Ukwehluleka kwezinso kusho ukuthi izinso (izin) zekati azisasebenzi kahle futhi azisakwazi ukwenza imisebenzi yazo. Kubalulekile ukwazi ukuthi ungahlukanisa kanjani ukwehluleka okukhulu kwezinso kokuhluleka kwezinso okungamahlalakhona. Kunoma ikuphi, uma unokungabaza okuncane ngempilo yekati lakho, ungangabazi ukuxhumana nodokotela wezilwane.

Ukuze uqonde ukuthi kuyini ukuhluleka kwezinso, kubalulekile ukuthi wazi ukuthi izinso zisebenza kanjani. Iqhaza eliyinhloko lokugcina ukuhlunga igazi lomzimba ukuze kukhiqizwe umchamo (oqukethe udoti wegazi) kepha ngaphezu kwakho konke ukugcina ukwakheka kwesitebele segazi. Ibuye ivumele ukuhlanganiswa kwamahomoni athile. I-nephron iyunithi yokusebenza yezinso. Inso ngalinye linamakhulu ezinkulungwane eziningana zazo futhi yilezi eziqinisekisa indima yokuhlunga. Uma kwenzeka ukwehluleka kwezinso, ukuhlunga akusenziwa ngendlela efanele ngoba amanye ama-nephrons awonakele. Njengoba kungasebenzi konke, ukuhlunga kuncane kakhulu.

Emakati, ukwehluleka okukhulu kwezinso (i-AKI) kuvame ukubuyiselwa emuva futhi kwenzeke ngokushesha, ngokungafani nokwehluleka kwezinso okungamahlalakhona (CKD) okuqala kancane kancane futhi okungenakuguqulwa.

Izimbangela eziningi zingaba ngumsuka we-ARI njengokuphuma kwegazi, ukumunca into enobuthi (ngokwesibonelo isitshalo) noma isithiyo ekugelezeni komchamo. Singabe sesibona ukuhlaselwa okungazelelwe esimweni esijwayelekile sekati (ukuhlanza, isifo sohudo, ukoma emzimbeni noma isimo sokushaqeka ngokuya ngesizathu) noma ubunzima bokuchama.

Kubalulekile ukukhumbula ukuthi i-ARI ingamela isimo esiphuthumayo, ngakho-ke kufanele ngokushesha uthathe ikati lakho liye kudokotela wezilwane wakho ukuze athole ukwelashwa.

Ukwehluleka kwezinso okungamahlalakhona kusho ukuthi izinso zonakaliswa kancane kancane futhi zilimale ngokungenakuphikiswa okungenani izinyanga ezintathu. 

Izimpawu eziningana zokuxwayisa kufanele zikwenze ucabange ngokubonisana nodokotela wezilwane futhi ikakhulukazi lokhu:

• I-Polyuro-polydipsia: ikati lichama kakhulu futhi liphuza amanzi amaningi. Kuyisibonakaliso sokuqala sokubiza ukwazi ukuthi ungabona kanjani. Ngempela, lapho i-nephrons yonakele, okunye ukusebenza kufanele kuqinisekise umthwalo omkhulu wokuhlunga okwandisa ivolumu yomchamo. Ngaphezu kwalokho, izinso azisakwazi ukugxilisa umchamo ohlanjululwa ngaleyo ndlela (umchamo ophuzi okhanyayo kakhulu). Ukunxephezela lokhu kulahleka kwamanzi emchameni, ikati lizophuza kakhulu. Kodwa-ke, lokhu kunzima ukukubona emakati, ikakhulukazi lawo ahlala ngaphandle.

Lezi zimpawu ezilandelayo zomtholampilo zivela ngezigaba ezithuthukile lapho izinso zilimele kakhulu:

• Ukwehla kwesisindo;
• Ukuphelelwa isifiso sokudla;
• Ijazi elifiphele;
• Ukuhlanza okungenzeka;
• Ukuphela kwamanzi emzimbeni.

kwesifo

Udokotela wakho wezilwane uzokwenza ukuhlolwa okuphelele kwesilwane sakho ngokuhlolwa okwengeziwe (ukuhlolwa kwegazi ukuze kuhlolwe, ukubamba izinso, ukuhlaziywa komchamo, izithombe, njll) ukuze kuqinisekiswe noma cha ukwehluleka kwezinso nokuthola imbangela. Ngokuya ngokulimala kwezinso nemiphumela yokuhlaziywa, kwahlelwa ukubekwa kwe-IRIS (International Renal Interest Society) ukuze kunikezwe ikati isigaba somtholampilo. Ngempela, ukuhlolwa kwegazi kuzokwenza ukuthi kutholakale ukuthi ukuhlunga kwezinso kusebenza kanjani, ikakhulukazi ngenxa yamazinga e-creatinine, urea ne-SDMA (Symmetric DiMethyl Arginine, i-amino acid) ekhona egazini. Lezi zinto ziyimfucuza evame ukukhishwa emchameni. Ngokushesha lapho ukuhlunga kungasalungile, zizoqoqeka egazini. Ukuphakama kwenani lazo, ukuhlunga okubi kakhulu ngakho-ke kulimaza kakhulu izinso.

Ngakho-ke, emakati, kunezigaba ezine ze-IRIS ezilandelayo:

• Isigaba 1: ileveli ejwayelekile ye-creatinine, azikho izimpawu, ileveli ye-SDMA ingahle ibe ngaphezulu;
• Isigaba 2: ileveli ye-creatinine ejwayelekile noma ephakeme kancane kunokujwayelekile, ukutholakala okungenzeka kube nezimpawu ezimnene, ileveli ephakeme kakhulu ye-SDMA;
• Isigaba 3: amazinga e-creatinine ne-SDMA aphakeme kunokujwayelekile, ukuba khona kwezimpawu zezinso (i-polyuropolydipsia) nokujwayelekile (ukulahlekelwa isifiso sokudla, ukuhlanza, ukuncipha komzimba, njll.);
• Isigaba 4: amazinga aphezulu kakhulu e-creatinine ne-SDMA, ikati lisesigabeni sokugcina seCRF futhi linomonakalo omkhulu esimweni salo sezempilo.

Kubalulekile ukukhumbula ukuthi lapho isiteji sithuthuka kakhulu, isibikezelo esimpofu sihamba phambili. Imvamisa, izimpawu aziveli kuze kube sekwephuzile, lapho izinso zibuthaka kakhulu, ngoba ezingeni lokuqala izinso ziyakwazi ukukhokhela ukulahleka okuqhubekayo kwama-nephrons.

Ukwelashwa kwezidakamizwa okusetshenzisiwe kuzoya ngesigaba sekati kanye nezimpawu elizivezayo. Ezimweni ezibucayi kakhulu, ikakhulukazi ezimweni zokuphelelwa amanzi emzimbeni, ukwelashwa kungadingeka.

Ukwelashwa okuyinhloko ushintsho ekudleni. Ngakho-ke kuyadingeka ukushintshela ekudleni kokwelashwa okwenzelwe amakati ngokuhluleka kwezinso ngokwenza ushintsho lokudla kancane kancane. Ngempela, lokhu kudla kuzomvumela ukuthi agcine izinso zakhe futhi andise isikhathi sakhe sokuphila. Ngaphezu kwalokho, kubalulekile ukuthi uhlale unikeza ikati amanzi amasha angenamkhawulo. Ukuvinjelwa kwamanzi kungaholela ekuphelelweni ngamanzi emzimbeni.

Kubalulekile ukukhumbula ukuthi iminyaka yekati iyindlela yokubheka. Lokhu kungenxa yokuthi izinso zamakati azisebenzi kahle lapho umuntu esegugile, ngakho-ke maningi amathuba okuthi abe nesifo esingapheliyo sezinso. Olayini bokudla manje sebetholakala ukuxhasa ukusebenza kwezinso zamakati amakhulu nokuvikela ukwehluleka kwawo. Unganqikazi ukuxoxa ngakho nodokotela wezilwane wakho.

Izinhlobo ezithile nazo zenzelwe ukuthuthukisa izifo ezithile zezinso, ikakhulukazi isifo se-polycystic noma i-amyloidosis ezingezinye zezimbangela zeCRF.

Ngaphezu kwalokho, ukubonisana njalo kwamakati aphakeme nodokotela wezilwane kunconywa njalo ngonyaka noma ngisho njalo ezinyangeni eziyisithupha kusukela eminyakeni yobudala eyi-6/7. Ngempela, udokotela wakho wezilwane uzokwazi ukwenza ukuhlolwa okuphelele ukuze ahlole ukuthi izinso zisebenza ngokujwayelekile yini futhi abeke ukwelashwa endaweni lapho kwenzeka ukuthi ukuqala kokuhluleka kutholakale.