Ƙananan raunin gaza yana faruwa a lokacin da kodan nan ba zato ba tsammani a iya kawar da lalata daga jini. Yana da wahala ga yawancin cututtuka ko rashin lafiya, sakamakon hakan yana haifar da ƙaddamar da ciwon gubobi da ƙaddamar da bayyanar cututtuka daga jigilar urination da gajiya zuwa ƙwaƙwalwar ƙwaƙwalwa da haɗari.
Duk da yake babban gazawar kodayaushe yakan iya faruwa ba tare da bayyanar cututtuka ba kuma za'a bayyana shi a lokacin gwajin gwaji don yanayin da ba shi da dangantaka, mafi yawancin lokuta ana bincikar su a cikin mutanen da ke fama da rashin lafiya ko kuma sun isa asibiti tare da rashin lafiya.
Idan an yi la'akari da rashin cin zarafi na ainihi, ana gwada gwaje-gwajen jini, fitsari gwaje-gwaje, duban dan tayi, da kuma biopsies don tabbatarwa da kafa matakin rashin lafiya. Bisa ga sakamakon, likita zai iya aiwatar da cutar kuma ya dauki aikin da ya dace. A cikin mummunar labari, yanayin ƙwaƙwalwar ƙwayar ƙarshe zai iya bayyana.
Labs da gwaje-gwaje
Ƙananan raunin gaza ( ARF ), wanda aka fi sani da babban ciwo na koda (AKI), an fara gano shi da jini da gwagwarmaya. Daga cikin gwaje-gwajen da yawa da aka yi amfani dasu don kimanta aikin koda, akwai manyan matakan mahimmanci guda biyu don ganewa da kuma kulawa da ARF.
Ma'adinin Halitta
Halitta creatinine (SCR) tana auna yawan abin da ake kira creatinine cikin jini. Creatinine abu ne mai samfurin tsofaffin ƙwayar cuta wanda aka cire shi cikin fitsari. Saboda an samar da shi kuma an cire shi a daidaiccen ƙimar, yana da ma'auni mai gwaninta na aikin koda kuma yana nuna alama ce ta rashin cin nasara koda.
Matakan SCr na al'ada a cikin manya sune:
- Kimanin 0.5 zuwa 1.1. milligrams (MGG) da deciliter (dL) cikin mata
- Kimanin 0.6 zuwa 1.2 mg / dL a cikin maza
Ƙarawar Urine
Ƙarar ƙararrawa tana auna yawan adadin ruwa wanda kake urinate akan lokacin da aka ba. Kamar yadda ARF ta bayyana ta asarar aikin koda, darajar da aka auna a milliliters (mL) kowace kilo na nauyin jikinka (kilogiram) a kowace awa (h) -is tsakiya don tabbatar da rashin lafiyar koda da auna ma'auninka zuwa magani.
Oliguria, samar da ƙananan ƙananan tsabar fitsari, an bayyana a matsayin wani abu mai kasa da 0.5 mL / kg / h.
Sauran Lab da Lab
Sauran jarrabawar jarrabawa da aka yi amfani da su don gano asali ARF sun hada da:
- Urea nitrogen (BUN) na jini yayi la'akari da adadin samfurin sharar da ke cikin jini da ake kira nitrogen mai urea. An halicci nitrogen a cikin Urea lokacin da hanta ya rushe furotin kuma, kamar sinadarin sinadarin, an samar da shi a cikin fitsari idan matakan da ya dace. Hannun BUN sune alamun na ARF kuma suna iya bayar da shawarar dalilin rashin gazawar koda (irin su ciwon zuciya, rashin jin dadi, ko ɓangaren urinary obstruction).
- Ka'idojin cinikin halittar Creinine a cikin samfurori na jini da fitsari wanda aka tattara a tsawon sa'o'i 24. Hanyoyin da aka haɗu za su iya gaya mana yadda ake tsabtace halittar halittar daga jini ta hanyar urination kamar yadda aka auna ta mL da minti (mL / min). Kullin tsarin halitta na al'ada shine 88 zuwa 128 mL / min cikin mata da 97 t0 137 mL / min a cikin maza.
- Ra'ayin ƙididdigar launi na duniya (eGFR) wata jarrabawar jini ce wadda ta ƙayyade yawan jini da ke wucewa ta hanyar bincike na kodan, wanda ake kira glomeruli. Saurin da wannan zai faru zai iya gaya mana yadda kullun ya lalace daga mataki na 1 (kadan ba tare da asarar aikin koda) ta hanyar mataki 5 (gazawar koda).
- Magani na potassium Ana amfani dashi don sanin ko akwai wuce haddi potassium cikin jini (yanayin da aka sani da hyperkalemia). Hyperkalemia yana da halayyar ARF kuma, idan aka bar shi ba tare da gurgunta ba, zai iya haifar da dysrhythmia mai tsanani kuma mai hadarin gaske mai rai.
- Urinalysis shine kawai nazarin labarun yin amfani da fitsari. Ana iya amfani dashi don gano ko akwai haran sunadari a cikin fitsari ( proteinuria ), wanda yayi la'akari da alama ta hanyar ARF. Haka kuma zai iya gano jini a cikin fitsari ( hematuria ) wanda zai iya faruwa idan ARF ta lalacewa ta hanyar irin lalacewar koda ko ƙuntataccen urinary.
Matsalar Magana
An kasa bincikar rashin cin zarafi mai mahimmanci bisa ga sakamakon kwayoyin halittar creatinine da fitowar ƙwayar fitsari.
An kafa ka'idojin ganewar asali daga cutar cututtuka: Inganta Ci Gaban Gida (KDIGO), kungiyar da ba ta da riba da ke kulawa da kuma aiwatar da ka'idoji na likitanci don cutar koda. Bisa ga KDIGO, bazawar rashin ƙarfi ba za a iya bincikar idan an sami ɗaya daga cikin wadannan:
- An karuwa a SCr ta 0.3 MG / dL ko fiye cikin sa'o'i 48
- An karuwa a SCR na akalla kashi 150 a cikin kwanaki bakwai
- Yarar fitsari mai kasa da lita 0.5 / kg / h a tsawon awa shida
Gwaje-gwajen Hoto
Bugu da ƙari, gwaje-gwaje da jini da gwagwarmaya, ana iya amfani da gwaje-gwaje na hoto don gano idan akwai wani irin lalacewar koda ko kuma akwai rashin lahani ga ƙwayar jini zuwa koda ko excretion na fitsari daga jiki.
Daga cikin wasu gwaje-gwaje da aka yi amfani da su:
- Duban dan tayi shine hanyar da aka fi dacewa na gwajin hoto kuma za'a iya amfani da su don auna girman da bayyanar kodan, gano ƙwayar ciwace ko ƙwayar koda, sa'annan gano wuri mai tsabta a cikin fitsari ko jini. Za'a iya amfani da sabon fasaha wanda ake kira Doppler Color Dama don tantance kullun, ragewa, ko ruptures a cikin arteries da veins na kodan.
- Hidimar kwaikwayo ta lissafi (CT) wani nau'i ne na fasaha na X-ray wadda ke samar da hotunan giciye na kwaya. CT na iya zama da amfani a gano kwayar cutar ciwon daji, raunuka, ƙwaƙwalwar ƙwayoyi, katsewa (kamar kudan zuma), da kuma haɗuwa da ruwa a kusa da kodan. An yi amfani dasu a cikin mutane masu girma wanda ba a samar da hoto cikakke ba.
- Hanyoyin fuska na Magnetic (MRI) yana amfani da raƙuman ruwa masu haɗari don samar da hotunan kodayake da kodan ba tare da radiation ba.
Koda Biopsy
A biopsy ya shafi kawar da kwayoyin halitta don jarrabawa ta lab. Irin wannan da ake amfani dasu don tantance cutar cututtukan da ake kira mai cututtuka ne wanda aka sanya wani allura a cikin fata kuma ya jagoranci cikin koda don cire samfurin sel.
Ana amfani da kwayoyin halitta a mafi yawancin lokuta don gano asibiti na ARF (ƙananan raunin da ya haifar da lalacewar kodan). Kwayoyin halitta na iya ganewa da sauri wasu daga cikin abubuwan da ke tattare da lalacewar koda, ciki har da:
- Maganin interstitial nema (AIN), da ƙonewar nama a tsakanin koda koda
- Kwayar ƙananan tubular necrosis (ATN), yanayin da kullin koda ya mutu saboda rashin isashshen oxygen
- Glomerulonephritis, ƙonewar glomeruli a cikin jini na kodan
Binciken Bambanci
Dangane da cutar da mummunar cuta ko rashin lafiya, mummunan rauni zai iya haifar da wasu abubuwa daban-daban, ciki har da rashin zuciya , ciwon hanta , cututtuka , ciwon zuciya , da magunguna mai tsanani.
A lokaci guda, akwai lokuta inda jarrabawar gwaje-gwajen sun nuna wa ARF amma wasu yanayi shine, a gaskiya, a zargi da matakan jini. Tsakanin su:
- Kwayar cutar koda (CKD) , sau da yawa wanda ba a sani ba, na iya samun dukkanin alamomi na ARF amma za su ci gaba da ƙara fiye da watanni uku. Tare da CKD, bayanin kawai na SCr mai girma zai zama nauyin tsaftacewa mai banƙyama. Jarabawar gwaji ta hanyar awa 24 yana iya bambanta tsakanin yanayin biyu.
- Wasu magunguna , kamar H2 blocker Tagamet (cimetidine) da kwayoyin Primsol (trimethoprim), na iya haifar da tayi na creatinine. Rashin ƙarancin wanda ake zaton likita yana da yawa don yin bambancin.
> Sources:
> Rahman, M .; Shad, F .; da kuma Smith, M. Mutuwar Raunuka Mai Raɗa: Jagora ga Gudanar da Gwaninta da Bincike. Amer Fam Phys. 2012; 86 (7): 631-9.
> Hertzberg, D .; Ryden, L .; Pickering, J. et al. Raunin koda mai tsanani - fassarar hanyoyin bincike da kuma kula da asibiti. Clin Kidney J. 2017 10 (3): 323-331. DOI: 10.1093 / ckj / sfx003.