Te ngoikore o te whatukuhu whakapeka me te mau tonu
He whekau nui ngā whatukuhu e mahi tonu ana ki te tātari toto, ki te tango i ngā para mā te mimi, ki te pupuri i te taurite wai me te electrolyte (pērā i te konutai, te pāhare pākawa, me te paikāponate), ā, hei āwhina i te whakahaere i te toto toto. He wāhi nui anō hoki tā rātou ki te whakaputa i ngā homoni nui, pērā i te erythropoietin, he mea nui mō te hanganga toto whero, me te whakahohe i te huaora D, he mea nui mō te hauora o te wheua. Ina tino heke te mahi a te whatukuhu, ka uaua te tinana ki te pupuri i tōna taurite o roto. E mōhiotia ana tēnei āhuatanga ko te ngoikore o te whatukuhu, e wehea whānuitia ana kia rua ngā wāhanga: te ngoikore o te whatukuhu whakapeka me te ngoikore o te whatukuhu mau tonu.
Te Mārama ki te Raru o te Whatukuhu Whakamataku
Ko te ngoikore o te whatukuhu whakapeka, te whara whatukuhu whakapeka rānei (AKI), he hekenga tere o te mahi a te whatukuhu—i roto i ngā hāora, i ngā rā rānei. I roto i tēnei āhuatanga, ka ngaro ohorere te kaha o ngā whatukuhu ki te tātari i ngā para pākia, ka hua ake he puranga o ngā para pērā i te urea me te creatinine i roto i te toto. Ka pā te AKI ki te tangata katoa, inā koa ki ngā tūroro e tino mate ana, e pāngia ana e te matewai, e ngā mate kino, e tango ana rānei i ētahi rongoā ka kino pea ngā whatukuhu.
Ngā Take o te Raru o te Whatukuhu Whakamataku
I roto i ngā āhuatanga haumanu, e toru ngā wāhanga e whakarōpūtia ai ngā pūtake o te AKI:
1. Prerenal (i mua i ngā whatukuhu)
Ka puta tēnei nā te mea ka heke te rere o te toto ki ngā whatukuhu, ka kore ai e ranea ngā "rauemi mata" e hiahiatia ana hei tātari i te toto. Hei tauira, ko te matewai nui nā te mate korere, te ruaki rānei, te toto, te ohorere, te ngoikore o te ngākau, te mate pāwera rānei.
2. I roto i ngā whatukuhu (i roto i ngā whatukuhu)
Ka pā tika te kino ki te kiko o te whatukuhu. Ko ngā take ko te glomerulonephritis, te necrosis tubular acute nā ngā paitini, ngā rongoā rānei, me ngā mate pūnaha ārai mate.
3. Postrenal (whai muri i ngā whatukuhu)
Ka puta tēnei nā te aukati i te rere o te mimi, ka pakaru ai ngā whatukuhu i te pēhanga whakamuri. Hei tauira, ko ngā kōhatu whatukuhu, te nui haere o te repeure, ngā pukupuku, ngā uauatanga rānei o te ara mimi.
Ngā Tohu o te Raru o te Whatukuhu Whakapeka
Ka rerekē pea ngā tohu o te AKI, ā, kāore i te motuhake i ngā wā katoa. Ko ētahi o ngā tohu noa ko:
– Te hekenga o te hanga mimi (oliguria), ahakoa kāore i te wā katoa
– Te pupuhi i ngā waewae, i te mata, i te tinana katoa rānei nā te mea he nui te wai e puritia ana
– Whakapairuaki, ruaki, hekenga o te hiahia kai
– Te poto o te manawa nā te nui o te wai
– Te pōhēhē, te ngoikore nui rānei i ētahi wā
– Te pikinga o te toto toto
Heoi, i roto i te nuinga o ngā take o te AKI, kāore e kitea wawetia ngā tohu e te hunga e pangia ana, ā, ka kitea noa mā roto i ngā whakamātautau toto.
Te Whakahaere i te Raru o te Whatukuhu Whakamataku
Ko te kaupapa matua o te maimoatanga o te AKI he aro ki te pūtake me te ārai i ngā kino atu. Tērā pea ka:
– Whakaoraora i te wai mā roto i ngā wai ā-uaua mēnā he matewai
– Kati, whakakapi rānei i ngā rongoā ka tūpono ka kino te whatukuhu.
– Whakaorahia ngā mate urutā, te sepsis rānei me te kaha
– Te rongoā i ngā aukati o te ara mimi (hei tauira, te whakaurunga o te catheter, ngā tikanga mimi rānei)
– Te aroturuki tata i ngā electrolytes, inā koa te pāhare pāporo, ki te nui haere te pāhare pāporo, ka raru pea te manawataki o te ngakau.
I ngā wā tino kino, ka hiahiatia pea he dialysis rangitahi mō ngā tūroro hei āwhina i te tango i ngā paitini me te wai nui.
Te Mārama ki te Raru o te Whatukuhu Mau tonu
Ko te mate tākihi mau tonu (CKD) he hekenga puhoi, haere tonu o te mahi tākihi e puta ana i roto i ngā marama ki ngā tau. He maha ngā wā kāore e kitea tēnei mate, ā, ka puta noa ngā tohu ina kua tino kino te kino. Ka tātaritatia te CKD mā te ine i te tere tātari glomerular (eGFR) me te kitea o ngā tohu o te kino o te tākihi, pērā i te pūmua i roto i te mimi.
Ngā Take o te Raru o te Whatukuhu Mau tonu
Ko ngā tino take o te CKD ko:
– Mate huka: ka pakaru ngā oko toto iti i roto i ngā whatukuhu i te nui o te huka toto.
– Te toto toto tiketike: ka pakaru te hanganga o ngā whatukuhu i te toto toto tiketike mau tonu.
– Te glomerulonephritis mau tonu: te mumura pumau o ngā glomeruli.
– Te mate tākihi polycystic: he mate ira e hanga ana i ngā cysts i roto i ngā tākihi.
– Te whakamahinga roa o ngā rongoā: hei tauira, ētahi rongoā mamae, ngā rongoā otaota rānei kāore i te whakahaerehia.
Ko ētahi atu āhuatanga mōrearea ko te koroheketanga, te hītori whānau, te momona, ngā tikanga momi hikareti, me te mate ngakau.
Ngā Tohu o te Raru o te Whatukuhu Mau tonu
I ngā wāhanga tōmua, he maha ngā wā kāore he tohu o te CKD. Ina heke te mahi a te whatukuhu, ka puta pea ngā tohu, pēnei i:
– Ngāwari te ngenge me te ngoikore (he maha ngā wā e pā ana ki te anemia)
– Te hekenga o te hiahia kai, te whakapairuaki
– Kiri maroke me te kiri mākūkū
– Ngā mamae o te uaua, te ngau kino
– Te pupuhi o ngā waewae (edema)
– He uaua ki te whakahaere i te toto toto tiketike
– Ngā raruraru moe me te heke o te aro
I te wāhanga whakamutunga (te wāhanga whakamutunga o te ngoikore o te whatukuhu), ka puta pea ngā tohu o te uremia i te kohikohinga o ngā paitini pērā i te whakapairuaki nui, te ruaki, te heke o te māramatanga, me te poto o te manawa nā te nui rawa o te wai.
Te Whakahaere i te Raru o te Whatukuhu Mau tonu
Ko te arotahi o te maimoatanga mō te CKD he whakaroa i te whanaketanga me te whakaiti i ngā raruraru. Ko ngā rautaki ko:
– Te whakahaere i te huka toto i roto i ngā tūroro mate huka
– Te whakahaere i te toto toto, he maha ngā wā mā te whakamahi i ngā rongoā pēnei i ngā aukati ACE, ngā ARB rānei e ai ki ngā tohu
– Te kai whatukuhu, ka uru pea ki roto ngā here i runga i te tote, te pūmua, te whākōkī, me te pāhare pāporo e ai ki ngā āhuatanga taiwhanga.
– Te rongoā i te anemia (hei tauira, ngā tāpiringa rino, te rongoā erythropoietin rānei)
– Whakahaerehia ngā kohuke wheua mā te whakamahi i ngā here huaora D hohe, ngā here phosphate rānei ina hiahiatia.
– Kaua e whakamahi i ngā rongoā paitini ki te roro, ā, kia rite te horopeta o te rongoā ki te mahi a te whatukuhu.
Mena ka tae te mate CKD ki te wāhanga whakamutunga, ka hiahiatia te rongoā whakakapinga whatukuhu mā te hemodialysis, te peritoneal dialysis, te whakawhitinga whatukuhu rānei.
Ngā Rerekētanga Matua i waenga i te Raru o te Whatukuhu Pakaru me te Raru o te Whatukuhu Mau tonu
Ahakoa he iti iho te mahi a te whatukuhu i roto i ngā mea e rua, he maha ngā rerekētanga o te AKI me te CKD. Ka tere te puta o te AKI, ā, he maha ngā wā ka taea te whakaora mēnā ka arohia wawetia te take matua. Ka puhoi te haere o te CKD, ā, kāore e taea te whakaora katoa, nō reira ko te arotahi ko te whakaroa i te kino me te pupuri i te kounga o te oranga.
Mō ngā tohu, he maha ngā wā ka honoa te AKI ki ngā āhuatanga whakapeka pēnei i te matewai, ngā mate kino rānei, ko te CKD ia he maha ngā wā ka honoa ki ngā āhuatanga roa pēnei i te mate huka me te toto toto tiketike. I te whakamātautau, he maha ngā wā ka whakaatuhia e te CKD te whakahekenga o te whatukuhu me ngā huringa mau tonu, ko te AKI ia ka whakaatu i ngā whatukuhu rahi noa me te hekenga ohorere o te mahi.
Te Ārai me te Kimi Wā Moata
Ko te ārai i te ngoikore o te whatukuhu, inā koa ko te CKD, e whakawhirinaki nui ana ki te momo noho me te whakahaere i ngā āhuatanga mōrearea. Ko ētahi o ngā mahi matua ko:
– Inuhia te wai kia nui e ai ki ngā hiahia o tō tinana.
– Whakahaerehia te toto toto me te huka toto i ia wā
– Whakaitihia te kai tote me ngā kai tukatuka-tino
– Kia mau tonu te taumaha tinana pai, me te whakakori tinana i ngā wā katoa
– Kaua e kai paipa me te waipiro nui rawa
Kaua e kai noa i ngā rongoā mamae, i ngā rongoā otaota rānei, me te kore he tirotiro.
– Whakahaerehia ngā tirotiro mahi whatukuhu i ia wā (creatinine, eGFR, mimi) mō te hunga e mōrearea ana
Whakamutunga
He mate kino te ngoikore o te whatukuhu whakapeka me te ngoikore o te whatukuhu mau tonu, engari he rerekē te ahunga whakamua o te mate. Ka puta ohorere mai te ngoikore o te whatukuhu whakapeka, ā, he maha ngā wā ka pai ake mēnā ka tere te rongoā, ko te ngoikore o te whatukuhu mau tonu ia ka puhoi te haere, ā, me roa te maimoatanga hei whakaroa i te kino me te whakahaere i ngā raruraru. Mā te mārama tika, te kite wawe, me te whakahaere i ngā āhuatanga mōrearea pēnei i te mate huka me te toto toto tiketike, ka taea te ārai, te whakaroa rānei i te maha o ngā take o te hekenga o te mahi whatukuhu. Mēnā ka pāngia koe e ngā tohu, ngā āhuatanga mōrearea rānei, he mahi whakaaro nui te kōrero ki tētahi tohunga hauora hei pupuri i te mahi pai o te whatukuhu.
