{"id":28375,"date":"2023-04-25T20:40:10","date_gmt":"2023-04-25T13:40:10","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=28375"},"modified":"2023-04-25T20:40:10","modified_gmt":"2023-04-25T13:40:10","slug":"hoi-chung-than-hu-tiep-can-lam-sang-va-chan-doan","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/25\/hoi-chung-than-hu-tiep-can-lam-sang-va-chan-doan\/","title":{"rendered":"H\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0: ti\u1ebfp c\u1eadn l\u00e2m s\u00e0ng v\u00e0 ch\u1ea9n \u0111o\u00e1n"},"content":{"rendered":"

H\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 (HCTH) l\u00e0 b\u1ec7nh c\u1ea7u th\u1eadn th\u01b0\u1eddng g\u1eb7p \u1edf tr\u1ebb em, \u0111a s\u1ed1 tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng c\u00f3 nguy\u00ean nh\u00e2n, \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb corticoid, di\u1ec5n ti\u1ebfn m\u1ea1n t\u00ednh v\u1edbi c\u00e1c \u0111\u1ee3t t\u00e1i ph\u00e1t v\u00e0 t\u00e1i ph\u00e1t th\u01b0\u1eddng xuy\u00ean nh\u01b0ng \u00edt khi d\u1eabn t\u1edbi suy th\u1eadn m\u1ea1n. H\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 (HCTH) th\u01b0\u1eddng bi\u1ec3u hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng t\u1ed1i thi\u1ec3u \u1edf c\u1ea7u th\u1eadn ho\u1eb7c nh\u1eefng t\u1ed5n th\u01b0\u01a1ng d\u00e0y v\u00e0 tho\u00e1i h\u00f3a m\u00e0ng \u0111\u00e1y c\u1ee7a mao m\u1ea1ch c\u1ea7u th\u1eadn. HCTH \u0111\u01a1n thu\u1ea7n nguy\u00ean ph\u00e1t nh\u1ea1y c\u1ea3m v\u1edbi Corticoides th\u01b0\u1eddng kh\u00f4ng c\u00f3 t\u0103ng huy\u1ebft \u00e1p, suy th\u1eadn v\u00e0 ti\u1ec3u m\u00e1u. M\u1ed9t s\u1ed1 l\u1edbn tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng \u0111\u1ec3 l\u1ea1i di ch\u1ee9ng \u1edf tu\u1ed5i tr\u01b0\u1edfng th\u00e0nh.<\/strong><\/p>\n

1. \u0110\u1ea1i c\u01b0\u01a1ng v\u1ec1 h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0:<\/h2>\n

1.1 \u0110\u1ecbnh ngh\u0129a:<\/strong>\u00a0 L\u00e0 c\u00e1c b\u1ec7nh c\u1ea7u th\u1eadn c\u00f3 t\u0103ng t\u00ednh th\u1ea5m m\u00e0ng l\u1ecdc c\u1ea7u th\u1eadn, bi\u1ec3u hi\u1ec7n b\u1eb1ng c\u00e1c tri\u1ec7u ch\u1ee9ng:
\n+ Ti\u1ec3u \u0111\u1ea1m ng\u01b0\u1ee1ng th\u1eadn h\u01b0:
\n\u2022 \u0110\u1ea1m ni\u1ec7u 24 gi\u1edd \u2265 50 mg\/kg\/ng\u00e0y.
\n\u2022 \u0110\u1ea1m ni\u1ec7u \u2265 40 mg\/m2\/gi\u1edd.
\n\u2022 \u0110\u1ea1m\/creatinine ni\u1ec7u \u2265 200 mg\/mmol.
\n+ Gi\u1ea3m albumin m\u00e1u < 25 g\/L.
\n+ Ph\u00f9.
\n+ T\u0103ng lipid m\u00e1u (\u00b1).<\/p>\n

\"hoi-chung-than-hu\"<\/h2>\n

1.2. Nguy\u00ean nh\u00e2n h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0<\/h3>\n

Nguy\u00ean ph\u00e1t (v\u00f4 c\u0103n)<\/h3>\n

– Th\u1eadn h\u01b0 nhi\u1ec5m m\u1ee1: T\u1ed5n th\u01b0\u01a1ng t\u1ed1i thi\u1ec3u m\u1ea5t ch\u00e2n l\u1ed3i bi\u1ec3u m\u00f4 m\u00e0ng \u0111\u00e1y c\u1ea7u<\/p>\n

th\u1eadn.<\/p>\n

– \u00a0HCTH do Vi\u00eam c\u1ea7u th\u1eadn (VCT)<\/p>\n

+ \u00a0Vi\u00eam c\u1ea7u th\u1eadn m\u00e0ng.<\/p>\n

+ VCT t\u0103ng sinh m\u00e0ng.<\/p>\n

+ VCT tho\u00e1i h\u00f3a t\u1eebng \u1ed5, \u0111o\u1ea1n.<\/p>\n

+ VCT t\u0103ng sinh lan t\u1ecfa.<\/p>\n

+ VCT t\u0103ng sinh ngo\u00e0i th\u00e0nh m\u1ea1ch (VCT t\u0103ng sinh h\u00ecnh li\u1ec1m).<\/p>\n

\u00a0Th\u1ee9 ph\u00e1t sau c\u00e1c b\u1ec7nh<\/strong><\/p>\n

B\u1ec7nh to\u00e0n th\u1ec3<\/strong><\/p>\n

– Lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng.<\/p>\n

– Vi\u00eam quanh \u0111\u1ed9ng m\u1ea1ch d\u1ea1ng n\u00fat.<\/p>\n

– Ban xu\u1ea5t huy\u1ebft d\u1ea1ng th\u1ea5p<\/p>\n

– Vi\u00eam \u0111a c\u01a1.<\/p>\n

– Takayashu.<\/p>\n

\u00a0B\u1ec7nh \u00e1c t\u00ednh<\/strong><\/p>\n

– Hodgkin.<\/p>\n

– B\u1ec7nh b\u1ea1ch c\u1ea7u m\u1ea1n th\u1ec3 Lympho.<\/p>\n

– \u0110a u t\u1ee7y x\u01b0\u01a1ng.<\/p>\n

– Ung th\u01b0 bi\u1ec3u m\u00f4.<\/p>\n

Nhi\u1ec5m \u0111\u1ed9c thai ngh\u00e9n.<\/strong><\/p>\n

\u00a0C\u00e1c b\u1ec7nh chuy\u1ec3n h\u00f3a<\/strong><\/p>\n

-Amylose nguy\u00ean ph\u00e1t- th\u1ee9 ph\u00e1t.<\/p>\n

– \u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng.<\/p>\n

– Suy gi\u00e1p.<\/p>\n

\u00a0C\u00e1c b\u1ec7nh nhi\u1ec5m \u0111\u1ed9c<\/strong><\/p>\n

– C\u00e1c mu\u1ed1i c\u1ee7a kim lo\u1ea1i n\u1eb7ng Hg, Au..<\/p>\n

– Thu\u1ed1c:Trim\u00e9thadione, Param\u00e9thadione, P\u00e9nicillamine, Prob\u00e9n\u00e9cid.<\/p>\n

– C\u00e1c d\u1ecb nguy\u00ean.<\/p>\n

\u00a0Nguy\u00ean nh\u00e2n v\u1ec1 m\u1ea1ch m\u00e1u<\/strong><\/p>\n

– T\u1eafc t\u0129nh m\u1ea1ch ch\u1ee7.<\/p>\n

– T\u1eafc t\u0129nh m\u1ea1ch th\u1eadn.<\/p>\n

Nhi\u1ec5m tr\u00f9ng<\/strong><\/p>\n

– Vi tr\u00f9ng: li\u00ean c\u1ea7u, giang mai, vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c b\u00e1n c\u1ea5p.<\/p>\n

– K\u00fd sinh tr\u00f9ng: s\u1ed1t r\u00e9t, Bilharziose.<\/p>\n

B\u1ec7nh v\u1ec1 m\u00e1u<\/strong><\/p>\n

– H\u1ed3ng c\u1ea7u h\u00ecnh li\u1ec1m.<\/p>\n

2. Ph\u00e2n lo\u1ea1i h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0:<\/h2>\n

2.1. HCTH nguy\u00ean ph\u00e1t:<\/strong> kh\u00f4ng t\u00ecm th\u1ea5y nguy\u00ean nh\u00e2n v\u00e0 kh\u00f4ng c\u00f3 c\u00e1c bi\u1ec3u hi\u1ec7n c\u1ee7a b\u1ec7nh h\u1ec7 th\u1ed1ng.
\n– Kh\u00f4ng c\u00f3 bi\u1ec3u hi\u1ec7n vi\u00eam c\u1ea7u th\u1eadn:
\n+ HCTH v\u00f4 c\u0103n:
\n\u2022 Th\u01b0\u1eddng g\u1eb7p nh\u1ea5t trong HCTH tr\u1ebb em: 90% kh\u1edfi ph\u00e1t t\u1eeb 1 \u2013 10 tu\u1ed5i, 50% kh\u1edfi ph\u00e1t sau 10 tu\u1ed5i.
\n\u2022 G\u1ed3m sang th\u01b0\u01a1ng t\u1ed1i thi\u1ec3u (MCD), x\u01a1 h\u00f3a c\u1ea7u th\u1eadn khu tr\u00fa t\u1eebng ph\u1ea7n (FSGS), t\u0103ng sinh trung m\u00f4 (DMP).<\/p>\n

* D\u1ef1a tr\u00ean \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb Steroid, chia l\u00e0m 2 lo\u1ea1i: nh\u1ea1y steroid (ti\u00ean l\u01b0\u1ee3ng t\u1ed1t), kh\u00e1ng steroid (nguy c\u01a1 suy th\u1eadn m\u1ea1n).
\n+ B\u1ec7nh c\u1ea7u th\u1eadn m\u00e0ng v\u00f4 c\u0103n.
\n– Vi\u00eam c\u1ea7u th\u1eadn nguy\u00ean ph\u00e1t: vi\u00eam c\u1ea7u th\u1eadn t\u0103ng sinh m\u00e0ng, b\u1ec7nh th\u1eadn IgA.
\n2.2. HCTH th\u1ee9 ph\u00e1t:<\/strong>
\n– C\u00f3 c\u00e1c bi\u1ec3u hi\u1ec7n c\u1ee7a vi\u00eam c\u1ea7u th\u1eadn:
\n+ H\u1eadu nhi\u1ec5m: VGSV B, C, vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m tr\u00f9ng\u2026
\n+ Lupus \u0111\u1ecf h\u1ec7 th\u1ed1ng.
\n+ Vi\u00eam m\u1ea1ch m\u00e1u: Henoch \u2013 Scholein, vi\u00eam \u0111a \u0111\u1ed9ng m\u1ea1ch vi th\u1ec3, vi\u00eam \u0111a \u0111\u1ed9ng m\u1ea1ch v\u1edbi u h\u1ea1t vi\u00eam Wegener.
\n+ H\u1ed9i ch\u1ee9ng Alport, h\u1ed9i ch\u1ee9ng t\u00e1n huy\u1ebft ure huy\u1ebft cao.
\n– Kh\u00f4ng c\u00f3 bi\u1ec3u hi\u1ec7n c\u1ee7a vi\u00eam c\u1ea7u th\u1eadn:
\n+ B\u1ec7nh c\u1ea7u th\u1eadn m\u00e0ng (do Lupus, nhi\u1ec5m HBV m\u1ea1n), c\u00e1c b\u1ec7nh amyloidosis.
\n+ X\u01a1 h\u00f3a c\u1ea7u th\u1eadn khu tr\u00fa t\u1eebng ph\u1ea7n th\u1ee9 ph\u00e1t sau m\u1ea5t nephron do s\u1eb9o th\u1eadn ho\u1eb7c thi\u1ec3u s\u1ea3n th\u1eadn.
\n2.3. HCTH b\u1ea9m sinh v\u00e0 nh\u0169 nhi<\/strong>
\n– Th\u1ee9 ph\u00e1t: sau nhi\u1ec5m tr\u00f9ng (giang mai, Toxoplasma, Rubella, Cytomegalovirus, vi\u00eam gan si\u00eau vi, HIV, s\u1ed1t r\u00e9t).
\n– Nguy\u00ean ph\u00e1t: th\u1eadn h\u01b0 b\u1ea9m sinh th\u1ec3 Ph\u1ea7n Lan, x\u01a1 h\u00f3a trung m\u00f4 lan t\u1ecfa, sang th\u01b0\u01a1ng t\u1ed1i thi\u1ec3u, x\u01a1 h\u00f3a c\u1ea7u th\u1eadn khu tr\u00fa t\u1eebng ph\u1ea7n.<\/p>\n

– 2\/3 tr\u01b0\u1eddng h\u1ee3p kh\u1edfi ph\u00e1t trong n\u0103m \u0111\u1ea7u, 85% tr\u01b0\u1eddng h\u1ee3p trong 3 th\u00e1ng \u0111\u1ea7u l\u00e0 do \u0111\u1ed9t bi\u1ebfn gen v\u00e0 c\u00f3 d\u1ef1 h\u1eadu x\u1ea5u \u00e0 kh\u00f4ng \u0111\u00e1p \u1ee9ng Corticoid \u00e0 Suy th\u1eadn.<\/p>\n

3. \u0110\u00e1nh gi\u00e1 l\u00e2m s\u00e0ng v\u00e0 c\u1eadn l\u00e2m s\u00e0ng:<\/h2>\n

3.1. B\u1ec7nh s\u1eed:<\/strong>
\n– Th\u1eddi gian xu\u1ea5t hi\u1ec7n v\u00e0 di\u1ec5n ti\u1ebfn ph\u00f9.
\n– C\u00e1c tri\u1ec7u ch\u1ee9ng to\u00e0n th\u00e2n \u0111i k\u00e8m (s\u1ed1t, ti\u1ec3u m\u00e1u, \u0111au kh\u1edbp, h\u1ed3ng ban da\u2026).
\n– \u0110\u00e1p \u1ee9ng v\u1edbi c\u00e1c thu\u1ed1c \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb.
\n3.2. Ti\u1ec1n c\u0103n:<\/strong>
\n– HCTH t\u00e1i ph\u00e1t: c\u1ea7n h\u1ecfi HCTH ch\u1ea9n \u0111o\u00e1n khi n\u00e0o, \u1edf \u0111\u00e2u, \u0111\u00e3 t\u00e1i ph\u00e1t bao nhi\u00eau l\u1ea7n, li\u1ec1u \u0111i\u1ec1u tr\u1ecb tr\u01b0\u1edbc \u0111\u00f3, sinh thi\u1ebft th\u1eadn ch\u01b0a, n\u1ebfu c\u00f3 khi n\u00e0o?
\n– Gia \u0111\u00ecnh: ti\u1ec3u m\u00e1u, t\u0103ng huy\u1ebft \u00e1p, b\u1ec7nh th\u1eadn m\u1ea1n.
\n3.3. Kh\u00e1m l\u00e2m s\u00e0ng:<\/strong>
\n– Ph\u00f9: ph\u00f9 tr\u1eafng, m\u1ec1m, \u1ea5n l\u00f5m, ph\u1ee5 thu\u1ed9c v\u00e0o tr\u1ecdng l\u1ef1c \u00b1 tr\u00e0n d\u1ecbch c\u00e1c m\u00e0ng (m\u00e0ng b\u1ee5ng, m\u00e0ng ph\u1ed5i, tinh m\u1ea1c).
\n– Huy\u1ebft \u00e1p: t\u0103ng huy\u1ebft \u00e1p trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p th\u1eadn h\u01b0 c\u00f3 x\u01a1 h\u00f3a c\u1ea7u th\u1eadn hay vi\u00eam c\u1ea7u th\u1eadn.
\n– Ti\u1ec3u m\u00e1u \u0111\u1ea1i th\u1ec3 \u00edt g\u1eb7p trong HCTH v\u00f4 c\u0103n.
\n– C\u00e1c tri\u1ec7u ch\u1ee9ng to\u00e0n th\u00e2n \u0111i k\u00e8m: s\u1ed1t, \u0111au kh\u1edbp, h\u1ed3ng ban c\u00e1nh b\u01b0\u1edbm, ban xu\u1ea5t huy\u1ebft 2 c\u1eb3ng ch\u00e2n.
\n– C\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a HCTH:<\/p>\n

+ Gi\u1ea3m th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n \u00e0 Kh\u00f4ng \u0111\u01b0\u1ee3c d\u00f9ng l\u1ee3i ti\u1ec3u m\u00e0 d\u00f9ng albumin (c\u1ea9n th\u1eadn ph\u00f9 ph\u1ed5i c\u1ea5p).
\n+ Nhi\u1ec5m tr\u00f9ng (ph\u1ebf c\u1ea7u, Gram \u00e2m): vi\u00eam ph\u00fac m\u1ea1c nguy\u00ean ph\u00e1t, vi\u00eam m\u00f4 t\u1ebf b\u00e0o, vi\u00eam ph\u1ed5i, nhi\u1ec5m tr\u00f9ng ti\u1ec3u.
\n+ T\u0103ng \u0111\u00f4ng: t\u1eafc m\u1ea1ch.
\n– C\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a \u0111i\u1ec1u tr\u1ecb: ph\u00ec \u0111\u1ea1i n\u01b0\u1edbu r\u0103ng, r\u1eadm l\u00f4ng\u2026<\/p>\n

4. C\u1eadn l\u00e2m s\u00e0ng:<\/h2>\n

– TPTNT: t\u1ea7m so\u00e1t ti\u1ec3u \u0111\u1ea1m, h\u1ed3ng c\u1ea7u, b\u1ea1ch c\u1ea7u.
\n– \u0110\u1ea1m ni\u1ec7u 24 gi\u1edd hay \u0111\u1ea1m\/creatinine ni\u1ec7u m\u1eabu n\u01b0\u1edbc ti\u1ec3u \u0111\u1ea7u bu\u1ed5i s\u00e1ng.
\n– Albumin, cholesterol m\u00e1u.
\n– Ch\u1ee9c n\u0103ng th\u1eadn: ure, creatinine, ion \u0111\u1ed3.
\n– C3, C4, ANA (kh\u1edfi ph\u00e1t sau 10 tu\u1ed5i ho\u1eb7c c\u00f3 d\u1ea5u hi\u1ec7u c\u1ee7a b\u1ec7nh Lupus).
\n– HBsAg, Anti HCV v\u00e0 HIV cho c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 cao.
\n– Sinh thi\u1ebft th\u1eadn khi:
\n+ HCTH kh\u00e1ng steroid.
\n+ HTCH kh\u1edfi ph\u00e1t < 1 tu\u1ed5i ho\u1eb7c sau 12 tu\u1ed5i (\u00b1).
\n+ HCTH k\u00e8m t\u0103ng huy\u1ebft \u00e1p, ti\u1ec3u m\u00e1u \u0111\u1ea1i th\u1ec3, t\u0103ng creatine m\u00e1u \u0111\u00e1ng k\u1ec3, gi\u1ea3m b\u1ed5 th\u1ec3 C3, C4.
\n+ HCTH k\u00e8m bi\u1ec3u hi\u1ec7n c\u1ee7a b\u1ec7nh h\u1ec7 th\u1ed1ng (Henoch \u2013 Schonlein, Lupus)<\/p>\n

5. \u0110\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 b\u1ec7nh (th\u1ec3 b\u1ec7nh)<\/strong><\/h2>\n

– Lui b\u1ec7nh ho\u00e0n to\u00e0n: h\u1ebft ph\u00f9, \u0111\u1ea1m ni\u1ec7u \u00e2m\/v\u1ebft ho\u1eb7c \u0111\u1ea1m\/creatinine ni\u1ec7u < 20 mg\/mmol 3 ng\u00e0y li\u00ean ti\u1ebfp.
\n– Lui b\u1ec7nh m\u1ed9t ph\u1ea7n: h\u1ebft ph\u00f9, \u0111\u1ea1m ni\u1ec7u gi\u1ea3m 50% ban \u0111\u1ea7u ho\u1eb7c \u0111\u1ea1m\/creatinine ni\u1ec7u 20 \u2013 200 mg\/mmol 3 ng\u00e0y li\u00ean ti\u1ebfp.
\n– T\u00e1i ph\u00e1t: \u0111\u1ea1m ni\u1ec7u 3+, 4+ ho\u1eb7c \u0111\u1ea1m\/creatinine ni\u1ec7u > 200 mg\/mmol 3 ng\u00e0y \u1edf tr\u1ebb \u0111\u00e3 lui b\u1ec7nh:
\n+ T\u00e1i ph\u00e1t kh\u00f4ng th\u01b0\u1eddng xuy\u00ean: 1 l\u1ea7n trong 6 th\u00e1ng lui b\u1ec7nh ho\u1eb7c 3 l\u1ea7n trong 12 th\u00e1ng.
\n+ T\u00e1i ph\u00e1t th\u01b0\u1eddng xuy\u00ean: \u2265 2 l\u1ea7n trong 6 th\u00e1ng ho\u1eb7c \u2265 4 l\u1ea7n trong 12 th\u00e1ng.
\n+ L\u1ec7 thu\u1ed9c Steroid: 2 l\u1ea7n t\u00e1i ph\u00e1t li\u00ean t\u1ee5c trong giai \u0111o\u1ea1n gi\u1ea3m li\u1ec1u ho\u1eb7c sau ng\u01b0ng Prednison trong 2 tu\u1ea7n.
\n– Kh\u00e1ng Steroid: kh\u00f4ng lui b\u1ec7nh sau \u0111i\u1ec1u tr\u1ecb Prednison 2mg\/kg\/ng\u00e0y sau 6 \u2013 8 tu\u1ea7n.<\/p>\n

6. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t:<\/h2>\n

– C\u00e1c nguy\u00ean nh\u00e2n g\u00e2y ph\u00f9 to\u00e0n th\u00e2n:
\n+ Suy tim: nh\u1ecbp tim nhanh, gallop, ran ph\u1ed5i, gan to, b\u00f3ng tim to \u2026
\n+ Gi\u1ea3m albumin m\u00e1u: x\u01a1 gan, suy dinh d\u01b0\u1ee1ng th\u1ec3 ph\u00f9, b\u1ec7nh \u0111\u01b0\u1eddng ru\u1ed9t m\u1ea5t \u0111\u1ea1m.
\n– H\u1ed9i ch\u1ee9ng vi\u00eam c\u1ea7u th\u1eadn c\u1ea5p: cao huy\u1ebft \u00e1p, ti\u1ec3u m\u00e1u \u0111\u1ea1i th\u1ec3, t\u0103ng creatinine m\u00e1u.<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

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