I-Nephrotic Syndrome

I-Nephrotic syndrome wukuphazamiseka kwezinso okwenza umzimba ukhiphe amaprotheni amaningi emchameni. Lesi simo esibucayi sithinta amacala amasha angu-2 kuya kwangu-7 ezinganeni ezingu-100,000 ezingaphansi kweminyaka engu-18 unyaka ngamunye. Lesi simo singakhula nakubantu abadala. Uma kwenzeka ukulimala kwezinso, kuholela ezimpawini ezihlukahlukene ezifana namazinga aphansi e-albhamuin egazini kanye ne-lipids ephezulu yegazi.

Odokotela abakwazi ukwelapha i-nephrotic syndrome, kodwa iziguli zingasilawula kangcono isimo sazo ngokwazi izimpawu zaso, izimbangela, kanye nokwelashwa. Izimpawu zalesi simo zihlanganisa ukuvuvukala okunamandla emehlweni, amaqakala nasezinyaweni, kanye nomchamo onegwebu. Iziguli zivame ukuzwa ukukhuluphala ngenxa yokugcinwa koketshezi, zizizwe zikhathele, futhi zingakuthandi ukudla. Lezi zimpawu zivela ngenxa yokuthi izingxenye zokuhlunga zezinso ziyalimala futhi zivumele amaprotheni avuzele emchamweni esikhundleni sokuwagcina egazini.

Lesi simo siphakamisa kakhulu ingozi yokutheleleka kanye namahlule egazi. Ucwaningo lubonisa ukuthi abantu abane-nephrotic syndrome banethuba eliphindwe ka-10 lokuthuthukisa i-venous thromboembolism kunabantu abaningi. Izindaba ezinhle ukuthi imithi efanele kanye nesiqondiso esivamile esivela kubahlinzeki bezempilo kungasiza ukulawula lezi zimpawu. Izingane ezinalesi simo zinombono ongcono nakakhulu - i-nephrotic syndrome ngokuvamile idlula lapho isanda kweva eshumini nambili noma ekuqaleni kweminyaka engamashumi amabili.

Iyini i-Nephrotic Syndrome?

Amayunithi okuhlunga ezinso (glomeruli) agcina umonakalo ku-nephrotic syndrome, okubangela ukuvuza ngokweqile kwamaprotheni emchameni. Izibalo zibonisa ukuthi i-nephrotic syndrome ezinganeni ivame kakhulu kunabantu abadala.

Iziguli ezine-nephrotic syndrome zibonisa izimpawu eziningana. Lokhu kufaka phakathi amaprotheni emchameni (i-proteinuria), amazinga aphansi e-albhamuin egazini (hypoalbuminemia), i-lipids ephezulu yegazi (hyperlipidemia), nokuvuvukala okukhulu (i-oedema). Lesi simo siba lapho i-glomeruli ivumela amagremu angu-3 noma ngaphezulu amaprotheni avuze emchameni phakathi namahora angu-24.

Izinhlobo ze-Nephrotic Syndrome

Odokotela bahlukanisa i-nephrotic syndrome ngezigaba ezimbili:

• Primary: Izifo zezinso ezihlasela izinso kuphela zibanga lolu hlobo.
• Okwesibili: Ezinye izifo ezithinta izingxenye eziningi zomzimba ziholela kulolu hlobo.

Isifo soshintsho oluncane ngokuvamile sithinta izingane. Abantu abadala abamnyama bavame ukuba ne-focal segmental glomerulosclerosis. Abantu abadala abamhlophe bavamise ukuba ne-membranous nephropathy.

Izimpawu ze-Nephrotic Syndrome

Iziguli zithola lezi zimpawu ezivamile ze-nephrotic syndrome:

• Ukuvuvukala kubonakala kuqala eduze kwamehlo
• Imilenze, izinyawo namaqakala kuyakhukhumala
• Umchamo ubukeka unegwebu
• Ukugcina uketshezi kuholela ekuzuzeni isisindo
• Abantu bazizwa bekhathele futhi bephelelwa isifiso sokudla

Izinkinga ze-Nephrotic Syndrome

Izifo zezinso ezifana ne-glomerulosclerosis noma i-glomerulonephritis zibangela i-primary nephrotic syndrome. Okulandelayo ezinye izimbangela ze-nephrotic syndrome:

• Diabetes
• I-Systemic lupus erythematosus
• I-Renal vein thrombosis
• Amagciwane afana ne-HIV, i-hepatitis
• Imithi ethile efana nezidakamizwa ezingezona ukuvuvukala (ama-NSAID) noma ama-antibiotic athile
• Kwesinye isikhathi umdlavuza udala izimo zesibili.

Ingozi ye-Nephrotic Syndrome

• Izingane eziphakathi kweminyaka engu-2-7 zibhekene nezingozi eziphakeme. 
• Abafana banokuthambekela okuphezulu kwe-nephrotic syndrome kunamantombazane.
• Abantu abadala abanesifo sikashukela, imishanguzo ethile noma izifo ezifana ne-HIV noma i-hepatitis zibonisa ukuba sengcupheni okwandisiwe.

Izinkinga zeNephrotic Syndrome

• Amahlule egazi, izifo, inkinga ye-hypovolemic, i-cholesterol ephezulu, ukulimala kwezinso okukhulu, kanye ne-anemia kubangela izingozi ezinkulu. 
• I-Thromboembolism isalokhu ikhathaza kakhulu. 
• Ucwaningo lubonisa ukuthi iziguli ezine-nephrotic zinethuba eliphindwe ka-3.4 lokuthuthukisa i-venous thromboembolism.

Sifo

Odokotela baqale basebenzise ukuhlolwa kwe-dipstick ukuhlola amaprotheni emchameni. Umphumela omuhle uholela ekuqinisekisweni ngokusebenzisa iqoqo lomchamo wamahora angu-24. 

Ukuhlolwa kwegazi kwembula amazinga e-albumin ancishisiwe kanye namazinga aphezulu e-cholesterol ezimweni eziningi. 

Kwezinye izimo, odokotela benza i-renal biopsy ukuze bathathe isampula lethishu elincane ukuze balihlole ngesibonakhulu. Lokhu kusiza odokotela bafunde mayelana nezinqubo futhi bakhethe ukwelashwa okufanele.

Ukwelashwa kwe-Nephrotic Syndrome

Umgomo oyinhloko ukukhomba izindlela ngenkathi uphatha izimpawu. Ama-steroid afana ne-prednisolone ahlala ewukwelashwa okujwayelekile, ikakhulukazi ezinganeni. Uhlelo lokwelapha luhlanganisa:

• Izidakamizwa zomfutho wegazi (ACE inhibitors) ukunciphisa ukuvuza kwamaprotheni
• Ama-diuretics ukunciphisa ukuvuvukala
• Imithi yokwehlisa i-cholesterol
• Amahlule egazi ukuvimbela amahlule

Ngaphezu kwalokho, iziguli kudingeka zinciphise usawoti eziwudlayo.

Uzoyibona Nini Udokotela

Kufanele ushayele udokotela wakho uma ubona:

• Ukuvuvukala okuqhubekayo, ikakhulukazi emehlweni nasemaqakaleni
• Umchamo onegwebu
• Ukuzuza kwesisindo kungazelelwe
• Izinkinga zokuphefumula

Thola ukunakekelwa okuphuthumayo uma amazinga amaprotheni ehlala ku-3+ ekuhlolweni kwe-dipstick izinsuku ezintathu eziqondile.

Prevention

Iziguli zingathatha izinyathelo ezilandelayo ukuze zinciphise ubungozi bazo:

• Gcina isifo sikashukela kanye nezimo zomfutho wegazi ophezulu zilawulwa
• Thatha wonke ama-antibiotics njengoba udokotela eyala
• Thola imithi yokugoma enconyiwe, ikakhulukazi amashothi e-pneumococcal

Isiphetho

Abantu abane-nephrotic syndrome babhekana nezinselele zansuku zonke, kodwa ukuphatha okuhle kungenza umehluko omkhulu ezimpilweni zabo. Lesi simo sezinso singathinta noma ubani futhi sibangele ukuvuza kwamaprotheni, ukuvuvukala nezinye izimpawu ezingakhululekile.

Odokotela baxilonga lesi simo ngokusebenzisa ukuhlolwa komchamo, ukusebenza kwegazi, futhi ngezinye izikhathi ukuhlolwa kwezinso. Ukwelashwa kugxile ekulawuleni izimpawu ngenkathi kubhekwa ukuthi kungani zenzeka. Ama-steroid ahlala ewumuthi oyinhloko, ikakhulukazi ezinganeni. Izidakamizwa zomfutho wegazi, ama-diuretics, nemithi yokwehlisa i-cholesterol isiza ukulawula izimpawu futhi.

Ukudla kwenza umthelela obalulekile ekululameni. Ukudla usawoti omncane kusiza ukulawula ukuvuvukala. Ukuqapha ngokucophelela kusiza ukuvimbela izinkinga ezifana namahlule egazi kanye nezifo. Abazali kufanele bazi ukuthi isimo sezingane zabo ngokuvamile siba ngcono lapho sekwephuzile.

I-Nephrotic syndrome idinga nje ukunakekelwa okungaguquki, futhi iziguli ezinamathela ezinhlelweni zazo zokwelashwa zingaphila ukuphila okuvamile. Isihluthulelo sokulawula lesi simo sisekuhlolweni njalo, ukuphuza imithi njengoba kuyalelwe, kanye nokwenza izinguquko endleleni yokuphila. Isenzo esisheshayo senza umehluko wangempela - kufanele ushayele udokotela wakho ngokushesha uma ubona ukuvuvukala okungapheli, umchamo onegwebu, noma ukuzuza kwesisindo okungachazeki.

Isayensi yezokwelapha ayikatholi ikhambi kuze kube manje, kodwa ukunakekelwa okufanele nokuxhumana okuqinile nabahlinzeki bezempilo kunikeza iziguli ithuba elingcono kakhulu lokulawula lesi sifo sezinso ngempumelelo.

Imibuzo Evame Ukubuzwa

Kuyini ukudla kwe-nephrotic syndrome?

I-nephrotic syndrome yokudla ihlanganisa: 

• Ukudla okuphansi kwe-sodium
• Ukudla amaprotheni okusesilinganisweni—cishe igremu elingu-1 ngekhilogremu yesisindo somzimba nsuku zonke. 
• Izithelo ezintsha, imifino, nokusanhlamvu kuyizinqumo ezingcono kunokudla okugayiwe. 

Uyini umehluko phakathi kwe-nephrotic ne-nephritic syndrome?

I-Nephrotic syndrome idala ukulahleka kwamaprotheni amaningi emchameni, ukuvuvukala okubonakalayo kanye nomfutho wegazi ojwayelekile. I-Nephritic syndrome, ngakolunye uhlangothi, ibangela ukuvuvukala, igazi emchamweni (i-hematuria), umfutho wegazi ophakeme, nokulimala kwe-glomerular okumaphakathi. Lo mehluko usiza odokotela ukuthi benze izinhlelo ezithile zokwelapha zesimo ngasinye.

Yisiphi isigaba sokuqala se-nephrotic syndrome?

Ubuso bezingane ngokuvamile buvuvukala kuqala, bese ukuvuvukala kudlulela kwezinye izitho zomzimba. Abantu abadala bavame ukuthuthukisa i-edema encike kuqala. Umchamo onegwebu uvame ukuvela, okhombisa ukuvuza kwamaprotheni.

Iyini iminyaka ephezulu ye-nephrotic syndrome?

Isifo soshintsho oluncane, uhlobo oluvame kakhulu, sifinyelela umvuthwandaba lapho sineminyaka engu-2½. Amacala amaningi avela lapho eneminyaka engu-6 ubudala, futhi abafana bayithola kabili kunamantombazane.
 

UDkt. Shiv Shankar Sharma

MD, DM (Nephrology)
Izibhedlela ze-CARE CHL, e-Indore

Ukuze Ubhukhe Isikhathi, shayela:

+91 406 810 6585