Ububabare bukomeye bw'amabuye y'amafyigo n'amafyigo yanduye (Urosepsis)¶

Igitero c’amabuye y’amafyigo kidakomeye (acute renal colic) kirazwi cane ko gitera ububabare bumwe bumwe bukomeye cane, bubabaza cane umuntu ashobora kugira, yamara ibuye ridakomeye riri munsi ya milimetero 5 (0,2 inches) rizoheza rikarengana ryonyene mu bice 80 gushika ku 90 kw’ijana vy’abantu. Ariko rero, igihe nyaco ibuye ry’amafyigo rifata amasobe yanduye inyuma yaryo imbere mu gitereko c’amafyigo (obstructive pyelonephritis / pyonephrose), ivy’ubuvuzi birahinduka bikava ku buye ry’umubabaro ry’abarwayi bavurirwa hanze rikaja ku ivyihutirwa vyo kubagwa mu mafyigo bishobora gutuma umuntu apfa. Kubera ko impyiko yazibiye ibandanya gucungera amaraso ku muvuduko munini, imigera n’ubumara bwo mu mubiri bufatwa hejuru y’ibuye birahatirwa guca mu nzira y’amafyigo bikaja mu mitsi y’amafyigo (pyelovenous backflow), bikaba bituma haba urosepsis, guhungabana, n’urupfu mu masaha 6 gushika kuri 24 kiretse iyo umuntu abazwe vyihutirwa (stent JJ yo mu maraso canke tube percutanée nephrostomie) akozwe ubwo nyene.

Inshingano zawe zica zishika iyo ububabare bukomeye bwo mu rubavu, mu mugongo, canke mu rubavu buteye ni ugusuzuma ubwo nyene ko ata "Ibuye ryanduye" ryihutirwa (ububabare bwose bw'amafyigo buherekejwe n'umuriro uri hejuru ya degre 38,0 Celsius / degre 100,4 Fahrenheit, guhungabana kw'amazi, guhungabana canke urujijo), gupima ugufunga amasobe yose (anuria canke kugira impyiko imwe gusa ikora), gusuzuma ku murwayi uwo ari we wese afise imyaka irenga 50 gushika kuri 60 ko ububabare butunguranye bwo mu ruhande atari gucagura umutsi w'amaraso wo mu nda (AAA), wirinde gufata amazi ku nguvu mu gihe umuntu afise ububabare bukomeye (butera ububabare bw’amafyigo buzibiye kandi bugatuma ububabare n’uguruka bikomera), kandi uhamagare abaganga b’ivyihutirwa ubwo nyene iyo hari amabendera atukura.

Ivyo ubikore ubu¶

1. Hamagara abaganga b’ivyihutirwa ubwo nyene iyo ibuye ry’amafyigo riherekejwe n’UMURIRO, UBWOKO, canke UBWOKO ("Impyiko Izibiwe n’Indwara"): Hamagara inomero y’ubuvuzi bwihutirwa yo mu karere kawe (911 muri Leta Zunze Ubumwe za Amerika na Canada, 112 hirya no hino mu Bumwe bw’Uburayi, 990 muri Ubwongereza bwacu direct che0ory our Australia . inomero z'ivyihutirwa iyo umuntu afise ububabare bukomeye bwo mu rubavu, mu mugongo canke mu rubavu afise umuriro (38,0 degrees Celsius / 100,4 degrees Fahrenheit canke n’ibindi) canke ubushuhe bw’umubiri bugabanuka bidasanzwe (<36,0 C / 96,8 F), **uguhungabana kudashobora gucungerwa,**uguhungabana, canke guhungabana ugutera urujijo gushasha canke ubunebwe, canke ukudashobora gusohora amasobe bimwe bishitse. Imiti yo mu kanwa yonyene ntishobora gukiza ibisebe bifunzwe inyuma y’ibuye; impyiko itegerezwa kubagwa mu bitaro mu masaha makeyi.
2. Genda mu bitaro vyihutirwa ubwo nyene iyo uwo muntu afise impyiko IMWE gusa ikora (canke impyiko zatewe) canke afise inda: Iyo ibuye rizibiye umuyoboro w’amafyigo y’impyiko iri wenyene canke impyiko zatewe, uwo muntu aba afise impyiko y’inyuma zero maze aca yinjira mu uric gukomerekera cane kw'amafyigo n’indwara y’amaraso menshi ishobora gutuma umuntu apfa.
3. Ikuraho rupturing Abdominal Aortic Aneurysm (AAA) ku muntu wese afise imyaka irenga 50: Ku bantu bakuze barenga 50 (na cane cane abagabo, abanywa itabi, canke abantu bafise umuvuduko munini w’amaraso) batigeze bagira ibuye ry’amafyigo mbere, gutabuka canke gusohoka umutsi w'amaraso wo mu nda amaraso ava inyuma y’igifu akanda ku mitsi imwe nyene n’ibuye ry’impyiko ry’ibubamfu canke ry’iburyo, bigatuma umuntu agira ububabare busa n’ubwo buva ku ruhande gushika ku rubavu, mbere n’amaraso makeyi cane mu mafyigo. Igihe cose ufate "ibuye ry'amafyigo rya mbere ry'imyaka irenga 50" nk'ikibazo gishobora gushika mu nzira y'amafyigo gisaba ko umuntu ahita akora CT scan canke ultrasound mu gisata c'ivyihutirwa.
4. NTUNYE amazi menshi ku nguvu mu gihe umuntu afise ububabare bw'amafyigo: Inkuru y'imigani ikwiragiye ibwira abantu ko bonywa amazi menshi mu gihe umuntu afise ububabare bw'amafyigo kugira ngo "bakuremwo ibuye." Mu gihe umuntu afise ubuzibuzi bw’amafyigo, **kunywa amazi menshi bituma amafyigo asohoka hejuru y’ibuye ry’amafyigo, bigatuma umubiri w’amafyigo uvyimba nk’umupira w’amafyigo (hydronephrose), bigatuma umuvuduko w’amafyigo utera cane, bigatuma umuntu aruha cane, kandi bikaba bishobora gutuma umutsi w’amafyigo ucika ** renal calyx (for)rupni. Nunywe amazi makeyi gusa iyo ufise inyota kandi udafise iseseme.
5. Shira ubushuhe bwo mu karere buhumuriza (ubwogero bushushe, ubwogero bushushe, canke igitambaro co gushushanya) ku ruhande iyo ATA muriro uriho: Bitandukanye n’indwara y’ibihaha (aho ubushuhe bubujijwe), ivyigwa vy’ubuvuzi vyerekana ko gushiramwo igitambaro co gushushanya canke igitambaro gishushe (40 gushika kuri 42 siel degrees /1010). Fahrenheit) hejuru y’umugongo wo hasi/inyuma bigabanya ububabare bw’amafyigo n’ugusesa amaraso mu gihe co gutwara.
6. Sesa amasobe yose biciye mu gisesa c’urusenga rwiza, akayunguruzo k’ikawa, canke gaze iyo uriko urakoresha ibuye ryemejwe ko ridakomeye: Gufata ibuye ryaciye (rishobora gusa n’agace gatoyi k’umusenyi canke k’amabuye y’agaciro k’iminota 2 gushika kuri 5) bituma abahinga mu vy’amasobe bashobora gupima ibuye aside urique, struvite canke cystine) kandi bikabuza amabuye azoza.

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    CheckSepsis -->|Yes| CallEMS["Hamagara abajejwe ivy’ivyihutirwa (911 / 112 / 999) Ubwo nyene: Bikenewe ko umuntu akora igikorwa co gukuraho ububabare bw’umubiri"]
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    CheckAAA -->|Yes| CallEMS_AAA["Hamagara abajejwe ivy’ubutabazi ubwo nyene: Ushireho ububabare bw’umutsi w’amaraso wo mu nda (AAA)"]
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    CheckRenal -->|No Red Flags| EvalED["Gutegura isuzuma ry'ubuvuzi ryihuse (CT / Ultrasound idafise ubudasa) n'ugupima amasobe"]
    CallEMS --> FirstAid["4. Shirako Warm Pack ku ruhande (Nimba Ata Muriro), NTUKORERE amazi ku nguvu mu gihe c'ugucika intege, ushire ahantu heza"]
    UrgentED --> FirstAid

Indwara y’amafyigo idakomeye n’iy’amafyigo yanduye (Pyonephrose na Urosepsis)¶

Ni kuki ibuye ry’amafyigo ritagira infection rishobora gufashwa neza hakoreshejwe ugucungera ububabare n’ukwihweza, mu gihe ibuye ry’amafyigo rifise infection y’amasobe ari rimwe mu bibazo vyihutirwa vyica cane mu buvuzi bw’ibitaro?

Mu ibuye ry’amafyigo ritagoye (colic renal), amasobe atagira ubumara asubira inyuma inyuma y’ibuye riri imbere mu nzira y’amafyigo n’igihimba c’amafyigo (hydronephrose). Naho ukurambura kw’igihimba c’amafyigo gifise intsinga be n’ugucika intege kw’umutsi w’amafyigo bitera ububabare bubabaje cane 10/10, amasobe ubwayo ntashobora gutera.

Mu imfyigo yanduye (indwara y’amafyigo canke indwara y’amafyigo), imigera (nk’iyitwa Escherichia coli, Proteus mirabilis, Klebsiella, Pseudomonas, canke Enterococcus) irafatwa n’imbere mu gice c’umubiri gipfutse, Impyiko yazibiye mu vy’ukuri iba igisebe gipfutse mu gihe c’umuvuduko munini w’ugucungera amaraso:

1. Kubera iki antibiyotike zonyene IDASHOBORA gushika canke gukiza impyiko yanduye: Ubwa mbere, kubera ko ugucungera glomerular guhagarara mu mfyigo yazibiye rwose, antibiyotike ziterwa mu mutsi canke zifatwa mu kanwa ntizishobora kuyungurura mu mafyigo ahagaze hejuru y’ibuye. Ubwa kabiri, umuvuduko munini wo mu gitereko (hejuru ya 30 gushika kuri 40 mmHg) ufungura amarira makeyi ku mpera z’ibihimba vy’amafyigo (pyelovenous and pyelolymphatic backflow), ugatera imigera nzima n’ubumara bw’imigera mu maraso y’umubiri igihe cose umutima utera.
2. Uko urosepsis yica ningoga ata n’amazi asohoka: Ata gukuraho amazi mu mfyigo mu buryo bwihutirwa (gutera stent y’amafyigo mu cumba co kubagiramwo canke gushiramwo umurongo w’amafyigo biciye mu mugongo hakoreshejwe ubuhinga bwa radiologie interventionnelle), urupfu ruterwa n’indwara y’amafyigo y’ubuzibuzi per**la000. amasaha arenga 12 gushika kuri 24 bishobora gutuma umuntu agira ingorane zo gufatwa n’indwara y’ibicurane n’urupfu incuro zitatu.

Ivyerekeye umubiri w’umuntu afise ibuye ry’amafyigo: Ingene aho ububabare buri hakurikirana urugendo rw’ibuye rimanuka mu nzira y’amaraso¶

Ibuye ry’amafyigo ntiribabaza iyo yicaye mu gacerere imbere mu gice kinini c’amafyigo c’amafyigo (kiretse iyo ari ibuye ry’indwara ry’amahembe y’inzovu ryinshi cane). Ububabare buraturika igihe iryo buye rigwa mu ureter (ifise ubwaguke bwa milimetero 2 gushika kuri 4 gusa) ry’imitsi y’amaso, rikagira urusenga kuri kimwe mu bice bitatu vy’umubiri (narrowings) vy’umuyoboro w’amaso. Uko iryo buye rigenda rimanuka ryerekeza ku rutirigongo, aho ububabare buri burahinduka mu buryo bushobora gutegekanirwa ku bijanye n’imitsi ya ilioinguinal na genitofemoral (T11 gushika kuri L2):

Igihuza 1: Igihuza amafyigo (UPJ, aho umurongo w’amafyigo uhurira hejuru y’umutsi w’amafyigo)¶

• Aho wumva: Ububabare butunguranye, bukomeye, bumeze nk’ubw’icumu hejuru cane mu costovertebral angle (CVA), imfuruka imeze nk’inyuguti ya V ku mugongo wawe aho urubavu rwa 12 rwo hasi ruhurira n’umugongo.
• Ibimenyetso bijana: Kubera ko igihimba c’amafyigo gisangiye n’inda imitsi y’umubiri yitwa celiac ganglion autonomic nerve fibres, iyo UPJ ihagaze cane, bituma umuntu ahita agira iseseme nyinshi kandi akaguma asubiramwo** ivyo bikaba bikunda kwigana igitero c'umuhogo, indwara y'amafyigo, canke ibicurane vyo mu nda.

Iciyumviro ca 2: Kujabuka imitsi y’amaraso yo mu gitereko (Ureter yo hagati ku ruhande rw’igihimba c’irondoka)¶

• Aho wumva: Ububabare buraba imbere no hasi buva ku ruhande rw’inyuma rwikikuje uruhande rw’amafyigo buja mu gice c’iburyo canke c’ibubamfu co hasi c’inda bukamanuka mu gice c’inyuma c’inda.
• Umutego wo gupima: Iyo ibuye rihagaze ku nzira y’amaraso hagati y’iburyo hejuru y’umutsi wa psoas, ryigana cane indwara y'umusonga (ku ruhande rw’iburyo) canke diverticulite acute (ku ruhande rw’ibubamfu). Ariko rero, raba ingene uwo murwayi yigenza:
• Umurwayi afise peritonite iva ku ndwara y’umusonga aryama akonje kandi ataco yinyiganza ku gitanda kuko kwinyiganza kwose kubabaza igihimba c’irondoka.
• Umurwayi afise renal colic aravyimba, akagendagenda mu koridoro, akagendagenda hasi, akaguma ahindura aho ari agerageza ubusa kurondera imfuruka igabanya ububabare bw’imbere mu maraso ("ikimenyetso c’ugutera imbere").

Igihuza 3: Igihuza umutsi w’umuhogo (UVJ, aho umutsi w’umuhogo winjira mu ruhome rw’umuhogo)¶

• Urugi rutoya cane mu nzira y’amasobe (ubwaguke bwa milimetero 1 gushika kuri 2 gusa): Amabuye arenga 60 gushika kuri 70 kw’ijana aboneka ku bipimo vya CT vy’igisata c’ivyihutirwa, afata hano nyene kuri UVJ, milimetero gusa imbere y’uko agwa mu muhogo.
• Aho wumva: Kubera ko hasi mu nzira y’amaraso hasangiye imitsi y’igitsina n’iy’igitsina (L1, L2, S2-S4) n’ibihimba vy’irondoka vyo hanze n’isonga ry’umuhogo (trigone), ibuye ryinjijwe ku UVJ rituma:
• Ububabare bukomeye bushika mu nzira y’amabere n’amabere y’abagabo, canke mu nzira y’amabere n’amabere y’abagore (bisaba gutandukanya neza uguhinduka kw'intanga canke uguhinduka kw'amabere; mu gihe c’ibuye ry’amafyigo, intanga ubwayo yumva isanzwe kandi ntivyimvye iyo umuntu ayikozeko buhoro buhoro, mu gihe iyo umuntu akoresheje intanga, intanga yicara hejuru, ivyimba kandi ikaba iryoshe cane).
• Ibimenyetso vy’indwara y’umuhogo itera umubabaro mwinshi: Ukwiyumva mu buryo bwihutirwa ko ukeneye gusohoka buri minota 3 (ugusohoka vyihutirwa n’incuro), ububabare bushasha ku mpera y’umuhogo (dysuria), no guca amatonyanga makeyi y’amazi y’umuhogo, ata n’ibara ry’umuhondo ry’umutuku, canke heventurima y’amaraso y’ibara ry’icayi (gross heventurima is present)
• Igihe co kwiruhutsa: Igihe ibuye riheza riciye mu UVJ rikaja mu gitereko c’amasobe, ububabare bubabaza 10/10 bwo mu rubavu no mu rubavu burazimangana hafi ako kanya. Guca iryo buye mu nyuma rivuye mu rutirigongo risohoka biciye mu nzira y’amaso yagutse (ifise ubwaguke bwa milimetero 6 gushika ku 8) akenshi bituma umuntu agira gusa ugucika intege mu masegonda 2 canke ugucika intege mu gitereko c’umwobo.

Ubwinshi bw’ibuye n’ubushobozi bwo guca mu mabuye: Ni ayahe mabuye arenga kandi ni ayahe afata?¶

Iyo abaganga b’ibihe vyihutirwa bakoze igipimo gitoyi c’inda n’igihimba c’irondoka (CT KUB) canke igipimo c’amafyigo, ingero imwe gusa ihambaye cane (twiyumvira ko ata ndwara canke impyiko iri yonyene iriho) ni uburebure bw’ibuye mu milimetero:

Kubera iki imiti igabanya ububabare itera ububabare bw’amabuye y’amafyigo (kandi igihe imiti igabanya ububabare ibujijwe cane)¶

Nimba uri mu bitaro vy’ibihe vyihutirwa canke umaze gusuzumwa n’umuganga yemeje ko ibuye ry’amafyigo ridakomeye, ridashobora gutera inda, rifise ubushobozi bwo gukora neza (normal serum creatinine), gutahura ingene imiti igabanya ububabare ikora ku nzira y’amafyigo birafasha cane:

1. Kubera iki imiti igabanya ububabare (NSAIDs) idakoreshwa n’imiti igabanya ububabare bw’amafyigo¶

Iyo ibuye rizibiye umuyoboro w’amaraso, umuvuduko uriko uraduga imbere mu mfyigo utuma habaho Prostaglandine E2 (PGE2) na Prostacycline. Prostaglandine E2 ikora ibintu bibiri bituma indwara y’amafyigo ibabara:

1. Iragwiza imitsi y’amaraso yinjira mu glomeruli z’amafyigo, igatuma umuvuduko wo kuyungurura amasobe ushika mu mafyigo asanzwe yazibiwe kandi yavyimvye.
2. Bitera ubukazi, ububabare imitsi y’uruhome rw’umuhogo ikikuje ibuye kandi bikongera ukuvyimba kw’uruhome rw’umuhogo rwo mu karere (edema).

Imiti igabanya ubukana bw’indwara (nk’iyo mu bitaro iterwa mu mutsi ketorolac [Toradol] canke iyo mu kanwa diclofenac, ibuprofen, canke naproxen) irabuza ata guca ku ruhande ugukora kwa prostaglandine (uguhagarika cyclooxygénase). Mu gufunga Prostaglandin E2, imiti igabanya ubukana bw’indwara igabanya icarimwe umuvuduko uri imbere mu gipfukisho c’amafyigo kivyimvye, irekura imitsi y’amafyigo, igabanura ibivyimba bikikuje ibuye, kandi itanga ububabare burengeye canke bungana ugereranije n’imiti iterwa mu mutsi yitwa morphine ataco itera.

2. Igihe imiti igabanya ubukana bw’indwara (NSAIDs) IBUZIJWE CANE ku murwayi w’amabuye y’amafyigo¶

Kubera ko imiti igabanya ubukana bw’amaraso igabanya uruja n’uruza rw’amaraso aja mu biyunguruzo vy’amafyigo yazibiye, ntiwigere ufata imiti yitwa ibuprofen, naproxen, ketorolac canke diclofenac nimba hariho kimwe muri ibi bikurikira:

• NTURI bwasuzumwe amaraso mu bitaro canke amateka yemeza ko amafyigo akora neza, canke ufise ububabare bukomeye bw’amafyigo (creatinine irengeye) canke indwara y’amafyigo idakira (CKD Stage 3, 4, canke 5).
• Ufise impyiko IMWE gusa ikora (impyiko iri yonyene) canke impyiko itewe: Gufata umuti w’indwara y’ibicurane (NSAID) iyo impyiko yawe imwe gusa izibiwe n’ibuye bifunga amaraso yayo asigaye mu mitsi y’amaraso maze bigatuma ubwo nyene acute renal failure ihagarara.
• Uratwite (Imiti igabanya ububabare ishobora gutuma amafyigo y’umwana akura neza, igafunga n’umutsi w’umwana atarashika).
• Ufise indwara y'ibisebe vyo mu nda, kuva amaraso mu nda, canke ukubura amazi mu mubiri cane/urosepsis.
• Muri ivyo bihe vyose, abaganga bo mu bitaro bakoresha imiti y’umutsi (paracetamol) n’imiti y’imitsi** (canke imiti y’umutsi w’umugongo / imiti y’imitsi y’umugongo) aho gukoresha imiti y’imitsi y’umubiri.

Intambwe ku yindi kwitaho imbere y'uko umuntu aja mu bitaro no kwirinda amabuye igihe kirekire¶

Intambwe ya 1: Gucungera neza inzu n'ivy'ugutwara abantu mu gihe c'ikibazo gikomeye¶

1. Uce usuzuma ubushuhe ukoresheje igipimo c’ubushuhe ubwo nyene: Imbere yo kuvura ibuye ryose ry’amafyigo wikekwa ko rifise i muhira, banza upime ubushuhe bw’umubiri. Niba ubushuhe buri 38.0 degre Celsius (100.4 degre Fahrenheit) canke hejuru (canke munsi ya 36.0 C / 96.8 F), canke iyo umuntu afise ububabare bwo guhungabana, hagarika kwitaho vyose mu rugo maze ugende ugororotse ku kigo c’ubuvuzi bw’ivyihutirwa canke uhamagare 911 / 9992.
2. Shira ubushuhe bukora hanze ku ruhande no ku mugongo wo hasi: Shira igikoresho co gushushanya gishushe, icupa ry’amazi asusurutse rizingiwe mu gitambaro, canke igipapuro c’ubushuhe bushushe bw’imiti ku 40 gushika kuri 42 degrees Celsius (104 gushika kuri 107.6 degrees Fahrenheit) hejuru y’umugongo no gutwara)**
3. Irinde gufata amazi ku nguvu mu gihe c’ububabare bukomeye: Mu gihe urindiriye ko umupfunda w’ububabare ugabanuka canke uriko uraja mu cumba c’ubuvuzi bw’ivyihutirwa, ntunywe amazi mu bikopo. Igihe igihimba c’umubiri citwa acute colic spasm kimaze gukurwaho kandi iseseme ikahera, subira gufata amazi asanzwe, adahinduka (litiro 2,0 gushika kuri 2,5 ku musi) kugira ngo ufashe gutwara ibuye hasi.
4. Kwegeranya kandi usenyere itosi ryose ry’amasobe: Senyera mu gitereko c’amasobe c’ipulasitike gisukuye, mu gikombe, canke mu nkofero hanyuma uyasuke mu gitereko c’amabuye y’ubuvuzi canke mu gitereko c’ikawa c’impapuro zera. Igihe ibuye rikomeye rifashwe, rireke ryumye mu kirere mu cupa ry’imiti isukuye (ntiwigere rizingira mu mpapuro zo mu bwiherero zitose, zica zisenyuka canke zifatanya n’ibuye) hanyuma uzizane ku muganga wawe kugira ngo akoreshe **Fourier-transform infrared spectroscopy (FTIR) canke X-ray diffrasis.

Intambwe ya 2: Intambwe zishingiye ku bimenyamenya zo kwirinda ibuye rya kabiri ry’amafyigo¶

Hatariho amahinduka yo kwirinda, 50 kw’ijana vy’abagira amabuye y’amafyigo ubwa mbere bazogira irindi buye mu myaka 5 gushika kuri 10:

• Nywa amazi ahagije kugira ngo ukore nibura litiro 2,5 (85 fluid ounces) z’amasobe y’umuhondo utukura buri masaha 24: Uwo mugenzo umwe gusa uragabanya ukugaruka kw’amabuye mu bice bibiri mu bwoko bwose bw’amabuye.
• Wongereko citrate kavukire (umutobe w’indimu canke umutobe w’umukaraba nyawo) mu mazi yawe ya misi yose: Citrate iri mu mafyigo ifatanya na calcium iri mu mafyigo kandi mu buryo busanzwe ibuza calcium oxalate na calcium phosphate gufatanya.
• NTUKIGEZE calcium mu vyo ufungura (urye amata asanzwe/calcium MURI UMUNTU), ariko GUBANYE ibiribwa birimwo sodium nyinshi (umunyu): Ikintu giteye ubwoba, ibiribwa bifise calcium nke vyongera amabuye y’amafyigo y’ivyo bita calcium oxalate kuko calcium yo mu vyo ufungura iri mu mara yawe ifatanya na o, beets, chocolat, tea) rero bikava mu mva yawe aho kuvyinjira mu nkari yawe. Ivyokurya vyinshi sodium (umunyu) bituma amafyigo asuka calcium irenze urugero mu mafyigo (hypercalciuria).

Gutahura ubwoko 4 bw'imiti y'amabuye y'amafyigo n'ibintu bidasanzwe vyihutirwa¶

Iyo ibuye ry’amafyigo rifashwe mu gikoresho co gusesa canke rikakurwamwo mu gihe c’ugupima amafyigo, isesengura ryo muri laboratwari rigaragaza imiryango ine ikomeye y’amabuye y’agaciro yatumye iryo buye rigira iryo buye, rimwe ryose rikaba rifise ibintu vyihutirwa bitandukanye:

Amabuye y'amafyigo mu gihe umuntu atwite no mu barwayi bafise Stent y'amafyigo¶

1. Indwara y’amafyigo mu gihe umuntu atwite (Kurinda umuvyeyi n’umwana)¶

Nk’uko 1 ku barwayi 200 gushika ku 1.500 batwite agira ibuye ry’amafyigo ry’agahomerabunwa, cane cane mu kiringo c’igice ca kabiri n’ica gatatu (igihe progesterone irekura imitsi y’amafyigo iryoshe kandi igitereko kigenda kirakura kigafatanya imitsi y’amafyigo, cane cane ku ruhande rw’iburyo).

• Kubera iki abarwayi batwite bafise indwara y'amafyigo basaba gusuzumwa mu bitaro vuba:
• Ububabare bukomeye bw’amafyigo n’indwara y’amafyigo (pyelonephrite obstructive) mu gihe umuntu atwite bitavuwe, birashobora gutuma umuntu agira ukuvyara atarashika no kuvyara atarashika, urosepsis y’umuvyeyi, n’indwara y’umutima imeze nk’iya preeclampsie.
• Ivyuma vyo gupima indwara ata mishwarara: Ibisata vy’ubuvuzi bw’ivyihutirwa ntivyigera bikoresha ubuhinga bwa CT nk’ikigeragezo ca mbere mu gihe umuntu atwite; ahubwo bakoresha Ultrasound y’amafyigo n’iy’igihimba c’irondoka (ugupima amazi y’amafyigo no gutandukanya amazi y’umubiri y’inda n’ibuye) hanyuma iyo bikenewe Urography y’amafyigo idakoreshwa n’ibindi bihimba (MRU) canke uburyo bwo gukoresha imiti igabanya ububabare.
• Umutekano w’imiti: Imiti igabanya ububabare (ibuprofen, ketorolac, naproxen) irabujijwe cane mu gihe umuntu atwite. Ububabare buragenzurwa neza hakoreshejwe imiti itera ububabare mu mutsi n’imiti igabanya ububabare, kandi iyo habaye umuriro, urosepsis, canke ububabare budashobora gukira, abaganga bafata ububabare budakira (bihindurwa buri ndwi 4 gushika ku 6 kubera ko inda yihutisha gutera calcium ku stent) gushika umuntu amaze kuvyara.

2. Kwitwararika vyihutirwa abarwayi basanzwe bafise Stent y'Ureteral ("JJ Stent")¶

Nimba umurwayi aherutse kugira double-J (JJ) ureteral stent yashizwe imbere mu nzira y’amaraso yiwe n’umuganga w’amaraso (kugira ngo arenge ibuye canke akire inyuma y’ugukora lithotripsy y’umuyagankuba), nusobanure neza ico ari co gisanzwe n’ikintu gikomeye:

• Ibimenyetso bisanzwe vyitezwe vy’ugutera stent: Amasobe y’umutuku canke y’umutuku inyuma yo kugenda, kubabara mu ruhande cane cane iyo umuntu ariko arasoma (biterwa n’umuvuduko w’umuhogo usubira hejuru y’uruzitiro rw’umuhogo), n’uguhunga kw’umuhogo gutoya/ugutera kenshi ku rubavu rwo hasi rw’umuhogo (uvuwe n’umuti wa andoxysinlisulocin).
• Ivyihutirwa vy'ibendera ry'umutuku bisaba ko umuntu ahita asura igisata c'ivyihutirwa:
• Umuriro mushasha (>=38.0 C / 100.4 F) canke ububabare (ibimenyetso vy’uko stent yacitse ibisebe canke yazibiwe n’ibisebe n’ibisebe).
• Kugaruka kw’ububabare buhoraho, bukomeye 10/10 bwo mu ruhande butahagarara inyuma yo gusohora (ibimenyetso vy’uko stent yimukiye hanze canke ko yazibiwe n’amaraso canke igice c’ibuye).
• Inkari zikomeye, zitukura cane zirimwo amaraso menshi canke ukudashobora gusohora (gufata amasobe cane).
• Umugozi wa stent uzunguruka uragenda canke urakwegwa: Hari stent z’igihe gito zifise umugozi mutoyi w’inylon usohoka mu nzira y’amasobe kugira ngo bishobore gukurwaho mu biro bitagoranye; ntukigere wikwegera umugozi wa stent wewe nyene kiretse iyo umuganga wawe w’amaraso akubwiye mu buryo butomoye ko wowukura kuri ico gihe categekanijwe.

Ibibazo bikunda kubazwa¶

Amasoko yasuzumwe¶

• Ishirahamwe ry’Uburaya ry’Ivy’Imitsi (EAU): Ingingo ngenderwako za EAU ku ndwara y’Imitsi y’Imitsi (2024 Update): Uburyo bwo kuvura indwara y’imitsi y’amafyigo, Ubuvuzi bwo kwirukana amafyigo, no Gukuraho indwara y’amafyigo yazibiwe mu buryo bwihutirwa.
• Ishirahamwe ry’abaganga b’amafyigo ryo muri Amerika (AUA) n’ishirahamwe ry’abaganga b’amafyigo (Leta Zunze Ubumwe za Amerika): Ubuvuzi bw’amabuye y’amafyigo na Ubuvuzi bw’amabuye mu kubaga: Ingingo ngenderwako y’ishirahamwe ry’abaganga b’amafyigo rya AUA/Endourological Society.
• Ikigo c'Igihugu c'Ubuzima n'Ukwitwararika (NICE, Ubwongereza): Amabuye y'amafyigo n'ay'amafyigo: Gusuzuma no gucungera (NG118).
• Isekeza ryo kurokoka indwara y’ibicurane (SSC) n’ishirahamwe ry’indwara zandukira ryo muri Amerika (IDSA): Ingingo mpuzamakungu zijanye n’ugucungera indwara y’ibihaha n’ugucungera vyihuse inkomoko y’ibihaha mu ndwara y’ibihaha.
• Patani SA, Mitra B, Straney L.D., n’abandi. (The Lancet): Gutanga ubuvuzi bw’ububabare butekanye kandi bukora neza bwo gufasha mu gufasha indwara y’amafyigo mu bitaro vy’ibihe vyihutirwa: igerageza ry’impumyi zibiri, ry’imigwi myinshi, ry’abantu bamwebamwe (ryerekana ko imiti igabanya ububabare iruta morphine ku ndwara y’amafyigo ikaze).

Inyobora zifitaniye isano¶

• Sepsis na septic shock kwemera n'ubutabazi bwa mbere bwihutirwa
• Gucagura umutsi w'amaraso n'ugucagura umutsi w'amaraso wo mu nda
• Gufata amasobe bikomeye no kwitaho vyihutirwa
• Guhinduka kw'intanga, uguhinduka kw'amabere, n'ububabare bukomeye bwo mu gitereko
• Rhabdomyolyse y'inguvu, ugukomeretswa cane kw'amafyigo, n'amasobe y'umwirabura
• Inomero z'ivyihutirwa hakurikijwe igihugu