Ua ʻike anei ʻoe ua pehu wale kou mau wāwae a me kou mau kuʻekuʻe wāwae? A i ʻole ua ʻike anei ʻoe i ka wā e mimi ai ʻoe, he huʻa ia? ʻAʻole kēia he mau hōʻailona e hoʻowahāwahā wale ʻia. Hiki iā lākou ke lilo i mau hōʻailona e hewa ana kekahi mea me kou mau puʻupaʻa. I kēia lā e kamaʻilio mākou e pili ana i kahi maʻi kakaʻikahi akā koʻikoʻi e hoʻopilikia ana i kou mau puʻupaʻa. ʻO ia ka Membranous Nephropathy (MN).
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He aha ka Membranous Nephropathy (MN)?
I ka ʻōlelo maʻalahi, ʻo ka Membranous Nephropathy (MN) kahi kūlana kahi e hoʻouka ai kāu ʻōnaehana pale, ka ʻōnaehana e pale iā ʻoe mai ka maʻi, i kou mau puʻupaʻa ponoʻī. ʻAʻole anei he mea kupaianaha? Ke hoʻouka mai nei ko kākou mau pale ponoʻī iā kākou.
I kēia manawa, e nānā, i loko o ko kākou mau puʻupaʻa, aia he miliona o nā kānana liʻiliʻi e hoʻomaʻemaʻe i ke koko. Kāhea mākou i kēia mau glomeruli . E like me ke kānana kī, kānana kēia mau glomeruli i nā huahana ʻōpala i makemake ʻole ʻia i loko o ke koko a hoʻokuʻu iā lākou i waho o ke kino ma ke ʻano he mimi. ʻO kekahi hana a kēia mau kānana, ʻo ia ka mālama ʻana i nā mea nui e like me nā protein e pono ai ke kino i loko o ke koko.
ʻO ka mea e hana ʻia i kekahi me MN, ʻo ia ka hoʻouka ʻana o ka ʻōnaehana pale maʻi a hōʻino i kēia mau kānana i kapa ʻia ʻo glomeruli. Ke hana ʻia kēia hōʻino, e nui aʻe nā lua i loko o nā kānana. A laila hoʻomaka nā protein e pono ai ke kino e kānana ma o ke kānana a puka mai me ka mimi. ʻO kēia ka pilikia nui o kēia maʻi.
Hiki ke ʻike koke ʻia kēia maʻi, a i ʻole hiki ke ulu mālie i ka hala ʻana o ka manawa. I kekahi manawa, ʻaʻole paha e ʻike ka poʻe he mau makahiki ko lākou e loaʻa ana kēia maʻi.
ʻElua ʻano nui o kēia maʻi.
Hoʻokaʻawale mākou i kēia kūlana o ka Membranous Nephropathy (MN) i ʻelua mau māhele nui. Hana ʻia kēia hoʻokaʻawale ʻana ma muli o ke kumu.
| ʻAno maʻi | Wehewehena |
|---|---|
| ʻO ka Nephropathy Membranous Mua (Idiopathic) | ʻO kēia ke ʻano maʻamau (ma kahi o 75% o nā maʻi). ʻO ka mea e hana ʻia ma ʻaneʻi, ʻo ia ka hoʻouka pololei ʻana o ka ʻōnaehana pale i nā puʻupaʻa, me ka ʻole o nā maʻi ʻē aʻe. Ua manaʻo ʻia kēia he maʻi autoimmune. |
| ʻO ka Nephropathy Membranous Lua | Hana ʻia kēia ke hōʻino ʻia nā puʻupaʻa e kekahi maʻi ʻē aʻe, maʻi, a lāʻau lapaʻau paha. ʻO ke ʻano kēia ua hōʻino ʻia nā puʻupaʻa ma muli o ka hopena o kekahi mea ʻē aʻe. Ma kahi o 25% o nā maʻi i loaʻa i kēia ʻano. |
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ʻO nā hōʻailona nui o ka maʻi MN ke kumu o ka nui o ka protein i hoʻokuʻu ʻia i loko o ka mimi, e like me kaʻu i ʻōlelo ai ma mua. I ka lāʻau lapaʻau, kapa mākou i ka hōʻiliʻili o nā hōʻailona i hoʻokumu ʻia e kēia ʻano ʻo Nephrotic Syndrome .
ʻO nā hōʻailona nui kēia:
- ʻEdema: Ka pehu ʻana, ʻoiai ma nā wāwae, nā kuʻekuʻe wāwae, nā wāwae, a i kekahi manawa ke alo a me nā lima. Hiki mai kēia pehu ʻana i ka wā e emi ai ka protein i loko o ke koko, e hoʻoulu ai i ka wai i loko o nā kīʻaha koko e kahe i loko o nā ʻiʻo.
- Ka mimi huʻa nui (Proteinuria): Ma muli o ke kiʻekiʻe o ka protein i loko o ka mimi, hiki ke ʻike ʻia he huʻa, e like me ka wai kopa.
- Luhi nui a me ka māluhiluhi: Hiki iā ʻoe ke luhi i nā manawa a pau no ka mea e nalowale ana kou kino i ka ikehu a me nā meaʻai e pono ai.
- Piʻi koke ke kaumaha: ʻAʻole kēia e piʻi nui ana, akā, e piʻi ana ke kaumaha ma muli o ka paʻa ʻana o ka wai.
- Ke kolekole kiʻekiʻe: Ke emi ka pae o ka protein i loko o ke koko, hana ko kākou akepaʻa i ka momona a me ka kolesterol hou aʻe e hoʻoponopono ai.
- Ke koko kiʻekiʻe: Hiki ke piʻi aʻe ke koko ke hāʻule nā pūnaʻau.
- Paʻakikī ka hanu ʻana: Hiki ke hana i kēia ʻano inā hōʻiliʻili ka wai a puni nā māmā.
No ke aha e hana ʻia ai kēia? He aha nā kumu?
ʻOkoʻa nō hoʻi nā kumu ma muli o nā ʻano ʻelua a mākou i kūkākūkā ai ma mua.
Ke kumu o ka MN mua
Ua ʻōlelo au he maʻi autoimmune ka MN mua. ʻO ka mea e hana ʻia ma ʻaneʻi, ua kuhi hewa kā mākou ʻōnaehana pale i kahi protein kūikawā i kapa ʻia ʻo phospholipase A2 receptor (PLA2R) i loko o nā kānana puʻupaʻa (glomeruli) ma ke ʻano he "ʻenemi." A laila, hana ia i nā antibodies e luku i kēia protein PLA2R a hoʻouka iā ia. ʻO kēia hakakā ke kumu e hōʻino ʻia ai kēlā mau kānana a e liki ka protein.
Nā mea e hiki ai ke hana i ka MN lua
ʻO ka MN lua ka hopena o kekahi mea ʻē aʻe. Eia kekahi mau mea e hiki ke hoʻopilikia iā ia:
- Nā maʻi autoimmune ʻē aʻe: Nā maʻi e like me Lupus a me Rheumatoid Arthritis.
- Nā maʻi: Nā maʻi e like me ka Hepatitis B, Hepatitis C, Malaria, a me Syphilis.
- Kanesa: ʻOi aku ka maʻi kanesa o ka māmā a me ka colon.
- Nā lāʻau lapaʻau:Ka hoʻohana lōʻihi ʻana i nā lāʻau lapaʻau e like me kekahi mau painkillers (NSAIDs) a me penicillamine.
- Nā mea ʻawaʻawa: Ka ʻike ʻia ʻana i nā metala kaumaha e like me ka mercury.
E hoʻomanaʻo, inā loaʻa iā ʻoe kēia mau hōʻailona, ʻo ka mea nui e ʻike koke i kāu kauka a ʻimi i ka ʻōlelo aʻo, ma mua o ke kuhi ʻana i ke kumu.
He aha nā pilikia e hiki ai i kēia ke hana?
Inā ʻaʻole mālama pono ʻia ʻo MN, hiki i nā pilikia koʻikoʻi ke ulu aʻe i ka hala ʻana o ka manawa.
- ʻO ke kiʻekiʻe o ka cholesterol a me ka pilikia o ka maʻi puʻuwai: ʻO ka hoʻonui ʻia o ka momona i loko o ke koko e hoʻonui ai i ka pilikia o nā maʻi e like me ka maʻi puʻuwai a me ka hahau.
- ʻO nā ʻūpā koko: Ke hoʻokuʻu ʻia ka protein i loko o ka mimi, hoʻokuʻu ʻia nā protein e pale ana i ke kāpili ʻana o ke koko mai ke kino. Hiki i kēia ke alakaʻi i nā ʻūpā koko e hana ana i loko o nā aʻa o nā wāwae. Kāhea mākou i kēia ʻo Deep Vein Thrombosis (DVT) . Inā haki kēia ʻūpā koko a paʻa i loko o kahi aʻa i loko o nā māmā, he kūlana koʻikoʻi a hoʻoweliweli i ke ola i kapa ʻia ʻo Pulmonary Embolism (PE) .
- Ka Holo ʻole ʻana o nā Puʻupaʻa: Inā ʻaʻole i kāohi ʻia ka maʻi, e piʻi mālie ka pōʻino i nā puʻupaʻa, a i ka hopena e hiki i nā puʻupaʻa ke holo ʻole loa.
Pehea e ʻike ai ke kauka i kēia?
Inā loaʻa iā ʻoe nā hōʻailona i luna, e kuhikuhi aku kāu kauka ʻohana iā ʻoe i kahi loea puʻupaʻa (Nephrologist). E hana ʻo ia i kekahi mau hoʻokolohua e ʻike pololei i ka maʻi.
| Hoʻāʻo | He aha kāu e nānā nei? |
|---|---|
| Hoʻāʻo mimi | Nānā lākou i ka nui o ka protein a me ke koko i loko o ka mimi. |
| Hoʻāʻo koko | E nānā ʻia nā mea e like me ka creatinine, ka naikokene urea koko (BUN) , e ana i ka hana o nā puʻupaʻa, a me nā pae protein koko (albumin). |
| Ka helu kānana Glomerular (GFR) | Hana ʻia kēia ma o kahi hoʻāʻo koko. Ana ia i ka wikiwiki o ke kānana ʻana o kou mau puʻupaʻa i nā huahana ʻōpala. |
| Biopsy o ka puʻupaʻa | ʻO kēia ke ala maikaʻi loa e hōʻoia i ka maʻi 100% o ka manawa. Me ka hoʻohana ʻana i kahi nila liʻiliʻi, lawe ʻia kahi ʻāpana liʻiliʻi loa o ka ʻiʻo mai ka puʻupaʻa a nānā ʻia ma lalo o kahi microscope. Hiki i kēia ke hoʻoholo pololei inā loaʻa nā loli a me nā antibodies e pili ana i ka maʻi MN. |
He aha nā lāʻau lapaʻau no kēia?
Aia ka lāʻau lapaʻau i ke ʻano o ka MN āu i loaʻa ai a me ke koʻikoʻi o kāu mau hōʻailona. ʻO ka pahuhopu nui o ka lāʻau lapaʻau, ʻo ia ka hōʻemi ʻana i nā hōʻailona a me ka pale ʻana i ka maʻi mai ka ʻoi aku ka ʻino.
Hiki ke hoʻohana ʻia kekahi a ʻoi aku paha o kēia mau mea ma ke ʻano he lāʻau lapaʻau:
- Nā lāʻau lapaʻau koko: ʻO nā lāʻau lapaʻau e like me nā ACE inhibitors a me nā ARBs e kāohi i ke koko a hōʻemi pū i ka excretion o ka protein i loko o ka mimi.
- Diuretics: Ua kapa ʻia kēia mau mea ʻo "nā pila wai." Kōkua lākou i ka hōʻemi ʻana i ka pehu ma ka hoʻopau ʻana i ka wai keu mai ke kino e like me ka mimi.
- Nā lāʻau hoʻohaʻahaʻa kolesterol (Statins): Hāʻawi ʻia kēia mau mea e kaohi i nā pae kolesterol kiʻekiʻe i loko o ke koko.
- Nā lāʻau hoʻokahe koko: Hoʻohana ʻia kēia mau mea e hōʻemi i ka pilikia o nā pilikia e like me DVT.
- Nā Immunosuppressants: Hāʻawi ʻia nā lāʻau lapaʻau e like me corticosteroids e kāohi i ka hana a ka ʻōnaehana pale a hoʻāʻo e hoʻōki iā ia mai ka hoʻouka ʻana i nā puʻupaʻa.
- Nā hoʻololi ʻana i ka ʻai: He mea nui loa ia e hōʻemi i kāu ʻai ʻana i nā meaʻai kiʻekiʻe i ka paʻakai a me ka momona . E aʻo aku kāu kauka iā ʻoe i kahi ʻai kūpono.
Inā ʻaʻole lawa kēia mau lāʻau lapaʻau maʻamau e kāohi i ka maʻi, hiki i ke kauka ke neʻe aku i nā lāʻau lapaʻau ikaika aʻe i kapa ʻia ʻo immunotherapy . Hoʻohana ʻia nā lāʻau lapaʻau e like me Rituximab lāua ʻo Cyclophosphamide e luku i nā cell e hana ana i nā antibodies e hoʻouka i nā puʻupaʻa.
No kekahi me ka MN lua, ʻo ka mālama ʻana i ke kumu kumu (e laʻa, ka maʻi hepatitis, lupus) hiki ke hoʻōki a hōʻemi paha i ka hōʻino ʻana o ka puʻupaʻa.
Inā hele ka maʻi i ke kahua koʻikoʻi loa a hoʻoulu i ka hāʻule ʻana o nā puʻupaʻa, pono paha ka dialysis a i ʻole ka hoʻoili puʻupaʻa.
Pehea ke ola me kēia maʻi?
ʻOkoʻa ke ʻano o kēia maʻi mai kēlā kanaka a kēia kanaka. No kekahi poʻe, hoʻopau loa ʻia ka maʻi me ka liʻiliʻi a ʻaʻohe lāʻau lapaʻau paha. No kekahi poʻe, mau ka maʻi no nā makahiki.
ʻO ka mea maikaʻi loa , ʻoi aku ka liʻiliʻi ma mua o 15% o ka poʻe me MN e hoʻomau i ka hoʻomohala ʻana i ka hāʻule ʻana o ka puʻupaʻa, ʻo ia hoʻi ka hapa nui e ola i ke ola maʻamau me ka lāʻau lapaʻau.
Akā ʻo ka mea nui e hoʻomanaʻo ai, hiki i kēia maʻi ke hoʻi hou mai ma hope o ka mālama ʻia ʻana. No laila, he mea nui e kipa aku i nā keʻena lapaʻau a hoʻāʻo ʻia i nā manawa i hoʻonohonoho ʻia e like me ke kuhikuhi ʻana a kāu nephrologist. A laila, inā he mau hōʻailona o ka maʻi e hoʻi hou mai ana, hiki ke hoʻomaka koke ʻia ka mālama ʻana.
Leka Lawe-Home
- Inā he pehu kou ma kou mau wāwae, nā wāwae, a i ʻole ke alo me ka ʻike ʻole ʻia, a i ʻole e ʻike i ka huʻa nui i loko o kou mimi, mai hoʻowahāwahā iā ia. E ʻike koke i kāu kauka.
- ʻO ka Membranous Nephropathy (MN) kahi maʻi autoimmune kahi e hoʻouka ai kāu ʻōnaehana pale ponoʻī i kou mau puʻupaʻa.
- He mea nui loa ka biopsy puʻupaʻa no ka ʻike pololei ʻana i kēia maʻi.
- ʻOiai ʻaʻole hiki ke ho'ōla loa ʻia kēia maʻi, aia nā lāʻau lapaʻau kūpono loa e kāohi i nā hōʻailona, hōʻemi i ka hōʻino ʻana i nā puʻupaʻa, a pale i nā pilikia.
- ʻO ka hahai pono ʻana i nā ʻōlelo a kāu kauka a me ka hele ʻana i nā keʻena lapaʻau i ka manawa kūpono he mea nui ia no ka mālama ʻana i ke olakino o kou mau puʻupaʻa.
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