukhipha isisu kanye nesimo soketshezi. Ukwenyuka ngesikhathi sokwelashwa kokukhipha isisu akusho ukuthi kukhona ukulimala kwezinso ngokuzenzakalelayo futhi kudinga ukuchazwa kanye nezimpawu kanye nesisindo.

Ukugula okukhulu, umkhuhlane noma ukuphelelwa amanzi emzimbeni

Amanani e-KFT athathwa ngesikhathi sokugula okukhulu angase angabonisi ukusebenza kwezinso okuyisisekelo. Ukuhlolwa okuphindaphindiwe ngemva kokululama kuvame ukudingeka ngaphambi kokubeka ilebula lesifo esingamahlalakhona.

Ukuhlolwa kokusebenza kwezinso kumongo waseNdiya

• Itemu: I-KFT ne-RFT zisetshenziswa ngokushintshana emalabhorethri aseNdiya, futhi okuqukethwe kwephaneli kuyahluka phakathi kwamalabhorethri. Hlola ukuthi yiziphi izingxenye ezifakwa umbiko wakho, amaphaneli amaningi "e-KFT" awafaki i-urine ACR, okumele icelwe ngokwehlukana.
• Isifo sikashukela kanye nomfutho wegazi ophakeme yizona ezibangela isifo sezinso esingamahlalakhona eNdiya, okwenza ukuhlolwa kwe-eGFR kanye nomchamo we-ACR minyaka yonke kubaluleke kakhulu kula maqembu.
• Ukwakheka komzimba waseNingizimu Asia: Isifo se-metabolic senzeka nge-BMI ephansi kubantu baseNingizimu Asia, kanti isisindo semisipha esiphansi kubantu abadala abaningi sisho ukuthi i-creatinine ingamelana nokukhubazeka kwezinso okungafanele. I-eGFR, hhayi i-creatinine yodwa, kufanele isetshenziswe.
• Imithi nama-supplements: Ukufinyelela kalula kuma-NSAID kanye nezinhlanganisela zobuhlungu ngaphandle kwemithi kadokotela, amanye amalungiselelo e-ayurvedic, amakhambi kanye ne-heavy-metal aqukethe, kanye ne-gym protein noma izithasiselo ze-creatine konke kuhlobene nemiphumela yezinso. Ukwelashwa okulwa nesifo sofuba kanye namanye ama-antibiotic nakho kudinga umthamo osekelwe ekusebenzeni kwezinso.
• Ukutheleleka kanye namatshe: umthwalo omkhulu wesifo samatshe omchamo ezingxenyeni ezisenyakatho nentshonalanga yeNdiya, kanye nezifo zasezindaweni ezishisayo ezingathinta izinso, kusho ukuthi ukuhlolwa komchamo kanye nezithombe kuvame ukudingeka kanye ne-KFT yegazi.
• I-Hemoglobinopathy kanye ne-anemia: Isici se-thalassemia kanye ne-anemia yokuntuleka kwensimbi kuvamile futhi kuthinta ukuchazwa kwezivivinyo ezihlobene njenge-HbA1c, ezibikwe kokubili ku-% (NGSP) kanye ne-mol/mol (IFCC), lapho isifo sikashukela nesifo sezinso kuhlolwa ndawonye.
• Ukuvikelwa kwedatha: Imibiko yelabhorethri kanye nokubhaliswa kwe-portal eku-inthanethi kuhilela idatha yezempilo yomuntu siqu ephathwa ngaphansi koMthetho Wokuvikelwa Kwedatha Yomuntu Siqu Yedijithali, 2023. Buza ukuthi idatha yombiko wakho igcinwa futhi yabelwana kanjani.
• Umthethonqubo wokuthatha izithombe: lapho kufakwa khona i-ultrasound ekuhlolweni kwezinso kowesifazane osekhulile, izikhungo zaseNdiya zisebenza ngaphansi koMthetho we-PC-PNDT, ka-1994, futhi ukunqunywa kobulili akuvunyelwe.

Izindleko kanye nomshuwalense eNdiya

Izindleko ziyahlukahluka kakhulu phakathi kwamadolobha, phakathi kwama-laboratory omphakathi nawangasese, futhi ngokuya ngokuthi zingaki izinhlaka ezihlaziyiwe ezifakiwe yiphaneli. Izibalo ezicashunwe noma kuphi kufanele zithathwe njengezibonisa kuphela; qinisekisa intengo yamanje nelabhorethri ngaphambi kokuhlola.

Izici ezithonya lokho okukhokhayo:

• Usayizi wephaneli: iphaneli eyisisekelo ye-urea-creatinine-electrolyte ibiza kancane kunephrofayili ende yezinso
• Ukuhlolwa okungeziwe: Ucwaningo lomchamo lwe-ACR, i-cystatin C kanye nokuhlolwa komchamo amahora angama-24 kuvame ukukhokhiswa ngokwehlukana; i-cystatin C ibiza kakhulu futhi ayitholakali kabanzi
• Uhlobo lwelabhorethri: isikhungo sikahulumeni, isikhungo sokuqoqa esizimele, ilabhorethri yesibhedlela noma ilabhorethri yokubhekisela
• Ukugunyazwa kanye nokuguqulwa: Amalebhu agunyaziwe kanye nokucutshungulwa okuphuthumayo noma kwe-STAT ngokuvamile kubiza kakhulu
• Iqoqo lasekhaya kanye nezindleko zokuthatha amasampula ngemva kwamahora okusebenza
• Amaphakheji ezempilo ahlanganisiwe, okuvame ukufaka i-creatinine ne-urea kodwa kungabi ne-ACR yomchamo
• Idolobha kanye nezindawo zokwelapha, okuhlanganisa ukukhokhiswa kweziguli ezilaliswe esibhedlela uma kuqhathaniswa nokukhokhiswa kweziguli ezingaphandle

Ngomshwalense: izivivinyo zokuxilonga iziguli zangaphandle azimbozwa umshwalense wezempilo ojwayelekile ngaphandle kokuthi inqubomgomo ifaka i-OPD noma inzuzo yokuxilonga. I-KFT eyenziwa njengengxenye yenqubo yokwamukelwa noma yokunakekelwa kwasemini ivame ukumbozwa ngaphakathi kwesicelo sokulaliswa esibhedlela. Izinhlelo zikahulumeni kanye nezinhlelo zezempilo zabaqashi zinezinhlu zazo zamanani. Buza nomshwalense wakho noma ideski lokukhokhisa esibhedlela ngaphambi kokuhlolwa.

Izinganekwane namaqiniso

Imibuzo ejwayelekile ukubuzwa

Ingabe ngidinga ukuzila ukudla ukuze ngibe ne-KFT?

I-Creatinine, i-urea kanye nama-electrolyte ngokuvamile akudingi ukuzila ukudla. Ukuzila ukudla kuvame ukucelwa uma i-glucose noma ama-lipid ehlanganiswa ekuvakasheni okufanayo. Ngenxa yokuthi izidingo ziyahlukahluka phakathi kwama-laboratory, landela imiyalelo ebhaliwe evela eyunithi eyenza ukuhlolwa kwakho kunomthetho ojwayelekile.

Ingabe i-KFT iyafana nokuhlolwa komchamo?

Cha. I-KFT yegazi ilinganisa ukuhluzwa nge-creatinine, i-eGFR, i-urea kanye nama-electrolyte. Ukuhlolwa komchamo, i-microscopy evamile noma isilinganiso se-albumin-to-creatinine, kuthola umonakalo, ukuvuza kwamaprotheni, igazi kanye nokutheleleka. Lezi zibili ziphendula imibuzo ehlukene, kanti ukuhlolwa kwegazi kukodwa kungaphuthelwa ngokuphelele umonakalo wezinso kusenesikhathi.

Ingabe i-creatinine yami ingaba phezulu ngaphandle kwesifo sezinso?

Yebo. Imisipha emikhulu, izithasiselo ze-creatine noma amaprotheni, ukudla inyama eningi, ukuzivocavoca okunzima, ukuphelelwa amanzi emzimbeni, kanye nezidakamizwa ezifana ne-trimethoprim noma i-cimetidine kungakhuphula i-creatinine ngaphandle kokunciphisa ukuhluzwa. Udokotela wakho uvame ukuphinda ukuhlolwa ngaphansi kwezimo ezizinzile ngaphambi kokufinyelela iziphetho.

Kusho ukuthini ukuthi i-eGFR ephansi embikweni owodwa?

I-eGFR eyodwa ephansi ikhombisa ukuncipha kokuhlunga okulinganiselwe ngalolo suku kuphela. Kungase kubonise ukugula okukhulu, ukuphelelwa amanzi emzimbeni noma umphumela wemithi. Isifo sezinso esingamahlalakhona sidinga ukungajwayelekile okuqhubeka isikhathi esingaphezu kwezinyanga ezintathu, ngakho-ke kudingeka ukuhlolwa okuphindaphindiwe nokuqhathaniswa nemibiko yangaphambilini.

Yikuphi okungcono, i-creatinine noma i-cystatin C?

Akukho okungcono kakhulu kuyo yonke indawo. I-eGFR esekelwe ku-Creatinine ayibizi futhi itholakala kabanzi. I-Cystatin C ayithonywa kakhulu yisisindo semisipha futhi iwusizo lapho i-creatinine ingase idukise, njengasebuthakathakeni, ekunqunyweni kwezicubu noma emisipheni ephezulu kakhulu. Ukutholakala kanye nezindleko kuyahlukahluka phakathi kwama-laboratory.

Kufanele ngiphinde kangaki i-KFT?

Ukuvama kuncike esizathwini sokuhlolwa. Ukuhlolwa kwesifo sikashukela esizinzile noma umfutho wegazi ophakeme kuvame ukwenziwa minyaka yonke nge-ACR yomchamo. Isifo sezinso esingamahlalakhona esiqinisekisiwe, izinguquko zemithi yakamuva noma ukugula okukhulu kungadinga ukuhlolwa okuvamile. Udokotela wakho okwelaphayo unquma isikhathi esinqunyiwe ngokusekelwe esigabeni sakho kanye nomkhuba wakho.

Ingabe kufanele ngiyeke umuthi wami womfutho wegazi noma wesifo sikashukela uma i-KFT yami ingajwayelekile?

Cha. Ungayeki noma ushintshe noma yimuphi umuthi owunikezwe udokotela ngokusekelwe embikweni. Eminye imithi evikela izinso ibangela ukwanda okuncane okulindelekile kwe-creatinine. Yisa umbiko kudokotela, ozonquma ukuthi ukulungiswa komthamo, ikhefu lesikhashana ngesikhathi sokugula, noma akukho shintsho olufanele.

Ingabe i-KFT ingakwazi ukubona amatshe ezinso?

Akuthembekile. I-KFT ingabonisa ukuhlunga okungasebenzi kahle uma itshe livimba, kodwa amatshe ngokwawo ayimbangela yesakhiwo. I-Ultrasound KUB ikhombisa i-hydronephrosis namatshe amaningi; i-CT KUB engeyona i-contrast ibucayi kakhulu ekusolweni kwe-renal colic kubantu abadala abaningi abangakhulelwe.

I-KFT yami ijwayelekile kodwa ngisenomchamo ovuvukile futhi onegwebu. Yini elandelayo?

Buyela kudokotela wakho. I-KFT ejwayelekile yegazi ayikuvimbeli ukugula kwezinso, futhi i-albuminuria ingaba khona ne-eGFR evamile. Iphrotheni yomchamo noma i-ACR elinganisiwe, i-microscopy yomchamo, ukubuyekezwa komfutho wegazi, kanye nezithombe noma ukudluliselwa kochwepheshe yizinyathelo ezilandelayo ezijwayelekile.

Imithombo

• Umhlahlandlela Wokusebenza Kwezokwelapha we-KDIGO Wokuhlola Nokuphatha Isifo Sezinso Esingapheli [Qinisekisa uhlelo lwamanje, KUZOQINISEKISWA]
• U-Inker LA, u-Eneanya ND, uCoresh J, nabanye. Izilinganiso Ezintsha Ezisekelwe ku-Creatinine- kanye ne-Cystatin Zokulinganisa i-GFR ngaphandle Kohlanga. I-New England Journal of Medicine, 2021.
• I-National Kidney Foundation kanye ne-American Society of Nephrology Task Force on Reclassifying the Use of Race in eGFR, izincomo ezihlangene, 2021.
• UMkhandlu WaseNdiya Wocwaningo Lwezokwelapha, ukwelashwa okujwayelekile kanye nesiqondiso sokuxilonga ngesifo sezinso esingamahlalakhona [Qinisekisa uhlelo lwamanje, KUZOQINISEKISWA]
• Umthetho Wokuvinjelwa Kokukhetha Ubulili Ngaphambi Kokukhulelwa kanye Nokuxilonga Kwangaphambi Kokukhulelwa, 1994, Uhulumeni waseNdiya.
• Umthetho Wokuvikelwa Kwedatha Yomuntu Siqu Yedijithali, 2023, Uhulumeni waseNdiya.