Renal tsinga stenosis: zvingangove zvinokonzera, zviratidzo uye kurapwa mamiriro

BP chinetso chaizvo. Kunyanya pakati vakwegura uye repakati vanhu. VaBennett neBP kunogona kuva mugove. Pakati pavo - mwoyo chirwere, chirwere cheitsvo, kwemakemikari anobudiswa zvirwere. Sezvo chikazozikamwa, yakawedzera kuomesa kunogona sitiroko uye kurwiswa mwoyo. Kuti tinzwisise sei kukurira chiratidzo ichi, unofanira kuona chikonzero. Mune zvimwe zviitiko, BP rikaitika pakanyorwa zvokurwara ichi sezvo renal tsinga stenosis. Tanga kurapwa chirwere ichi sezvo mangwanani sezvinobvira. Pashure arterial stenosis kungaita kwete chete kune kuwedzera BP, asiwo kune vamwe migumisiro zvakakomba. The zvokurwara rinowanikwa mune vose varume pakati pavakadzi. Mune zvimwe zviitiko, chirwere chacho vachiberekwa. Kakawanda richiwanika pamusoro colour ose vascular zvirwere.

Kuti uwane mashoko pamusoro renal tsinga stenosis

Renal tsinga stenosis - munhu aienda pamusoro lumen ari mudziyo, nokuda siyana pathological ezvinhu. The chirwere anoonekwa kuti nefropaticheskim pathologies. Renal tsinga - chikuru midziyo ropa kuti kupa ropa kumuviri tishu. Stenosis vari chaizvo wakaderedzwa mu dhayamita. Somugumisiro, muitiro akashatirwa ropa wedzerai neitsvo. zvokurwara Izvi zvinotungamirira zvakadai kutyorwa zvakakura sezvo yechipiri BP, chirwere renal kukundikana. Pane 2 budiriro mashandiro stenosis. Pakati pavo:

1. Atherosclerotic kuita. Zvinonzi kuchengetwa dzakawanda varwere kutambura kubva chirwere ichi. mashandiro kwakadaro kubva stenosis ndiyo zvishoma nezvishoma blockage pamusoro lumen kuti chikwangwani chakanyorwa. Kunowanzoratidzwa mudziyo occlusion kuchengetwa vakwegura.
2. Fibromuscular dysplasia. musiyano wezvinyorwa Iri ishoma zvokurwara. Zvinogona kuitika mu repakati vakadzi nevasikana vaduku. Dysplasia tsandanyama rinenge rinoreva nhaka vakaremara.

Chete unogona kuita zvokuongorora "renal tsinga stenosis" pashure chombo vaongo-. ICD - a kupatsanura pakati pathologies, kushandiswa munyika yose. Anosanganisira muzvizhinji zvirwere, chimwe nechimwe chine mumwe remitemo. Renal tsinga stenosis iri encoded ne nzira mbiri, zvichienderana mhosva parinowanika. Mumwe nzira - a Cipher I15.0, izvo zvinoreva kuti "renovascular neBP". Other remitemo iri ICD - Q27.1. Iye anomirira "vachiberekwa renal tsinga stenosis." Zvirwere zvacho zvinoda kurapwa chiremba wezvedundira kana vascular chiremba.

Renal tsinga stenosis: Inoita zvokurwara

Aienda pamusoro peripheral arteries ndezvaJehovha pathologies ari vascular hurongwa. Ziva zvinokonzera siyana pamusoro stenosis. Vakawanda vavo ndiyo atherosclerosis. Sezvazvakanyorwa zvinozivikanwa, kazhinji richiwanika munyika vanhu vane kufuta, kutungamirira munhu ndakagara mararamiro kana chirwere cheshuga. Atherosclerosis anogona kuva pamusoro nguva. Zvisinei, zviri kashoma chirwere kusvikira zviratidzo tsinga arteries. Other zvinokonzera stenosis dzinosanganisira:

1. Fibromuscular dysplasia. Iri izwi rinoreva munhu vachiberekwa nemagene urema, somugumisiro iyo pane kushayikwa mhasuru fibers ari vascular pamadziro. The zvokurwara kuchengetwa vakadzi chero zera.
2. Aneurysm renal arteries.
3. Mapundu ose peripheral vascular chirwere.
4. Vachiberekwa uye vawana vasculitis.
5. Compression of renal tsinga yamamota zvinobva munyama pedyo nhengo.

Izvi zvinokonzera kuitika mune zvisingawanzoitiki zviitiko. Naizvozvo, chirwere chavo kutanga chete pashure kuchaitwa atherosclerosis.

The mashandiro kuti BP

The chikuru chiratidzo renal tsinga stenosis anoonekwa kuti BP. Saka, iyi kurapwa chirwere, renal kuongorora mamiriro vanoda. Sezvo kuyeuka renal tsinga stenosis uye neBP? Kuwedzera BP kunosanganisira nzira mbiri:

1. Activation of renin-angiotensin hurongwa. Pasi pokudzora izvi zvoutachiona zvinhu anovandudza arteriolar aienda. Somugumisiro peripheral vascular nemishonga inowedzerawo. Saka, kweropa iri arteries anowedzera.
2. Kuitwa aldosterone. kemikari ichi anogadzirwa adrenal cortex. It dzinowanzoona mumuviri zvachose. Zvisinei, kana tsinga stenosis ayo kugadzirwa inowedzerawo. Nokuda kunyanyisa uwandu aldosterone mumuviri Urume rinoungana uye yavaibvisa ions. Izviwo, uyewo kunokonzera kuwedzera BP.

Somugumisiro chirwere vane chirwere cheBP chirwere pane kuchinja kudivi kumwoyo. Kusiyiwa ventricular hypertrophy, uye zvishoma nezvishoma rwakatambanudzwa. Ndiyo imwe chinokonzera neBP.

Renal tsinga stenosis: chirwere zviratidzo

Kuderedza pakati arteries etsvo kunotungamirira kuti muzvizhinji pakati nechirevo. Zviratidzo stenosis hakusi pakarepo, asi chete pamwe zvikuru occlusion. Muchiitiko chino, kuchinja mabatiro haisi nguva dzose inobudirira. Kuwedzera vascular zvinetso, arterial stenosis kunotungamirira ischemic zvachinja itsvo. Mugumisiro ndechokuti filtration uye mumisasa vanotambura nhego chaitika. Yakapiwa ichi, zvinokwanisika kuti govera 2 kunotoda chirwere zvinokura stenosis. First - neBP. chirwere ichi kunoratidzwa dzinoverengeka yokuora kuratidzwa. Pakati pavo:

1. Inosimudzira BP. Zvinogona kunge episodic kana kugara. Zvikuru kukosha kuti chirwere kuti kuwedzera diastolic BP (100 mm. HG. V.).
2. Pakuonekwa ruzha munzeve.
3. Dzungu.
4. Kuda kurutsa, usina chokuita kudya.
5. Kuvheneka "Nhunzi" pamberi ake.
6. Nomusoro mutemberi, pahuma.
7. Kugumbuka.

Wechipiri chiremba chirwere ischemic nephropathy. Nokuda kuti kutyorwa renal ropa kuyerera "zvokudya" nhego kwamira. Kunyanya ngozi bilateral renal tsinga stenosis. NeBP - chirwere chinogona kuva zvishoma kudzora zvinodhaka. Zvinosuruvarisa akaratidza nhengo ischemia hakusi correctable kushandisa zvinodhaka. Zviratidzo "okisijeni nenzara" itsvo zvinosanganisira: yakaderera musana kurwadziwa, kuchinja dundira. Kazhinji pane kuderera uwandu Urume siyana, vakawanda simba. The weti kuonekwe admixture ropa, madhaka emadhaka.

Diagnostics

Chirwere chinogona kuitwa chete pashure pokuongororwa "renal tsinga stenosis." zvokurwara chirwere kunosanganisira muunganidzwa zvichemo nhoroondo zvokurapa, sokuongorora kwomurabhoritari uye richishanda nzira. Kakawanda, aitungamirira chirwere ndiyo BP havaratidzi kudzora antihypertensive kurapa. Uyewo, varwere vanogona chokunyunyuta pamusoro kusagadzikana mune yepazasi shure (pamwe chete kana mbiri panhivi), kuchinja hunhu weti. rokuongorora urongwa zvinosanganisira:

1. KLA uye urinalysis.
2. ECG.
3. Nemakemikari Kuongororwa kweropa. Maperembudzi vanofungidzirwa pamwe kuwedzera serum creatinine uye urea.
4. Renal Ultrasound.
5. Special miedzo: weti Nechiporenko, Zimnitskiy.
6. X-ray musiyano kuongorora nhumbi - renografiya.
7. Doppler Ultrasound of renal arteries.
8. Angiography.
9. CT uye MRI.

differential kuongorora chirwere

Akapiwa chokwadi kuti vane chirwere cheBP chirwere ari kutungamirira, renal tsinga stenosis iri kusiyaniswa nomoyo chirwere, atherosclerosis yacho yeropa. Zviratidzo zvinogona vakafanana Itsengo chirwere, Cushing uye pheochromocytoma.

Kana zviratidzo ischemic nephropathy kuchawanda, stenosis iri kusiyaniswa navo anogumbura pathologies yacho itsvo. Izvi zvinosanganisira pielo- uye glomerulonephritis. Sezvo Zviratidzo izvi zvinogona kuitika kana matambudziko ose cheshuga.

Kuchinja kurapa nokuti renal tsinga stenosis

Mabatirwo renal tsinga stenosis kunotanga kuchinja nzira. NeBP kunokonzerwa constriction pamusoro renal midziyo, zvinoda mubatanidzwa zvinodhaka zvakawanda. Zvatinofarira rakapiwa FIs pamusoro angiotensin-rokutendeutsa enzayemu. Asi mishonga izvi hazvina anokurudzirwa varwere zvakakomba atherosclerotic vascular maronda. Tikafunga rinoumbwa zvinotevera mumapoka zvinodhaka:

1. Beta-blockers. Izvi zvinosanganisira zvinodhaka, "metoprolol", "in coronal", "bisoprolol".
2. Loop diuretics. The mushonga rwokusarudza - mushonga "Furosemide".
3. Karusiyamu mugero blockers. Pakati pavo - mishonga "Verapamil" "Diltiazem".

Mukuwedzera, murwere vanofanira kutora mishonga vaifanira kubata runotikurudzira chirwere (atherosclerosis, chirwere cheshuga).

Kuvhiya Mabatirwo stenosis

Zvinosuruvarisa kazhinji, antihypertensive kurapa iri isashande. Uyezve, kunoderedza BP chete exacerbates ischemic nephropathy. Naizvozvo zvakafanira kushandisa kuvhiyiwa. Zvichienderana rwakadini kukuvadza, kusarudza kuvhiya nzira kurapwa. Kakawanda vanopedza tsinga stenting unokupai kuti itsvo. Kana yose mudziyo lumen obturated pamusoro nzvimbo guru rinoitwa ndavhiyiwa - yaitsiva chikamu mudziyo kusvika nokuisazve. Panguva rufu itsvo nephrectomy rinoitwa.

The fungidziro pashure kuvhiya Mabatirwo stenosis

Zvisinei idivi yakakundwa (stenosis ari kuruboshwe renal tsinga kana kurudyi), kuti fungidziro pashure pokuvhiyiwa kunobva zvaidiwa chiremba kunenge uye mamiriro ezvinhu murwere. Kazhinji, Kuvhiya anogona kuzadzisa zvakanaka mugumisiro. Pashure pemwedzi mishomanana muna 60-70% varwere normalization ropa nevezera kunoitika.

Matambudziko renal stenosis

Zvinosuruvarisa renal tsinga stenosis akaonekwa chete panguva kunonoka padanho okukura. Naizvozvo, hazvibviri kufuratira chiremba kurumbidzwaka. Pashure kutyisidzira yematambudziko angatanga pasina kurapwa. Pakati pavo - a myocardial infarction uye sitiroko pamusoro pakanyorwa vane chirwere cheBP dambudziko, chenjera uye chirwere renal kukundikana. Kana nguva asingadi aite kuvhiyiwa, murwere anogona kurasikirwa simba.

dziviriro

Matanho anosanganisira chichiitwa richiona nezvezvabuda BP pamberi Zvichemo dzungu uye tinnitus, kurega kusvuta uye doro. Kuti tidzivise kuchiita atherosclerosis, zvakafanira kuti kuremekedza inokosha hypolipidemic zvokudya, kushingaira mararamiro. Vamwe varwere vanofanira kutora zvinodhaka anokosha - statins.