I-Hemolytic Uremic Syndrome

I-Haemolytic uremic syndrome (HUS) ithinta izinkulungwane zabantu emhlabeni wonke unyaka ngamunye, ikakhulukazi izingane ezincane kanye nabantu abadala. Lesi simo sezempilo esingavamile kodwa esibi kakhulu singaholela ezinkingeni ezisongela ukuphila uma singabonwa futhi zelashwa ngokushesha. Ake sihlole izici ezibalulekile zalesi simo, kusukela ezinhlotsheni nezimpawu zaso ezihlukahlukene kuye kuzinketho zokwelapha ze-HUS syndrome namasu okuvimbela.

Iyini i-Hemolytic Uremic Syndrome (HUS)?

I-Haemolytic uremic syndrome (HUS) yisimo sezempilo esibucayi esiba khona lapho imithambo emincane yegazi ilimala futhi ivuvukala. Lesi simo esiyinkimbinkimbi siqondise ngokuyinhloko imithambo yegazi ezinso, okwenza uchungechunge lwezinkinga zempilo ezidinga ukunakwa ngokushesha.

Isimo sezempilo se-HUS siqala lapho ukulimala kwemithambo yegazi kuholela ekwakhekeni kwamahlule amancane kuwo wonke umzimba. Lawa mahlule angathinta kakhulu izitho ezihlukahlukene, kanti izinso yizona ezisengozini enkulu yokulimala. Okwenza i-HUS syndrome ithinteke ikakhulukazi amandla ayo okubangela izinkinga ezintathu eziyinhloko:

• Ukubhujiswa kwamaseli abomvu egazi (i-anemia ye-hemolytic)
• Ukunciphisa amaplatelet egazi (thrombocytopenia)
• Ukuhluleka kwezinso okungenzeka
• Umthelela kwezinye izitho, okuhlanganisa inhliziyo nobuchopho

Nakuba noma ubani engase abe ne-HUS, ngokuvamile ihlasela izingane ezineminyaka engaphansi kweyi-10. Isiqalo esivame kakhulu ukutheleleka ngezinhlobo ezithile zebhaktheriya i-Escherichia coli (E. coli). Nokho, ezinye izici ezifana ukukhulelwa, umdlavuza, noma izifo ezizimele nazo zingaholela ekukhuleni kwayo.

Izinhlobo ze-Hemolytic Uremic Syndrome

Izinhlobo ezintathu eziyinhloko ze-HUS zifaka:

• I-HUS ejwayelekile: Ifomu elivame kakhulu, ngokuvamile elibangelwa izifo ezibangelwa amagciwane ezithinta amathumbu. Lolu hlobo lwenza u-90% wazo zonke izimo ezinganeni.
• I-Atypical HUS (aHUS): I-Atypical HUS syndrome yisimo sofuzo esingajwayelekile esithinta umuntu ongaphansi koyedwa kubantu abayisigidi esingu-1. Leli fomu lingenzeka unyaka wonke futhi alidingi ukugula kwesisu ukuze kubangele izimpawu.
• I-HUS yesibili: Lolu hlobo lukhula ngokuhambisana nezinye izimo zezokwelapha futhi lumelela iphesenti elincane lezimo.

Izimpawu ze-Hemolytic Uremic Syndrome

Okulandelayo ezinye zezimpawu zesifo se-HUS ezivamile:

• Uhudo olunegazi
• Ubuhlungu besisu kanye ne-cramping
• Umkhuhlane namakhaza
• I-nausea kanye nokuhlanza
• bekhanda

Njengoba isimo siqhubeka, kuvela izimpawu ezimbi kakhulu ngenxa yokulimala kwemithambo yegazi:

• Izinguquko zomzimba ziba sobala, kuhlanganise nesikhumba esiphaphathekile, ikakhulukazi ezihlathini nasezinkopheni ezingezansi. 
• Iziguli zingase futhi zithole imihuzuko engachazeki noma amabala abomvu amancane esikhumbeni, okubonisa ukulimala kwemithambo yegazi.

Yiziphi Izingozi Nezimbangela Ze-HUS?

Lesi simo ngokuyinhloko sisukela ezifweni ezithile zebhaktheriya, nakuba ezinye izici ezihlukahlukene zingase zibangele ukuqala kwazo.

• Izimbangela Eziyinhloko: Isiqalo esivame kakhulu ukungenwa yizinhlobo ezithile zebhaktheriya i-E. coli, ikakhulukazi i-E. coli O157:H7, ekhiqiza ubuthi obuyingozi obubizwa ngokuthi i-Shiga. Leli bhaktheriya ngokuvamile lingena emzimbeni ngokusebenzisa:
  • Inyama engaphekiwe, ikakhulukazi yenkomo egayiwe
  • Ubisi olungagcwalisiwe noma ijusi yezithelo
  • Izithelo nemifino engageziwe
  • Amachibi okubhukuda angcolile noma amachibi
  • Ukuxhumana ngqo nabantu abangenwe yilesi sifo
• Izimbangela zesibili: Kwezinye izimo, i-HUS ingathuthuka njengomphumela ohlangothini wemithi ethile, okuhlanganisa:
  • Ukwelashwa ngamakhemikhali izidakamizwa (i-bleomycin, i-cisplatin, i-gemcitabine)
  • Imithi ye-immunosuppressant
  • I-quinine yokwelapha umalaleveva

Izingozi Zezingozi

Izinto ezimbalwa zandisa amathuba omuntu okuthuthukisa i-HUS. Lokhu kubandakanya:

• Izingane ezingaphansi kweminyaka engu-5 ubudala zibhekene nengozi enkulu kakhulu, ebonisa amathuba acishe abe kahlanu okuba nesifo uma kuqhathaniswa nabantu abadala. 
• Isivikelo somzimba sokuzivikela
• Umlando womndeni wakwa-HUS
• Ukukhulelwa noma ukubeletha kwakamuva
• Isikhathi esinwetshiwe sohudo ngaphambi kokulaliswa esibhedlela

Izinkinga ze-Hemolytic Uremic Syndrome

Izinkinga ezinkulu zingabandakanya:

• Ukwehluleka kwezinso okukhulu okudinga i-dialysis ku-50-70% weziguli
• Izinkinga ze-neurological, kuhlanganise ukuhlukunyezwa, unhlangothi, kanye nekoma
• Izinkinga zenhliziyo kanye ne-cardiomyopathy
• Izinkinga ezinkulu zokugaya ukudla, okuhlanganisa nokulimala kwamathumbu
• Izinkinga zokujiya kwegazi ezingase ziholele ekopheni

Sifo

Udokotela uqala ngokuhlola umzimba wonke futhi abuyekeze umlando wezokwelapha wesiguli, okuhlanganisa ukugula kwamuva noma izimpawu. Uma i-HUS isolwa, odokotela benza izivivinyo eziningana ukuze baqinisekise ukuxilongwa.

Ukuhlola okubalulekile okuhlanganisa:

• Ukuhlolwa kwegazi ukuthola amangqamuzana abomvu egazi awonakele kanye nenani eliphansi leplatelet nokuhlola ukusebenza kwezinso ngamaleveli e-creatinine
• Ukuhlaziywa komchamo ukuhlola amazinga amaprotheni angavamile kanye igazi emchameni
• Ukuhlolwa kwesampula yesitulo ukukhomba i-E. coli O157:H7 namanye amagciwane angase aqalise i-HUS
• Ukuhlolwa kofuzo ezimeni ze-HUS okusolwa ukuthi i-atypical ukuze kuhlonzwe okungavamile kofuzo

Ukwelashwa

Isisekelo sokwelashwa kwe-HUS syndrome sihilela ukunakekelwa okusekelayo, okunezindlela ezimbalwa ezibalulekile:

• Ukulawula Uketshezi: Uketshezi olufakwa emthanjeni kanye nezithako zokudla okunomsoco ngokusebenzisa amashubhu okuphakelayo kusiza ekugcineni ukugeleza kwamanzi kanye namazinga okudla okufanele
• Ukumpontshelwa Igazi: Iziguli zithola amangqamuzana egazi abomvu namaplatelet ukubhekana nezimpawu ze-anemia nokuthuthukisa ukujiya kwegazi
• Ukwesekwa Kwezinso: I-Dialysis ingase idingeke ukuze kuhlanzeke igazi kuyilapho izinso ziphola, kanti ezinye iziguli zidinga ukwelashwa isikhathi eside
• Ukulawula Umfutho Wegazi: Imithi isiza ukunciphisa umfutho wegazi futhi inciphise ukulimala kwezinso

Ezigulini ezine-HUS engavamile, odokotela banikeza imithi ekhethekile njenge-eculizumab noma i-ravulizumab. Lokhu kwelashwa kudinga ukugonywa kwe-meningococcal kanye ne-pneumococcal kusenesikhathi ukuvimbela izinkinga ezingaba khona.

Uzoyibona Nini Udokotela

Ngokushesha thintana nodokotela uma kuvela noma yiziphi zalezi zimpawu eziyisixwayiso:

• Uhudo olunegazi noma isifo sohudo esithatha isikhathi esingaphezu kwezinsuku ezintathu
• Ukuvuvukala okungajwayelekile kunoma iyiphi ingxenye yomzimba
• Ukulimala noma ukopha okungachazwanga
• Ukukhathala okukhulu noma ubuthakathaka
• Ukuchama okwehlisiwe

Prevention

Nakuba ezinye izimo zingagwemeka, ikakhulukazi lezo ezixhunywe nezici zofuzo, izimo eziningi zingagwenywa ngokunaka ukuphepha kokudla kanye nenhlanzeko yomuntu siqu.

Izinyathelo Zokuvimbela Ezibalulekile:

• Pheka inyama kahle ekushiseni kwangaphakathi okungenani okungu-160° F (71° C)
• Gwema ubisi olungagcotshiwe, ijusi, nemikhiqizo ye-cider
• Hlanza izinto zasekhishini nezindawo zokudla njalo
• Gcina ukudla okuluhlaza ngokwehlukana nokudla okuphekiwe
• Gcina inyama ngokwehlukana esiqandisini
• Geza izandla kahle, ikakhulukazi ngaphambi kokudla nangemuva kokusebenzisa indlu yangasese
• Gwema ukubhukuda ezindaweni ezinamanzi angcolile
• Ungangeni emachibini uma uhlangabezana isifo sohudo

Isiphetho

I-Hemolytic uremic syndrome isalokhu iyisimo esibucayi sezokwelapha esidinga ukunakekelwa ngokushesha nokunakekelwa okufanele kwezokwelapha. Nakuba kungavamile, umthelela wawo ungaba mkhulu, ikakhulukazi ezinganeni ezincane nakubantu asebekhulile. Izindaba ezinhle ukuthi iziguli eziningi zilulama ngokugcwele ngosizo lwezokwelapha olusheshayo nokunakekelwa okufanele. Ukuqapha njalo nokunakekelwa kokulandelela kusiza ukuphatha izinkinga ezingase zibe khona zesikhathi eside ngempumelelo.

Ukuqonda izimpawu eziyisixwayiso nezici zobungozi kusiza abantu ukuthi bafune usizo lwezokwelapha ngokushesha. Izinyathelo ezilula zokuvimbela, njengokuphatha ukudla ngendlela efanele, ukuphekwa kahle kwenyama, nemikhuba emihle yenhlanzeko, kunganciphisa kakhulu ingozi yokuthuthukisa i-HUS. Abazali, abanakekeli, nodokotela kufanele bahlale beqaphele izimpawu eziyisixwayiso kusenesikhathi, ikakhulukazi ngemva kokugula kwesisu, njengoba isenzo esisheshayo ngokuvamile siholela emiphumeleni engcono.

Imibuzo Evame Ukubuzwa

1. I-hemolytic uremic syndrome ithinta bani?

Nakuba i-haemolytic uremic syndrome ingathinta noma ubani, amaqembu athile abhekana nezingozi eziphakeme. Izingane ezingaphansi kweminyaka engu-5 ubudala zisengozini kakhulu, okubonisa amazinga aphezulu ezigameko. Lesi simo sivame ukuphatha izingane ezincane eziphakathi kwezinyanga eziyisi-6 kanye neminyaka emi-4 ubudala.

Izici zengozi zihlanganisa:

• Amasosha omzimba abuthaka
• Isakhi sofuzo
• Ukukhulelwa noma ukubeletha kwakamuva
• Ukusetshenziswa kwemithi ethile

2. Ingabe i-hemolytic uremic syndrome iyathathelana?

I-haemolytic uremic syndrome ngokwayo ayitheleleki futhi ayikwazi ukusakazeka ngokuthintana nomuntu nomuntu. Nokho, amagciwane e-E. coli ngokuvamile abangela i-HUS angasakazeka phakathi kwabantu ngabanye. Ukudluliselwa ngokuvamile kwenzeka ngokusebenzisa:

• Ukusebenzisa ukudla noma iziphuzo ezingcolile
• Ukubhukuda emanzini angcolile
• Ukuthintana ngqo nabantu abanaleli gciwane
• Ukuchayeka endle yezilwane engcolile

UDkt. P Vamsi Krishna

MBBS, MS, MCh
CARE Hospitals, Banjara Hills, Hyderabad

Ukuze Ubhukhe Isikhathi, shayela:

+ 91 40-68106529