Isifo sikashukela i-Insipidus

Naphezu kokwabelana ngengxenye yegama laso nesifo sikashukela esaziwa kakhulu, isifo sikashukela i-insipidus siyisimo esihluke ngokuphelele esithinta indlela umzimba olawula ngayo ibhalansi yamanzi. Lo mhlahlandlela uchaza isifo sikashukela i-insipidus, izinhlobo zaso ezahlukahlukene, izimpawu, izimbangela kanye nokwelashwa okutholakalayo. 

Kuyini isifo sikashukela i-Insipidus?

Isifo sikashukela i-insipidus yisimo esingavamile esiphazamisa ikhono lomzimba lokulondoloza uketshezi olufanele. Lesi sifo sibangela ukuthi abantu abathintekile bakhiqize inani elikhulu lomchamo, kwesinye isikhathi kuze kufike kumalitha ayi-15-20 ngosuku, uma kuqhathaniswa nojwayelekile wamamililitha angama-800-2,000.

I-Antidiuretic hormone (ADH), eyaziwa nangokuthi i-vasopressin, isenhliziyweni yalesi simo. Le hormone ebalulekile ikhiqizwa ku-hypothalamus yobuchopho futhi igcinwe ku-pituitary gland. Uma isebenza ngendlela efanele, i-ADH isiza izinso ukuthi zilinganisele amazinga oketshezi ngokulawula ukuthi angakanani amanzi abuyela egazini ngemva kokuhlunga.

Inqubo isebenza kanje:

• Izinso zihlunga igazi ukuze zikhiphe imfucuza
• Uketshezi oluningi oluhlungiwe ngokuvamile lubuyela egazini
• I-ADH ikhombisa izinso ukuthi zilondoloze amanzi
• Isamba esincane samaqabunga njengomchamo

Ku-diabetes insipidus, kungenzeka ukuthi umzimba awukhiqizi ngokwanele noma izinso aziyisebenzisi kahle i-ADH, kuphazamise le nqubo futhi kwandise inani lomchamo.

Yiziphi Izinhlobo ze-Diabetes Insipidus?

Izinhlobo ezine eziyinhloko zihlanganisa:

• I-Central Diabetes Insipidus: Uhlobo oluvame kakhulu, okwenzeka lapho umzimba ungakhiqizi i-antidiuretic hormone eyanele (ADH)
• I-Nephrogenic Diabetes Insipidus: Isimo se-nephro lapho izinso zingaphenduli kahle ku-ADH naphezu kwamazinga amahomoni avamile
• I-Dipsogenic Diabetes Insipidus: Kubangelwa ukungasebenzi kahle kwendlela yokoma kwengqondo
• I-Gestational Diabetes Insipidus: Isimo esingavamile, sesikhashana esingaba khona ngesikhathi ukukhulelwa

Izimpawu zesifo sikashukela i-Insipidus

Izimpawu ezibaluleke kakhulu zesifo sikashukela i-insipidus zifaka:

• Ukukhipha umchamo omningi ophaphathekile noma ongenambala (3-20 amalitha nsuku zonke)
• Ukoma okwedlulele, ikakhulukazi iziphuzo ezibandayo
• Ukuvuthwa njalo, kuhlanganise nasebusuku
• Ukukhathala nobuthakathaka obungachazeki
• Izinhlungu zemisipha nokungakhululeki okuvamile
• Ukuhlushwa okuphansi komchamo

Izinkinga zesifo sikashukela i-Insipidus

Izimbangela eziyinhloko zesifo sikashukela i-insipidus zibangelwa izinkinga ze-antidiuretic hormone (ADH), eyaziwa nangokuthi i-vasopressin, esiza ukulawula amazinga oketshezi emzimbeni. 

I-Central Diabetes Insipidus yenzeka ngenxa yalokhu:

• Ukuhlinzwa kobuchopho izinkinga
• Ukulimala kwekhanda, ikakhulukazi ukuphuka kogebhezi lwekhanda
• Izimila ezithinta i-hypothalamus noma i-pituitary gland
• Ukusabela kwe-autoimmune kulimaza amaseli akhiqiza amahomoni
• Ukuguqulwa kofuzo ku-chromosome 20

Ukuze Isifo sikashukela i-Nephrogenic insipidus, izimbangela eziyinhloko zihlanganisa imithi efana ne-lithium ne-tetracycline, kanye nezimo ezihlukahlukene zezokwelapha. Uhlobo lofuzo luphumela ekuguqulweni kofuzo ezakhini zofuzo ezimbili ezithile: i-AVPR2 (90% yamacala) kanye ne-AQP2 (10% yamacala).

Isifo sikashukela i-Dipsogenic insipidus ivela ekulimaleni kwe-hypothalamus okubangelwa ukuhlinzwa, ukutheleleka, noma ukulimala ekhanda. Izinkinga zempilo yengqondo, okuhlanganisa i-schizophrenia & obsessive-compulsive disorder (OCD), nazo zingaba nomthelela ekuthuthukisweni kwayo.

Isifo sikashukela i-insipidus, isimo sesikhashana phakathi nokukhulelwa, kwenzeka lapho i-placenta ikhiqiza ama-enzyme amaningi aphula i-ADH. Abesifazane abathwele izingane eziningi babhekene nengozi enkulu ngenxa yokwanda kwezicubu ze-placenta.

Izingozi Zezingozi

Kunezici ezimbalwa ezibalulekile ezinomthelela ekwandeni kwengozi yokuthola isifo sikashukela i-insipidus:

• Umlando Womndeni: Abantu abanezihlobo ezinesifo sikashukela i-insipidus basengozini enkulu ngenxa yezakhi zofuzo
• Izinqubo Zokwelashwa: Labo abahlinzwe ubuchopho noma abalimele kakhulu ekhanda
• Ukusetshenziswa Kwemithi: Abantu abaphuza imithi ethile, ikakhulukazi ama-diuretics, athinta ukusebenza kwezinso
• Izinkinga ze-Metabolic: Abantu abanamazinga egazi angajwayelekile, ikakhulukazi:
  • Amazinga aphezulu e-calcium
  • Amazinga e-potassium aphansi
• Ezinye Izinto: 
  • Ukukhulelwa okuningi 
  • Abesifazane abanezinkinga ezihlobene nesibindi ngesikhathi sokukhulelwa, njenge-preeclampsia nesifo se-HELLP

Izinkinga zesifo sikashukela i-Insipidus

Ukuphelelwa amanzi emzimbeni, inkinga ebaluleke kakhulu, kwenzeka lapho umzimba ulahlekelwa uketshezi oluningi olungakwazi ukukubuyisela ngokushesha ngokwanele. Abantu abanesifo sikashukela i-insipidus esingalashwa bangase babe nalezi zimpawu zokuphelelwa amanzi emzimbeni:

• Ukukhathala nobuthakathaka obukhulu
• Isiyezi noma ikhanda elikhanyayo
• Umlomo omile nezindebe
• Izici zobuso ezishonile
• Ukudideka nokucasuka
• Iziphonso zokuquleka
• I-nausea

Ukungalingani kwe-electrolyte kubangela enye ingozi enkulu, ethinta amaminerali abalulekile njenge-sodium ne-potassium egazini. Lapho la mazinga ephazamiseka, iziguli zingase zibe buthakathaka, zingakuthandi ukudla, nokudideka. Lokhu kungalingani kungaholela ekushayeni kwenhliziyo okungajwayelekile nezinye izinkinga zenhliziyo nemithambo yegazi uma kungalungiswanga ngokushesha.

Ukuxilongwa kwesifo sikashukela i-Insipidus

• Ukuhlolwa Kokuncishwa Amanzi: Isisekelo sokuxilongwa kwesifo sikashukela i-insipidus ukuhlolwa kokuntuleka kwamanzi, okusiza odokotela baqonde ukuthi umzimba wesiguli ulawula kanjani ibhalansi yoketshezi. Phakathi nalokhu kuhlolwa okugadwa ngokucophelela, isiguli siyakugwema ukuphuza noma yiluphi uketshezi amahora ambalwa kuyilapho odokotela beqapha:
  • Ukukhipha umchamo nokugxila
  • Isisindo somzimba siyashintsha
  • Amazinga e-sodium yegazi
  • Impendulo ekuphathweni kwe-vasopressin
• Izivivinyo ezengeziwe: Odokotela futhi benza izinqubo ezengeziwe zokuxilonga ukuze bakhiphe ezinye izimo ezinezimpawu ezifanayo. Lokhu kubandakanya: 
  • Ukuhlolwa kwegazi ukuhlola amazinga e-antidiuretic hormone 
  • Amazinga eglucose
• Ukuhlolwa Okukhethekile Kwezithombe
  • I-Brain MRI ukuthola noma yikuphi ukungahambi kahle ku-pituitary gland noma i-hypothalamus 

Ukwelashwa kwesifo sikashukela i-Insipidus

Ezimweni ezithambile, ukumane ukwandise umthamo wamanzi kusiza ukuvimbela ukuphelelwa amanzi emzimbeni. Kodwa-ke, iziguli eziningi zidinga izindlela ezibanzi zokwelapha isifo sikashukela i-insipidus:

• Ukwelashwa kwe-Desmopressin: Ukwelashwa okuyinhloko kwe-central diabetes insipidus, etholakala njengezifutho zamakhala, amaphilisi, noma ukuncibilika ngomlomo.
• I-Thiazide diuretics: Isetshenziselwa ikakhulukazi i-nephrogenic diabetes insipidus, evame ukuhlanganiswa nokudla okunosawoti omncane.
• Ukuguqulwa kwendlela yokuphila: Ukunciphisa ukudla kukasawoti kanye namaprotheni ukusiza ukwehlisa ukukhiqizwa komchamo
• Ukulungiswa Kwemithi: Ezimweni lapho eminye imithi idala lesi simo, odokotela bangase baphakamise eminye imithi

Uzoyibona Nini Udokotela

Izimo eziphuthumayo zidinga ukuvakashelwa ngokushesha esibhedlela, ikakhulukazi uma kuvela lezi zimpawu:

• Ukudideka okukhulu noma ukudideka
• Isiyezi esikhulu noma ikhanda elilula
• Ukuvilapha okungajwayelekile noma ukukhathala
• Izimpawu zokuphelelwa amanzi emzimbeni kakhulu
• Izinguquko ezingachazeki ekwazini

Prevention

Ukuguqulwa kokudla kwakha insika yamasu okuvimbela. Odokotela bavame ukutusa ukulandela ukudla okunosawoti omncane kanye namaprotheni aphansi ukusiza ukunciphisa ukukhiqizwa komchamo. 

Abantu abanesifo sikashukela i-insipidus kufanele basebenzise lezi zinyathelo zokuvimbela:

• Gcina ukufinyelela okungaguquki emanzini okuphuza ahlanzekile
• Gwema imisebenzi eyandisa ingozi yokuphelelwa amanzi emzimbeni
• Gada ukusebenzisana kwemithi ngokucophelela
• Yehlisa ukusetshenziswa kokudla okugayiwe
• Nciphisa ukudla okunamaprotheni amaningi njengamaqanda namantongomane
• Landelela umthamo wansuku zonke nokukhishwayo koketshezi

Isiphetho

Isifo sikashukela i-insipidus sidinga ukunakwa okucophelela kanye nokuphathwa kwezokwelapha okufanele ukuze iziguli ziphile impilo evamile. Abantu abanalesi simo bangakwazi ukulawula izimpawu zabo ngempumelelo ngezinketho zokwelashwa ezifanele, ukuhlolwa kwezokwelapha okuvamile, nokulungiswa kwendlela yokuphila. Ukwelashwa kwezokwelapha, ukufakwa kwamanzi ngendlela efanele, kanye nezinguquko zokudla kusiza iziguli eziningi ukulawula isimo sazo ngempumelelo.

Imibuzo Evame Ukubuzwa

1. Ingabe i-potassium iphezulu noma iphansi ku-diabetes insipidus?

Amazinga aphansi e-potassium ngokuvamile avela ku-diabetes insipidus. Lesi simo singathinta ibhalansi ye-electrolyte yomzimba, ikakhulukazi lapho ukuchama ngokweqile kuholela ekulahlekelweni kwamaminerali. Odokotela bahlale beqapha amazinga e-potassium njengengxenye yokuphatha ukwelashwa.

2. Yini isifo sikashukela i-insipidus vs mellitus?

Lezi zimo zinegama lazo lokuqala kuphela kodwa zihluke ngokuphelele. Isifo sikashukela i-insipidus sithinta ibhalansi yamanzi ngezinkinga ze-antidiuretic hormone (ADH), kanti isifo sikashukela sibandakanya ukulawulwa kokushukela egazini nge-insulin. Umehluko oyinhloko uhlanganisa:

• Ushukela wegazi ojwayelekile ku-diabetes insipidus vs ushukela ophezulu wegazi ku-diabetes mellitus
• Amahomoni ahlukene ahilelekile (ADH vs insulin)
• Kudingeka izindlela ezahlukene zokwelapha

3. Ingabe isifo sikashukela i-insipidus singelapheka?

Yize lingekho ikhambi elihlala njalo lesifo sikashukela i-insipidus, lesi simo siyalawuleka ngokwelashwa okufanele. Ezinye izimo, njenge-Gestational diabetes insipidus, zixazulula ngokwemvelo ngemva kokukhulelwa. Ezinye zidinga ukuphathwa okuqhubekayo ngokusebenzisa imithi kanye nokulungiswa kwendlela yokuphila.

4. Ungasithola kanjani isifo sikashukela i-insipidus?

Odokotela basebenzisa izindlela ezimbalwa zokuthola isifo sikashukela i-insipidus:

• Ukuhlolwa kokuncishwa kwamanzi
• Ukuhlolwa kwegazi kwe-sodium namanye ama-electrolyte
• Ukuhlaziywa komchamo
• I-MRI ihlola uma kunesidingo

5. Imuphi umehluko omkhulu phakathi kwesifo sikashukela i-insipidus nesifo sikashukela i-mellitus?

Umehluko oyinhloko usezimbangela zabo. Isifo sikashukela i-insipidus sihlobene nokulawulwa kwamanzi nge-ADH, kanti isifo sikashukela sithinta amazinga kashukela egazini nge-insulin. Ukwelashwa kwabo kwehluka kakhulu, ngesifo sikashukela i-insipidus esidinga ukulawulwa kokulingana kwamanzi futhi mhlawumbe ne-desmopressin, kuyilapho isifo sikashukela sidinga i-insulin noma imithi yokwehlisa ushukela wegazi.

6. Isifo sikashukela i-insipidus sithinta bani?

Isifo sikashukela i-insipidus singathinta abantu bayo yonke iminyaka. Izici eziyingozi zihlanganisa ukulimala ekhanda, ukuhlinzwa kobuchopho, imithi ethile, kanye nezakhi zofuzo. Abesifazane abakhulelwe bangase babe uhlobo lwesikhashana, kuyilapho abanye abantu bezuza lesi simo ngokuguqulwa kofuzo.

UDkt. Sandeep Kharkar

MBBS, MD (Int Med),PGCC (Rheumatology)
I-Ganga CARE Hospital Limited, eNagpur

Ukuze Ubhukhe Isikhathi, shayela:

+ 91 40-68106529