{"id":31511,"date":"2023-05-06T14:20:01","date_gmt":"2023-05-06T07:20:01","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=31511"},"modified":"2023-05-06T14:28:27","modified_gmt":"2023-05-06T07:28:27","slug":"benh-than-dai-thao-duong-dich-te-hoc-va-dien-tien-benh","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/benh-than-dai-thao-duong-dich-te-hoc-va-dien-tien-benh\/","title":{"rendered":"B\u1ec7nh th\u1eadn \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng: d\u1ecbch t\u1ec5 h\u1ecdc v\u00e0 di\u1ec5n ti\u1ebfn b\u1ec7nh"},"content":{"rendered":"<p><strong><a href=\"https:\/\/vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/benh-do-dai-thao-duong\/\">B\u1ec7nh th\u1eadn \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/a> (DKD) l\u00e0 m\u1ed9t b\u1ec7nh th\u1eadn m\u1ea1n t\u00ednh g\u00e2y ra do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, c\u00f3 t\u1ec9 l\u1ec7 m\u1eafc ng\u00e0y c\u00e0ng t\u0103ng do s\u1ef1 b\u00f9ng ph\u00e1t c\u1ee7a \u0111\u00e1i \u0111\u01b0\u1eddng tr\u00ean to\u00e0n c\u1ea7u. Tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh th\u01b0\u1eddng kh\u00f4ng c\u00f3 cho t\u1edbi khi b\u1ec7nh ti\u1ebfn tri\u1ec3n, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 c\u00f3 tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng nh\u01b0 m\u1ec7t, ch\u00e1n \u0103n, ph\u00f9 chi; d\u1ea5u hi\u1ec7u th\u1ef1c th\u1ec3 bao g\u1ed3m huy\u1ebft \u00e1p t\u0103ng, ph\u00f9, tri\u1ec7u ch\u1ee9ng b\u1ec7nh m\u1ea1ch m\u00e1u nh\u1ecf (b\u1ec7nh v\u00f5ng m\u1ea1c, th\u1ea7n kinh). \u0110\u1ea1m ni\u1ec7u l\u00e0 d\u1ea5u hi\u1ec7u \u0111\u1eb7c tr\u01b0ng c\u1ee7a b\u1ec7nh.\u00a0<\/strong><\/p>\n<h2>1. \u0110\u1ecbnh ngh\u0129a b\u1ec7nh th\u1eadn \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng.<\/h2>\n<p>DKD l\u00e0 m\u1ed9t ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng \u1edf b\u1ec7nh nh\u00e2n <a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/tong-quan-ve-benh-dai-thao-duong\/\">\u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/a> (\u0110T\u0110) k\u00e9o d\u00e0i &gt;10 n\u0103m c\u00f3 albumin ni\u1ec7u v\u00e0\/ho\u1eb7c gi\u1ea3m \u0111\u1ed9 l\u1ecdc c\u1ea7u th\u1eadn \u01b0\u1edbc t\u00ednh (eGFR) khi kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng c\u01a1 c\u1ee7a nguy\u00ean nh\u00e2n ti\u00ean ph\u00e1t kh\u00e1c g\u00e2y t\u1ed5n th\u01b0\u01a1ng th\u1eadn.<\/p>\n<p>B\u1ec7nh th\u1eadn \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 c\u00f3 s\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a albumin ni\u1ec7u (b\u00e0i xu\u1ea5t albumin ni\u1ec7u, t\u1ec9 s\u1ed1 albumin:creatinine \u226530 mg\/g theo ADA) v\u00e0 s\u1ef1 gi\u1ea3m ti\u1ebfn tri\u1ec3n eGFR trong b\u1ec7nh c\u1ea3nh \u0110T\u0110 k\u00e9o d\u00e0i (&gt;10 n\u0103m \u0111\u1ed1i v\u1edbi \u0110T\u0110 type 1, c\u00f3 th\u1ec3 ngay l\u00fac ch\u1ea9n \u0111o\u00e1n v\u1edbi \u0110T\u0110 type 2), v\u00e0 \u0111i\u1ec3n h\u00ecnh c\u00f3 li\u00ean quan v\u1edbi b\u1ec7nh v\u00f5ng m\u1ea1c.<\/p>\n<ul>\n<li><a href=\"https:\/\/vinmec.com\/vi\/chu-de\/albumin-nieu-vi-luong\/\">Albumin ni\u1ec7u<\/a> c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c chia ra 2 th\u00e0nh\u00a0 <a href=\"https:\/\/vinmec.com\/vi\/chu-de\/albumin-nieu-vi-luong\/\">albumin ni\u1ec7u vi l\u01b0\u1ee3ng<\/a> (30\u2013299\u202fmg\/g) v\u00e0 albumin \u0111\u1ea1i l\u01b0\u1ee3ng (\u2265300\u202fmg\/g) li\u00ean quan v\u1edbi t\u0103ng huy\u1ebft \u00e1p v\u00e0 t\u0103ng nguy c\u01a1 suy th\u1eadn. Theo danh ph\u00e1p c\u1ee7a KDIGO, albumin ni\u1ec7u vi l\u01b0\u1ee3ng hi\u1ec7n nay \u0111\u01b0\u1ee3c xem nh\u01b0 albumin ni\u1ec7u l\u01b0\u1ee3ng v\u1eeba; albumin \u0111\u1ea1i l\u01b0\u1ee3ng t\u01b0\u01a1ng \u0111\u01b0\u01a1ng albumin n\u1eb7ng, b\u1ec7nh c\u1ea7u th\u1eadn r\u00f5 r\u00e0ng ho\u1eb7c c\u00f3 \u0111\u1ea1m ni\u1ec7u qua nhe nh\u00fang.<\/li>\n<\/ul>\n<p>B\u00ean c\u1ea1nh albumin ni\u1ec7u, GFR c\u0169ng \u0111\u01b0\u1ee3c ph\u00e2n th\u00e0nh c\u00e1c nh\u00f3m: G1 &gt;90, G2 60\u221289, G3a 45\u221259, G3b 30\u221244, G4 15\u221229, G5&lt;15\u202fml\/min\/1.73\u202fm\u00a0<sup>2<\/sup>. Gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 GFR d\u01b0\u1edbi 60\u202fml\/min\/1.73\u202fm\u00a0<sup>2<\/sup> v\u00e0 <a href=\"https:\/\/www.vinmec.com\/vi\/benh\/suy-than-man-3199\/\">suy th\u1eadn<\/a> \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 ch\u1ee9c n\u0103ng th\u1eadn d\u01b0\u1edbi 15\u202fml\/min\/1.73\u202fm\u00a0<sup>2<\/sup><\/p>\n<p>\u1ede ph\u1ea7n l\u1edbn ng\u01b0\u1eddi b\u1ec7nh \u0110T\u0110, b\u1ec7nh th\u1eadn m\u1ea1n c\u00f3 th\u1ec3 quy k\u1ebft do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng n\u1ebfu c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m tr\u00ean th\u1ecfa m\u00e3n; tuy nhi\u00ean, b\u1ec7nh th\u1eadn m\u1ea1n c\u00f3 th\u1ec3 kh\u00f4ng k\u00e8m theo b\u1ec7nh v\u00f5ng m\u1ea1c \u1edf ng\u01b0\u1eddi b\u1ec7nh \u0110T\u0110 type 2, v\u00e0 c\u00f3 th\u1ec3 kh\u00f4ng k\u00e8m albumin ni\u1ec7u \u1edf \u0110T\u0110 type 1 v\u00e0 type 2.<\/p>\n<p>N\u00ean xem x\u00e9t nguy\u00ean nh\u00e2n kh\u00e1c c\u1ee7a b\u1ec7nh th\u1eadn m\u1ea1n khi c\u00f3 s\u1ef1 t\u0103ng nhanh ch\u00f3ng c\u1ee7a albumin ni\u1ec7u ho\u1eb7c h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0, c\u00f3 s\u1ef1 gi\u1ea3m nhanh c\u1ee7a eGFR, x\u00e9t nghi\u1ec7m c\u1eb7n l\u1eafng d\u01b0\u01a1ng t\u00ednh (v\u00ed d\u1ee5 c\u00f3 tr\u1ee5 t\u1ebf b\u00e0o trong n\u01b0\u1edbc ti\u1ec3u), kh\u00f4ng k\u00e8m b\u1ec7nh v\u00f5ng m\u1ea1c \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng \u1edf b\u1ec7nh nh\u00e2n \u0110T\u0110 type 1, ho\u1eb7c c\u00f3 tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh h\u1ec7 th\u1ed1ng kh\u00e1c. Ch\u1ea9n \u0111o\u00e1n sau c\u00f9ng c\u1ea7n d\u1ef1a v\u00e0o d\u1ea5u hi\u1ec7u t\u0103ng sinh gian m\u1ea1ch v\u00e0 x\u01a1 h\u00f3a c\u1ea7u th\u1eadn d\u1ea1ng n\u1ed1t tr\u00ean sinh thi\u1ebft th\u1eadn, m\u1eb7c d\u00f9 hi\u1ebfm khi c\u1ea7n thi\u1ebft.<\/p>\n<p>B\u1ec7nh th\u1eadn m\u1ea1n kh\u00f4ng do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng c\u1ea7n xem x\u00e9t khi ng\u01b0\u1eddi b\u1ec7nh kh\u00f4ng c\u00f3 b\u1ec7nh v\u00f5ng m\u1ea1c \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng k\u00e8m albumin ni\u1ec7u b\u00ecnh th\u01b0\u1eddng ho\u1eb7c vi l\u01b0\u1ee3ng v\u00e0 GFR d\u01b0\u1edbi 60\u202fml\/min\/1.73\u202fm\u00a0<sup>2<\/sup> . C\u00e1c nguy\u00ean nh\u00e2n c\u1ee7a b\u1ec7nh th\u1eadn m\u1ea1n kh\u00f4ng do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng c\u0169ng n\u00ean xem x\u00e9t khi c\u00f3 gi\u1ea3m nhanh GFR, t\u0103ng huy\u1ebft \u00e1p kh\u00e1ng tr\u1ecb, c\u1eb7n Addis d\u01b0\u01a1ng t\u00ednh, tri\u1ec7u ch\u1ee9ng b\u1ec7nh h\u1ec7 th\u1ed1ng kh\u00e1c, gi\u1ea3m nhanh &gt;30% GFR trong v\u00f2ng 2 &#8211; 3 th\u00e1ng sau khi kh\u1edfi \u0111\u1ea7u \u1ee9c ch\u1ebf men chuy\u1ec3n (ACEi) ho\u1eb7c ch\u1eb9n th\u1ee5 th\u1ec3 angiotensin (ARB). C\u1ea7n chuy\u1ec3n b\u00e1c s\u0129 th\u1eadn h\u1ecdc khi bi\u1ec3u hi\u1ec7n kh\u00f4ng \u0111i\u1ec3n h\u00ecnh ho\u1eb7c \u0111i\u1ec3n h\u00ecnh nh\u01b0ng GFR d\u01b0\u1edbi 30\u202fml\/min\/1.73\u202fm\u00a0<sup>2<\/sup><\/p>\n<h2>2. D\u1ecbch t\u1ec5 h\u1ecdc b\u1ec7nh th\u1eadn \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng.<\/h2>\n<p>S\u1ed1 ng\u01b0\u1eddi m\u1eafc \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng \u0111\u00e3 t\u0103ng g\u1ea5p \u0111\u00f4i trong v\u00f2ng 20 n\u0103m qua, Li\u00ean \u0111o\u00e0n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng th\u1ebf gi\u1edbi IDF \u0111\u00e3 t\u00ednh to\u00e1n c\u00f3 415 tri\u1ec7u ng\u01b0\u1eddi \u0111\u1ed9 tu\u1ed5i t\u1eeb 20 &#8211; 79 m\u1eafc \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng trong n\u0103m 2015. Kho\u1ea3ng 91% ng\u01b0\u1eddi m\u1eafc \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng thu\u1ed9c type 2, v\u1edbi kho\u1ea3ng 3\/4 (\u0111a s\u1ed1 type 2) \u0111ang sinh s\u1ed1ng \u1edf c\u00e1c n\u01b0\u1edbc thu nh\u1eadp th\u1ea5p v\u00e0 trung b\u00ecnh.<\/p>\n<p>Kho\u1ea3ng 1\/3 ng\u01b0\u1eddi l\u1edbn m\u1eafc \u0110T\u0110 \u1edf M\u1ef9 c\u00f3 DKD, \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a t\u1ec9 s\u1ed1albumin:creatinine ni\u1ec7u &gt; 30\u202fmg\/g ho\u1eb7c eGFR &lt; 60\u202fml\/min\/1.73\u202fm <sup>2<\/sup><\/p>\n<p>B\u1ec7nh th\u1eadn \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng g\u1eb7p \u1edf c\u1ea3 2 gi\u1edbi nam v\u00e0 n\u1eef v\u1edbi t\u1ef7 l\u1ec7 ngang nhau. B\u1ec7nh g\u1eb7p nhi\u1ec1u nh\u1ea5t (t\u1ef7 l\u1ec7 kho\u1ea3ng 3%\/n\u0103m) \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n \u0111\u00e3 b\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng t\u1eeb 10 \u2013 20 n\u0103m. Tu\u1ed5i trung b\u00ecnh \u1edf nh\u1eefng ng\u01b0\u1eddi c\u00f3 b\u1ec7nh th\u1eadn m\u1ea1n giai \u0111o\u1ea1n cu\u1ed1i l\u00e0 kho\u1ea3ng 60 tu\u1ed5i.<\/p>\n<p>C\u00f3 \u0111\u1ebfn 40% b\u1ec7nh nh\u00e2n \u0110T\u0110 c\u00f3 t\u1ed5n th\u01b0\u01a1ng th\u1eadn v\u00e0 \u0110T\u0110 l\u00e0 nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn d\u1eabn \u0111\u1ebfn b\u1ec7nh th\u1eadn m\u1ea1n.<\/p>\n<p>\u1ede b\u1ec7nh nh\u00e2n \u0110T\u0110 type 1, t\u1ec9 su\u1ea5t m\u1edbi m\u1eafc c\u1ee7a albumin ni\u1ec7u \u0111\u1ea1i l\u01b0\u1ee3ng b\u1eaft \u0111\u1ea7u t\u0103ng sau 5 n\u0103m k\u1ec3 t\u1eeb l\u00fac kh\u1edfi ph\u00e1t v\u00e0 \u0111\u1ea1t \u0111\u1ec9nh v\u00e0o 10 &#8211; 20 n\u0103m sau ch\u1ea9n \u0111o\u00e1n. K\u1ebft qu\u1ea3 t\u1eeb th\u1eed nghi\u1ec7m DCCT v\u00e0 EDIC cho th\u1ea5y t\u1ec9 su\u1ea5t m\u1edbi m\u1eafc trong 10 n\u0103m c\u1ee7a albumin ni\u1ec7u \u0111\u1ea1i l\u01b0\u1ee3ng l\u00e0 28%, ti\u1ebfn tri\u1ec3n \u0111\u1ebfn gi\u1ea3m GFR(&lt;60\u202fml\/min\/1.73\u202fm\u00a0<sup>2<\/sup> ) l\u00e0 15%, v\u00e0 \u0111\u1ebfn suy th\u1eadn giai \u0111o\u1ea1n cu\u1ed1i (ESKD) l\u00e0 4%.<\/p>\n<p>\u1ede b\u1ec7nh nh\u00e2n \u0110T\u0110 type 2, t\u1ec9 l\u1ec7 m\u1edbi m\u1eafc c\u1ee7a albumin ni\u1ec7u li\u00ean quan v\u1edbi th\u1eddi gian m\u1eafc \u0110T\u0110 kh\u00f4ng r\u00f5 r\u00e0ng. Tuy nhi\u00ean, d\u1eef li\u1ec7u t\u1eeb qu\u1ea7n th\u1ec3 Pima Indians cho th\u1ea5y ph\u1ea7n l\u1edbn b\u1ec7nh nh\u00e2n \u0110T\u0110 type 2 d\u1ec5 m\u1eafc DKD h\u01a1n. <strong><em>T\u1ec9 l\u1ec7 m\u1eafc t\u00edch l\u0169y ESKD trong qu\u1ea7n th\u1ec3 n\u00e0y l\u00e0 40% sau 10 n\u0103m c\u00f3 protein ni\u1ec7u v\u00e0 61% sau 15 c\u00f3 protein ni\u1ec7u d\u01b0\u01a1ng t\u00ednh.<\/em><\/strong><\/p>\n<section id=\"hl0001007\" tabindex=\"-1\">\n<h2 id=\"hl0001019\">3. Y\u1ebfu t\u1ed1 nguy c\u01a1 c\u1ee7a b\u1ec7nh th\u1eadn \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng.<\/h2>\n<ul>\n<li>Th\u1eddi gian m\u1eafc \u0110T\u0110: l\u00e0 y\u1ebfu t\u1ed1 nguy c\u01a1 quan tr\u1ecdng c\u1ee7a DKD. Th\u1eddi gian m\u1eafc kh\u00e1 tin c\u1eady v\u1edbi type 1, nh\u01b0ng k\u00e9m tin c\u1eady h\u01a1n v\u1edbi type 2 do b\u1ec7nh kh\u1edfi ph\u00e1t \u00e2m th\u1ea7m.<\/li>\n<li>T\u0103ng \u0111\u01b0\u1eddng huy\u1ebft: l\u00e0 y\u1ebfu t\u1ed1 quy\u1ebft \u0111\u1ecbnh s\u1ef1 xu\u1ea5t hi\u1ec7n bi\u1ebfn ch\u1ee9ng, k\u1ec3 c\u1ea3 DKD.<\/li>\n<li>T\u0103ng huy\u1ebft \u00e1p: th\u01b0\u1eddng g\u1eb7p \u1edf b\u1ec7nh nh\u00e2n DKD, v\u1eeba l\u00e0 nguy\u00ean nh\u00e2n v\u1eeba l\u00e0 h\u1eadu qu\u1ea3.<\/li>\n<li>T\u0103ng l\u1ecdc: hi\u1ec7n t\u01b0\u1ee3ng t\u0103ng l\u1ecdc tr\u00ean sinh l\u00fd c\u1ee7a t\u1ea5t c\u1ea3 nephron nh\u1eb1m l\u00e0m t\u0103ng GFR s\u1ebd g\u00f3p ph\u1ea7n th\u00fac \u0111\u1ea9y ph\u00e1 h\u1ee7y nephron v\u0129nh vi\u1ec5n.<\/li>\n<li>Lipid: r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a lipoprotein l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a suy ch\u1ee9c n\u0103ng th\u1eadn, \u0111\u1ed3ng th\u1eddi \u0111\u00f3ng g\u00f3p l\u00e0m t\u1ed5n th\u01b0\u01a1ng c\u1ea7u th\u1eadn.<\/li>\n<li>Protein trong ch\u1ebf \u0111\u1ed9 \u0103n: \u0103n nhi\u1ec1u protein l\u00e0m gi\u00e3n m\u1ea1ch th\u1eadn, l\u00e0m t\u0103ng t\u01b0\u1edbi m\u00e1u th\u1eadn, t\u0103ng \u00e1p l\u1ef1c trong c\u1ea7u th\u1eadn. H\u1eadu qu\u1ea3 l\u00e0 t\u0103ng protein ni\u1ec7u v\u00e0 ph\u00e1 h\u1ee7y c\u1ea7u th\u1eadn.<\/li>\n<li>B\u00e9o ph\u00ec: l\u00e0 y\u1ebfu t\u1ed1 nguy c\u01a1 \u0111\u1ed9c l\u1eadp d\u1eabn \u0111\u1ebfn b\u1ec7nh th\u1eadn.<\/li>\n<li>C\u00e1c y\u1ebfu t\u1ed1 kh\u00e1c: \u0111\u1ec1 kh\u00e1ng insulin, mang thai, h\u00fat thu\u1ed1c l\u00e1.<\/li>\n<\/ul>\n<h2>4. Di\u1ec5n ti\u1ebfn t\u1ef1 nhi\u00ean c\u1ee7a DKD.<\/h2>\n<p>Di\u1ec5n ti\u1ebfn t\u1ef1 nhi\u00ean c\u1ee7a b\u1ec7nh th\u1eadn \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng theo bi\u1ec3n \u0111\u1ed5i c\u1ee7a GFR v\u00e0 s\u1ef1 b\u00e0i xu\u1ea5t albumin ni\u1ec7u theo ti\u1ebfn tr\u00ecnh l\u1ea7n l\u01b0\u1ee3t sau:<\/p>\n<ul>\n<li>Giai \u0111o\u1ea1n l\u1ecdc b\u00ecnh th\u01b0\u1eddng 1: GFR \u1edf m\u1ee9c b\u00ecnh th\u01b0\u1eddng, kh\u00f4ng c\u00f3 albumin ni\u1ec7u, ch\u1ee9c n\u0103ng th\u1eadn b\u1ea3o t\u1ed3n, c\u00f2n 100% kh\u1ed1i l\u01b0\u1ee3ng nephron.<\/li>\n<li>Giai \u0111o\u1ea1n t\u0103ng l\u1ecdc to\u00e0n th\u1eadn: GFR c\u00f3 th\u1ec3 t\u0103ng \u0111\u1ebfn 180ml\/ph\u00fat, b\u1eaft \u0111\u1ea7u c\u00f3 b\u00e0i xu\u1ea5t albumin ni\u1ec7u, \u0111\u1ec9nh GFR \u0111\u1ea1t l\u00fac ti\u1ec1n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng ho\u1eb7c giai \u0111o\u1ea1n s\u1edbm sau ch\u1ea9n \u0111o\u00e1n. Kh\u1ed1i l\u01b0\u1ee3ng nephron b\u1eaft \u0111\u1ea7u gi\u1ea3m &lt;100%.<\/li>\n<li>Giai \u0111o\u1ea1n l\u1ecdc b\u00ecnh th\u01b0\u1eddng 2: GFR b\u1eaft \u0111\u1ea7u gi\u1ea3m (m\u1ea5t b\u00f9) nh\u01b0ng v\u1eabn tr\u00ean 60ml\/ph\u00fat, giai \u0111o\u1ea1n n\u00e0y albumin ni\u1ec7u t\u0103ng cao (\u0111\u1ea1i l\u01b0\u1ee3ng). Kh\u1ed1i l\u01b0\u1ee3ng nephron ch\u1ec9 c\u00f2n 50%.<\/li>\n<li>Giai \u0111o\u1ea1n gi\u1ea3m l\u1ecdc: GFR gi\u1ea3m m\u1ea1nh, albumin ni\u1ec7u \u0111\u1ea1i th\u1ec3 &#8211; c\u00f3 th\u1ec3 gi\u1ea3m d\u1ea7n r\u1ed3i m\u1ea5t theo ti\u1ebfn tri\u1ec3n b\u1ec7nh. Kh\u1ed1i l\u01b0\u1ee3ng nephron c\u00f2n 0 &#8211; &lt;50%.<\/li>\n<\/ul>\n<p>Theo nghi\u00ean c\u1ee9u UKPDS, kho\u1ea3ng 2 &#8211; 3% b\u1ec7nh nh\u00e2n trong nh\u00f3m nghi\u00ean c\u1ee9u chuy\u1ec3n m\u1ed9t giai \u0111o\u1ea1n\/n\u0103m v\u1edbi \u0110T\u0110 type 2 (v\u00ed d\u1ee5 normoalbuminuria \u2192 microalbuminuria \u2192 macroalbuminuria \u2192 gi\u1ea3m GFR). Trung b\u00ecnh 15 n\u0103m sau ch\u1ea9n \u0111o\u00e1n, 38% b\u1ec7nh nh\u00e2n xu\u1ea5t hi\u1ec7n albumin ni\u1ec7u v\u00e0 29% xu\u1ea5t hi\u1ec7n gi\u1ea3m GFR. Ngo\u00e0i ra, sau khi xu\u1ea5t hi\u1ec7n albumin ni\u1ec7u vi l\u01b0\u01a1ng, s\u1ed1 b\u1ec7nh nh\u00e2n trong m\u1ed7i giai \u0111o\u1ea1n c\u1ee7a DKD ch\u1ebft nhi\u1ec1u h\u01a1n t\u0103ng giai \u0111o\u1ea1n\/n\u0103m.<\/p>\n<p>&nbsp;<\/p>\n<\/section>\n<p class=\"w-75\"><strong>T\u00e0i li\u1ec7u tham kh\u1ea3o:\u00a0<\/strong><\/p>\n<p class=\"ng-binding\">Brenner and Rector&#8217;s The Kidney<span class=\"ng-binding ng-scope\">, Eleventh Edition.<\/span><\/p>\n<p data-test=\"topic-title\">&#8220;Diabetic kidney disease&#8221;, BMJ best practice.<\/p>\n<p class=\"entry-title\">\u0110\u1ed7 Gia Tuy\u1ec3n, &#8220;B\u1ec7nh th\u1eadn v\u00e0 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng: ph\u1ea7n 1 \u2013 \u0110\u1ecbnh ngh\u0129a v\u00e0 d\u1ecbch t\u1ec5 h\u1ecdc&#8221;.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>B\u1ec7nh th\u1eadn \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng (DKD) l\u00e0 m\u1ed9t b\u1ec7nh th\u1eadn m\u1ea1n t\u00ednh g\u00e2y ra do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, c\u00f3 t\u1ec9 l\u1ec7 m\u1eafc ng\u00e0y c\u00e0ng t\u0103ng do s\u1ef1 b\u00f9ng ph\u00e1t c\u1ee7a \u0111\u00e1i \u0111\u01b0\u1eddng tr\u00ean to\u00e0n c\u1ea7u. Tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh th\u01b0\u1eddng kh\u00f4ng c\u00f3 cho t\u1edbi khi b\u1ec7nh ti\u1ebfn tri\u1ec3n, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 c\u00f3 tri\u1ec7u ch\u1ee9ng [&hellip;]<\/p>\n","protected":false},"author":69,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[80,33],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>B\u1ec7nh th\u1eadn \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng: d\u1ecbch t\u1ec5 h\u1ecdc v\u00e0 di\u1ec5n ti\u1ebfn b\u1ec7nh - Vinmec<\/title>\n<meta name=\"description\" content=\"B\u1ec7nh th\u1eadn \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 xu\u1ea5t hi\u1ec7n albumin ni\u1ec7u v\u00e0 gi\u1ea3m ti\u1ebfn tri\u1ec3n GFR \u1edf ng\u01b0\u1eddi m\u1eafc \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng l\u00e2u n\u0103m.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"B\u1ec7nh th\u1eadn \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng: d\u1ecbch t\u1ec5 h\u1ecdc v\u00e0 di\u1ec5n ti\u1ebfn b\u1ec7nh - Vinmec\" \/>\n<meta property=\"og:description\" content=\"B\u1ec7nh th\u1eadn \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 xu\u1ea5t hi\u1ec7n albumin ni\u1ec7u v\u00e0 gi\u1ea3m ti\u1ebfn tri\u1ec3n GFR \u1edf ng\u01b0\u1eddi m\u1eafc \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng l\u00e2u n\u0103m.\" \/>\n<meta property=\"og:url\" content=\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/benh-than-dai-thao-duong-dich-te-hoc-va-dien-tien-benh\/\" \/>\n<meta property=\"og:site_name\" content=\"Vinmec\" \/>\n<meta property=\"article:published_time\" content=\"2023-05-06T07:20:01+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-05-06T07:28:27+00:00\" \/>\n<meta name=\"author\" content=\"Nguy\u1ec5n Ch\u00ed Nguy\u1ec7n\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Nguy\u1ec5n Ch\u00ed Nguy\u1ec7n\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"7 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/benh-than-dai-thao-duong-dich-te-hoc-va-dien-tien-benh\/\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/benh-than-dai-thao-duong-dich-te-hoc-va-dien-tien-benh\/\",\"name\":\"B\u1ec7nh th\u1eadn \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng: d\u1ecbch t\u1ec5 h\u1ecdc v\u00e0 di\u1ec5n ti\u1ebfn b\u1ec7nh - Vinmec\",\"isPartOf\":{\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/#website\"},\"datePublished\":\"2023-05-06T07:20:01+00:00\",\"dateModified\":\"2023-05-06T07:28:27+00:00\",\"author\":{\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/b812b6273d037966dff4008e0eed896e\"},\"description\":\"B\u1ec7nh th\u1eadn \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 xu\u1ea5t hi\u1ec7n albumin ni\u1ec7u v\u00e0 gi\u1ea3m ti\u1ebfn tri\u1ec3n GFR \u1edf ng\u01b0\u1eddi m\u1eafc \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng l\u00e2u n\u0103m.\",\"breadcrumb\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/benh-than-dai-thao-duong-dich-te-hoc-va-dien-tien-benh\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/benh-than-dai-thao-duong-dich-te-hoc-va-dien-tien-benh\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/benh-than-dai-thao-duong-dich-te-hoc-va-dien-tien-benh\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/noithathoaphat.in\/ctv\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"B\u1ec7nh th\u1eadn \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng: d\u1ecbch t\u1ec5 h\u1ecdc v\u00e0 di\u1ec5n ti\u1ebfn b\u1ec7nh\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/#website\",\"url\":\"https:\/\/noithathoaphat.in\/ctv\/\",\"name\":\"Vinmec\",\"description\":\"H\u1ec7 th\u1ed1ng Y t\u1ebf Vinmec\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/noithathoaphat.in\/ctv\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/b812b6273d037966dff4008e0eed896e\",\"name\":\"Nguy\u1ec5n Ch\u00ed Nguy\u1ec7n\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/image\/\",\"url\":\"http:\/\/1.gravatar.com\/avatar\/d8b9ad8e288884ecf4bc8ee441f3596b?s=96&d=mm&r=g\",\"contentUrl\":\"http:\/\/1.gravatar.com\/avatar\/d8b9ad8e288884ecf4bc8ee441f3596b?s=96&d=mm&r=g\",\"caption\":\"Nguy\u1ec5n Ch\u00ed Nguy\u1ec7n\"},\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/author\/meogods1234gmail-com\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"B\u1ec7nh th\u1eadn \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng: d\u1ecbch t\u1ec5 h\u1ecdc v\u00e0 di\u1ec5n ti\u1ebfn b\u1ec7nh - Vinmec","description":"B\u1ec7nh th\u1eadn \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 xu\u1ea5t hi\u1ec7n albumin ni\u1ec7u v\u00e0 gi\u1ea3m ti\u1ebfn tri\u1ec3n GFR \u1edf ng\u01b0\u1eddi m\u1eafc \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng l\u00e2u n\u0103m.","robots":{"index":"noindex","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"og_locale":"en_US","og_type":"article","og_title":"B\u1ec7nh th\u1eadn \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng: d\u1ecbch t\u1ec5 h\u1ecdc v\u00e0 di\u1ec5n ti\u1ebfn b\u1ec7nh - Vinmec","og_description":"B\u1ec7nh th\u1eadn \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 xu\u1ea5t hi\u1ec7n albumin ni\u1ec7u v\u00e0 gi\u1ea3m ti\u1ebfn tri\u1ec3n GFR \u1edf ng\u01b0\u1eddi m\u1eafc \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng l\u00e2u n\u0103m.","og_url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/benh-than-dai-thao-duong-dich-te-hoc-va-dien-tien-benh\/","og_site_name":"Vinmec","article_published_time":"2023-05-06T07:20:01+00:00","article_modified_time":"2023-05-06T07:28:27+00:00","author":"Nguy\u1ec5n Ch\u00ed Nguy\u1ec7n","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Nguy\u1ec5n Ch\u00ed Nguy\u1ec7n","Est. reading time":"7 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/benh-than-dai-thao-duong-dich-te-hoc-va-dien-tien-benh\/","url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/benh-than-dai-thao-duong-dich-te-hoc-va-dien-tien-benh\/","name":"B\u1ec7nh th\u1eadn \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng: d\u1ecbch t\u1ec5 h\u1ecdc v\u00e0 di\u1ec5n ti\u1ebfn b\u1ec7nh - Vinmec","isPartOf":{"@id":"https:\/\/noithathoaphat.in\/ctv\/#website"},"datePublished":"2023-05-06T07:20:01+00:00","dateModified":"2023-05-06T07:28:27+00:00","author":{"@id":"https:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/b812b6273d037966dff4008e0eed896e"},"description":"B\u1ec7nh th\u1eadn \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 xu\u1ea5t hi\u1ec7n albumin ni\u1ec7u v\u00e0 gi\u1ea3m ti\u1ebfn tri\u1ec3n GFR \u1edf ng\u01b0\u1eddi m\u1eafc \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng l\u00e2u n\u0103m.","breadcrumb":{"@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/benh-than-dai-thao-duong-dich-te-hoc-va-dien-tien-benh\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/benh-than-dai-thao-duong-dich-te-hoc-va-dien-tien-benh\/"]}]},{"@type":"BreadcrumbList","@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/benh-than-dai-thao-duong-dich-te-hoc-va-dien-tien-benh\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/noithathoaphat.in\/ctv\/"},{"@type":"ListItem","position":2,"name":"B\u1ec7nh th\u1eadn \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng: d\u1ecbch t\u1ec5 h\u1ecdc v\u00e0 di\u1ec5n ti\u1ebfn b\u1ec7nh"}]},{"@type":"WebSite","@id":"https:\/\/noithathoaphat.in\/ctv\/#website","url":"https:\/\/noithathoaphat.in\/ctv\/","name":"Vinmec","description":"H\u1ec7 th\u1ed1ng Y t\u1ebf Vinmec","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/noithathoaphat.in\/ctv\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"en-US"},{"@type":"Person","@id":"https:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/b812b6273d037966dff4008e0eed896e","name":"Nguy\u1ec5n Ch\u00ed Nguy\u1ec7n","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/image\/","url":"http:\/\/1.gravatar.com\/avatar\/d8b9ad8e288884ecf4bc8ee441f3596b?s=96&d=mm&r=g","contentUrl":"http:\/\/1.gravatar.com\/avatar\/d8b9ad8e288884ecf4bc8ee441f3596b?s=96&d=mm&r=g","caption":"Nguy\u1ec5n Ch\u00ed Nguy\u1ec7n"},"url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/author\/meogods1234gmail-com\/"}]}},"_links":{"self":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/31511"}],"collection":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/users\/69"}],"replies":[{"embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/comments?post=31511"}],"version-history":[{"count":4,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/31511\/revisions"}],"predecessor-version":[{"id":32262,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/31511\/revisions\/32262"}],"wp:attachment":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/media?parent=31511"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/categories?post=31511"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/tags?post=31511"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}