Hoʻopilikia pū kekahi ka maʻi diabetes i nā puʻupaʻa? E makaʻala kākou i ka maʻi Diabetic Kidney Disease!

Loaʻa iā ʻoe ka maʻi diabetes? A i ʻole kekahi o kou ʻohana a hoaaloha paha i loaʻa i ka maʻi diabetes? A laila ua ʻike paha ʻoe i nā pilikia like ʻole e hele mai me ka maʻi diabetes. I kekahi manawa hiki iā mākou ke makaʻu no ka mea ʻaʻole mākou i ʻike piha i kēia mau mea. I kēia lā e kamaʻilio mākou e pili ana i nā hopena o ka maʻi diabetes i ko mākou mau puʻupaʻa. Ua kapa ʻia kēia ʻo Diabetic Kidney Disease (DKD).

He aha ka maʻi Diabetic Kidney Disease (Diabetic Kidney Disease)?

I ka ʻōlelo maʻalahi, he hōʻino kēia i kou mau puʻupaʻa ma muli o ka maʻi diabetes. Ua ʻike mākou e kānana nā puʻupaʻa ʻelua i loko o ko mākou kino i ke koko a hoʻoneʻe i nā huahana ʻōpala . E noʻonoʻo i nā puʻupaʻa e like me ʻelua mau kānana super i loko o ko mākou kino. Kānana kēia i nā huahana ʻōpala nitrogenous, no ka laʻana urea, nā huahana ʻōpala mai nā ʻiʻo (creatinine), a me nā mea ʻawahia ʻē aʻe he nui a hoʻokuʻu iā lākou me ka mimi. ʻAʻole wale kēlā, kōkua pū nā puʻupaʻa i ka mālama ʻana i ke kaulike o ka wai a me nā electrolytes i loko o ke kino.

Aia i loko o kēlā me kēia puʻupaʻa ma mua o hoʻokahi miliona mau ʻāpana kānana liʻiliʻi i kapa ʻia he nephrons. I loko o kēia mau nephrons, ua hoʻopili ʻia nā kīʻaha koko liʻiliʻi e hana i kahi ʻano mesh i kapa ʻia he glomeruli. ʻO ka ʻoiaʻiʻo, ʻo kēia mau glomeruli ka hana mua i ka kānana koko. ʻAe lākou i ka wai a me nā huahana ʻōpala i hoʻoheheʻe ʻia e hele ma o ko lākou mau membrane semi-permeable, a laila e hoʻokuʻu ʻia mai ke kino ma ke ʻano he mimi.

E nānā, he aha ka mea e hana ʻia i ke kino o ke kanaka me ka maʻi diabetes? ʻAʻole hiki i ko lākou kino ke hoʻohana pono i ke kō a mākou e loaʻa ai mai ka meaʻai a mākou e ʻai ai, ʻo ia hoʻi, `(glucose)`. A laila piʻi ka pae `(glucose)` i loko o ke koko. Ke loaʻa kēia nui o `(glucose)` no ka manawa lōʻihi, hoʻomaka nā membrane palupalu o kēlā mau `(glomeruli)` e hōʻino ʻia. A hiki ke hōʻino ʻia nā ʻāpana ʻē aʻe o `(nephron)`. ʻAʻole hiki i nā `(glomeruli)` i hōʻino ʻia ma kēia ʻano ke kānana pono i ke koko. A laila, ʻo ka mea e hana ʻia, ʻo ia ka hoʻomaka ʻana o nā mea ʻawahia e pono e hoʻokuʻu ʻia me ka mimi e hōʻiliʻili i loko o ke kino.

He koʻikoʻi anei kēia kūlana?

ʻAe, he maʻi koʻikoʻi ka maʻi puʻupaʻa i hoʻokumu ʻia e ka maʻi diabetes. Inā ʻaʻole mālama pono ʻia, hiki iā ia ke alakaʻi i ka hāʻule ʻana o ka puʻupaʻa . Hiki i ka hāʻule ʻana o ka puʻupaʻa ke hoʻoweliweli i ke ola. No laila, he mea nui loa ka makaʻala i kēia.

He aha nā pae o ka maʻi puʻupaʻa ma muli o ka maʻi diabetes?

ʻO ka eGFR kahi ana o ka maikaʻi o ka hana ʻana o kou mau puʻupaʻa. ʻO ka eGFR kahi pōkole no ka helu kānana glomerular i manaʻo ʻia. I ka ʻōlelo maʻalahi, he helu ia o ka maikaʻi o ke kānana ʻana o kou mau puʻupaʻa i nā huahana ʻōpala. ʻO ka eGFR o ke kanaka olakino ma kahi o 100. Hiki i kēia waiwai ke hāʻule i ka 0, ʻo ia hoʻi, ʻaʻole hana iki kou mau puʻupaʻa.

Aia kekahi mau pae o kekahi maʻi puʻupaʻa, me ka maʻi puʻupaʻa i hoʻokumu ʻia e ka maʻi diabetes:

• Pae I:ʻO kāu GFR he 90 a ʻoi aku paha. I kēia manawa, ua hōʻino ʻia paha kou mau puʻupaʻa, akā ke hana mau nei lākou ma ke ʻano maʻamau.
• Pae II: Hiki ke loaʻa ka waiwai GFR ma waena o 60 a me 89. ʻOi aku ka hōʻino ʻia o nā puʻupaʻa ma mua o ke kahua I, akā hana maikaʻi nō naʻe.
• Pae III: Aia paha ka waiwai GFR ma waena o 30 a me 59. I kēia manawa, hiki ke hōʻemi iki ʻia a nui paha ka hana o nā puʻupaʻa.
• Pae IV: Hiki ke loaʻa ka waiwai GFR ma waena o 15 a me 29. ʻO ke ʻano kēia ua emi nui ka hana o nā puʻupaʻa.
• Pae V: ʻOi aku ka liʻiliʻi o ka GFR ma mua o 15. ʻO ke ʻano kēia ua kokoke nā puʻupaʻa i ka hāʻule piha ʻana, a ua hāʻule paha.

ʻO wai ka mea e loaʻa pinepine ai kēia maʻi? He aha nā kumu pilikia?

Hiki i kekahi kanaka me ka maʻi diabetes Type 1 a i ʻole Type 2 ke loaʻa i ka maʻi puʻupaʻa. Eia nō naʻe, ʻoi aku ka nui o ka pilikia o kekahi poʻe. Eia kekahi laʻana:

• Poʻe ʻeleʻele
• Nā kānaka ʻAmelika ʻInikini, ʻAlaska Native, a i ʻole nā ​​​​kānaka First Nations
• Poʻe Polenekia
• Poʻe Māori

Aia kekahi mau kumu pilikia ʻē aʻe:

• Loaʻa ka maʻi puʻupaʻa i loko o ka ʻohana.
• Loaʻa ke koko kiʻekiʻe.
• Ka hoʻohana ʻana i nā huahana paka (e like me nā cigarettes).
• ʻO ka Hyperglycemia kahi maʻi kahi e kiʻekiʻe mau ai ke kō koko.
• Nā pae kolesterol koko kiʻekiʻe (Hyperlipidemia).

Pehea ka maʻamau o kēia maʻi?

He maʻi maʻamau loa ka maʻi puʻupaʻa i hoʻokumu ʻia e ka maʻi diabetes. ʻO ia ke kumu nui o ka maʻi puʻupaʻa hope loa ma ka honua holoʻokoʻa. Ua manaʻo ʻia aia ma kahi o 40% o ka poʻe me ka maʻi diabetes e loaʻa i kēia maʻi puʻupaʻa.

He aha nā hōʻailona o ka maʻi puʻupaʻa i hoʻokumu ʻia e ka maʻi diabetes?

I ka hapanui o nā hihia, ʻaʻole ʻike ʻia nā hōʻailona maopopo a hiki i ka hōʻino ʻia ʻana o 80% a 90% o nā puʻupaʻa. Ke ʻike ʻia nā hōʻailona, ​​​​e ʻike paha ʻoe i nā mea e like me:

• Ka pehu ʻana o ka maka, nā lima, a me nā wāwae (edema).
• Ka luaʻi a me ka luaʻi.
• Ka luhi mau a me ka luhi paha.
• Ka paʻakikī o ka hanu ʻana (dyspnea).
• ʻAʻohe ʻono o ka meaʻai.
• Mimi huʻa a pehu paha.
• Paʻakikī i ka noʻonoʻo ʻana a i ʻole ka huikau.
• ʻIli maloʻo a ʻānai.
• ʻŌpū ʻiʻo.
• Pono e hoʻemi i ka nui o ka insulin i lawe ʻia (no ka poʻe e lawe ana i ka lāʻau lapaʻau no ka maʻi diabetes).

He aha nā hōʻailona i nā pae mua?

ʻO ka maʻi puʻupaʻa ma muli o ka maʻi diabetes ʻaʻole hōʻike pinepine i nā hōʻailona i nā pae mua.Loaʻa paha iā ʻoe ka protein i loko o kou mimi (proteinuria). Akā hiki ke ʻike ʻia kēia e ke kauka nāna e hana i kahi urinalysis.

He aha ke kumu o kēia? He mea laha paha ia?

ʻO ke kumu nui o kēia, ʻo ia ka maʻi diabetes type 1 a i ʻole type 2.

ʻAʻole, ʻaʻole kēia he maʻi lele. ʻAʻole hiki iā ʻoe ke hoʻolaha i kēia maʻi i kekahi.

Pehea ʻoe e ʻike ai inā he maʻi puʻupaʻa kou ma muli o ka maʻi diabetes?

Inā loaʻa iā ʻoe ka maʻi diabetes, he mea nui e ʻike i kāu kauka i kēlā me kēia ʻekolu a ʻeono mahina no ka nānā ʻana, e like me ka ʻōlelo a kāu kauka. Inā kānalua kāu kauka he maʻi puʻupaʻa paha kāu e pili ana i ka maʻi diabetes, e kauoha ʻo ia i kekahi mau hoʻokolohua.

He aha nā hoʻokolohua e hana ʻia e ʻike ai i kēia?

Kōkua nā hoʻokolohua ma lalo nei i ka ʻike ʻana i kēia maʻi:

• Ka nānā ʻana i ka mimi:

ʻO kēia ka lawe ʻana i kahi hāpana o kāu mimi a nānā iā ia no kona ʻano, ka haku mele kemika, a me ka hoʻokolokolo microscopic. Hiki i kāu kauka ke hoʻohana i kahi dipstick e hana i kēia hoʻāʻo. Hiki iā ia ke paipai i nā ʻano hoʻāʻo mimi like ʻole. I loko o kahi hoʻāʻo dipstick, mimi ʻoe i loko o kahi pahu kūikawā. A laila kau ʻia kahi ʻāpana pepa (dipstick) me nā kemika i hoʻopili ʻia ma luna. Inā he protein (albumin) i loko o ka mimi, e loli ke kala o ka ʻāpana.

Inā makemake kāu kauka i kahi ana pololei, hiki iā lākou ke kauoha i kahi hoʻāʻo protein mimi . Pili kēia i ka hoʻouna ʻana i kahi hāpana o kāu mimi i kahi keʻena hoʻokolohua e nānā i ka lakio o ka protein i ka creatinine i loko o kāu mimi (lakio protein-a-creatinine). Inā kiʻekiʻe loa kēia lakio, he hōʻailona paha ia o ka maʻi puʻupaʻa e pili ana i ka maʻi diabetes.

• Nā hoʻāʻo koko:

Ke ana nei ka hoʻāʻo eGFR i ka hiki o kou mau puʻupaʻa ke kānana i ke koko. E lawe kāu kauka i kahi koko liʻiliʻi mai kahi aʻa koko ma kou lima a hoʻohana i ka pae creatinine i loko o ke koko a me kekahi ʻike olakino maʻamau e helu ai i kāu eGFR.

• Nā hoʻāʻo kiʻi:

Hiki i kēia mau hoʻokolohua ke kōkua i kāu kauka e loaʻa kahi manaʻo no ke olakino o kou mau puʻupaʻa.

• Nā hoʻāʻo ultrasound: Hiki i kēia ke nānā i ke ʻano a me ka nui o nā puʻupaʻa.
• Nā scan MRI a me CT: Hiki i kēia ke ʻike maopopo i nā kīʻaha koko a me ke kahe koko i nā puʻupaʻa.

• ʻO ka biopsy puʻupaʻa:

Ma kēia kaʻina hana, lawe ke kauka i kahi ʻāpana liʻiliʻi o ka ʻiʻo mai kou puʻupaʻa a nānā iā ia ma lalo o kahi microscope i loko o kahi keʻena hoʻokolohua. Ma mua o ka hana ʻana i kēia, hoʻomānoʻo ʻia ka ʻāpana i ʻole ʻoe e ʻeha. E hāʻawi pū ʻo ia iā ʻoe i kahi mea hoʻomaha māmā e kōkua iā ʻoe e hoʻomaha. A laila, hoʻokomo ʻia kahi nila ma o ka ʻili i loko o ka puʻupaʻa a lawe ʻia ka hāpana ʻiʻo.

He aha nā lāʻau lapaʻau no kēia?

Aia ka lāʻau lapaʻau i ke kahua o kou maʻi, kou makahiki, a me kou olakino holoʻokoʻa. ʻO ka kaohi ʻana i kāu maʻi diabetes ka hana mua i ka mālama ʻana i kēia maʻi puʻupaʻa. Hiki i kēia mau mea ke kōkua iā ʻoe e hoʻokele i kāu maʻi diabetes:

• E hoʻokomo i nā meaʻai he nui i ka fiber, haʻahaʻa i ka momona a me nā calorie i kāu papaʻai.
• Hoʻoikaika kino mau.
• Ke kāohi nei i ke kaumaha o ke kino.
• E ho'ōki i ka puhipaka a i ʻole ka hoʻohana ʻana i nā huahana paka ʻē aʻe.

Inā loaʻa iā ʻoe ke koko kiʻekiʻe, he mea nui e mālama pū iā ia. Hiki i kāu kauka ke kuhikuhi i ka lāʻau lapaʻau no ke koko kiʻekiʻe.

Hiki ke hoʻohuli ʻia ka pōʻino o ka puʻupaʻa?

ʻAʻole, ʻaʻole hiki ke hoʻihoʻi piha ʻia ka pōʻino o nā puʻupaʻa i hoʻokumu ʻia e ka maʻi diabetes. Eia nō naʻe, hiki iā ʻoe ke kaohi, hoʻolohi, a hiki paha ke hoʻōki i ka pōʻino hou aʻe o nā puʻupaʻa ma ka lawe ʻana i kāu mau lāʻau lapaʻau e like me ke kauoha a kāu kauka, e hahai ana i kahi ʻai olakino, a me ka noho kino ʻana.

He aha nā lāʻau lapaʻau i hāʻawi ʻia no kēia?

No ka mālama ʻana i ka maʻi puʻupaʻa maʻi diabetes, he mea nui e kāohi i kāu maʻi diabetes, e hoʻohaʻahaʻa i kou koko, a e hoʻohaʻahaʻa i kou pae cholesterol. Hiki i kāu kauka ke kuhikuhi i nā lāʻau lapaʻau e mālama ai i kēia mau kūlana:

• No ka maʻi diabetes:
• ʻO nā Biguanides (e.g. metformin): Hoʻemi kēia i ka nui o ka glucose i hana ʻia e kou ake. Hoʻomaikaʻi pū lākou i ke ʻano o ka hana ʻana o ka insulin i loko o ke kino, e hoʻolohi ana i ka wikiwiki o ka hoʻololi ʻia ʻana o nā kalapona i ke kō.
• Nā mea hoʻopaʻa i ka sodium-glucose cotransporter 2 (SGLT2): Kōkua kēia i nā puʻupaʻa e wehe i ka glucose mai ke kino ma o nā puʻupaʻa a me ka mimi.
• ʻO nā agonists Glucagon-like peptide 1 (GLP-1): Hoʻonui kēia i ka hoʻokuʻu ʻana o ka insulin, hoʻemi i ka hoʻokuʻu ʻana o ka glucose mai ke akepaʻa ma hope o ka ʻai ʻana, a hoʻopaneʻe i ka hoʻokahe ʻana o ka ʻōpū. Hiki paha i kēia ke kōkua i ka pohō kaumaha.

• No ke koko kiʻekiʻe:
• Nā mea hoʻopaʻa i ka enzyme hoʻololi-angiotensin (ACE): Ke ālai nei kēia i ka hana ʻana o kahi hormone i kapa ʻia ʻo angiotensin II. Hoʻohana maoli ke kino i kēia hormone e kāohi i ke koko. Ma hope o ka mālama ʻana me nā mea hoʻopaʻa ACE, pono e emi ke koko.
• Nā mea pale i ka mea loaʻa Angiotensin II (ARB): Hoʻōki kēia i ka hormone angiotensin II mai ka hoʻopaʻa ʻana i nā mea loaʻa ma nā kīʻaha koko. Hana like nā ARB me nā mea pale ACE, e hoʻohaʻahaʻa ana i ke koko.

He mea nui: Ma waho aʻe o ka hoʻohaʻahaʻa ʻana i ke koko, kōkua pū nā ACE inhibitors a me nā ARB i ka hoʻolohi ʻana i ka holomua o nā maʻi puʻupaʻa e pili ana i ka maʻi diabetes.

• No ke kolesterol kiʻekiʻe:
• Statins: Hoʻohaʻahaʻa kēia i ka cholesterol maikaʻi ʻole a hoʻokiʻekiʻe i ka cholesterol maikaʻi. He mea kōkua paha lākou no kekahi poʻe me ka maʻi puʻupaʻa e pili ana i ka maʻi diabetes.

He aha ka lāʻau lapaʻau inā e ʻoi aʻe ka maʻi?

Inā lilo ka maʻi puʻupaʻa maʻi diabetes i mea koʻikoʻi, aia nā koho lapaʻau:

• Dialysis: Inā ʻaʻole hana pono kou mau puʻupaʻa, hiki i ka dialysis ke hana i ka hana no kou mau puʻupaʻa. Ma kēia, lawe kahi mīkini i kou koko, kānana i nā huahana ʻōpala a me nā wai keu, a hoʻihoʻi i ke koko i hoʻomaʻemaʻe ʻia i kou kino.
• Hoʻoili puʻupaʻa: Ma kēia, loaʻa iā ʻoe kahi puʻupaʻa olakino mai kekahi kanaka ʻē aʻe (he mea hāʻawi puʻupaʻa).

Pehea e hiki ai iā ʻoe ke pale aku i kēia maʻi?

ʻO ke ala maikaʻi loa e pale aku ai i ka maʻi puʻupaʻa maʻi diabetes, ʻo ia ka mālama pono ʻana i kāu maʻi diabetes a me ke koko. He mea nui e hahai pono i ka hoʻolālā lapaʻau a kāu kauka i kuhikuhi ai.

He aha ka mea hiki i kekahi me kēia maʻi ke manaʻo?

He maʻi holomua mālie ka maʻi puʻupaʻa maʻi diabetes. Inā loaʻa iā ʻoe kēia maʻi, ʻaʻole hiki ke hoʻihoʻi ʻia ka pōʻino i kou mau puʻupaʻa. Eia nō naʻe, inā loaʻa koke ʻoe i ka maʻi a hahai i kahi hoʻolālā lapaʻau kūpono, hiki iā ʻoe ke hoʻolohi a hoʻōki paha i ka holomua o ka maʻi.

Inā lilo kēia maʻi i mea koʻikoʻi, hiki iā ia ke alakaʻi i ka hāʻule ʻana o nā puʻupaʻa, kahi mea e hoʻoweliweli ai i ke ola. ʻO nā koho lapaʻau no ka hāʻule ʻana o nā puʻupaʻa he dialysis a i ʻole ka hoʻoili puʻupaʻa.

Pehea lā wau e mālama ai iaʻu iho?

E kōkua kāu kauka iā ʻoe e hoʻomohala i kahi hoʻolālā lapaʻau kūpono iā ʻoe. Hiki ke komo pū me nā lāʻau lapaʻau a me nā hoʻololi ʻana i ke ʻano o ka nohona. Hiki i kāu hoʻolālā lapaʻau ke komo pū me:

• Ke lawe nei i nā lāʻau lapaʻau maʻi diabetes a me ke koko kiʻekiʻe i kauoha ʻia e ke kauka me ka pololei.
• E nānā pinepine i kou pae kō koko a me ke kaomi koko.
• Ma hope o kahi papaʻai olakino (e like me ka papaʻai Mediterranean a i ʻole ka papaʻai DASH).
• E hoʻoikaika kino no ka liʻiliʻi he 30 mau minuke i ka lā i ka hapa nui o nā lā o ka pule. E ho'āʻo e loaʻa ma ka liʻiliʻi he 150 mau minuke o ka hoʻoikaika kino i ka pule. Hiki iā ʻoe ke hele wāwae, holo, paikikala, ʻauʻau, a i ʻole kekahi hana cardiovascular ʻē aʻe āu e makemake ai.
• Ke pale ʻana i nā lāʻau lapaʻau e hiki ke hōʻino i nā puʻupaʻa. Hiki i kēia ke komo pū me kekahi mau lāʻau ʻeha (nā lāʻau anti-inflammatory non-steroidal - NSAID).
• Mālama i nā manawa i hoʻopaʻa ʻia e ke kauka a me nā hoʻokolohua lab āpau i ka manawa.
• E ho'ōki i ka puhipaka a i ʻole ka hoʻohana ʻana i nā huahana paka ʻē aʻe.
• Ke kaupalena nei i ka nui o ka waiʻona āu e inu ai.
• E hiamoe ma waena o ʻehiku a ʻeiwa hola i kēlā me kēia pō.

Āhea wau e ʻike ai i ke kauka?

Inā loaʻa iā ʻoe ka maʻi diabetes, pono ʻoe e ʻike mau i kāu kauka i kēlā me kēia ʻekolu a ʻeono mahina, e like me ka ʻōlelo a kāu kauka.

Inā loaʻa iā ʻoe ka maʻi diabetes, e ʻōlelo aku kāu kauka i ka nānā ʻana i kēlā me kēia makahiki no ka maʻi puʻupaʻa maʻi diabetes , e hoʻomaka ana i ʻelima mau makahiki ma hope o kou ʻike ʻia ʻana. ʻAʻole ʻike pinepine ʻia ka hōʻino ʻana o ka puʻupaʻa i loko o nā makahiki 10 mua ma hope o kou ʻike ʻia ʻana me ka maʻi diabetes. Inā ua loaʻa iā ʻoe ka maʻi diabetes no nā makahiki he 25 a ʻaʻole i hōʻino ʻia kou mau puʻupaʻa, ʻaʻole ʻoe e loaʻa i ka maʻi puʻupaʻa maʻi diabetes.

He aha nā nīnau e pono iaʻu e nīnau aku i ke kauka?

He mea nui loa e nīnau i nā nīnau e like me kēia ke ʻike ʻoe i kāu kauka:

• Pehea ʻoe e ʻike ai inā he maʻi puʻupaʻa koʻu ma muli o ka maʻi diabetes?
• Pono anei au e ʻike i kahi nephrologist a i ʻole kekahi loea ʻē aʻe?
• He aha nā hoʻokolohua āu e hana ai e ʻike ai i nā maʻi puʻupaʻa e pili ana i ka maʻi diabetes?
• Pehea ke koʻikoʻi o koʻu maʻi puʻupaʻa ma muli o ka maʻi diabetes?
• He aha nā hoʻololi o ke ʻano o ka nohona e hiki iaʻu ke hana e hoʻolohi a hoʻōki paha i ka holomua o kaʻu maʻi puʻupaʻa e pili ana i ka maʻi diabetes?
• He aha nā lāʻau lapaʻau āu e paipai nei?
• He aha nā lāʻau lapaʻau āu e paipai nei?
• ʻEhia pinepine e pono ai iaʻu e hele mai no nā hoʻonohonoho?
• Hiki iā ʻoe ke kuhikuhi i nā hui kākoʻo no ka poʻe me ka maʻi puʻupaʻa e pili ana i ka maʻi diabetes?

ʻO kēia kaʻu leka koʻikoʻi loa e hāʻawi aku iā ʻoe...

He maʻi koʻikoʻi ka hōʻino ʻana o nā puʻupaʻa mai ka maʻi diabetes. Hiki iā ia ke holomua i ka hāʻule ʻana o nā puʻupaʻa, kahi mea e hoʻoweliweli ai i ke ola. Inā ʻike kāu kauka iā ʻoe me ka maʻi puʻupaʻa e pili ana i ka maʻi diabetes, he mea maʻamau ke makaʻu a me ke kaumaha. Eia nō naʻe, inā loaʻa iā ʻoe ka maʻi i ka wā mua a hahai pono i kāu hoʻolālā lapaʻau, hiki iā ʻoe ke hoʻolohi a hoʻōki paha i ka holomua o ka maʻi puʻupaʻa e pili ana i ka maʻi diabetes.

Hiki i ka loaʻa ʻana o ka lāʻau lapaʻau no kahi ʻano e like me kēia ke hoʻoluhi i ka naʻau. Akā e hoʻomanaʻo, aia kāu kauka ma laila e kōkua iā ʻoe. Ua kūpaʻa ʻo ia e pane i kāu mau nīnau a pau a kōkua iā ʻoe e mālama i kou ʻano ola. No laila, mai makaʻu e kamaʻilio me kāu kauka e pili ana i nā mea āpau ma kou manaʻo.

ʻO ka maʻi diabetes, ka maʻi puʻupaʻa, ka maʻi puʻupaʻa diabetes, DKD, Nephropathy, eGFR, hoʻāʻo mimi, Dialysis