ʻO kou mau puʻupaʻa ke kumu o kou koko kiʻekiʻe? E kamaʻilio kākou e pili ana i ka Renovascular Hypertension

Ke lawe nei hoʻi ʻoe i ka lāʻau lapaʻau no kou koko koko , akā ʻaʻole naʻe e iho i lalo? Malia paha e ʻōlelo ana kāu kauka, "ʻOiai ma hope o ka hāʻawi ʻana iā ʻoe i kekahi mau ʻano lāʻau lapaʻau , ʻaʻole e iho kou koko koko ." I kekahi manawa, ʻaʻohe mea nui ka nui o kou hoʻololi ʻana i kou nohona, kaohi ʻana i kāu ʻai , a me ka hoʻoikaika kino, hiki nō i kou koko koko ke kiʻekiʻe. I nā manawa e like me kēia, pono kākou e noʻonoʻo he pilikia paha me nā puʻupaʻa ke kumu. I kēia lā e kamaʻilio kākou e pili ana i ia ʻano kūlana.

I ka ʻōlelo maʻalahi, he aha ka hypertension renovascular?

ʻOiai ke kani iki nei ka inoa he mea paʻakikī, he maʻalahi loa ka moʻolelo. ʻO ke koko kiʻekiʻe ʻo Renovascular Hypertension i hoʻokumu ʻia e kahi pilikia me kou mau puʻupaʻa.

E noʻonoʻo i kēia ʻano. ʻO nā puʻupaʻa kekahi o nā ʻōkana koʻikoʻi loa i loko o ko kākou kino. ʻO kā lākou hana nui, ʻo ia ke kānana i ke koko a wehe i nā huahana ʻōpala e like me ka mimi . No ka hana pono ʻana i kēia hana, pono nā puʻupaʻa i kahi lako koko maikaʻi. ʻO nā kīʻaha koko nui ( nā aʻa ) e lawe ana i ke koko i nā puʻupaʻa ua kapa ʻia ʻo 'renal arteries'.

I kēia manawa, e noʻonoʻo ʻoe no kekahi kumu e emi mālie ai kēia mau kīʻaha koko a lahilahi paha. E like me ka paipu wai e ʻomi ʻia ana i waenakonu. He aha ka mea e hana ʻia? Ke emi nei ka nui o ke koko e hiki aku ana i nā puʻupaʻa.

Ke emi ke kahe koko e like me kēia, manaʻo ko kākou mau puʻupaʻa akamai, "Auē, ua haʻahaʻa koʻu koko ma ke kino holoʻokoʻa, ʻo ia ke kumu e emi ai koʻu koko." No laila, no ka mea makemake lākou e hana pono i kā lākou hana, hana lākou i nā hana e hoʻonui ai i ke koko i loko o ke kino. No ka hana ʻana i kēlā, hoʻāla lākou i kahi ʻōnaehana hormonal i loko o ke kino. Ma nā ʻōlelo lapaʻau, kapa mākou i kēia ʻo RAAS (Renin-Angiotensin-Aldosterone System) . Ke hoʻāla ʻia kēia ʻōnaehana hormonal, ʻūlū nā kīʻaha koko ma ke kino holoʻokoʻa, a piʻi ke koko.

ʻAʻole like kēia me ke koko maʻamau. Hāʻule kēia i loko o kahi māhele i kapa ʻia ʻo ke koko kiʻekiʻe lua. ʻO ia hoʻi, ke koko kiʻekiʻe i hoʻokumu ʻia e kekahi maʻi ʻē aʻe.

He aha nā hōʻailona o kēia maʻi? Pehea mākou e kānalua ai?

ʻO ka pilikia nui ma ʻaneʻi, ʻaʻohe mau hōʻailona kikoʻī no kēia ʻano. ʻO ia hoʻi, ʻaʻole paha ʻoe e ʻike i kekahi mea ʻokoʻa. Eia nō naʻe, ke nānā ke kauka i kāu mōʻaukala olakino a me nā lāʻau lapaʻau āu e lawe ai, hiki iā ia ke ʻike i kekahi mau hōʻailona. ʻO kēia nā mea e kānalua ai ke kauka i kēia.

E nānā kākou i kēlā mau hōʻailona.

No ke aha lā kēia e hana nei? He aha nā kumu nui?

ʻO ke kumu nui o ke ālai ʻana o nā kīʻaha koko e alakaʻi ana i nā puʻupaʻa, he ʻano i kapa ʻia ʻo renal artery stenosis . ʻO ke ʻano kēia, ua emi nā aʻa i loko o nā puʻupaʻa. ʻElua kumu nui no kēia.

1. Atherosclerosis: ʻO kēia ke kumu maʻamau. I ka ʻōlelo maʻalahi, ʻo ia ka emi mālie ʻana o nā kīʻaha koko ma muli o ka hōʻiliʻili ʻana o ka momona a me ka cholesterol (i kapa ʻia ʻo 'plaque') ma nā paia o nā kīʻaha koko. ʻOi aku ka maʻamau o kēia me ka makahiki, ka maʻi diabetes, ke kiʻekiʻe o ka cholesterol, a me ka puhipaka.

2. Fibromuscular Dysplasia (FMD): He ʻano laha ʻole kēia. Hana ʻia ia i ka wā e ulu kūpono ʻole ai nā ʻiʻo a me nā ʻiʻo i loko o nā paia o nā kīʻaha koko, e hoʻohāiki ana i nā kīʻaha koko ma nā wahi. ʻOi aku ka maʻamau o kēia ʻano i nā wahine ʻōpio.

Ma waho aʻe o kēia mau kumu nui ʻelua, aia paha kekahi mau kumu ʻē aʻe kakaʻikahi.

He aha nā pilikia e hiki mai ana inā hoʻowahāwahā ʻia kēia?

E like me kekahi ʻano koko kiʻekiʻe, hiki i kēia kūlana ke alakaʻi i nā pilikia koʻikoʻi inā waiho ʻole ʻia no ka manawa lōʻihi.

• Ka pōʻino o ka puʻuwai: Hiki i ke koko kiʻekiʻe no ka manawa lōʻihi ke hoʻoikaika i ka puʻuwai, e alakaʻi ana i nā kūlana e like me ka mānoanoa o ka ʻiʻo o ka puʻuwai, ka hōʻeha puʻuwai, a me ka hāʻule ʻana o ka puʻuwai.
• Ka hōʻino hou ʻana i nā puʻupaʻa: Hiki i nā puʻupaʻa, ka mea i emi mua ke kahe o ke koko, ke hōʻino hou ʻia e ke kaomi kiʻekiʻe, e alakaʻi ana i ka hāʻule ʻana o nā puʻupaʻa.
• ʻEha maka: ʻO ka hōʻino ʻana i nā kīʻaha koko palupalu i loko o ka maka hiki ke alakaʻi i ka nalowale o ka ʻike (maʻi retinal).
• Hahau: ʻO ka hōʻino ʻana i nā kīʻaha koko e hiki ai i ka lolo e hoʻonui i ka pilikia o ka hahau ʻana.

Pehea lā e ʻike ai ke kauka i kēia?

Inā kānalua kāu kauka i kēia maʻi, e hana ʻo ia e like me kahi mākaʻi, e hōʻiliʻili ana i nā hōʻailona e hiki ai i kahi hopena. Pili kēia kaʻina hana i kekahi mau ʻanuʻu koʻikoʻi.

1. Hoʻokolokolo kino: E nānā ke kauka iā ʻoe, ʻoiai ke kau ʻana i ka stethoscope ma kou ʻōpū e nānā i ke kani 'bruit' a mākou i ʻōlelo ai ma mua.

2. Ke nīnau ʻana e pili ana i kou mōʻaukala olakino: E nīnau ʻia ʻoe i nā nīnau he nui, e like me ka makahiki i loaʻa ai iā ʻoe ke koko kiʻekiʻe, inā paha he kanaka o kou ʻohana i loaʻa iā ia, nā lāʻau lapaʻau āu e lawe nei, a inā he mau maʻi ʻē aʻe kāu.

3. Nā hoʻokolohua kūikawā: Pono e hana ʻia kekahi mau hoʻokolohua e hōʻoia i ke kānalua.

• Nā hoʻāʻo koko: E nānā i ka hana o nā puʻupaʻa (creatinine, eGFR) a me nā pae hormone o ka ʻōnaehana RAAS.
• Nā hoʻāʻo mimi: E nānā i nā mea e like me ka protein i loko o ka mimi.
• ʻO ka Kidney Ultrasound Doppler: ʻO kēia ka hoʻāʻo koʻikoʻi loa. Ana ia i ka wikiwiki o ke kahe ʻana o ke koko i loko o nā aʻa e lawe ana i ke koko i nā puʻupaʻa a hiki ke ʻike pololei i nā mea āpau e ālai ʻia ana.
• Nā scan ʻē aʻe: I kekahi mau hihia, ʻōlelo ʻia paha nā scan paʻakikī e like me ka CT angiogram a i ʻole MR angiogram.

ʻAe, e kamaʻilio kākou e pili ana i ka lāʻau lapaʻau.

Ke ʻike ʻia kēia maʻi, ʻaʻohe mea e makaʻu ai. Aia nā lāʻau lapaʻau kūpono no kēia. ʻO ka pahuhopu nui o ka lāʻau lapaʻau, ʻo ia ke kāohi i ke koko a pale i nā puʻupaʻa a me nā ʻōpū ʻē aʻe.

Nā lāʻau lapaʻau (nā lāʻau lapaʻau)

I ka hapanui o nā hihia, hiki ke hoʻomalu maikaʻi ʻia kēia kūlana me ka lāʻau lapaʻau. Ma waho aʻe o nā lāʻau lapaʻau i hāʻawi ʻia no ke koko koko maʻamau, e kuhikuhi ke kauka i nā lāʻau lapaʻau e pili pono ana i kēia kūlana.

• Nā mea pale i ka Angiotensin-Converting Enzyme (ACE): No ka laʻana, nā lāʻau lapaʻau e like me Enalapril lāua ʻo Lisinopril.
• Nā Palekana Receptor Angiotensin (ARB): No ka laʻana, nā lāʻau lapaʻau e like me Losartan lāua ʻo Telmisartan.

Hoʻomalu kēia mau lāʻau ʻelua i ka hana o ka ʻōnaehana hormone RAAS a mākou i kamaʻilio ai ma mua a hoʻōki i ke piʻi ʻana o ke koko.

Eia kekahi, hiki ke kuhikuhi ʻia nā lāʻau lapaʻau ʻē aʻe e like me nā statins e hoʻohaʻahaʻa ana i ka cholesterol, nā blockers channel calcium, a me nā diuretics ma muli o kou kūlana.

Nā kaʻina hana e hana ʻia inā pono

I kekahi manawa he paʻakikī ke kāohi i kou koko me ka lāʻau lapaʻau wale nō. A i ʻole inā ua paʻa loa ke kīʻaha koko, e kuhikuhi paha kāu kauka i kahi hana kūikawā.

• ʻO Renal Artery Angioplasty a me Stenting: Ua like kēia me ka angioplasty no nā kīʻaha koko i loko o ka puʻuwai. Hoʻokomo ʻia kahi ʻōmole lahilahi ma o kahi aʻa koko ma ka wāwae a i ʻole ka lima a hoʻoneʻe ʻia i ke aʻa renal i paʻa. A laila hoʻopiha ʻia ka ʻōmole me kahi pōpō liʻiliʻi e hoʻonui i ka wahi i paʻa. I mea e pale ai i ka paʻa hou ʻana, ua kau ʻia kahi ʻōmole liʻiliʻi e like me ka mesh (he stent) ma ia wahi.

• ʻO ka Renal Denervation: He lāʻau lapaʻau hou kēia. Hoʻohana ia i ka wela a i ʻole ka ikehu ultrasound e hōʻemi i ka hana o nā aʻalolo a puni ke aʻa renal. ʻO kēia mau aʻalolo nā mea e hoʻouna i nā hōʻailona i ka lolo e hoʻonui i ke kaomi. No laila ma ka hōʻemi ʻana i kā lākou hana, hiki ke hoʻemi ʻia ke koko.

ʻoki kino

ʻAʻole hoʻohana pinepine ʻia ke ʻoki kino. Hoʻohana wale ʻia ke ʻoki kino inā paʻakikī loa ke ʻano o nā kīʻaha koko no nā kaʻina hana e like me ka angioplasty, a inā ʻaʻole holo pono kēlā mau ʻano hana.

• ʻO ke ʻoki kino renal renal renal renal Revascularization: Ua kapa ʻia hoʻi kēia ʻo ke ʻoki kino bypass renal.Maanei, hoʻohana ke kauka lapaʻau i kahi ʻāpana o ke kīʻaha koko i lawe ʻia mai kahi ʻāpana ʻē aʻe o kou kino a i ʻole kahi paipu hana e hana i kahi ala hou (bypass) e lawe i ke koko i ka puʻupaʻa, e pale ana i ka ʻāpana i ālai ʻia.

He aha ka mea e hana ʻia ma hope o ka lāʻau lapaʻau?

Mai manaʻo ua pau nā mea āpau ke hoʻomaka ʻoe i ka lāʻau lapaʻau. He mea nui e hele i nā manawa hoʻopaʻa e like me ke kuhikuhi a kāu kauka.

Ma kēia mau keʻena lapaʻau, ua ʻōlelo ʻo Dr.

• Ana lākou i kou koko a ʻike i ka holomua o ka lāʻau lapaʻau.
• Hana ʻia nā hoʻāʻo koko e nānā i ka hana o ka puʻupaʻa.
• Inā pono, e hoʻololi ʻia ka nui o kāu lāʻau lapaʻau a i ʻole e hoʻohui ʻia nā lāʻau hou.

He mea nui loa kēia mau manawa hoʻopaʻa nou. He manawa kūpono kēia e nīnau ai i ke kauka i nā nīnau a hopohopo paha āu e loaʻa ai.

Hiki ke ho'ōla loa ʻia kēia maʻi?

He maʻi hiki ke mālama ʻia ke koko kiʻekiʻe Renovascular. ʻO ia hoʻi, me ka lāʻau lapaʻau kūpono a, inā pono, nā hana kūpono, hiki ke hoʻohaʻahaʻa i kou koko i kahi pae olakino. Akā ʻoi aku ka pololei o ka ʻōlelo ʻana hiki ke "hoʻomalu maikaʻi ʻia" ma mua o ka "hoʻōla loa ʻia."

• E lawe i kāu lāʻau lapaʻau i ka manawa kūpono: E lawe i kāu lāʻau lapaʻau e like me ke kauoha a kāu kauka, me ka ʻole o ka hoʻokuʻu ʻana i hoʻokahi lā.
• E mālama i kāu papaʻai: E hōʻemi i nā meaʻai kiʻekiʻe i ka paʻakai, ka ʻaila, a me ke kō. Inā ʻōlelo kāu kauka i kahi papaʻai kūikawā e like me ka papaʻai DASH , e hahai ia.
• Hoʻoikaika Kino: E nīnau i kāu kauka i nā hoʻoikaika kino kūpono no kou kino a me ka lōʻihi o kou hana ʻana iā lākou, a hana e like me ia.

Ke ʻike ʻoe ʻo ia ke kumu o kou koko kiʻekiʻe hiki ʻole ke kāohi ʻia, e ʻike ʻoe i kahi manaʻo nui o ka hōʻoluʻolu. No ka mea, i kēia manawa ua ʻike ʻoe i ke kumu, hiki iā ʻoe ke loaʻa ka lāʻau kūpono no ia. No laila, inā he mau nīnau kāu e pili ana i kēia, mai makaʻu e kamaʻilio me kāu kauka.

Renovascular Hypertension, hypertension, kaomi, puʻupaʻa, renal artery stenosis, koko kiʻekiʻe, koko kiʻekiʻe Sinhala, maʻi puʻupaʻa Sinhala, maʻi puʻupaʻa, nā kumu o ke kaomi