I-hypertension yenzakale yindlela yokushisa komfutho wegazi odala obangelwa izinguquko ezingavamile ekugezeni kwegazi njalo ezintsheni. Ngenkathi i-hypertension ye-renovascular ngezinye izikhathi itholakele ngokushesha ezigulini eziyazi ukuthi zinenkinga yezinso, zivame ukutholakala ngemva kwesikhathi sokubona nokuhlolwa. Ngenxa yokuthi izinso zisebenza kanjani, ukucindezeleka komfutho wegazi okuvame ukwanda kakhulu uma kungelashwa.
Izimbangela
Imishanguzo ephakathi nendawo ebizwa ngokuthi imishanguzo ye -renal ihlinzeka izinso ngokugeleza kwegazi okumele kuhlungwe futhi kubuyiselwe ukujikelezwa okuvamile komzimba. Ngenxa yokuthi imisebenzi yokuhlunga kwezinso ngokuyinhloko ixhaswe amandla egazi, izinso zihle kakhulu ekuboneni ushintsho ekucindezeni kwegazi. Uma izinso zibona ukuthi ukucindezeleka kwegazi kuhla kakhulu kakhulu ukuze kutholakale ukuhlunga kwegazi okujwayelekile, basabela ngokukhulula amahomoni ayenzela ukuphakamisa umfutho wegazi.
Uma ukugeleza kwegazi ngokusebenzisa imishanguzo ye-renal kunciphisa nganoma yisiphi isizathu, izinso zingakhohliswa ekucabangeni ukuthi ukucindezeleka kwegazi kuphansi kakhulu. Isibonelo, isifo esibizwa ngokuthi i-renal artery stenosis singabangela imishanguzo ye-renal ukuze ilula, okwehlisa inani legazi eligeleza ezinso. Izinso zibona lokhu kunciphisa futhi kukhululeke i-hormone renin emzamweni wokuphakamisa ukucindezeleka kwegazi nokubuyisela ukugeleza kwegazi okujwayelekile.
Izinkinga ziphakama lapho, njengokwehla komzimba we-stenosis, ukunciphisa ukugeleza kwegazi akubangelwa yi-low blood pressure. Kulezi zimo, izinso ziphelela ukuphakamisa umfutho wegazi emazingeni aphakeme kakhulu ukuze ushaye igazi eliningi ngokusebenzisa imishanguzo yokuqothulwa komzimba.
Ukuxilongwa
Ezigulini eziyaziwa ukuthi zinezigaxa zegazi noma izinkinga zezinso, ngokuzumayo ukuthuthukisa umfutho wegazi ophezulu kuyisignali eqinile ukuthi ukucindezeleka komfutho wegazi kungase kube icala.
Nokho, ngokuvamile ukuxilongwa kudinga ukuphenywa ngokucophelela nokuhlolwa okuningi. Ezinye izimpawu ezikhombisa ukucindezeleka komfutho wegazi okungukuthi:
- Umfutho wegazi ophezulu kakhulu kubantu abangaphansi kuka-30
- Ukuqala kanzima kwe-high blood pressure kubantu asebekhulile kunama-55
- Ukucindezelwa kwegazi okungaphenduli ukwelashwa kwezidakamizwa
- Umfutho wegazi oyeka ukuphendula ngemithi yokwelashwa yangaphambili
Ukuhlolwa kwegazi kuvame ukuqhutshwa emacaleni okusolakala ukuthi kune-hypertension yokuvuselelwa kabusha, kodwa indlela ewukuphela kokuqinisekile yokuthola inkinga ukuthola empeleni imishanguzo ye-renal. Lokhu kuvame ukuqhutshwa ngenqubo engeyona insalela efana ne-MRI noma i-CT scan, kodwa ngezinye izikhathi izinyathelo ezingavamile ezingadingekile ziyadingeka. Kulezi zimo, i-catheter encane isuke isetshenziswe ngokusebenzisa ubuhlungu emgodini we-renal ngokwayo, futhi kukhishwa amanani amancane we-teythani. Izithombe zithathwa ezikhombisa inkambo elandelayo; lokhu kuzokwethula noma yiziphi izindawo ezincane emthini.
Ukwelapha
Ukwelapha umfutho wegazi ophezulu we-renovascular akufani nokuphatha umfutho wegazi ophakeme wendabuko. Ngenxa yokuthi esinye sezibonakaliso zalesi sifo ukwehluleka ukuphendula ukwelashwa kwezidakamizwa zendabuko, izindlela zokwelapha ezivamile aziphumelelanga. I-high blood pressure component ye-hypertension yokuvuselela imvelo empeleni iyimpawu yesifo esiyisisekelo - umshini onqenqemeni we-renal - okufanele ekugcineni uphathwe.
Izinketho zokwelapha ziyahlukahluka kuye ngokuthi yini eyenza umthambo we-renal uphazamise, kodwa imigomo ifana naleso simo ngasinye - ukwandisa umthamo ngokwawo futhi ubuyekeze ukugeleza kwegazi okujwayelekile ezinsoweni. Indlela yangempela lokhu okufeziwe incike ekubambeni okwenza umthamo ube mncane endaweni yokuqala. Kubantu asebekhulile, ukwehlisa imvamisa kuvame ukuba ngumphumela wamanoni athile afana nalawo angabangela ukuhlaselwa kwenhliziyo. Isinyathelo sokuqala ekwelapheni ngokuvamile ukuzama imithi echitha lezi zimali. Uma lokhu kungaphumeleli, kungenzeka ukuthi izinketho eziningi ezingavamile zidingeke, kufaka phakathi ngokomzimba ukwandisa umkhumbi obuye usayizi ojwayelekile ngendlela yokuhlinzwa ebizwa nge-stenting.
Kwezinye izimo, ukumiswa kungenxa yezimo ezinzima kakhulu ukuzilawula. Ezinye izifo zingenza izindonga zemithana yegazi zithinte, ezingabangela ukuthi umkhumbi ube mncane. Lokhu akukwazi ukuphathwa ngemithi, ngakho-ke izinhlobo ezihlukahlukene zokuhlinzwa - ezivame kakhulu noma ezivame kakhulu - zivame ukudingwa. Izinketho ezithinta ukwelashwa kulezi zimo zithembele ezintweni eziningi ezingahlukahluka kwesineke kuya kwesineke, izinhlelo eziningi zokwelashwa ezicacile zivame ukubekezela ngesineke.
Ukwelashwa ngokweqile kwengculazi kunzima kunokwelapha ezinye, izinhlobo eziningi "ezivamile" zengcindezi ephezulu yegazi, kanti nakuba izinga lokuphumelela liphakeme, lithatha izingozi ezingaphezulu nezinkinga ezingenzeka. Ukusebenza nodokotela ukuthuthukisa uhlelo olufanele lokulashwa yisinyathelo esibalulekile sokulwa nalesi sifo esibi.
> Imithombo:
> Derkx, FH, uSchalekamp, MA. I-Renal Artery Stenosis ne-Hypertension. Lancet 1994; 344: 237.
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> Mann, SJ, Pickering, TG. Ukutholwa kwe-Hypertension Yokuvuselelwa Kwamanzi. I-State of the Art: 1992. Ann Intern Med 1992; 117: 845.
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