I-Renal Tubular Acidosis

I-RTA (Renal Tubular Acidosis) yisimo sezinso esingavamile esivame ukuhlala singabonwa noma singahlonzwa kahle. Izinso zeziguli ze-RTA azikwazi ukususa kahle ama-acids emzimbeni. Izinso ezinempilo kufanele zikhiphe cishe i-1 mmol/kg/day ye-acids engaguquki.

Uhlobo 4 lwe-hyperkalemic renal tubular acidosis luhlala luwuhlobo oluvame kakhulu emhlabeni jikelele. Ukuhlolwa kwegazi kuvame ukuveza lesi sifo sezinso ngesikhathi sokuhlolwa okujwayelekile esikhundleni sokuhlolwa okuthile. Uhlobo ngalunye lwe-RTA lubonisa izimpawu nezimbangela ezahlukene. Iziguli zokufakelwa izinso zinethuba lokuthuthukisa lesi simo ngenxa yokwenqatshwa noma imishanguzo ye-immunosuppressive. Izingane ezine-RTA engelashiwe zibhekana nezingozi ezinkulu zempilo ezifana nokungakhuli kahle, amatshe ezinso kanye nokulimala okungapheli kwamathambo noma izinso.

Lesi sihloko sinikeza ulwazi oluphelele mayelana nokuxilonga i-RTA, izinketho zokwelapha, kanye nesikhathi esifanele sokubona udokotela. Ukuqonda okucacile kwalokhu kuphazamiseka kwezinso okungajwayelekile kodwa okunenjongo kusiza ukuqinisekisa ukunakekelwa okufanele futhi kuvimbele izinkinga zezempilo zesikhathi eside.

Iyini i-Renal Tubular Acidosis?

Izinso zisiza ukulawula i-pH yomzimba futhi iwugcine phakathi kuka-7.35 no-7.45. Isifo sezinso se-RTA senzeka lapho izinso zingakwazi ukukhipha i-asidi eyengeziwe egazini ngendlela efanele. Lokhu kuholela ku-acidosis nakuba umsebenzi wezinso usuwonke uhlala ujwayelekile.

I-RTA iqala lapho izinso zehluleka ukukhipha ama-ion e-hydrogen noma ukumunca i-bicarbonate ehlungiwe emuva. Lesi simo sidala i-metabolic acidosis yesikhathi eside enegebe elivamile le-anion futhi ngokuvamile libonisa i-hyperchloremia. Lesi sifo sithinta indlela amashubhu ezinso abhalansisa ngayo i-asidi namazinga ayisisekelo, kodwa amandla okuhlunga ezinso ahlala eqinile.

Izinhlobo ze-Renal Tubular Acidosis

Okulandelayo yizinhlobo ze-renal tubular acidosis:

• Uhlobo 1 (distal RTA): Ithinta ingxenye yokugcina yamashubhu lapho ukukhishwa kwe-ion ye-hydrogen kungasebenzi kahle. I-pH yomchamo ihlala ngaphezu kwe-5.5.
• Uhlobo 2 (proximal RTA): Kuthinta ingxenye yokuqala yamashubhu lapho ukumuncwa kabusha kwe-bicarbonate kwehluleka khona. Lolu hlobo luvame ukubonakala ebuntwaneni.
• Thayipha 3: Lolu hlobo oluyivelakancane luhlanganisa izici zezinhlobo 1 no-2.
• Uhlobo 4 (hyperkalemic RTA): Lolu hlobo lwenzeka kaningi. Kwenzeka ngenxa yokuntuleka kwe-aldosterone noma lapho ama-distal tubules engaphenduli ku-aldosterone.

Izimpawu ze-Renal Tubular Acidosis

Iziguli eziningi azibonisi zimpawu kuze kube yilapho ukuhlolwa kwegazi kwembula izinkinga. Izimpawu ezijwayelekile ze-renal tubular acidosis zihlanganisa:

• Imisipha ebuthaka
• Ubuhlungu be-Bone
• Ukukhathala
• Ukudideka
• Ukuphefumula ngokushesha
• Ukushaya kwenhliziyo okusheshayo
• Ama-cramp muscle
• Izingane zingakhula kancane futhi zibe nama-rickets.

Izinkinga ze-Renal Tubular Acidosis

Uhlobo ngalunye lunezimbangela ezithile: 

• Uhlobo loku-1 lungatholwa njengefa noma luqale ezifweni ezizimele njenge-Sjögren's syndrome noma i-lupus. 
• Thayipha 2 izixhumanisi ezimweni ezizuzwe njengefa njenge-Fanconi syndrome noma ukuchayeka kwensimbi enzima. 
• Uhlobo 4 luvamise ukuvela ku-nephropathy ehlobene nesifo sikashukela noma imithi ethinta i-aldosterone.

Ingozi ye-Renal Tubular Acidosis

Abantu abanezimo ezilandelayo babhekana nezingozi eziphakeme: 

• Ukuvinjwa komgudu womchamo
• Izifo ezizenzakalelayo
• I-Cadmium noma ukuchayeka komthofu
• Izici zofuzo
• Ukufakelwa kwezinso
• Imithi ethile

Izinkinga ze-Renal Tubular Acidosis

I-RTA idinga ukwelashwa ukuze igweme izinkinga ezinkulu. I-renal tubular acidosis engalashwa ingabangela: 

• Ama-electrolyte angalingani
• Amatshe ezinso
• Ukwakhiwa kwe-calcium ezinso (nephrocalcinosis)
• Izinkinga zamathambo
• Ukukhula kancane ezinganeni
• Isifo sezinso ezingapheli 
• Abanye abantu abanoHlobo loku-1 bangase balahlekelwe ukuzwa.

Sifo 

Odokotela babheka isifo se-RTA ezigulini ezibonisa izimpawu ze-hyperchloremic metabolic acidosis. Ukuthola ukuxilongwa okucacile kudinga isithombe esigcwele ekuhlolweni okuningi:

• Odokotela basebenzisa ukuhlolwa kwegazi ukukala ibhalansi ye-acid-base, ama-electrolyte, nokusebenza kwezinso. 
• Ukuhlolwa komchamo kubasiza ukuthi bafunde ngokuqukethwe kwe-asidi namazinga e-pH. 
• Ukuhlolwa kwe-ammonium chloride kubonisa ukuthi iziguli zoHlobo loku-1 lwe-RTA azikwazi ukufaka i-asidi emchamweni njengoba igazi lazo liba ne-asidi kakhulu. 
• Ukuxilongwa kwe-RTA yohlobo 2 kudinga ukuhlolwa kokufakwa kwe-bicarbonate okubonisa i-bicarbonate eningi emchamweni. 
• Ukuhlolwa kwesithombe njenge-ultrasound kusiza ukubona amatshe ezinso noma idiphozithi ye-calcium.

Ukwelashwa kwe-Renal Tubular Acidosis

Ukwelashwa nge-alkali kuyisisekelo sokwelashwa kwe-RTA kunoma yiluphi uhlobo. I-sodium bicarbonate noma i-potassium citrate isebenza ukunciphisa ubumuncu begazi. Imithamo yansuku zonke ye-1-2 mmol/kg yanele ku-Type 1 kanye no-2 RTA. Iziguli zohlobo 2 zidinga imithamo ephezulu ku-10-15 mmol/kg ngosuku. 
Odokotela basebenzisa izithasiselo ze-potassium ukuze balungise i-hypokalemia eziNhlotsheni 1 no-2. I-thiazide diuretics isiza iziguli zoHlobo 2 ukugcina amazinga azo e-bicarbonate ezinzile. Ukushintsha ukudla okulula njengokudla izithelo nemifino eminingi kanye nokunciphisa amaprotheni ezilwane kunganciphisa umthwalo we-asidi.

Uzoyibona Nini Udokotela

Shayela udokotela wakho ngokushesha uma ubona:

• Ubuthakathaka bemisipha
• Ukuphefumula okusheshayo
• Ukubambezeleka kokukhula kwezingane
• Qiniseka ukuthi uyahlola futhi uma izimpawu zakho zingathuthuki ngemva kokuqala kokwelashwa.

Prevention

Ayikho indlela yokuvimbela izinhlobo ezizuzwe njengefa ze-RTA. Noma kunjalo, ungagwema imishanguzo ye-trigger futhi uphathe ezinye izimo zezempilo ukuze uvimbele i-RTA yesibili.

Isiphetho

I-Renal Tubular Acidosis (RTA) yinkinga yezinso ephazamisa ibhalansi ye-acid-base ethambile yomzimba. Ngaphandle kokwelashwa, kungase kubangele ukukhathala, ubuthakathaka bemisipha, izinso, ngisho nezinkinga zamathambo. Uhlaka olusiliva luwukuthi i-RTA ingaphathwa kahle ngokunakekelwa okufanele nokuxilongwa. Imithi, ukulungisa ukudla okunempilo, nokuhlolwa okuvamile kudlala indima enkulu ekulawuleni izimpawu nokugwema izinkinga ezingathi sína. Ukuyibamba kungasiza ukuvikela impilo yezinso kanye nempilo yonke. Uma belashwa futhi besekelwa abantu abaningi abane-RTA bangajabulela izimpilo ezigcwele ngaphandle kwezinkinga eziningi.

Imibuzo Evame Ukubuzwa

Ingabe i-RTA ibangela isifo sohudo?

Yebo, i-RTA ingaholela ezinkingeni zokugaya ukudla. Iziguli ezine-primary distal RTA zivame ukuba nezinkinga zesisu ezifana nesifo sohudo, ukuqunjelwa, ukuhlanza, kanye ne-anorexia. I-Metabolic acidosis ngokuvamile idala lezi zimpawu. Amazinga e-potassium aphansi, okuyisenzakalo esivamile ku-RTA, angase futhi abangele izinkinga zokugaya ukudla. Iziguli zingase zibe nokungakhululeki kwesisu kanye nobuhlungu bomhlane nohlangothi.

Ungayithola kanjani i-renal tubular acidosis?

Odokotela basebenzisa izindlela ezimbalwa zokuthola i-RTA:

• Ukuhlolwa ngokomzimba kwezimpawu zesifo
• Ukuhlolwa kwegazi ukukala ama-electrolyte namazinga e-pH
• Ukuhlolwa komchamo ukuhlola i-pH nokuqukethwe kwe-electrolyte

Umsebenzi wegazi ojwayelekile uvamise ukuveza i-RTA ngokungalindelekile. Odokotela baqale baqinisekise i-hyperchloremic metabolic acidosis eqhubekayo. Kufanele bakhiphe isifo sohudo esingapheli ngoba sihlala siyimbangela evame kakhulu yokuphazamiseka okufanayo kwe-acid-base.

Iyiphi imbangela evame kakhulu ye-RTA?

Thayipha i-RTA ye-hyperkalemic engu-4 ibalwa njengefomu elivame kakhulu emhlabeni jikelele. Izimbangela eziyinhloko zihlanganisa:

• I-nephropathy yesifo sikashukela eholela ku-hyporeninemic hypoaldosteronism
• Ukuvinjwa kwendlela yomchamo

Yiziphi izivivinyo zegazi ezikhombisa i-renal tubular acidosis?

Ukuhlolwa kwegazi kubonisa amaphethini ahlukene:

• Amazinga e-asidi aphezulu ane-acid-base balance ephazamisekile
• I-bicarbonate ephansi kanye namazinga e-potassium angajwayelekile
• Uhlobo 1 no-2 lubonisa i-potassium ye-plasma ephansi, kuyilapho uhlobo 4 lubonisa amazinga aphezulu
• Uhlobo ngalunye lunezigaba ezithile ze-plasma bicarbonate: thayipha 1 ngaphansi kuka-10-20 mEq/L, uhlobo 2 phakathi kuka-12-18 mEq/L, bese uthayipha u-4 ngaphezu kuka-17 mEq/L.

UDkt. Shiv Shankar Sharma

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

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