Ua ʻike anei ʻoe he ʻano huʻa iki kou mimi , a i ʻole ka mimi? A i ʻole ua hana kekahi kauka i kahi hoʻāʻo mimi a ʻōlelo mai, "He nui loa kou protein i loko o kou mimi." ʻO ia ka mea a mākou e kapa nei he proteinuria ma ke ʻano lapaʻau. I ka ʻōlelo maʻalahi, ʻo ia hoʻi, ʻoi aku ka nui o ka protein i loko o kāu mimi ma mua o ka mea e pono ai. I kekahi manawa hiki i kēia ke lilo i hōʻailona mua o ka hāʻule ʻana o nā puʻupaʻa.
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He aha ka protein a no ke aha he mea nui ia i ko mākou kino?
E noʻonoʻo e pili ana i ia mea, ua like nā protein me nā mea hana i loko o ko kākou kino. Hana lākou i nā hana koʻikoʻi he nui.
- Kōkua ia i ke kūkulu ʻana i nā ʻiʻo a me nā iwi . Ke holo a lele mākou, ke hāpai mākou i nā mea kaumaha, pono mākou i nā ʻiʻo ikaika.
- Hoʻoponopono i ka nui o ke wai i loko o ko mākou koko .
- Kōkua lākou i ko mākou kino e hakakā i nā maʻi . Ua like lākou me nā koa liʻiliʻi i loko o ko mākou kino.
- ʻO lākou ke kuleana no ka hoʻoponopono ʻana i nā ʻiʻo i hōʻino ʻia .
Ua manaʻo ʻia aia kēia mau protein i loko o ko kākou koko. Ma laila lākou e hana ai i kā lākou hana koʻikoʻi. Akā, inā no kekahi kumu e kahe ai kēia mau protein mai loko mai o ke koko a hiki i loko o ka mimi, ʻo ia hoʻi ke hoʻopau ʻia nei lākou mai ke kino. Inā hana ʻia kēlā, hiki ke hoʻopilikia i ke olakino o ko kākou kino holoʻokoʻa.
He mea koʻikoʻi anei ka protein i loko o ka mimi?
ʻAe, he mea hopohopo maoli ka protein i loko o ka mimi, e like me ka hōʻike ʻana o kekahi mau noiʻi e hoʻonui kēia ʻano i ka pilikia o ka make mai ka maʻi puʻuwai a me nā maʻi cardiovascular.
I kekahi manawa, ʻo kēia kūlana, i kapa ʻia ʻo proteinuria, hiki ke lilo i hōʻailona mua o ka maʻi puʻupaʻa mau loa (CKD) . Eia nō naʻe, loaʻa paha i kekahi poʻe nā pae maʻamau o ka protein i loko o ko lākou mimi ʻoiai ua loaʻa iā lākou ʻo CKD. ʻO CKD ka nalowale mālie o ka hana puʻupaʻa. Inā hoʻomau kēia, pono paha ʻoe i kahi hoʻoili puʻupaʻa a i ʻole dialysis. ʻO ka maʻi diabetes a me ke koko kiʻekiʻe nā kumu nui ʻelua o ka hōʻino ʻana o nā puʻupaʻa. ʻO kēia nā kumu maʻamau o ka maʻi puʻupaʻa.
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Hiki i kekahi ke loaʻa ka proteinuria. Eia nō naʻe, ʻoi aku ka nui o kou loaʻa ʻana i kēia maʻi inā:
- Inā ʻoe ma luna o 65 mau makahiki .
- Inā ua loaʻa i kekahi o kou ʻohana ka maʻi puʻupaʻa a i ʻole i kēia manawa .
- Inā loaʻa iā ʻoe kekahi maʻi ʻē aʻe e hoʻopilikia ai i kou mau puʻupaʻa, e like me ka maʻi diabetes .
- Ua ʻike ʻia kēia pilikia he kiʻekiʻe aʻe i kekahi mau hui lāhui (no ka laʻana, nā ʻeleʻele, nā Hispanics, nā ʻAmelika ʻōiwi, a i ʻole nā Pākīpika).
Pehea ka maʻamau o kēia ʻano?
He ʻano maʻamau ka Proteinuria. No ka laʻana, ua hōʻike ʻia ma kahi o 6.7% o ka heluna kanaka ma ʻAmelika Hui Pū ʻIa i loaʻa i kēia ʻano.
Pehea e komo ai ka protein i loko o ka mimi? He aha ka mea e hana ʻia i loko o nā puʻupaʻa?
E noʻonoʻo i ko kākou mau puʻupaʻa he kānana nui loa. ʻO kā lākou hana nui, ʻo ia ke kānana i nā huahana ʻōpala a me ka wai keu mai ko kākou koko. ʻO kēia mau huahana ʻōpala i kānana ʻia a me ka wai ka mea e puka i waho o ke kino ma ke ʻano he mimi.
Aia i loko o nā puʻupaʻa he nui nā kīʻaha koko liʻiliʻi i kapa ʻia ʻo glomeruli . ʻO kēia ke kahua mua o ka kānana koko. ʻO ka maʻamau, ʻaʻole ʻae kēia mau glomeruli i nā ʻāpana protein nui a i ʻole nā kelepona koko e hele i loko o ka mimi. Ua like ia me kahi kānana mesh e hopu ana i nā ʻāpana nui. Eia nō naʻe, inā hele kekahi mau ʻāpana protein liʻiliʻi ma o kēia mau glomeruli, ʻo nā ʻōmole lōʻihi a lahilahi (tubules) i loko o nā puʻupaʻa e hoʻihoʻi hou i kēlā mau protein i loko o ke kino.
No laila, hoʻomaka ka protein e komo i loko o ka mimi inā hewa kekahi mea me kēia kaʻina hana:
- Inā he hōʻino i ka glomeruli a i ʻole nā tubules.
- Inā he pilikia me ke kaʻina hana reabsorption protein.
He aha nā hōʻailona o kēia? Pehea mākou e ʻike ai?
ʻAʻole hōʻike pinepine ʻo Proteinuria i kekahi mau hōʻailona i nā pae mua . ʻO ia ke kumu he mea weliweli iki paha ia. Eia nō naʻe, i ka holomua ʻana o ke kūlana, nā hōʻailona e like me:
- Ka pehu ʻana o ka maka, ka ʻōpū, nā wāwae, a i ʻole nā kuʻekuʻe wāwae (edema) . Hōʻike kekahi poʻe ua pehu ko lākou helehelena ke ala lākou i ke kakahiaka, a i ʻole ua pehu ko lākou mau wāwae i ke ahiahi.
- Pono e mimi pinepine.
- Paʻakikī ka hanu ʻana.
- Luhi nui, pauaho.
- Ka luaʻi a me ka luaʻi.
- ʻAʻohe ʻono o ka meaʻai.
- ʻEha nā ʻiʻo i ka pō.
- ʻO ka pupuhi a puni nā maka, ʻoi aku hoʻi i ke kakahiaka.
- Mimi huʻa a pehu paha. ʻO kēia ka hōʻailona mua a ka poʻe he nui e ʻike ai. Inā huʻa e like me ka wai kopa, pono ʻoe e hopohopo.
He mea nui: Hiki i kēia mau hōʻailona ke lilo i mau hōʻailona o ka maʻi puʻupaʻa mau loa. Inā ʻike ʻoe i kēia mau hōʻailona, ʻoiai ka mimi huʻa a me ka pehu ʻana, e ʻike koke i ke kauka.
He aha nā kumu o ka proteinuria?
I ka hapanui o nā hihia, hiki ke hana ʻia ka proteinuria e nā kūlana olakino ʻino ʻole (ʻaʻole kanesa) a i ʻole nā kūlana olakino manawa pōkole. ʻO nā hiʻohiʻona o kēia mau mea:
- Dehydration - ʻO ke ʻano kēia ʻaʻole lawa ka wai i loko o ke kino.
- Ka mumū- He mumū ma kekahi wahi o ke kino.
- Ke koko haʻahaʻa (Hypotension).
- Nā pōhaku puʻupaʻa.
Eia kekahi, ʻo nā mea e like me ka hoʻoikaika kino nui, ke kaumaha, ka lawe ʻana i nā lāʻau lapaʻau e like me ka aspirin i kēlā me kēia lā, a me ka ʻike ʻana i ke anu nui hiki ke hoʻonui i ka pae protein i loko o ka mimi no kekahi manawa.
Eia nō naʻe, hiki i nā kūlana olakino koʻikoʻi ke hōʻino i nā puʻupaʻa a hoʻoulu i ka proteinuria. ʻO ia mau kūlana:
- ʻO kekahi mau maʻi palekana , e like me ka lupus a me ka maʻi Goodpasture.
- ʻO ka mumū ʻoi o nā puʻupaʻa , i ʻike ʻia hoʻi he glomerulonephritis.
- ʻO ke kanesa cell plasma , i ʻike ʻia hoʻi he myeloma maha.
- ʻO ka luku ʻia ʻana o nā hunaola koko ʻulaʻula ke kumu o ka hōʻiliʻili ʻana o ka hemoglobin i loko o ke koko (hemolysis intravascular).
- Maʻi cardiovascular.
- ʻO ka proteinuria a me ke koko kiʻekiʻe i ka wahine hāpai i ka manawa like - ua kapa ʻia kēia he preeclampsia.
- Ka lāʻau make.
- Nā ulia/ʻeha kino ('Trauma').
- Ka maʻi ʻaʻai puʻupaʻa.
- Nā maʻi puʻuwai ('Congestive heart failure').
ʻEhia ka nui o ka protein i loko o kā mākou mimi e pono ai mākou e hopohopo?
ʻO ka maʻamau, ʻo ka nui o ka protein i loko o kā mākou mimi e emi iho ma mua o 150 milligrams i kēlā me kēia lā. Inā ʻoi aku ka nui o ka protein i loko o kāu mimi ma mua o 150 milligrams i kēlā me kēia lā, ua kapa ʻia kēlā he proteinuria. Hiki ke ʻokoʻa iki ka palena kiʻekiʻe o kēia pae maʻamau mai kēlā me kēia keʻena hoʻokolohua.
Inā loaʻa iā ʻoe ma waena o 3 a me 3.5 grams o ka protein i loko o kou mimi i kēlā me kēia lā, ua kapa ʻia ia he nephrotic-range proteinuria . ʻO ka maʻi Nephrotic kahi ʻano kakaikahi kahi e hoʻokuʻu ai nā puʻupaʻa i ka nui o ka protein i loko o ka mimi.
He maʻi lele anei kēia?
ʻAʻole, ʻaʻole he maʻi lele ka proteinuria. Eia nō naʻe, inā loaʻa i nā poʻe ʻē aʻe o kou ʻohana ke ʻano, ʻoi aku ka nui o kou loaʻa ʻana iā ia. ʻO ke ʻano kēia, aia paha kahi predisposition hoʻoilina.
Pehea ʻoe e ʻike pono ai i kēia? He aha nā hoʻokolohua e hana ʻia?
E hana mua kāu kauka i kahi hoʻāʻo dipstick e ʻike i ka proteinuria.Ma kēia hoʻāʻo, mimi ʻoe i loko o kahi pahu kūikawā ma ke keʻena o kāu kauka a i ʻole ka haukapila. A laila, e hoʻoluʻu ke kauka i kahi lāʻau palakiko lahilahi (dipstick) i uhi ʻia me kahi kemika kūikawā i loko o ka hāpana mimi. Inā he nui ka protein i loko o ka mimi, e loli ke kala o ka lāʻau.
A laila, e hana kāu kauka i kahi urinalysis ma luna o ka hāpana mimi i koe. E nānā kēia i ke ʻano, ka haku mele kemika, a me nā ʻano kūloko o ka mimi ma lalo o kahi microscope. E nānā ke kauka i nā mea i loaʻa ʻole i ka mimi. No ka laʻana, nā hunaola koko ʻulaʻula, nā hunaola koko keʻokeʻo, nā bacteria, a me nā kristal paʻakai a protein paha e hiki ke hana i nā pōhaku puʻupaʻa.
He aha kāu e hana ai inā kānalua ʻoe i ka maʻi puʻupaʻa?
Inā kānalua kāu kauka he maʻi puʻupaʻa kou, e noi ʻo ia iā ʻoe e hana hou i nā hoʻāʻo mimi ʻekolu manawa i loko o ʻekolu mahina. Inā loaʻa ka protein i kēlā me kēia o nā hāpana mimi, he mea hiki ke loaʻa iā ʻoe kahi maʻi mau (lōʻihi). ʻO ka wikiwiki o ka ʻike ʻia ʻana o kēia, ʻoi aku ka maikaʻi o ka hiki ke kāohi a hoʻōki i ka holomua o ka maʻi puʻupaʻa.
Eia kekahi, hiki ke hana ʻia nā hoʻokolohua aʻe:
- Hoʻāʻo hoʻomaʻemaʻe Creatinine: He huahana ʻōpala kemika ka Creatinine. Ana kēia hoʻāʻo i ka nui o ka creatinine i loko o kou mimi a me ke koko. Inā olakino kou mau puʻupaʻa, wehe lākou i ka creatinine mai kou koko a hoʻouna iā ia i loko o kou mimi. Akā inā ʻaʻole hana pono kou mau puʻupaʻa, noho ka creatinine i loko o kou koko.
- Hoʻāʻo koko Glomerular filtration rate (GFR): Hoʻohālikelike ka GFR i nā pae o nā protein i kapa ʻia ʻo creatinine a me albumin i loko o kou koko, ma muli o ka nui o kou kino, ka makahiki, ke kāne, a me ka lāhui. Hiki i ka GFR ke haʻi i kāu kauka i ka maikaʻi o ka hana ʻana o kou mau puʻupaʻa a me ka holomua o kou maʻi puʻupaʻa. Hiki i kēia ʻike ke kōkua iā ʻoe e hoʻomohala i ka hoʻolālā lapaʻau maikaʻi loa.
- Nā hoʻāʻo koko e ana i ka nui o ka protein i loko o ke koko: ʻO ke koko ka ʻāpana o ke koko i loaʻa ka protein.
- Nā hoʻokolohua kiʻi: Hiki i nā hoʻokolohua e like me nā CT scans a me nā ultrasounds ke ʻike i nā pilikia e like me nā pōhaku puʻupaʻa, nā ʻōpū, a i ʻole nā mea e pale ai i ka urinary tract.
- ʻElectrophoresis protein urine (UPEP): ʻAe ʻo UPEP i kāu kauka e ʻimi i nā ʻano protein kikoʻī. Hoʻouna ʻia kāu hāpana mimi i kahi keʻena hoʻokolohua. Ma laila, hoʻopili kahi loea keʻena hoʻokolohua i kahi au uila i kāu hāpana mimi. Hiki i kēia ke hōʻike i ka nui o ka protein i loko o kāu mimi.
- Hoʻāʻo koko Immunofixation (IFE):Hoʻohana ke kauka i kahi nila liʻiliʻi a me ka ʻōmole e lawe i kahi hāpana koko mai kahi aʻa koko ma kou lima a lima paha. Hoʻouna ʻia ka hāpana koko i kahi keʻena hoʻokolohua e hoʻāʻo ʻia no nā protein kikoʻī i loko o ke koko.
- Biopsy puʻupaʻa: Ma kēia hoʻāʻo, wehe kāu kauka i kahi ʻāpana liʻiliʻi loa o kou puʻupaʻa. Hoʻouna ʻia ka hāpana i kahi keʻena hoʻokolohua. Nānā kekahi loea keʻena hoʻokolohua i ka hāpana puʻupaʻa ma lalo o kahi microscope e ʻike i ke kumu o kou maʻi puʻupaʻa a me ka nui o ka pōʻino i hana ʻia.
Pehea e mālama ʻia ai kēia?
ʻO ke ʻano o ka mālama ʻana no ka proteinuria ma muli o ke kumu . Loaʻa i kēlā me kēia kumu kāna lāʻau ponoʻī.
Inā maʻi puʻupaʻa ka proteinuria, hiki i kāu hoʻolālā lapaʻau ke komo pū me nā lāʻau lapaʻau, nā hoʻololi ʻai, a me ka hoʻoikaika kino . Inā he koko kiʻekiʻe kou, e kuhikuhi kāu kauka i ka lāʻau lapaʻau. Inā he koko haʻahaʻa kou, he manaʻo maikaʻi e hana i kahi hoʻāʻo mimi a nānā i ke koko i kēlā me kēia makahiki.
Inā loaʻa iā ʻoe ka maʻi diabetes , pono ʻoe e kaohi i kou pae kō koko . Pono nō hoʻi ʻoe e hoʻāʻo ʻia kou koko GFR i kēlā me kēia makahiki.
Pono nā wāhine hāpai me ka mōʻaukala o ka preeclampsia e ʻike pinepine i kā lākou kauka no nā nānā ʻana. ʻOiai he maʻi koʻikoʻi ka preeclampsia, e hoʻomaikaʻi pinepine ia i loko o kekahi mau lā a i ʻole mau pule ma hope o ka hānau ʻana.
Inā loaʻa iā ʻoe ka proteinuria akā ʻaʻohe maʻi diabetes, ke koko kiʻekiʻe, a i ʻole kekahi mau maʻi ʻē aʻe, hiki i kāu kauka ke kuhikuhi i ka lāʻau koko e kōkua i ka pale ʻana i ka hōʻino ʻana o nā puʻupaʻa. He manaʻo maikaʻi e nānā i kou koko a hoʻāʻo ʻia kāu mimi i kēlā me kēia ʻeono mahina e hōʻoia ʻaʻole ʻoe he maʻi puʻupaʻa.
Inā loaʻa iā ʻoe ka proteinuria iki a manawa pōkole paha, ʻaʻole paha ʻoe e pono i kekahi lāʻau lapaʻau.
Ke hōʻemi nei anei ka inu ʻana i ka wai i ka protein i loko o ka mimi?
ʻAʻole, ʻaʻole e ho'ōla ka inu ʻana i ka wai hou aku i ka proteinuria. ʻO ka inu ʻana i ka wai hou aku e hoʻonui ai i kou mimi ʻana, kahi e hōʻemi ai i ka nui o ka protein i loko o kou mimi i hoʻokahi manawa. Eia naʻe, ʻaʻole ia e pale i nā puʻupaʻa mai ka hoʻokahe ʻana o ka protein.
Pehea wau e mālama ai iaʻu iho? He aha nā mea e pono ai iaʻu e hana?
ʻO ke ala maikaʻi loa e mālama ai iā ʻoe iho, ʻo ia ke lawe i kāu mau lāʻau lapaʻau e like me ke kauoha a kāu kauka.
Eia kekahi, eia kekahi mau ala ʻē aʻe e hiki ai iā ʻoe ke kōkua:
- ʻO ka hōʻemi ʻana i nā meaʻai waiwai i ka protein.
- Ka hoʻēmi ʻana i ka ʻai ʻana i ka paʻakai. E kōkua kēia i ka hoʻohaʻahaʻa ʻana i kou koko.
- ʻO ka ʻai ʻana i nā meaʻai waiwai i ka fiber e hiki ke kōkua i ka hoʻohaʻahaʻa i ka cholesterol a hoʻoponopono i nā pae kō koko.
- Ka hoʻoikaika kino a i ʻole ka noho hana mau ʻana.E ho'āʻo e hana i ʻelua hola o ka hana i kēlā me kēia pule.
- E nānā pinepine i kou pae kō koko.
- Ke haʻalele nei i ka puhipaka a me ka hoʻohana ʻana i ka paka.
- Mai lawe i nā lāʻau anti-inflammatory nonsteroidal (NSAID) ke ʻole i kuhikuhi ʻia e ke kauka. ʻO nā NSAID i hoʻohana pinepine ʻia ʻo aspirin (Bayer®), ibuprofen (Advil®), a me naproxen (Aleve®).
Aia kekahi ala e pale aku ai i kēia?
ʻAʻole hiki ke pale loa ʻia ka Proteinuria. Eia nō naʻe, hiki iā ʻoe ke hoʻokele iā ia. Hiki ke hoʻomalu ʻia nā kūlana he nui e hoʻoulu ai i ka proteinuria me nā lāʻau lapaʻau a me nā loli o ke ʻano o ka nohona.
He aha ke kūlana no kekahi me ka proteinuria?
Inā ua ʻike pololei ʻia a mālama pono ʻia, maikaʻi ka nānā ʻana no ka poʻe me ka proteinuria.
Eia nō naʻe, inā ʻaʻole mālama ʻia, hiki i ka proteinuria ke alakaʻi i ka make. Ua hōʻike ʻia nā noiʻi e ola lōʻihi ka poʻe me ka ʻole o ka proteinuria ma mua o ka poʻe me ka proteinuria iki a koʻikoʻi paha.
Āhea wau e ʻike ai i ke kauka?
Inā ʻike ʻoe i kekahi o kēia mau hōʻailona, e ʻike koke i ke kauka:
- Inā pono ʻoe e mimi pinepine ma mua o ka maʻamau, a inā paha ʻoe e ʻeha i ka wā e mimi ai.
- Inā he huʻa a he pehu paha kou mimi.
- Inā manaʻo ʻoe ua luaʻi a luaʻi paha.
- Inā ʻoe e manaʻo ana he poniuniu, nāwaliwali, a poʻo māmā paha.
- Inā he pehu a pupuhi paha kou maka, ʻōpū, a i ʻole ke kino haʻahaʻa.
- Inā ʻaʻole hoʻomaikaʻi kāu mau hōʻailona ma hope o ka mālama ʻana.
He aha nā nīnau e pono iaʻu e nīnau aku i kaʻu kauka?
Ke hele ʻoe e ʻike i ke kauka, hiki iā ʻoe ke nīnau i nā nīnau e like me kēia:
- Pehea e ʻike maopopo ai ke kauka he proteinuria koʻu?
- He aha ke kūlana i hoʻoulu ai iaʻu i ka proteinuria?
- He aha nā hoʻokolohua āu e paipai nei?
- Loaʻa iaʻu ka proteinuria iki a manawa pōkole paha?
- He aha nā lāʻau lapaʻau a i ʻole nā lāʻau lapaʻau āu e ʻōlelo nei?
- Pono anei iaʻu e hana i kekahi mau hoʻololi i kaʻu meaʻai a i ʻole ke ʻano o ka nohona?
- Inā ʻaʻohe oʻu proteinuria, he aha nā maʻi ʻē aʻe e loaʻa iaʻu?
He aha ka ʻokoʻa ma waena o ka Proteinuria a me ka Orthostatic Proteinuria?
ʻO ka proteinuria Orthostatic ( i kapa ʻia hoʻi ʻo postural proteinuria) ʻo ia hoʻi ʻoeʻO ke ʻano kēia, he nui ka protein i loko o kou mimi ke mimi ʻoe i kou kū ʻana, akā he mea maʻamau ka protein i loko o kou mimi ke mimi ʻoe i kou moe ʻana. He ʻano maʻamau kēia i ʻike ʻia i nā poʻe ʻōpio, ʻoiai hoʻi nā poʻe lōʻihi a wiwi, a ʻaʻole ia he mea weliweli loa.
He aha ka ʻokoʻa ma waena o ka Proteinuria a me ka Transient Proteinuria?
He kūlana manawa pōkole ka transient proteinuria . Hoʻokumu pinepine ʻia e nā mea e like me ka hoʻoikaika kino nui, ke kaumaha, ke kuni, a me ka lōʻihi o ka hoʻopili ʻana i ke anu nui. Hoʻopau pinepine ka transient proteinuria iā ia iho me ka ʻole o ka lāʻau lapaʻau.
ʻO Proteinuria kahi pae kiʻekiʻe o ka protein i loko o kou mimi. Inā loaʻa iā ʻoe ka proteinuria, pono paha ʻoe e mimi pinepine, a hiki ke huʻa a pehu paha kou mimi. Hiki iā ʻoe ke ʻike i nā hōʻailona maʻamau o ka maʻi, e like me ka nausea, ka luaʻi ʻana, ka luhi, a me ka pehu ʻana. Inā loaʻa iā ʻoe kēia mau hōʻailona no nā lā he nui, ʻoi aku ka maikaʻi o ke ʻike ʻana i ke kauka. Hiki iā ia ke ʻike i ke kūlana e hoʻoulu ai i kou proteinuria a kuhikuhi i nā lāʻau lapaʻau e kōkua i ka mālama ʻana i kou mau puʻupaʻa i ke olakino.
ʻO ka mea hope loa, nā mea e hoʻomanaʻo ai
ʻAe, mai nā mea a mākou i kūkākūkā ai, ke lana nei koʻu manaʻo ua loaʻa iā ʻoe kahi manaʻo maikaʻi e pili ana i ka proteinuria. ʻO ka mea nui loa, ʻo ia ke ʻike ʻana i ke kauka inā ʻike ʻoe i kekahi mau loli i loko o kāu mimi (ʻoi aku ka mimi huʻa) a i ʻole ka pehu ʻana i loko o kou kino. Inā ʻike mua ʻoe iā ia, hiki iā ʻoe ke pale i nā pilikia he nui. Ua like nā puʻupaʻa me nā kauwā leo ʻole o ko mākou kino. ʻO kā mākou kuleana ke mālama pono iā lākou. Mai hopohopo, hiki ke hoʻomalu ʻia kēia mau kūlana me ka ʻōlelo aʻoaʻo lapaʻau kūpono a me ka mālama ʻana.
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