Ngā tohu o te mate whatukuhu (kidney disease): ngā tohu o te tūkino whatukuhu, me ngā whakamātautau e kitea ai

E rua ō whatukuhu, he rite te rahi o ia mea ki te ringa kua kuku, kei raro i ō rara, kei ia taha o tō iwi tuarā. Ia meneti ka tātaria e rāua tō toto, ka tango i te para me te wai tāpiri hei mimi. Ka pupuri anō rāua i te taurite o ō tote me ō kohuke, ka āwhina ki te whakahaere i te pēhanga toto, ka āwhina ki te hanga pūtau toto whero, ā, ka pupuri i te kaha o ngā kōiwi.

Ko te mate whatukuhu mau tonu (CKD), ko te tikanga kua tūkinotia ngā whatukuhu, ā, he iti iho tā rāua tātari i te tika, mō te toru marama, neke atu rānei. He mea noa, inarā i te pakeketanga, ā, he nui ake i te hunga nō Āhia ki te Tonga me te hunga mangu.

He nui te kaha tāpiri o ngā whatukuhu, nō reira ka ngaro te nuinga o tā rāua mahi i mua i tō rongo i tētahi mea. E ai ki te whakatau tata a te National Kidney Foundation, ko te 1 anake pea i ia 10 o te hunga he CKD tōna e mōhio ana kei a rātou. Koia, ko ngā whakamātautau, ehara ko ngā tohu, te huarahi e kitea ai te mate whatukuhu i te nuinga o te wā.

I te tīmatanga: i te nuinga kāore rawa he aha. Ko te tohu tuatahi i te nuinga o te wā ko tētahi whakamātautau toto, mimi rānei auau i mahia mō tētahi take kē. Ka kite ētahi i te mimi pahupahu, i ngā karu pupuhi, i te nui ake o te mimi i te pō rānei, he tohu tōmua pea o te turuturu o te pūmua (protein), o te iti iho rānei o te whakakukū a ngā whatukuhu i te mimi.

I muri mai, i te hekenga o te mahi:

• Ngā tohu wai: ngā rekereke, ngā waewae, ngā ringa rānei e pupuhi ana, ngā karu pupuhi, te poto o te hā
• Ngā tohu mimi: te nui ake o te mimi, inarā i te pō, he toto i te mimi, te mimi pahupahu
• Ngā tohu kohinga para: te ngenge, te kiri mangeo, maroke rānei, te kore hiakai me te heke o te taumaha, te hiahia ruaki, te kūmenge uaua (cramps), te uaua o te moe, te ngoikore o te arotahi, te ānini
• I ngā tāne: ngā raruraru whakatū o te ure (erectile problems). I ngā wāhine: ka kōtiti, ka mutu rānei te mate wahine i te mate kua kaha haere.

Ina rahua ngā whatukuhu (wāhanga 5): ka kaha ake ēnei tohu, ā, tērā pea ka hiahiatia te tātari toto (dialysis), te whakawhitinga whatukuhu (transplant) rānei. E ai ki ngā tatauranga a te NHS, ka pā tēnei ki te 2 anake pea i ia 100 o te hunga he CKD tōna; ko te nuinga ka whakahaere i te mate mā ngā rongoā me ngā tirotiro.

He rerekē te whara whatukuhu ohorere (AKI): ka pā mai i roto i ngā hāora, ngā rā rānei, i te nuinga i te wā o tētahi atu māuiui. Ko ngā tohu ko te tino iti iho o te mimi i te tikanga, te tino hiainu, te hiahia ruaki, te ruaki rānei, ngā kūwaewae pupuhi, te rangirua, te hiamoe rānei, me te poto o te hā ina takoto. Me kite te tangata he AKI tōna i te rata i taua rā tonu.

I te nuinga, kāo. Tata ki te kore rawa e mamae te mate whatukuhu mau tonu, koia tētahi take e kore ai e kitea.

Ko te mamae nō ngā whatukuhu ka rongohia i te taha, i te tuarā rānei, i raro tonu i ngā rara, ā, he take kē tōna i te nuinga:

• Pokenga whatukuhu: he mamae i te taha, i te tuarā rānei me te kirika, te wiriwiri, te hiahia ruaki, ā, i te nuinga he wera ina mimi. Me kite i te rata i taua rā tonu.
• Kōhatu whatukuhu: he mamae taumaha, kūmenge e haere ngaru mai ana, mai i te tuarā, i te taha rānei ki te kūwhā (groin), i ētahi wā me te toto i te mimi.

Ko te nuinga o te mamae o raro o te tuarā nō ngā uaua me ngā hononga, ehara nō ngā whatukuhu. Ko te mamae tuarā anake, kāore he kirika, kāore he rerekētanga o tō mimi, he onge te raruraru whatukuhu.

• Te mate huka (diabetes): ka tūkino te huka toto teitei i ngā tātari iti rawa o ngā whatukuhu. Ko tētahi o ngā take e rua tino noa.
• Te pēhanga toto teitei: ka whakararu i ngā ia toto iti i ngā whatukuhu. Ko tērā atu o ngā take tino noa tēnei, ā, ka taea e te mate whatukuhu te whakapiki ake anō i te pēhanga toto.
• Te mate manawa me te cholesterol teitei, e pā ana ki ngā ia toto e kawe toto ana ki ngā whatukuhu.
• Te kakā o ngā whatukuhu (glomerulonephritis), ngā pokenga whatukuhu e hoki tonu mai ana, me ngā mate tuku iho pērā i te polycystic kidney disease.
• Ngā ārainga o te rere o te mimi, pērā i ngā kōhatu whatukuhu e hoki tonu mai ana, i te repe prostate kua rahi rānei.
• Te kai roa i ētahi rongoā, pērā i te kai auau i ngā rongoā mamae whakaheke kakā (NSAIDs pērā i te ibuprofen, te diclofenac rānei) me te lithium. Kaua e whakamutu i tētahi rongoā kua tuhia nā tēnei: pātai ki tō rata mēnā me whakamātautau ō whatukuhu.
• He whara whatukuhu ohorere i mua, ka waiho pea he tūkino pūmau.

I te mea he wahangū te mate whatukuhu tōmua, ka tohutohutia te hunga e nui ake ana te tūpono kia whakamātautauria auautia ahakoa e pai ana te āhua o te tinana:

• Te mate huka: he tirotiro whatukuhu ia tau
• Te pēhanga toto teitei, te mate manawa rānei
• He hītori i te whānau o te rahunga whatukuhu, o te mate whatukuhu tuku iho rānei
• He whara whatukuhu ohorere i mua, he kōhatu whatukuhu e hoki tonu mai ana, he repe prostate kua rahi, he lupus rānei
• Ngā rongoā mō te wā roa ka pā pea ki ngā whatukuhu, pērā i te lithium, i ngā rongoā mamae NSAID auau rānei
• Kua neke atu i te 60 tau te pakeke, me te hunga nō Āhia ki te Tonga, te hunga mangu rānei, he nui ake nei te tūpono
• He pūmua, he toto rānei i kitea i te mimi i mua, kāore he take i mōhiotia

Pātai ki tō rata kia hia te auau o tō whakamātautau.

E rua ngā whakamātautau māmā e kite ana i te nuinga o te mate whatukuhu, i te nuinga i mua noa atu i ngā tohu:

• He whakamātautau toto mō te creatinine, he para ka whakawāteatia e ō whatukuhu. Ka hurihia e te taiwhanga hei eGFR (estimated glomerular filtration rate), e whakaatu ana i te nui o te toto ka tātaria e ō whatukuhu ia meneti. Ko te eGFR raro iho i te 60 mō te toru marama, neke atu rānei, he CKD, ā, ko te raro iho i te 15, he rahunga whatukuhu. Ka whakamārama tā mātou aratohu creatinine i ngā tau me ngā wāhanga, me tētahi pūtātai.
• He whakamātautau mimi mō te albumin, he pūmua ka puritia e ngā whatukuhu ora ki te toto. Ka whakaatu te ōwehenga albumin-ki-te-creatinine (ACR) i te nui e turuturu ana.

Ka whakamahi ngā pūrongo i tētahi o ngā waeine e rua, nō reira tirohia ko tēhea kei tō pūrongo. Ko te hua teitei, ka whakamātautauria anō i te nuinga kia whakaū, nā te mea ka taea e te korikori, e tētahi pokenga, e te mate wahine rānei te whakapiki mō tētahi wā.

Tērā pea ka mahi anō ngā rata i te rākau whakamātautau mimi (dipstick) mō te toto me te pūmua, i te matawai oro (ultrasound) hei titiro ki ngā whatukuhu, me ētahi atu whakamātautau toto pērā i te pāhare (potassium) me te tatauranga toto katoa (CBC), nā te mea ka taea e te mate whatukuhu te whakaputa anaemia.

Kāore he rongoā whakaora mō te mate whatukuhu mau tonu, engari ka taea e te maimoatanga te whakapōturi i a ia me te tiaki i te manawa, ā, ko te tōmua o te tīmata, ko te pai ake.

• Ko te whakahaere i te pēhanga toto te mahi nui rawa. He maha ngā wā ka whakamahi ngā rata i ngā rongoā e tiaki anō ana i ngā whatukuhu; mā tō rata e whakatau ko ēhea, ā, kia hia te nui.
• Te whakahaere i te huka toto mēnā he mate huka tōu. Ka āwhina anō ētahi rongoā mate huka i ngā whatukuhu kia roa ake tā rāua mahi.
• Ngā rongoā whakaheke cholesterol hei tiaki i te manawa, nā te mea ka whakapiki te CKD i te tūpono o te manawa-hē (heart attack) me te ikura roro (stroke).
• Tirohia i mua i ia rongoā hou, rongoā mamae, pire āpiti, rongoā otaota rānei, tae atu ki ngā rongoā tuku iho: ka tūkino ētahi i ngā whatukuhu, ā, he maha ngā rongoā me rerekē te inenga ina iti iho te tātari a ngā whatukuhu. Kōrerotia tō eGFR ki ia rata, ki ia kaiwhakarite rongoā (pharmacist).
• Kaua e kai paipa, kia korikori tonu, whāia he taumaha ora, ā, kia iti iho te tote. Ka taea e tētahi mātanga kai (dietitian) te tohutohu mō te pūmua, te pāhare (potassium) me te phosphate mēnā he iti te mahi a ō whatukuhu.
• Inu kia rawaka kia kōmā te tae o tō mimi, ki te kore tō rata i kī kia whakaitihia ngā wai.
• Haere tonu ki ō tirotiro. Mā ngā whakamātautau toto me te mimi anō e whakaatu mēnā kei te whai hua te maimoatanga.

Ki te rahua ngā whatukuhu, ka whakakapia tā rāua mahi e te tātari toto (dialysis), e te whakawhitinga whatukuhu (kidney transplant) rānei. Ka kōrero tō rōpū whatukuhu mō tēnei i mua noa atu i te wā e hiahiatia ai.