{"id":32260,"date":"2023-05-06T17:30:39","date_gmt":"2023-05-06T10:30:39","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=32260"},"modified":"2023-05-06T17:30:39","modified_gmt":"2023-05-06T10:30:39","slug":"benh-than-man-do-dai-thao-duong-chan-doan-va-dieu-tri","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/benh-than-man-do-dai-thao-duong-chan-doan-va-dieu-tri\/","title":{"rendered":"B\u1ec7nh th\u1eadn m\u1ea1n do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng: ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"<p><strong><a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/dac-diem-cua-benh-man\/\">B\u1ec7nh th\u1eadn m\u1ea1n<\/a> do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng (DKD) th\u01b0\u1eddng l\u00e0 m\u1ed9t ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng d\u1ef1a tr\u00ean s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a albumin ni\u1ec7u v\u00e0\/ho\u1eb7c gi\u1ea3m eGFR khi kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng v\u00e0 th\u1ef1c th\u1ec3 c\u1ee7a nguy\u00ean nh\u00e2n nguy\u00ean ph\u00e1t kh\u00e1c g\u00e2y t\u1ed5n th\u01b0\u01a1ng th\u1eadn. D\u1ea5u hi\u1ec7u \u0111i\u1ec3n h\u00ecnh c\u1ee7a DKD l\u00e0 th\u1eddi gian m\u1eafc \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng (\u0110T\u0110) d\u00e0i, c\u00f3 b\u1ec7nh v\u00f5ng m\u1ea1c, albumin ni\u1ec7u kh\u00f4ng k\u00e8m \u0111\u00e1i m\u00e1u \u0111\u1ea1i th\u1ec3, v\u00e0 gi\u1ea3m ti\u1ebfn tri\u1ec3n eGFR. Chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb DKD bao g\u1ed3m ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft, huy\u1ebft \u00e1p, c\u1ea3i thi\u1ec7n lipid m\u00e1u, cai thu\u1ed1c l\u00e1.<\/strong><\/p>\n<h2>1. Ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n b\u1ec7nh th\u1eadn m\u1ea1n do \u0110T\u0110.<\/h2>\n<h3>1.1. H\u1ecfi b\u1ec7nh.<\/h3>\n<ul>\n<li>B\u1ec7nh nh\u00e2n c\u00f3 kh\u1ea3 n\u0103ng m\u1eafc DKD th\u01b0\u1eddng c\u00f3 <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 ki\u1ec3m so\u00e1t k\u00e9m<\/a> v\u00e0 ti\u1ec1n s\u1eed giai \u0111\u00ecnh c\u00f3 t\u0103ng huy\u1ebft \u00e1p v\u00e0\/ho\u1eb7c b\u1ec7nh th\u1eadn.<\/li>\n<li>B\u1ec7nh nh\u00e2n th\u01b0\u1eddng c\u0169ng c\u00f3 t\u0103ng huy\u1ebft \u00e1p v\u00e0 \u0111\u1eb7c bi\u1ec7t l\u00e0 t\u0103ng huy\u1ebft \u00e1p v\u1ec1 \u0111\u00eam.<\/li>\n<li>B\u1ec7nh kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng cho t\u1edbi khi v\u00e0o giai \u0111o\u1ea1n ti\u1ebfn tri\u1ec3n c\u1ee7a DKD. C\u00e1c tri\u1ec7u ch\u1ee9ng to\u00e0n th\u00e2n nh\u01b0 m\u1ec7t m\u1ecfi, ch\u00e1n \u0103n. Khi c\u00f3 t\u0103ng ure m\u00e1u, ng\u01b0\u1eddi b\u1ec7nh ch\u00e1n \u0103n, c\u00f3 bi\u1ec3u hi\u1ec7n b\u1ec7nh l\u00fd n\u00e3o, bu\u1ed3n n\u00f4n v\u00e0 n\u00f4n, thay \u0111\u1ed5i v\u1ecb gi\u00e1c, ch\u1ea3y m\u00e1u ti\u00eau h\u00f3a, co gi\u1eadt c\u01a1 v\u00e0 c\u00f3 th\u1ec3 c\u00f3 tri\u1ec7u ch\u1ee9ng vi\u00eam m\u00e0ng ngo\u00e0i tim.<\/li>\n<li>Ng\u01b0\u1eddi b\u1ec7nh c\u0169ng c\u00f3 th\u1ec3 khai c\u1ea3m gi\u00e1c t\u00ea \u1edf 2 ch\u00e2n (g\u1ee3i \u00fd b\u1ec7nh th\u1ea7n kinh ngo\u1ea1i bi\u00ean), gi\u1ea3m th\u1ecb l\u1ef1c (<a href=\"https:\/\/www.vinmec.com\/vi\/benh\/vong-mac-2945\/\">g\u1ee3i \u00fd b\u1ec7nh v\u00f5ng m\u1ea1c<\/a> ho\u1eb7c th\u1ee7y tinh th\u1ec3), v\u00e0 \u0111au ch\u00e2n (g\u1ee3i \u00fd <a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/benh-ly-kinh-ngoai-bien-la-gi\/#:~:text=B%E1%BB%87nh%20l%C3%BD%20th%E1%BA%A7n%20kinh%20ngo%E1%BA%A1i%20bi%C3%AAn%20l%C3%A0%20b%E1%BB%87nh%20l%C3%BD%20x%E1%BA%A3y,v%C3%A0%20d%E1%BB%85%20b%E1%BB%8B%20t%E1%BB%95n%20th%C6%B0%C6%A1ng.\">b\u1ec7nh th\u1ea7n kinh ngo\u1ea1i bi\u00ean<\/a> ho\u1eb7c m\u1ea1ch m\u00e1u ngo\u1ea1i bi\u00ean) l\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng \u0111i\u1ec3n h\u00ecnh c\u1ee7a \u0110T\u0110 ti\u1ebfn tri\u1ec3n v\u00e0 n\u00ean \u0111\u00e1nh gi\u00e1 th\u00eam v\u1ec1 DKD.<\/li>\n<\/ul>\n<h3>1.2. Kh\u00e1m l\u00e2m s\u00e0ng.<\/h3>\n<p>Trong giai \u0111o\u1ea1n s\u1edbm, kh\u00e1m l\u00e2m s\u00e0ng ho\u00e0n to\u00e0n b\u00ecnh th\u01b0\u1eddng. Kh\u00e1m c\u1ea7n \u0111\u00e1nh gi\u00e1 c\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a DKD bao g\u1ed3m t\u0103ng huy\u1ebft \u00e1p v\u00e0 ph\u00f9 ngo\u1ea1i bi\u00ean, c\u0169ng nh\u01b0 c\u00e1c bi\u1ebfn ch\u1ee9ng m\u1ea1ch m\u00e1u nh\u1ecf kh\u00e1c c\u1ee7a \u0110T\u0110:<\/p>\n<ul>\n<li>B\u1ec7nh v\u00f5ng m\u1ea1c: gi\u1ea3m th\u1ecb l\u1ef1c, soi \u0111\u00e1y m\u1eaft th\u1ea5y d\u1ea5u hi\u1ec7u xu\u1ea5t huy\u1ebft d\u1ea1ng ch\u1ea5m, d\u1ea1ng v\u1ebft.<\/li>\n<li>B\u1ec7nh th\u1ea7n kinh ngo\u1ea1i bi\u00ean: gi\u1ea3m c\u1ea3m gi\u00e1c \u1edf chi d\u01b0\u1edbi, lo\u00e9t b\u00e0n ch\u00e2, b\u00e0n ch\u00e2n Charcot, v\u00e0\/ho\u1eb7c h\u1ea1 huy\u1ebft \u00e1p t\u01b0 th\u1ebf kh\u00f4ng k\u00e8m t\u0103ng t\u1ea7n s\u1ed1 tim (b\u1ec7nh th\u1ea7n kinh t\u1ef1 ch\u1ee7).<\/li>\n<\/ul>\n<p>Kh\u00e1m l\u00e2m s\u00e0ng c\u0169ng gi\u00fap \u0111\u00e1nh gi\u00e1 c\u00e1c bi\u1ebfn ch\u1ee9ng m\u1ea1ch m\u00e1u l\u1edbn kh\u00e1c nh\u01b0 t\u0103ng huy\u1ebft \u00e1p, ti\u1ebfng th\u1ed5i \u0111\u1ed9ng m\u1ea1ch, m\u1ea1ch chi y\u1ebfu, lo\u00e9t thi\u1ebfu m\u00e1u. C\u00f3 th\u1ec3 k\u00e8m c\u00e1c d\u1ea5u hi\u1ec7u kh\u00e1c c\u1ee7a \u0110T\u0110 k\u00e9o d\u00e0i kh\u00f4ng ki\u1ec3m so\u00e1t t\u1ed1t nh\u01b0:<\/p>\n<ul>\n<li>Thay \u0111\u1ed5i v\u1ec1 da nh\u01b0 kh\u00f4 da, t\u0103ng s\u1eafc t\u1ed1, d\u1ea5u gai \u0111en, necrobiosis lipoidica.<\/li>\n<li>Teo c\u01a1<\/li>\n<li>D\u1ea1 ni\u00eam nh\u1ea1t: do thi\u1ebfu m\u00e1u.<\/li>\n<li>Khi c\u00f3 ure m\u00e1u r\u00f5, b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ebfng c\u1ecd m\u00e0ng ph\u1ed5i v\u00e0\/ho\u1eb7c m\u00e0ng tim, run chi v\u00e0\/ho\u1eb7c co gi\u1eadt c\u01a1.<\/li>\n<li>Gi\u1ea3m ch\u1ee9c n\u0103ng ti\u1ec3u c\u1ea7 g\u00e2y xu\u1ea5t huy\u1ebft.<\/li>\n<li>Toan chuy\u1ec3n h\u00f3a.<\/li>\n<\/ul>\n<h3>1.3. C\u1eadn l\u00e2m s\u00e0ng ch\u1ea9n \u0111o\u00e1n b\u1ec7nh th\u1eadn m\u1ea1n \u0110T\u0110.<\/h3>\n<p><a href=\"https:\/\/vinmec.com\/vi\/chu-de\/albumin-nieu-vi-luong\/\">Albumin ni\u1ec7u<\/a> v\u00e0 eGFR th\u1ea5p l\u00e0 2 y\u1ebfu t\u1ed1 quan tr\u1ecdng nh\u1ea5t ch\u1ec9 \u0111i\u1ec3m ch\u1ee9c n\u0103ng th\u1eadn suy gi\u1ea3m. M\u1ed9t s\u1ed1 x\u00e9t nghi\u1ec7m kh\u00e1c \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 DKD bao g\u1ed3m:<\/p>\n<p><strong>T\u1ed5ng ph\u00e2n t\u00edch n\u01b0\u1edbc ti\u1ec3u:\u00a0<\/strong><\/p>\n<ul>\n<li>Cho th\u1ea5y protein ni\u1ec7u. T\u0103ng t\u1ec9 tr\u1ecdng c\u00f3 th\u1ec3 g\u1ee3i \u00fd nguy\u00ean nh\u00e2n suy th\u1eadn tr\u01b0\u1edbc th\u1eadn.<\/li>\n<li>B\u1ea1ch c\u1ea7u ni\u1ec7u, vi khu\u1ea9n ni\u1ec7u, nitrite g\u1ee3i \u00fd nhi\u1ec5m tr\u00f9ng ti\u1ec3u.<\/li>\n<li>Sau t\u1ea7m so\u00e1t ban \u0111\u1ea7u, t\u1ed5ng ph\u00e2n t\u00edch n\u01b0\u1edbc ti\u1ec3u kh\u00f4ng c\u00f2n gi\u00e1 tr\u1ecb ngo\u00e0i tr\u1eeb m\u1ed9t s\u1ed1 ch\u1ec9 \u0111\u1ecbnh ri\u00eang bi\u1ec7t nh\u01b0 ch\u1ee9c n\u0103ng th\u1eadn gi\u1ea3m nhanh, c\u00f3 tri\u1ec7u ch\u1ee9ng nhi\u1ec5m tr\u00f9ng ti\u1ec3u.<\/li>\n<\/ul>\n<p><strong>\u0110\u1ecbnh l\u01b0\u1ee3ng albumin ni\u1ec7u:\u00a0<\/strong><\/p>\n<ul>\n<li>Albumin ni\u1ec7u c\u00f3 th\u1ec3 \u0111\u1ecbnh l\u01b0\u1ee3ng d\u1ef1a tr\u00ean t\u1ec9 s\u1ed1albumin:creatinine (ACR) trong m\u1eabu n\u01b0\u1edbc ti\u1ec3u b\u1ea5t k\u1ef3 ho\u1eb7c albumin ni\u1ec7u 24h hay albumin excretion rate (AER). Tuy nhi\u00ean, \u0111\u1ecbnh l\u01b0\u1ee3ng 24h g\u00e2y phi\u1ec1n to\u00e1i cho b\u1ec7nh nh\u00e2n v\u00e0 kh\u00f4ng c\u1ea3i thi\u1ec7n \u0111\u1ed9 ch\u00ednh x\u00e1c.<\/li>\n<li>Thu\u1eadt ng\u1eef albumin ni\u1ec7u \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 theo t\u1eebng m\u1ee9c \u0111\u1ed9: ACR t\u1eeb 30-300 mg\/g ho\u1eb7c AER t\u1eeb 30-300 mg\/24 h \u0111\u01b0\u1ee3c xem l\u00e0 t\u0103ng albumin ni\u1ec7u v\u1eeba v\u00e0 ACR &gt;300 mg\/g ho\u1eb7c AER &gt;300 mg\/24 h \u0111\u01b0\u1ee3c xem l\u00e0 albumin ni\u1ec7u n\u1eb7ng (macroalbuminuria).<\/li>\n<li>Albumin ni\u1ec7u l\u00e0 \u0111\u1ecbnh ngh\u0129a \u0111\u1ed9c l\u1eadp c\u1ee7a b\u1ec7nh th\u1eadn m\u1ea1n ngay c\u1ea3 khi eGFR is \u226560 mL\/<br \/>\nmin\/1.73 m\u00b2.<\/li>\n<li>Ph\u00e1t hi\u1ec7n albumin ni\u1ec7u quan tr\u1ecdng v\u00ec can thi\u1ec7p s\u1edbm gi\u00fap ng\u0103n ng\u1eeba ti\u1ebfn tri\u1ec3n c\u1ee7a b\u1ec7nh th\u1eadn m\u1ea1n.<\/li>\n<li>ACR t\u1eeb m\u1eabu n\u01b0\u1edbc ti\u1ec3u \u0111\u1ea7u d\u00f2ng s\u00e1ng s\u1edbm \u0111\u01b0\u1ee3c \u01b0u ti\u00ean l\u1ef1a ch\u1ecdn, tuy nhi\u00ean m\u1eabu n\u01b0\u1edbc ti\u1ec3u ng\u1eabu nhi\u00ean c\u0169ng ch\u1ea5p nh\u1eadn \u0111\u01b0\u1ee3c.<\/li>\n<\/ul>\n<p><strong>Sinh h\u00f3a m\u00e1u:\u00a0<\/strong><\/p>\n<ul>\n<li>Creatinine huy\u1ebft thanh n\u00ean \u0111\u01b0\u1ee3c x\u00e9t nghi\u1ec7m v\u00e0 t\u00ednh to\u00e1n eGFR.<\/li>\n<li>eGFR &lt;60 mL\/min\/1.73 m\u00b2 k\u00e9o d\u00e0i \u0111\u01b0\u1ee3c xem l\u00e0 b\u1ea5t th\u01b0\u1eddng m\u1eb7c d\u00f9 ng\u01b0\u1ee1ng ch\u1ea9n \u0111o\u00e1n DKD c\u00f3 th\u1ec3 thay \u0111\u1ed5i \u1edf ng\u01b0\u1eddi gi\u00e0.<\/li>\n<\/ul>\n<p><strong>H\u00ecnh \u1ea3nh h\u1ecdc:\u00a0<\/strong><\/p>\n<ul>\n<li>Si\u00eau \u00e2m \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn \u0111\u1ec3 t\u1ea7m so\u00e1t ban \u0111\u1ea7u, gi\u00fap \u00edch trong \u0111\u00e1nh gi\u00e1 k\u00edch th\u01b0\u1edbc th\u1eadn v\u00e0 lo\u1ea1i tr\u1eeb c\u00e1c ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t nh\u01b0 th\u1eadn \u1ee9 n\u01b0\u1edbc, vi\u00eam \u0111\u00e0i b\u1ec3 th\u1eadn, s\u1ecfi th\u1eadn. K\u00edch th\u01b0\u1edbc th\u1eadn l\u1edbn n\u1ebfu \u0110T\u0110 ki\u1ec3m so\u00e1t k\u00e9m, nh\u01b0ng th\u01b0\u1eddng b\u00ecnh th\u01b0\u1eddng khi DKD x\u1ea3y ra. Si\u00eau \u00e2m Doppler c\u00f3 th\u1ec3 cho th\u1ea5y h\u1eb9p \u0111\u1ed9ng m\u1ea1ch th\u1eadn.<\/li>\n<li>Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh gi\u00fap \u00edch trong \u0111\u00e1nh gi\u00e1 s\u1ecfi th\u1eadn, th\u1eadn \u1ee9 n\u01b0\u1edbc, k\u00edch th\u01b0\u1edbc th\u1eadn v\u00e0 c\u0169ng l\u00e0m r\u00f5 c\u00e1c ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t.<\/li>\n<li>C\u1ed9ng h\u01b0\u1edfng t\u1eeb gi\u00fap ch\u1ea9n \u0111o\u00e1n h\u1eb9p \u0111\u1ed9ng m\u1ea1ch th\u1eadn ho\u1eb7c b\u1ec7nh m\u1ea1ch m\u00e1u th\u1eadn.<\/li>\n<\/ul>\n<p><strong>Sinh thi\u1ebft th\u1eadn<\/strong>: gi\u00fap ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh DKD d\u1ef1a v\u00e0o h\u00ecnh \u1ea3nh t\u0103ng sinh gian m\u1ea1ch v\u00e0 x\u01a1 h\u00f3a d\u1ea1ng n\u1ed1t c\u1ea7u th\u1eadn. Th\u01b0\u1eddng \u00edt c\u1ea7n ch\u1ec9 \u0111\u1ecbnh, c\u00f3 th\u1ec3 c\u1ea7n thi\u1ebft trong m\u1ed9t s\u1ed1 t\u00ecnh hu\u1ed1ng \u0111\u1eb7c bi\u1ec7t.<\/p>\n<h3>1.4. Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t.<\/h3>\n<ul>\n<li>B\u1ec7nh th\u1eadn m\u1ea1n kh\u00f4ng do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng.<\/li>\n<li>\u0110a u t\u1ee7y: c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n suy th\u1eadn k\u00e8m \u0111\u1ea1m ni\u1ec7u.<\/li>\n<li>Vi\u00eam th\u1eadn, c\u1ea7u th\u1eadn do lupus, cryoglobulinemia.<\/li>\n<li>S\u1ecfi ni\u1ec7u, h\u1eb9p \u0111\u1ed9ng m\u1ea1ch th\u1eadn.<\/li>\n<\/ul>\n<h2>2. \u0110i\u1ec1u tr\u1ecb b\u1ec7nh th\u1eadn m\u1ea1n do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng.<\/h2>\n<h3>2.1. Ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p.<\/h3>\n<ul>\n<li>M\u1ee5c ti\u00eau huy\u1ebft \u00e1p &lt;140\/90\u202fmm Hg \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho b\u1ec7nh nh\u00e2n \u0110T\u0110 v\u00e0 DKD khi kh\u00f4ng c\u00f3 albumin ni\u1ec7u.<\/li>\n<li>Khi b\u1ec7nh nh\u00e2n c\u00f3 AER &gt;30\u202fmg\/24 h ho\u1eb7c t\u01b0\u01a1ng \u0111\u01b0\u01a1ng th\u00ec m\u1ee5c ti\u00eau n\u00ean th\u1ea5p h\u01a1n &lt;130\/80\u202fmm Hg.<\/li>\n<li>C\u00e1c khuy\u1ebfn c\u00e1o hi\u1ec7n nay \u0111\u1ec1u khuy\u00ean d\u00f9ng thu\u1ed1c \u1ee9c ch\u1ebf h\u1ec7 renin-angiotensin-aldosterone \u1edf b\u1ec7nh nh\u00e2n \u0110T\u0110 v\u00e0 c\u00f3 albumin ni\u1ec7u tr\u1eeb khi c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh.<\/li>\n<li>\u1ede b\u1ec7nh nh\u00e2n \u0110T\u0110 type 1 k\u00e8m t\u0103ng huy\u1ebft \u00e1p, \u0111\u1ea1m ni\u1ec7u, n\u00ean d\u00f9ng \u1ee9c ch\u1ebf men chuy\u1ec3n (ACEi); b\u1ec7nh nh\u00e2n \u0110T\u0110 type 2 c\u00f3 th\u1ec3 l\u1ef1a ch\u1ecdn ACEi ho\u1eb7c ch\u1eb9n th\u1ee5 th\u1ec3 (ARB), c\u00f3 th\u1ec3 \u0111\u1ed5i thu\u1ed1c n\u1ebfu kh\u00f4ng dung n\u1ea1p. \u0110\u1ed1i v\u1edbi DKD bi\u1ec3u hi\u1ec7n r\u00f5 tr\u00ean l\u00e2m s\u00e0ng, khuy\u1ebfn c\u00e1o n\u00ean d\u00f9ng ARB l\u00e0 \u0111\u1ea7u tay.<\/li>\n<li>Ph\u1ed1i h\u1ee3p ACEi v\u00e0 ARB: nghi\u00ean c\u1ee9u cho th\u1ea5y hi\u1ec7u qu\u1ea3 gi\u1ea3m \u0111\u1ea1m ni\u1ec7u t\u1ed1t h\u01a1n nh\u01b0ng l\u00e0m x\u1ea5u c\u00e1c k\u1ebft c\u1ee5c ch\u00ednh c\u1ee7a th\u1eadn, do \u0111\u00f3 kh\u00f4ng an to\u00e0n.<\/li>\n<li>Ph\u1ed5i h\u1ee3p thu\u1ed1c kh\u00e1ng aldosteron v\u00e0 \u1ee9c ch\u1ebf h\u1ec7 renin-angiotensin-aldosterone: nghi\u00ean c\u1ee9u cho th\u1ea5y l\u00e0m gi\u1ea3m \u0111\u1ea1m ni\u1ec7u t\u1ed1t h\u01a1n nh\u01b0ng kh\u00f4ng c\u00f3 d\u1eef li\u1ec7u v\u1ec1 t\u00ednh an to\u00e0n l\u00e2u d\u00e0i, \u0111\u1eb7c bi\u1ec7t nguy c\u01a1 t\u0103ng kali m\u00e1u. Finerenon l\u00e0 thu\u1ed1c kh\u00e1ng aldosteron kh\u00f4ng steroid ch\u1ecdn l\u1ecdc cao, cho th\u1ea5y hi\u1ec7u qu\u1ea3 gi\u1ea3m ACR khi k\u1ebft h\u1ee3p ACEi\/ARB v\u00e0 gi\u1ea3m albumin \u0111\u1ea1i l\u01b0\u1ee3ng, \u0111ang ti\u1ebfn h\u00e0nh nghi\u00ean c\u1ee9u pha 3.<\/li>\n<li>\u0110\u1ed1i kh\u00e1ng th\u1ee5 th\u1ec3 endothelin: \u0111\u1eb7c bi\u1ec7t l\u00e0 endothelin A receptor blocker (ETARB) cho th\u1ea5y gi\u1ea3m \u0111\u1ea1m ni\u1ec7u t\u1ed1t (atrasentan)<\/li>\n<\/ul>\n<h3>2.2. Ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft.<\/h3>\n<ul>\n<li>C\u00e1c khuy\u1ebfn c\u00e1o v\u1ec1 ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft trong d\u1ef1 ph\u00f2ng DKD khuy\u1ebfn c\u00e1o m\u1ee5c ti\u00eau A1C l\u00e0 7%. C\u1ea7n c\u00e1 nh\u00e2n h\u00f3a theo \u0111\u1eb7c \u0111i\u1ec3m b\u1ec7nh nh\u00e2n.<\/li>\n<li>EMPA-REG OUTCOME trial cho th\u1ea5y empagliflozin gi\u1ea3m ti\u1ebfn tri\u1ec3n x\u1ea5u DKD, gi\u1ea3m \u0111\u1ea1m ni\u1ec7u, gi\u1ea3m t\u0103ng creatinine huy\u1ebft thanh.<\/li>\n<\/ul>\n<h3>2.3. Thu\u1ed1c h\u1ea1 lipid m\u00e1u.<\/h3>\n<ul>\n<li>Khuy\u1ebfn c\u00e1o ADA \u0111\u01b0a ra m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb r\u1ed1i lo\u1ea1n lipid m\u00e1u v\u1edbi LDL-C &lt;70 &#8211; 100\u202fmg\/dl.<\/li>\n<li>T\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n DKD n\u00ean \u0111i\u1ec1u tr\u1ecb statin \u0111\u1ec3 gi\u1ea3m b\u1ec7nh su\u1ea5t v\u00e0 t\u1eed su\u1ea5t li\u00ean quan tim m\u1ea1ch.<\/li>\n<li>KDIGO khuy\u1ebfn c\u00e1o n\u00ean d\u00f9ng statin c\u01b0\u1eddng \u0111\u1ed9 trung b\u00ecnh, li\u1ec1u c\u1ed1 \u0111\u1ecbnh v\u00e0 kh\u00f4ng c\u1ea7n x\u00e9t nghi\u1ec7m l\u1ea1i.<\/li>\n<\/ul>\n<h3>2.4. Ch\u1ebf \u0111\u1ed9 \u0103n h\u1ea1n ch\u1ebf \u0111\u1ea1m.<\/h3>\n<p>Ch\u1ebf \u0111\u1ed9 \u0103n v\u1edbi l\u01b0\u1ee3ng \u0111\u1ea1m 0.8\u202fg\/kg\/day \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho b\u1ec7nh nh\u00e2n DKD khi ch\u01b0a ti\u1ebfn tri\u1ec3n \u0111\u1ebfn giai \u0111o\u1ea1n cu\u1ed1i.<\/p>\n<p><strong>T\u00e0i li\u1ec7u tham kh\u1ea3o:\u00a0<\/strong><\/p>\n<p>Brenner and Rector&#8217;s the kidney eleventh edition.<\/p>\n<p>Diabetic kidney disease, BMJ best practice.<\/p>\n<p>Nuha A. ElSayed, Grazia Aleppo, Vanita R. Aroda, Raveendhara R. Bannuru, Florence M. Brown, Dennis Bruemmer, Billy S. Collins, Marisa E. Hilliard, Diana Isaacs, Eric L. Johnson, Scott Kahan, Kamlesh Khunti, Jose Leon, Sarah K. Lyons, Mary Lou Perry, Priya Prahalad, Richard E. Pratley, Jane Jeffrie Seley, Robert C. Stanton, Robert A. Gabbay; on behalf of the American Diabetes Association, 11. Chronic Kidney Disease and Risk Management:\u00a0<em>Standards of Care in Diabetes\u20142023<\/em>.\u00a0<em>Diabetes Care<\/em>\u00a01 January 2023; 46 (Supplement_1): S191\u2013S202.<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>B\u1ec7nh th\u1eadn m\u1ea1n do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng (DKD) th\u01b0\u1eddng l\u00e0 m\u1ed9t ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng d\u1ef1a tr\u00ean s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a albumin ni\u1ec7u v\u00e0\/ho\u1eb7c gi\u1ea3m eGFR khi kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng v\u00e0 th\u1ef1c th\u1ec3 c\u1ee7a nguy\u00ean nh\u00e2n nguy\u00ean ph\u00e1t kh\u00e1c g\u00e2y t\u1ed5n th\u01b0\u01a1ng th\u1eadn. D\u1ea5u hi\u1ec7u \u0111i\u1ec3n h\u00ecnh c\u1ee7a DKD l\u00e0 th\u1eddi gian [&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 m\u1ea1n do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng: ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb - Vinmec<\/title>\n<meta name=\"description\" content=\"Ch\u1ea9n \u0111o\u00e1n b\u1ec7nh th\u1eadn m\u1ea1n \u0110T\u0110 d\u1ef1a tr\u00ean albumin ni\u1ec7u, eGFR, t\u0103ng huy\u1ebft \u00e1p, b\u1ec7nh v\u00f5ng m\u1ea1c. \u0110i\u1ec1u tr\u1ecb: ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p, \u0111\u01b0\u1eddng huy\u1ebft, h\u1ea1n ch\u1ebf \u0111\u1ea1m.\" \/>\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 m\u1ea1n do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng: ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb - 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