Hiki i kou mau pilikia puʻupaʻa ke hoʻopilikia i kou mau iwi? E aʻo kākou e pili ana i ka Renal Osteodystrophy!

Loaʻa iā ʻoe ka maʻi puʻupaʻa, a i ʻole ka mea a mākou e kapa nei he maʻi puʻupaʻa mau loa (CKD) ? A i ʻole ʻike ʻoe i kekahi e ʻeha nei i kēia maʻi? Manaʻo ka poʻe he nui ke ʻōlelo mākou i ka maʻi puʻupaʻa, hoʻopilikia wale ia i nā puʻupaʻa. Akā ʻo ka ʻoiaʻiʻo, ke hana pono ʻole ko mākou mau puʻupaʻa, hiki iā ia ke loaʻa ka hopena nui i nā ʻōnaehana ʻē aʻe i loko o ke kino, ʻoiai ko mākou ʻōnaehana iwi, ʻo ia hoʻi ko mākou mau iwi . No laila, i kēia lā e kamaʻilio mākou e pili ana i kahi kūlana e nāwaliwali ai ko mākou mau iwi a hoʻoulu i nā pilikia ma muli o ka maʻi puʻupaʻa. Ua kapa ʻia kēia ma ke ʻano lapaʻau he renal osteodystrophy . ʻOiai he paʻakikī iki ka inoa, e hoʻomaopopo maʻalahi kākou.

He aha ka Renal Osteodystrophy?

I ka ʻōlelo maʻalahi, ʻo Renal Osteodystrophy kahi maʻi iwi e hiki ke hoʻopilikia i nā pākeke a me nā keiki me ka maʻi puʻupaʻa mau loa (CKD).

I kēia manawa, e nānā, he kuleana koʻikoʻi ko ko kākou mau puʻupaʻa. ʻO ia ke kāohi ʻana i nā pae o nā minelala e like me ka calcium a me ka phosphorus i loko o ko kākou koko. Eia kekahi, kuleana nā puʻupaʻa no ka hoʻoulu ʻana i ka huaora D a me ka hana ʻana i kahi hormone i kapa ʻia ʻo calcitriol , ka mea e kōkua ai i ka ikaika o ko kākou mau iwi.

No laila, ke hāʻule nā ​​puʻupaʻa a hana pono ʻole paha, ʻaʻole hiki iā lākou ke kāohi i ka nui o kēia mau minelala a me ka hormone calcitriol. ʻO ia ka manawa e hoʻomaka mālie ai ko kākou mau iwi e nāwaliwali . Hoʻonui kēia i ka pilikia o ka haki maʻalahi ʻana o nā iwi, ʻo ia hoʻi ka haki ʻana .

He aha nā minelala a me nā hormones e kōkua i ka mālama ʻana i ko mākou mau iwi i ke olakino?

Aia kekahi mau minelala koʻikoʻi a me nā hormones e kōkua i ka mālama ʻana i ko kākou mau iwi i ke olakino a me ka ikaika. E aʻo iki kākou e pili ana iā lākou.

• Kalipuna: ʻO kēia ka ʻāpana nui o ko kākou mau iwi. Ua like nā iwi me kahi "panakō kalipuna" i loko o ko kākou kino. ʻAʻole wale ka kalipuna e hoʻoikaika i nā iwi, akā he mea nui nō hoʻi no nā mea ʻē aʻe he nui, e like me ka hana o ka ʻōnaehana nerve a me ka hana ʻiʻo. Kōkua ko kākou mau puʻupaʻa i ke kaulike ʻana i nā pae kalipuna i loko o ke koko.
• ʻO Phosphorus: E like me ka calcium, he mineral koʻikoʻi nō hoʻi ka phosphorus i nā iwi. Hoʻopau ko mākou mau puʻupaʻa i ka phosphorus keu i pono ʻole i ke kino a mālama i kahi kaulike kūpono ma waena o ka calcium a me ka phosphorus i loko o ke koko.
• ʻO Calcitriol: ʻO kēia ke ʻano hana o ka wikamina D. Hana ʻia ia e ko kākou mau puʻupaʻa. Kōkua kēia hormone i ka hoʻomalu ʻana i ka nui o ka calcium a ko kākou kino e omo ai mai nā meaʻai a kākou e ʻai ai a kōkua pū i kā kākou mau kelepa parathyroid e hana.
• ʻO ka Fibroblast Growth Factor 23 (FGF23):He hormone kēia i hana ʻia e ko kākou mau iwi. Kōkua ia i ka hoʻoponopono ʻana i nā pae phosphorus a me ka wikamina D. ʻO ka maʻamau, kiʻekiʻe nā pae FGF23 i ka poʻe me ka maʻi puʻupaʻa mau.
• ʻO ka Hormone Parathyroid (PTH): Hoʻopuka ʻia kēia hormone e nā kelepa liʻiliʻi ʻehā ma hope o ke kelepa thyroid i loko o ko kākou ʻāʻī. Ua kapa ʻia kēia mau mea he mau kelepa parathyroid. ʻO ka hana a kēia hormone PTH, ʻo ia ke hoʻokuʻu i ka calcium mai nā iwi ke pono ke kino i ka calcium a mālama i ka pae calcium i loko o ke koko i paʻa.

He aha nā ʻano nui o ka Renal Osteodystrophy?

Ulu nā iwi i ko kākou wā ʻōpiopio. Akā, i ko kākou lilo ʻana i poʻe mākua, ʻaʻole e waiho wale ana ko kākou mau iwi ma laila. Ke hoʻohou mau ʻia nei a hoʻoponopono ʻia nei lākou. E like me ka wehe ʻana i nā piliki kahiko a me ke kau ʻana i nā mea hou e kūkulu i kahi pā, haki nā ʻiʻo iwi kahiko a hana ʻia nā ʻiʻo iwi hou. Kāhea mākou i kēia kaʻina hana "bone turnover."

Hiki ke loaʻa ka Renal Osteodystrophy inā wikiwiki loa kēia hoʻololi iwi a lohi paha. ʻEhā ʻano nui:

• ʻOsteitis Fibrosa: He ʻano kēia e haki koke ai nā ʻiʻo iwi. Hoʻokumu ʻia kēia e ka piʻi ʻana o nā pae hormone parathyroid (PTH). Ua kapa ʻia kēia he hyperparathyroidism .
• Osteomalacia: He ʻano kēia kahi e haki ai nā ʻiʻo iwi, akā lohi loa ka hana ʻana o ka iwi hou. Lilo nā iwi i mea huʻa a nāwaliwali. Hiki ke hana ʻia kēia e ka nele o ka wikamina D, ka ʻawahia o ka metala, a me ka hana nui ʻana o ka hormone FGF23 ma muli o kekahi mau ʻano maʻi kanesa.
• Maʻi Iwi Adynamic: He kūlana kēia e emi nui ai ke kūkulu ʻia ʻana a me ka hoʻoponopono ʻana o nā ʻiʻo iwi. ʻO ke kumu nui o kēia, ʻo ia ka haʻahaʻa o ka hormone parathyroid (PTH).
• ʻO ka Mixed Renal Osteodystrophy: Hoʻohui kēia ʻano i nā hōʻailona o Osteitis Fibrosa a me Osteomalacia.

I kēia manawa, e kamaʻilio kākou e pili ana i kēia mau ʻano me nā kikoʻī hou aku.

ʻO ka maʻi ʻōpū fibrosis

Lohe pinepine mākou he kiʻekiʻe ko ka hormone parathyroid (PTH) o ka poʻe me ka maʻi puʻupaʻa mau. ʻO PTH ke kuleana no ka hoʻokuʻu ʻana i ka calcium mai nā iwi i loko o ke koko e kaulike i ka pae calcium i loko o ke koko. Eia nō naʻe, inā kiʻekiʻe loa ka pae PTH, huki nui ia i ka calcium mai nā iwi. Hiki i kēia ke alakaʻi i ka hoʻokumu ʻia ʻana o nā cysts fibrous i loko o nā iwi, e hoʻonāwaliwali ana i nā iwi.

Aia kekahi mau kumu e hoʻonui ai i ka nui o ka PTH:

• Ka hemahema o Calcitriol: Ke hōʻino ʻia nā puʻupaʻa, ʻaʻole hiki iā lākou ke hana pono i ka calcitriol, kahi e hoʻonui ai i ka hana ʻana o PTH.
• Hoʻonui ʻia nā pae FGF23:Hiki i kēia ke lilo i hōʻailona mua o ka maʻi puʻupaʻa. Hiki nō hoʻi ke lilo i pane mai nā iwi e kāohi i ka piʻi ʻana o nā pae phosphorus i loko o ke koko.
• Hoʻonui ʻia ka phosphorus: I ka maʻi puʻupaʻa mau loa, hōʻiliʻili ka phosphorus i loko o ke koko no ka mea ʻaʻole hiki i nā puʻupaʻa ke wehe pono iā ia. Hoʻoulu pū kēia i ka hana ʻana o PTH.

ʻOsteomalacia

ʻO ke kumu nui o kēia maʻi, ʻo ia ka nele o ka wikamina D. He mea maʻamau kēia i nā poʻe me ka maʻi puʻupaʻa no ka manawa lōʻihi.

Eia kekahi, hiki i kekahi mau metala ke hoʻoulu i ka osteomalacia ma muli o ka ʻawahia o ka metala . No ka laʻana, hoʻopilikia nā metala e like me ka alumini i ka hoʻokumu ʻana a me ka mālama ʻana i ka iwi. I ka wā ma mua, aia kekahi mau lāʻau lapaʻau i hoʻohana ʻia e kāohi i nā pae phosphorus (nā mea hoʻopaʻa phosphate) i loko o ka alumini. Eia nō naʻe, ʻaʻole ʻōlelo hou ʻia kēia mau lāʻau lapaʻau no ka poʻe me ka maʻi puʻupaʻa, ʻoiai ka poʻe ma ka dialysis . Loaʻa i kēia manawa nā mea hoʻopaʻa phosphorus ʻaʻole alumini. Ke lawe ʻia me ka meaʻai, pale lākou i ka phosphorus i loko o ka meaʻai mai ka komo ʻana i loko o ke koko.

Hiki i kekahi ʻano maʻi kanesa ke hoʻoulu i ka hana nui ʻana o ka hormone FGF23, hiki ke alakaʻi i ka osteomalacia a me nā haki iwi.

Maʻi Iwi Adynamic

ʻO kēia ka manawa e hoʻemi nui ʻia ai ke kūkulu ʻia ʻana a me ka hoʻoponopono ʻana o nā ʻiʻo iwi. He mea maʻamau kēia ʻano i nā poʻe me ka maʻi puʻupaʻa koʻikoʻi a me ka poʻe ma ka dialysis. ʻO ke kumu nui o kēia, ʻo ia ka nui o ka calcium a me ka wikamina D i loko o ke kino . I ka mālama ʻana i ka maʻi puʻupaʻa, i kekahi manawa pono e hāʻawi ʻia ka calcium a me ka wikamina D keu. ʻOiai kōkua kēia i ka pale ʻana i ka renal osteodystrophy, ka mea i hoʻokumu ʻia e ka nui o ka iwi turnover, hiki i kekahi manawa ke kumu i ka emi ʻana o nā pae parathyroid hormone (PTH).

Aia kekahi mau kumu ʻē aʻe:

• ʻO ka Dialysis Peritoneal Hoʻomau: He ʻano dialysis kēia. Maanei, hoʻomaʻemaʻe ʻia ke koko i loko o ka lua ʻōpū. He ʻokoʻa kēia mai ka hemodialysis , kahi i hana ʻia ma o kahi aʻa koko i loko o kou lima. Loaʻa i kekahi mau wai dialysis peritoneal ka calcium. Hiki i kēia ke hana i nā pae PTH haʻahaʻa.
• Maʻi diabetes: I ka maʻi diabetes, hiki i ka piʻi ʻana o ke kō koko a me ka emi ʻana o ka pae insulin ke hōʻemi i ka hana ʻana o PTH.

He aha ka CKD-MBD (Chronic Kidney Disease-associated Mineral and Bone Disorder)?

Ke hoʻopilikia ʻia ke kaulike o nā minelala a me nā hormones i loko o ko kākou koko, hiki iā ia ke hoʻopilikia i ko kākou puʻuwai a me nā kīʻaha koko. ʻO CKD-MBD (Chronic Kidney Disease Mineral and Bone Disorder) kahi huaʻōlelo ākea e komo pū ana me nā kūlana e like me Renal Osteodystrophy a me nā maʻi cardiovascular pili.

I ka ʻōlelo maʻalahi, ke piʻi nui ka calcium a me ka phosphorus i loko o ke koko, hiki iā ia ke alakaʻi i nā maʻi cardiovascular. ʻO ke kumu o kēia he hana i kapa ʻia ʻo calcification . ʻO ia hoʻi, hōʻiliʻili ka calcium a waiho ma loko o nā kīʻaha koko. Hiki i kēia ke hoʻomānoanoa a paʻakikī i nā paia o nā kīʻaha koko. Ua kapa ʻia kēia he atherosclerosis . Hiki i kēia ke alakaʻi i nā maʻi koʻikoʻi e like me ke koko kiʻekiʻe, ka hōʻeha puʻuwai, a me ka hahau. E noʻonoʻo i ka mamao o ka pilikia o ka puʻupaʻa!

Pehea ka maʻamau o ka Renal Osteodystrophy?

Ua manaʻo ʻia aia ma kahi o 15% o nā pākeke ma ʻAmelika Hui Pū ʻIa e loaʻa ana i ka maʻi puʻupaʻa mau. He nui o lākou e loaʻa paha i kekahi kekelē o ka renal osteodystrophy. Hiki i kēia hōʻino iwi ke lilo i mea koʻikoʻi ma hope o ka hāʻule loa ʻana o nā puʻupaʻa, a ma hope o ka dialysis lōʻihi. He mea maʻamau hoʻi kēia maʻi ma Sri Lanka.

He aha nā kumu o ka Renal Osteodystrophy?

ʻO ke kumu nui, ʻo ia ka maʻi puʻupaʻa mau loa (CKD) . Hoʻopilikia ka maʻi puʻupaʻa i nā pae mineral a me nā hormone, a hoʻopilikia pū i ke kaʻina hana maʻamau o ka hoʻoponopono ʻana i ka iwi (hoʻololi iwi). Inā wikiwiki loa a lohi paha kēia hoʻololi iwi, hiki i nā mea ʻelua ke alakaʻi i nā iwi nāwaliwali.

He aha nā hōʻailona o ka Renal Osteodystrophy?

ʻO nā hōʻailona nui ka ʻeha o ka iwi a me nā haki . ʻAʻole paha i loaʻa i kekahi poʻe kekahi mau hōʻailona i nā pae mua o ka maʻi. ʻO ia ka ʻāpana weliweli loa.

Hiki i nā keiki ʻōpio me ka maʻi puʻupaʻa ke loaʻa i ka lohi o ka ulu ʻana ma muli o ka renal osteodystrophy. Hiki iā lākou ke loaʻa nā ʻano iwi i kapa ʻia ʻo rickets . ʻO Rickets kahi ʻano kamaliʻi o ke ʻano osteomalacia. ʻO ke ʻano kēia e palupalu nā iwi a kūlou paha.

Pehea e ʻike ʻia ai ka Renal Osteodystrophy?

E hoʻolohe pono kāu kauka i kāu mau hōʻailona, ​​​​kou mōʻaukala olakino, a inā paha ua loaʻa i kekahi o kou ʻohana nā maʻi like. A laila, e hana lākou i kahi hoʻokolokolo kino.

Aia kekahi mau hoʻokolohua i hoʻohana ʻia e hōʻoia pololei i kēia ʻano:

• Nā hoʻāʻo koko: Nānā kēia i nā pae o ka calcium, phosphorus, vitamin D, a me ka parathyroid hormone (PTH) i loko o ke koko. Ana pū lākou i nā māka ʻē aʻe o ka hoʻololi ʻana o ka iwi, e like me ka alkaline phosphatase . Inā loaʻa iā ʻoe ka maʻi puʻupaʻa no ka manawa lōʻihi, e hana pinepine kāu kauka i kēia mau hoʻāʻo koko e nānā i nā loli i kēia mau pae.
• Biopsy Iwi: Pili kēia i ka lawe ʻana i kahi ʻāpana liʻiliʻi o ka ʻiʻo mai ka iwi a hoʻāʻo iā ia i loko o kahi keʻena hoʻokolohua. Hiki i kēia ke hāʻawi i kahi manaʻo maikaʻi o ka mānoanoa a me ke ʻano o ka iwi. Eia naʻe, ʻaʻole kēia he hoʻāʻo maʻamau.
• Hoʻāʻo mānoanoa o ka iwi: Kapa ʻia hoʻi he scan DEXA , ana kēia i ka ikaika o kou mau iwi a me ko lākou pilikia o ka haki ʻana.
• Nā hoʻāʻo kiʻi: Hiki i nā hoʻāʻo e like me nā X-ray , CT scans , a me MRI ke nānā i nā loli i nā iwi. Hoʻohana ʻia nā CT scans a me nā echocardiograms ( kahi scan o ka puʻuwai) e nānā i nā waihona calcium (calcification) i loko o nā kīʻaha koko.

E hoʻomanaʻo, ʻaʻole pono nā kānaka a pau e hana i kēia mau hoʻokolohua a pau. Na kāu kauka e hoʻoholo i nā hoʻokolohua e pono loa ana ma muli o kou kūlana.

He aha nā lāʻau lapaʻau no ka Renal Osteodystrophy?

ʻO ka lāʻau lapaʻau āu e loaʻa ai e pili ana i ka nui o ka pōʻino i hana ʻia i kou mau iwi, ke kahua o kou maʻi puʻupaʻa, a inā wikiwiki a lohi paha kou huli ʻana o ka iwi. Aia kekahi mau koho lapaʻau nui:

• Nā hoʻololi ʻana i ka ʻai: Hiki i kāu kauka ke ʻōlelo aku i kahi ʻai haʻahaʻa-phosphorus . ʻO ia hoʻi ka palena ʻana i nā meaʻai i kiʻekiʻe i ka phosphorus (nā meaʻai i hana ʻia a me nā meaʻai i hoʻopaʻa ʻia) - e like me nā meaʻai i loko o ka pahu, nā noodles koke, a me nā sausage. Inā koʻikoʻi kou maʻi puʻupaʻa, pono paha ʻoe e kaupalena i nā meaʻai i kiʻekiʻe maoli i ka phosphorus (e.g., kekahi mau huahana waiū, nā nati, a me nā ʻiʻo maloʻo a me nā iʻa).
• Nā lāʻau lapaʻau a me nā mea hoʻohui: Hiki i kēia mau mea ke kōkua i ke kaulike ʻana i nā pae mineral a me nā hormone. No ka laʻana, hiki ke kuhikuhi ʻia nā mea hoʻohui calcium a me ka wikamina D, nā lāʻau lapaʻau e hoʻohaʻahaʻa i nā pae hormone parathyroid (PTH), a me nā mea hoʻopaʻa phosphorus. Paipai pinepine nā kauka i nā mea hoʻopaʻa phosphorus ʻaʻole calcium no ka mea hiki i ka nui o ka calcium ke alakaʻi i ka maʻi iwi adynamic.
• ʻO ke ʻoki parathyroid: Inā ʻaʻole i holo pono nā lāʻau ʻē aʻe, hiki ke hana ʻia ke ʻoki. Pili kēia i ka wehe ʻana i hoʻokahi a ʻoi aku paha o nā kelepa parathyroid. Ua kapa ʻia kēia he parathyroidectomy . ʻO ka maʻamau, ma ka liʻiliʻi hoʻokahi kelepa parathyroid i koe. Hiki i kēia ke kōkua i ka pale ʻana i nā pae PTH mai ka hāʻule haʻahaʻa loa a me ka hoʻoulu ʻana i ka maʻi iwi adynamic.

Ma waho aʻe o kēia mau mea a pau, e kōkua pū kāu kauka iā ʻoe e mālama i kou maʻi puʻupaʻa. Ma ka hahai pono ʻana i ka hoʻolālā lapaʻau, hiki iā ʻoe ke pale aku i ka hōʻino hou ʻana i kou mau iwi.

Hiki ke pale ʻia ka Renal Osteodystrophy?

He mea paʻakikī ke pale loa i ka Renal Osteodystrophy. Eia nō naʻe, ma ka mālama pono ʻana i ka maʻi puʻupaʻa mau loa (CKD), hiki ke kaohi ʻia ke kūlana a lohi kona holomua.ʻO ia hoʻi, he mea nui loa ka lawe ʻana i ka lāʻau lapaʻau i kuhikuhi ʻia e ke kauka i ka manawa kūpono, ka hahai ʻana i ka papaʻai i kuhikuhi ʻia, a me ka hana pono ʻana i nā lāʻau dialysis. Eia kekahi, he mea kōkua nō hoʻi ka hoʻoikaika kino, ka haʻalele ʻana i ka puhipaka, a me ka hoʻēmi ʻana i ka inu ʻona.

He aha ka mea e hiki ai i kekahi me Renal Osteodystrophy ke manaʻo?

ʻAʻohe lāʻau lapaʻau mau loa no kēia maʻi koe wale nō ka hoʻoili ʻana o nā puʻupaʻa . ʻO ka poʻe me ka maʻi puʻupaʻa lōʻihi e nalowale mālie ka hana o nā puʻupaʻa. He nui ka poʻe i ka hopena e loaʻa ka hāʻule piha ʻana o nā puʻupaʻa a pono i ka dialysis. ʻO Renal Osteodystrophy kahi pilikia maʻamau o kēia kaʻina hana.

Eia kekahi, nui ka poʻe me ka maʻi puʻupaʻa mau e loaʻa pū i ka maʻi puʻuwai. ʻO ka maʻi puʻuwai ke kumu o ka hapa nui o nā make mai ka hāʻule ʻana o ka puʻupaʻa.

Akā, mai hopohopo. E nānā mau kāu kauka i kāu mau pae mineral a me nā hormone a paipai i nā lāʻau lapaʻau e pale i kou mau iwi a me kou puʻuwai.

Āhea ʻoe e kamaʻilio ai me ke kauka?

Inā loaʻa iā ʻoe ka maʻi puʻupaʻa mau loa (CKD), e hōʻoia e haʻi i kāu kauka inā loaʻa iā ʻoe ka ʻeha o ka iwi a i ʻole ka ʻoʻoleʻa . He hōʻailona paha ia o ka renal osteodystrophy.

ʻIke wale ka poʻe he nui i ko lākou maʻi puʻupaʻa mau loa ke holomua. No laila, hiki i nā nānā lapaʻau maʻamau ke kōkua i ka ʻike mua ʻana i ka maʻi puʻupaʻa. Inā loaʻa, hiki iā ʻoe ke hana i nā hana e pale aku ai i ka ʻino ʻana. He mea nui loa kēia inā he kumu pilikia kou no ka maʻi puʻupaʻa (e laʻa, ka momona nui, ka maʻi diabetes, ka moʻolelo ʻohana o ka maʻi puʻupaʻa, ka maʻi puʻuwai, a i ʻole ke koko kiʻekiʻe).

Leka Lawe-Home

ʻAe, e hōʻuluʻulu kākou i kekahi o nā mea e pono ai ʻoe e hoʻomanaʻo mai nā mea a mākou i kamaʻilio ai:

• ʻO ka Renal Osteodystrophy kahi maʻi iwi i hoʻokumu ʻia e ka maʻi puʻupaʻa mau loa (CKD).
• Ke hana pono ʻole nā ​​​​puʻupaʻa, lilo ke pae o ka calcium, phosphorus, a me ka wikamina D i loko o ke koko i mea kaulike ʻole, a hiki i nā iwi ke lilo i mea nāwaliwali.
• ʻO ka ʻeha o ka iwi a me nā haki nā hōʻailona nui, akā ʻaʻole paha he mau hōʻailona i ka wā mua.
• Hoʻomaopopo nā kauka i kēia kūlana ma o nā hoʻāʻo koko a me nā scan.
• ʻO ka lāʻau lapaʻau e komo pū ana me ka kaohi ʻana i ka ʻai, nā lāʻau lapaʻau, a i kekahi manawa ke ʻoki kino.
• ʻO ke ala maikaʻi loa e kaohi ai i kēia maʻi, ʻo ia ka mālama pono ʻana i nā maʻi puʻupaʻa.
• Inā loaʻa iā ʻoe ka maʻi puʻupaʻa a ʻeha kou mau iwi, e ʻike koke i ke kauka.
• Hiki i nā hoʻokolohua lapaʻau maʻamau ke kōkua i ka ʻike ʻana i nā maʻi puʻupaʻa i ka wā mua.

ʻOiai ʻaʻole hiki ke ho'ōla loa ʻia kēia maʻi, me ka mālama pono ʻana a me ka hahai ʻana i nā ʻōlelo aʻoaʻo lapaʻau, hiki iā ʻoe ke mālama i kahi ola maikaʻi. No laila, mai hopohopo, e kamaʻilio me kāu kauka, a e hoʻokō i nā mea e pono ai.

ʻO ka osteodystrophy renal, maʻi puʻupaʻa, maʻi iwi, calcium, phosphorus, wikamina D, hormone parathyroid, CKD-MBD