ʻO ka stenosis ʻo ke kuʻikiʻi. ʻO ka stenosis arene Renal ka kahi nui i ka lumen o ke kīʻaha koko e ʻai ana i nā aʻalolo ma muli o ka pani ʻana i kā lākou mau atherosclerotic plam. I nā poʻe maʻi ʻelemakule me ka maʻi diabetes type 2, ʻo kēia kekahi o nā kumu maʻamau o ka maikaʻi ʻole o ka renal. ʻO ka stenosis arene Renal hoʻi e hōʻeha i ka hypertension koʻikoʻi, kahi hoʻomaʻamaʻa ʻole ʻia.
ʻO ka nui o ke koko e hiki ai i nā ʻāpana o ke kino ke hele ma waena ona, ma ka nui, e hāʻawi i ka lako pono o nā huelo me ka oxygen. No laila, hiki i nā stenosis renal arene ke ulu i kahi lōʻihi me ka ʻole o nā hōʻailona. Hōʻike nā hoʻopiʻi ma nā maʻi, e like me ke ʻano he kānāwai, ma ka manawa i ka hopena o ke vascular patency e 70-80%.
ʻO wai ka pilikia no ka stenosis hāmeʻa renal
I nā maʻi me ka diabetes type mellitus type 2, he mea maʻamau loa ka stenosis renal artery. No ka mea, hoʻomaka mua lākou i kahi metabolic syndrome, a laila hoʻokiʻekiʻe nui ʻia ko lākou koko koko. Hōʻalo kēia mau mea metabolic i ka atherosclerosis, i.e., ka pani ʻana i nā moku nui e hāʻawi ana i ka puʻuwai a me ka noʻonoʻo. I ka manawa like, ʻo ka lumen i loko o nā hāpala e hānai i nā pūlū pōkole.
I USA, ua aʻo ʻia ka palekana o nā mea maʻi me ka stenosis renal renal no 7 mau makahiki. Ka mea i loaʻa i kēia mau maʻi nā pilikia nui loa o ka poino cardiovascular catastrophe. Aia iā 2 mau manawa ke kiʻekiʻe aʻe o ka hopena o ka hikiʻole o ka kidney. Eia kekahi, hoʻihoʻi hou ʻia ka renal vascular patency ʻaʻole ia e hōʻemi i ka hopena o ka make mai ka hōʻeha ʻana a i ʻole hōʻeha ʻana.
ʻO ka stenosis arene Renal hiki ke unilateral (monolateral) aiʻole bilateral (bilateral). Bilateral - ʻo ia ka mea e hoʻopiʻi i nā āina pili i ka pōpoki ʻelua. Hoʻokahi ʻaoʻao - ke kīwaha i ke kīpē i loko o kahi pā mīkina renal kahi, a ma kahi ʻē aʻe he ʻano maʻamau ia. Hiki ke hoʻopili ʻia nā lala o nā kuʻi renal, akā ʻaʻole paha nā moku nui.
ʻO ka stenosis atherosclerotic o nā moku ʻōiwi i alakaʻi i ka ischemia maʻi (lawa i lawa ke koko) o nā keiki. Aia a pōloli nā keiki a "pōʻino" kā lākou hana. I ka manawa like, hoʻonui ka nui o ka loaʻa ʻole o ka renal, ʻo ia hoʻi me ka hoʻohui pū ʻana me ka nephropathy maʻi maʻi.
Nā ʻlelo a me nā Diagnosis
ʻO nā mea pilikia no ka stenosis hāpau ka mea like me ka "maʻamau" atherosclerosis. E papa inoa iā mākou:
- ke koko kiʻekiʻe;
- momona;
- kāne kāne;
- ke kiʻekiʻe o nā fibrinogen i loko o ke koko;
- ʻoi aku ke kiʻekiʻe;
- ulaula
- nā pōpō maikaʻi a me nā momona momona;
- maʻi mellitus maʻiʻi.
Hiki ke ʻike ʻia i ka hapa nui o kēia mau mea kūpono e hiki ke hoʻoponopono ʻia inā ua pili ka maʻi lolo i kona olakino i kona wā ʻōpiopio a i ʻole ka waena. Inā hōʻino kekahi o ka stenosis o kekahi o ka lāʻau o ka renal, a laila piʻi ka hopena i ka lua o ka maʻi.
Hiki ke kahakaha ke kauka i ka stenosis renal artery i loko o ka mea maʻi me ka maʻi mellitus i mua o nā hōʻailona me ka ʻike kikoʻī.
- ʻoi aku ka nui o ka makahiki ma mua o 50;
- hele ka hopena o ka renal i ka manawa like, i ka manawa like, proteinuria <1 g / lā a me nā loli i ka seditation urinary ka liʻiliʻi;
- maʻi hypertension maʻi koʻikoʻi - hoʻonui nui ʻia ke koko, a ʻaʻole hiki ke hoʻohaʻahaʻa iā ia me nā lāʻau lapaʻau;
- ka heleʻana o nā hana vascular (maʻi maʻi coronary, pani ʻana o nā moku nui, ke kani ʻana i ka projection o nā ʻāpana renal);
- i ka mālamaʻana i nā inhibitor ACE - hoʻonui nui i hana iho;
- luhi ke ahonui i nā manawa lōʻihi;
- i ka wā e nānā ʻia ai e kahi ophthalmologist - kiʻi kiʻi maikaʻi ma ka retina o ka pli Hollenhorst.
No ka maʻiʻana, hiki i nā ʻano noiʻi like ʻole ke hāʻawi i kahi kiʻi i ʻike ʻia i ke kūlana o nā aralinal renal. ʻO kā lākou papa inoa he:
- ʻO ka ʻōpiopio uila (scan ultrasound) o nā renal uaua;
- Angiography koho
- Hoʻomauleʻa resonance résonance;
- Kūkulu ʻia nā pākuʻina (CT);
- Positron emission tomography (PET);
- Captril scintigraphy.
ʻO kekahi o kēia mau ala e koi ai i ka hoʻomaka ʻana o nā mea hoʻohālikelike i ke kahe koko, hiki ke loaʻa kahi hopena nephrotoxic, ʻo ia hoʻi, e hōʻeha i nā maʻi o ka maʻi. Kūkala ke kauka iā lākou inā ʻo ka mea hiki ke loaʻa i ka pono o ka hoʻomaʻamaʻa ʻana i ka maʻi maʻi ma mua o ka hopena. Hoʻopau maoli nō kēia i nā hihia ke hoʻonohonoho ʻia nei kahi hana maʻi e hoʻihoʻi hou i ka maʻi o nā hāmeʻe o nā renal.
ʻO ka hoʻomaʻamaʻa ʻana o ka stenosis aʻa renal
Pono ka hoʻomaʻamaʻa ʻana o ka stenosis renal e koi i ka hoʻoikaika mau ʻana i ka hoʻomohala ʻana i ka hoʻomohala ʻana i ka hana atherosclerotic. ʻO ke kuleana nui no lākou e pili pū me ka mea maʻi iā ia iho a me kona ʻohana. ʻO ka papa inoa o nā hana e pono ai:
- holo i ka ulaula;
- ka pae kaila o nā pae ʻai koko;
- ka hoʻohaʻahaʻa ʻana i ke koko i ka maʻamau;
- i ka hihia o ka momona o ke kino - kau kaumaha;
- laau kauoha mai i nā lāʻau - anticoagulants;
- ka lawe ʻana i nā lāʻau lapaʻau mai ka papa o nā statins e hoʻomaikaʻi i ka cholesterol a me ka triglycerides i ke koko.
Manaʻo mākou i kahi meaʻai haʻahaʻa-haʻahaʻa haʻahaʻa no ka maʻi type a me ka type 2. ʻO ke ala maikaʻi loa kēia e hoʻohaʻahaʻa i kāu kōkela koko i ke maʻamau a no laila e pale aku i kou mau maʻi mai ka maʻi maʻi. ʻO ka meaʻai haʻahaʻa-haʻahaʻa ʻaʻole ia e hoʻohaʻahaʻa i ke kō, akā hoʻohua nō hoʻi i ka triglycerides, "maikaʻi" a me ka "kino" kolamu koko. No laila, he hāmeʻa ikaika e lohi ai i ka atherosclerosis, me ka pale ʻana o ka stenosis arela renal. ʻAʻole e like me nā loea statin, ʻaʻohe hopena maikaʻi o ka papaʻai. ʻO ka ʻāpana ma kā mākou mau hānai no ka maʻi hānai he mea nui loa ia iā ʻoe.
ʻO ka Stenosis a me ka lāʻau lapaʻau
No ka pilikia ʻana i nā pilikia maʻi o ka maʻi maʻi, ua kuhikuhi pinepine ʻia nā mea maʻi mai nā pūʻulu o nā mea paʻa o ACE a i ʻole na angiotensin-II receptor blockers (ARBs). Inā loaʻa i ka stenosis renal aral stalosis ka mea maʻi, a laila pono e hoʻomau i ka lawe ʻana i ka lāʻau. A inā he ʻano ʻai ka stenosis o nā hāmeʻa o ka lua, he pono ke hoʻopau ʻia ka ACE a me ARB. No ka mea hiki iā lākou ke hāʻawi i ka hoʻopiʻi hou ʻana i ka hana ʻole.
ʻO nā lāʻau mai ke papa o nā statins e hoʻohaʻahaʻa i ka pae o ka cholesterol "kino" i ke koko. Hōʻike pinepine kēia iā ʻoe i ka hoʻomau ʻana i nā plakle atherosclerotic i nā ʻalaki honu a pale i ko lākou holomua hou. Me nā leʻaleʻa atherosclerotic o nā lāʻau renal, kuhikuhi pinepine ka poʻe maʻi i ka aspirin. I ka manawa like, ʻo ka hiki a me ke palekana o ka hoʻohana ʻana i ke kūlana e like me ke kū ʻole o ka loiloi hou a koi ʻia hou. Hele ka mea like no ka heparins haʻahaʻa haʻahaʻa a me nā mea hao glycoprotein.
Nā ʻōmole no ka hoʻomaʻamaʻa ʻana o ka stenosis arela o ko renal (American Heart Association, 2005):
- Hemodynamically nui bilateral renal aren stenosis;
- ʻO ka stenosis artery o ka hoʻokahi hana hana;
- Unilateral a bilateral hemodynamically koʻikoʻi renal aren stenosis, i alakaʻi ʻia ʻole e ka lula;
- Hōʻea ʻole ka hopena o ke ola me ka stenosis unilateral;
- E hoʻopiʻi pinepine ʻia nā edema pulmonary me ka stodyosis hemodynamically koʻikoʻi;
- ʻO ka pectoris angina ka lōʻihi me ka stodyosis hemodynamically nui.
Hoʻomaopopo ʻO ka Hemodynamics ka neʻe o ke koko ma o nā moku. ʻO ka stenosis kīhaʻi hemodynamically koʻikoʻi - hoʻokahi mea weliweli i ke kahe koko. Inā lawa ka hāʻawi o ke koko i ka ʻeha ma muli o ka stenosis o nā aralial o ka renal, a laila hiki ke nui aʻe ka nui o ka hōʻemi o ka hoʻomaʻemaʻe ʻana i kona pōmaikaʻi.
