{"id":32587,"date":"2023-05-08T12:42:05","date_gmt":"2023-05-08T05:42:05","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=32587"},"modified":"2023-05-09T13:22:25","modified_gmt":"2023-05-09T06:22:25","slug":"benh-cau-than-nguyen-phat-cac-ton-thuong-benh-hoc","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/08\/benh-cau-than-nguyen-phat-cac-ton-thuong-benh-hoc\/","title":{"rendered":"B\u1ec7nh c\u1ea7u th\u1eadn nguy\u00ean ph\u00e1t: c\u00e1c t\u1ed5n th\u01b0\u01a1ng b\u1ec7nh h\u1ecdc"},"content":{"rendered":"<p><strong>B\u1ec7nh c\u1ea7u th\u1eadn \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i th\u00e0nh nh\u00f3m c\u00e1c b\u1ec7nh ch\u1ec9 t\u1ed5n th\u01b0\u01a1ng \u1edf th\u1eadn (<a href=\"https:\/\/vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/benh-cau-nguyen-phat-chan-doan-va-cach-dieu-tri\/?link_type=related_posts\">b\u1ec7nh c\u1ea7u th\u1eadn nguy\u00ean ph\u00e1t<\/a>) v\u00e0 nh\u00f3m t\u1ed5n th\u01b0\u01a1ng \u1edf th\u1eadn ch\u1ec9 l\u00e0 m\u1ed9t ph\u1ea7n c\u1ee7a r\u1ed1i lo\u1ea1n h\u1ec7 th\u1ed1ng (b\u1ec7nh c\u1ea7u th\u1eadn th\u1ee9 ph\u00e1t). B\u00e0y vi\u1ebft n\u00e0y ch\u1ec9 \u0111\u1ec1 c\u1eadp \u0111\u1ebfn b\u1ec7nh c\u1ea7u th\u1eadn nguy\u00ean ph\u00e1t.\u00a0<\/strong><\/p>\n<h2>1. C\u00e1c h\u1ed9i ch\u1ee9ng c\u1ee7a b\u1ec7nh c\u1ea7u th\u1eadn.<\/h2>\n<h3>1.1. Ti\u1ec3u \u0111\u1ea1m.<\/h3>\n<p>\u0110\u1ea1m ni\u1ec7u c\u00f3 th\u1ec3 g\u00e2y ra do s\u1ea3n xu\u1ea5t qu\u00e1 m\u1ee9c protein qua \u0111\u01b0\u1ee3c th\u00e0nh mao m\u1ea1ch (nh\u01b0 trong \u0111a u t\u1ee7y v\u1edbi ti\u1ec3u \u0111\u1ea1m Bence Jones), suy ch\u1ee9c n\u0103ng \u1ed1ng th\u1eadn (h\u1ed9i ch\u1ee9ng Fanconi), ho\u1eb7c suy ch\u1ee9c n\u0103ng c\u1ea7u th\u1eadn. Do \u0111\u00f3 c\u1ea7n x\u00e1c \u0111\u1ecbnh ti\u1ec3u \u0111\u1ea1m \u1edf b\u1ec7nh nh\u00e2n l\u00e0 bi\u1ec3u hi\u1ec7n c\u1ee7a t\u1ed5n th\u01b0\u01a1ng c\u1ea7u th\u1eadn hay l\u00e0 ti\u1ec3u \u0111\u1ea1m ch\u1ee9c n\u0103ng l\u00e0nh t\u00ednh, t\u1ea1m th\u1eddi, do t\u01b0 th\u1ebf(\u0111\u1ee9ng) ho\u1eb7c ti\u1ec3u \u0111\u1ea1m ng\u1eaft qu\u00e3ng.<\/p>\n<ul>\n<li id=\"hl0002004\">B\u00ecnh th\u01b0\u1eddng, c\u00e1c protein k\u00edch th\u01b0\u1edbc tr\u00ean 70kDa qua m\u00e0ng \u0111\u00e1y m\u1ed9t c\u00e1ch r\u1ea5t h\u1ea1n ch\u1ebf nh\u1edd m\u00e0ng l\u1ecdc ch\u1ecdn l\u1ecdc v\u1ec1 k\u00edch th\u01b0\u1edbc v\u00e0 \u0111i\u1ec7n t\u00edch. M\u1ea5t ch\u1ecdn l\u1ecdc v\u1ec1 \u0111i\u1ec7n t\u00edch g\u00e2y ti\u1ec3u \u0111\u1ea1m c\u00f3 th\u1ec3 g\u1eb7p trong th\u1ec3 sang th\u01b0\u01a1ng t\u1ed1i thi\u1ec3u (MCD), m\u1ea5t ch\u1ecdn l\u1ecdc v\u1ec1k\u00edch th\u01b0\u1edbc c\u00f3 th\u1ec3 g\u1eb7p trong b\u1ec7nh c\u1ea7u th\u1eadn m\u00e0ng (MN).<\/li>\n<li>C\u00e1c enzyme ph\u00e2n gi\u1ea3i m\u00f4, b\u1ed5 th\u1ec3 c\u00f3 th\u1ec3 l\u1eafng \u0111\u1ecdng \u1edf m\u00e0ng \u0111\u00e1y l\u00e0m g\u1ed1c oxy h\u00f3a t\u1ef1 do t\u1ea5n c\u00f4ng m\u00e0ng \u0111\u00e1y v\u00e0 khe l\u1ecdc (slit diaphragm). C\u00e1c bi\u1ebfn \u0111\u1ed5i v\u1ec1 men heparinase v\u00e0 hyaluronidase th\u00e0nh mao m\u1ea1ch c\u1ea7u th\u1eadn c\u0169ng \u0111\u00f3ng vai tr\u00f2 trong ti\u1ec3u \u0111\u1ea1m. \u0110\u1ed9t bi\u1ebfn c\u00e1c ch\u00e2n gi\u1ea3 (podocyte) ho\u1eb7c protein khe l\u1ecdc c\u0169ng g\u00e2y \u0111\u1ea1m ni\u1ec7u.<\/li>\n<li>M\u1ed9t c\u01a1 ch\u1ebf kh\u00e1c g\u00e2y \u0111\u1ea1m ni\u1ec7u l\u00e0 do gi\u1ea3m h\u1ea5p thu protein huy\u1ebft thanh \u1edf t\u1ebf b\u00e0o bi\u1ec3u m\u00f4 \u1ed1ng l\u01b0\u1ee3n g\u1ea7n. \u0110\u00f3 l\u00e0 c\u00e1c albumin, \u03b2 <sub>1<\/sub>\u00a0-, \u03b2\u00a0<sub>2<\/sub> -, v\u00e0 \u03b1 <sub>1<\/sub> &#8211; microglobulins.<\/li>\n<\/ul>\n<p>Ti\u1ec3u \u0111\u1ea1m \u0111\u01a1n \u0111\u1ed9c c\u00f3 th\u1ec3 g\u1eb7p trong nhi\u1ec1u b\u1ec7nh l\u00fd nh\u01b0 ti\u1ec3u \u0111\u1ea1m tho\u00e1ng qua &lt;1g\/ng\u00e0y c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n do li\u00ean quan stress nh\u01b0 s\u1ed1t n\u1ed9i vi\u1ec7n, v\u1eadn \u0111\u1ed9ng th\u1ec3 l\u1ef1c v\u00e0 suy tim sung huy\u1ebft.<\/p>\n<p>Ti\u1ec3u \u0111\u1ea1m do t\u01b0 th\u1ebf \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a kh\u00f4ng ti\u1ec3u \u0111\u1ea1m khi b\u1ec7nh nh\u00e2n \u0111ang t\u01b0 th\u1ebf n\u1eb1m v\u00e0 xu\u1ea5t hi\u1ec7n khi \u1edf t\u01b0 th\u1ebf \u0111\u1ee9ng, t\u1ed5ng protein th\u01b0\u1eddng d\u01b0\u1edbi 1g\/24h. Th\u01b0\u1eddng g\u1eb7p \u1edf thanh thi\u1ebfu ni\u00ean (2-5%)v\u00e0 \u00edt g\u1eb7p \u1edf ng\u01b0\u1eddi tr\u00ean 30. Sinh thi\u1ebft th\u1eadn th\u1ea5y 47% kh\u00f4ng b\u1ea5t th\u01b0\u1eddng c\u1ea7u th\u1eadn v\u00e0 45% c\u00f3 b\u1ec7nh l\u00fd c\u1ea7u th\u1eadn nh\u1eb9 &#8211; v\u1eeba. Ch\u1ea9n \u0111o\u00e1n d\u1ef1a v\u00e0o \u0111o \u0111\u1ea1m ni\u1ec7u trong m\u1ed7i 12h, \u1edf t\u01b0 th\u1ebf n\u1eb1m v\u00e0 \u0111\u1ee9ng. Ti\u1ec3u \u0111\u1ea1m di\u1ec5n ti\u1ebfn l\u00e0nh t\u00ednh v\u00e0 t\u1ef1 h\u1ebft.<\/p>\n<p>\u0110\u1ea1m ni\u1ec7u c\u1ed1 \u0111\u1ecbnh: xu\u1ea5t hi\u1ec7n kh\u00f4ng ph\u1ee5 thu\u1ed9c t\u01b0 th\u1ebf; t\u1ed5n th\u01b0\u01a1ng c\u00f3 th\u1ec3 m\u1ea5t \u1edf m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n v\u00e0 t\u1ed5n th\u01b0\u01a1ng c\u1ea7u th\u1eadn g\u00e2y k\u1ebft c\u1ee5c x\u1ea5u \u1edf b\u1ec7nh nh\u00e2n kh\u00e1c. Ti\u00ean l\u01b0\u1ee3ng ph\u1ee5 thu\u1ed9c th\u1eddi gian k\u00e9o d\u00e0i v\u00e0 m\u1ee9c \u0111\u1ed9 ti\u1ec3u \u0111\u1ea1m.<\/p>\n<h3>1.2. Ti\u1ec3u m\u00e1u.<\/h3>\n<p><a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/cac-nguyen-nhan-gay-di-tieu-ra-mau\/\">Ti\u1ec3u m\u00e1u<\/a> l\u00e0 s\u1ef1 hi\u1ec7n di\u1ec7n s\u1ed1 l\u01b0\u1ee3ng l\u1edbn h\u1ed3ng c\u1ea7u trong n\u01b0\u1edbc ti\u1ec3u v\u00e0 \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i th\u00e0nh ti\u1ec3u m\u00e1u vi th\u1ec3 v\u00e0 \u0111\u1ea1i th\u1ec3. Ti\u1ec3u m\u00e1u c\u00f3 th\u1ec3 do t\u1ed5n th\u01b0\u01a1ng c\u1ea7u th\u1eadn nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3 \u1edf v\u1ecb tr\u00ed kh\u00e1c c\u1ee7a \u0111\u01b0\u1eddng ni\u1ec7u.<\/p>\n<p>\u1ede ng\u01b0\u1eddi kh\u1ecfe m\u1ea1nh c\u00f3 th\u1ec3 ti\u1ec3u ra \u0111\u1ebfn 10\u00a0<sup>5 <\/sup>h\u1ed3ng c\u1ea7u trong 12h.M\u1ed9t \u0111\u1ecbnh ngh\u0129a c\u1ee7a ti\u1ec3u m\u00e1u \u0111\u01b0\u1ee3c ch\u1ea5p nh\u1eadn l\u00e0 c\u00f3 t\u1eeb 2 h\u1ed3ng c\u1ea7u tr\u00ean m\u1ed9t quang tr\u01b0\u1eddng \u0111\u1ed9 ph\u00e2n gi\u1ea3i cao. Que nh\u00fang r\u1ea5t nh\u1ea1y, ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c ch\u1ec9 1 &#8211; 2 h\u1ed3ng c\u1ea7u tr\u00ean m\u1ed9t quang tr\u01b0\u1eddng; k\u1ebft qu\u1ea3 que nh\u00fang h\u1ea7u nh\u01b0 lo\u1ea1i tr\u1eeb ti\u1ec3u m\u00e1u.<\/p>\n<p>V\u1ec1 d\u1ecbch t\u1ec5, ti\u1ec3u m\u00e1u c\u00f3 th\u1ec3 c\u00f3 \u1edf 5 &#8211; 6% d\u00e2n s\u1ed1 chung v\u00e0 4% \u1edf l\u1ee9a tu\u1ed5i \u0111i h\u1ecdc. \u1ede ph\u1ea7n l\u1edbn ng\u01b0\u1eddi b\u1ec7nh, ti\u1ec3u m\u00e1u l\u00e0 b\u1ec7nh l\u00fd c\u1ee7a ni\u1ec7u \u0111\u1ea1o, b\u00e0ng quang v\u00e0 tuy\u1ebfn ti\u1ec1n li\u1ec7t.<\/p>\n<h2 id=\"hl0002067\">2. C\u00e1c t\u1ed5n th\u01b0\u01a1ng g\u00e2y h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 v\u00e0 vi\u00eam c\u1ea7u th\u1eadn.<\/h2>\n<p><a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/hoi-chung-hu-chan-doan-va-dieu-tri\/\">H\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0<\/a> x\u1ea3y ra khi \u0111\u1ea1m ni\u1ec7u &gt;3.5g\/ng\u00e0y, \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi ph\u00f9, t\u0103ng lipid m\u00e1u, gi\u1ea3m \u0111\u1ea1m m\u00e1u, v\u00e0 c\u00e1c r\u1ed1i lo\u1ea1n kh\u00e1c. H\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 kh\u00f4ng ch\u1ec9 g\u00e2y ra b\u1ec7nh c\u1ea7u th\u1eadn nguy\u00ean ph\u00e1t m\u00e0 c\u00f2n c\u00f3 th\u1ec3 do nhi\u1ec1u b\u1ec7nh th\u1ee9 ph\u00e1t kh\u00e1c. M\u1ed9t s\u1ed1 nguy\u00ean nh\u00e2n nguy\u00ean ph\u00e1t nh\u01b0 MCD, x\u01a1 chai c\u1ea7u th\u1eadn khu tr\u00fa t\u1eebng v\u00f9ng (FSGS), MN, b\u1ec7nh th\u1eadn IgA.\u00a0 M\u1ed9t s\u1ed1 nguy\u00ean nh\u00e2n th\u1ee9 ph\u00e1t g\u00e2y h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 nh\u01b0:<\/p>\n<ul>\n<li>Thu\u1ed1c, \u0111\u1ed9c ch\u1ea5t: th\u1ee7y ng\u00e2n, v\u00e0ng h\u1eefu c\u01a1, <i>Penicillamine, probenecid, captopril, NSAID.<\/i><\/li>\n<li>D\u1ecb nguy\u00ean: n\u1ecdc ong, ph\u1ea5n hoa, n\u1ecdc r\u1eafn.<\/li>\n<li>Nhi\u1ec5m tr\u00f9ng: vi\u00eam c\u1ea7u th\u1eadn h\u1eadu nhi\u1ec5m li\u00ean c\u1ea7u, vi\u00eam gan B, C, k\u00ed sinh tr\u00f9ng nh\u01b0 s\u1ed1t r\u00e9t, toxoplasma.<\/li>\n<li>Ung th\u01b0: ph\u1ed5i, \u0111\u1ea1i tr\u00e0ng, b\u1ec7nh b\u1ea1ch c\u1ea7u.<\/li>\n<li>B\u1ec7nh h\u1ec7 th\u1ed1ng: lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng, vi\u00eam da c\u01a1, vi\u00eam m\u1ea1ch IgA.<\/li>\n<\/ul>\n<p>Tuy nhi\u00ean, \u0111\u00f4i khi kh\u00f3 ph\u00e2n \u0111\u1ecbnh gi\u1eefa b\u1ec7nh c\u1ea7u th\u1eadn nguy\u00ean ph\u00e1t v\u00e0 th\u1ee9 ph\u00e1t, v\u00ed d\u1ee5 b\u1ec7nh th\u1eadn IgA, vi\u00eam c\u1ea7u th\u1eadn ti\u1ebfn tri\u1ec3n nhanh v\u00e0 vi\u00eam c\u1ea7u th\u1eadn li\u00ean quan m\u1ed9t ph\u1ea7n v\u1edbi mi\u1ec5n d\u1ecbch, vi\u00eam c\u1ea7u th\u1eadn do kh\u00e1ng th\u1ec3 anti-GBM, b\u1ec7nh c\u1ea7u th\u1eadn m\u00e0ng, vi\u00eam c\u1ea7u th\u1eadn t\u0103ng sinh m\u00e0ng c\u00f3 th\u1ec3 x\u1ea3y ra nh\u01b0 m\u1ed9t b\u1ec7nh th\u1eadn nguy\u00ean ph\u00e1t nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3 l\u00e0 bi\u1ec3u hi\u1ec7n c\u1ee7a b\u1ec7nh h\u1ec7 th\u1ed1ng nh\u01b0 vi\u00eam m\u1ea1ch m\u00e1u IgA, vi\u00eam m\u1ea1ch m\u00e1u nh\u1ecf li\u00ean quan mi\u1ec5n d\u1ecbch m\u1ed9t ph\u1ea7n, h\u1ed9i ch\u1ee9ng Goodpasture, lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng (SLE), vi\u00eam m\u1ea1ch cryoglobulin.<\/p>\n<h2>3. C\u00e1c th\u1ec3 t\u1ed5n th\u01b0\u01a1ng b\u1ec7nh h\u1ecdc c\u1ee7a nh\u00f3m b\u1ec7nh nguy\u00ean ph\u00e1t.<\/h2>\n<h3>3.1. Th\u1ec3 sang th\u01b0\u01a1ng t\u1ed1i thi\u1ec3u (MCD).<\/h3>\n<p>MCD \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 \u0111\u1ea7u ti\u00ean n\u1eb1m 1913 b\u1edfi Munk, \u00f4ng g\u1ecdi n\u00f3 l\u00e0 b\u1ec7nh c\u1ea7u th\u1eadn m\u1ee1 do s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a lipid trong t\u1ebf b\u00e0o bi\u1ec3u m\u00f4 \u1ed1ng th\u1eadn v\u00e0 n\u01b0\u1edbc ti\u1ec3u.<\/p>\n<p>V\u1ec1 b\u1ec7nh h\u1ecdc, MCD cho h\u00ecnh \u1ea3nh m\u1ea5t c\u00e1c tua c\u1ee7a ch\u00e2n gi\u1ea3 (podocyte) v\u00e0 t\u0103ng m\u1eadt \u0111\u1ed9 khung x\u01b0\u01a1ng t\u1ebf b\u00e0o (cytoskeleton) nh\u01b0 vi s\u1ee3i actin, ch\u00fang k\u1ebft c\u1ee5m g\u1ea7n m\u00e0ng \u0111\u00e1y c\u1ee7a ch\u00e2n gi\u1ea3. M\u1ee9c \u0111\u1ed9 m\u1ea5t tua ch\u00e2n gi\u1ea3 li\u00ean quan th\u1eddi gian h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 ho\u1ea1t \u0111\u1ed9ng h\u01a1n l\u00e0 m\u1ee9c \u0111\u1ed9 ti\u1ec3u \u0111\u1ea1m. Tr\u00ean k\u00ednh hi\u1ec3n vi \u0111i\u1ec7n t\u1eed kh\u00f4ng th\u1ea5y t\u1ed5n th\u01b0\u01a1ng c\u1ea7u th\u1eadn, ch\u1ec9 th\u1ea5y t\u0103ng sinh gian m\u1ea1ch t\u1eebng \u1ed5 nh\u1ecf.<\/p>\n<p>Sinh b\u1ec7nh h\u1ecdc c\u1ee7a MCD kh\u00f4ng r\u00f5 r\u00e0ng, c\u00f3 th\u1ec3 do h\u1eadu qu\u1ea3 c\u1ee7a r\u1ed1i lo\u1ea1n \u0111i\u1ec1u h\u00f2a lympho T. B\u1eb1ng ch\u1ee9ng l\u00e0 b\u1ec7nh c\u00f3 \u0111\u00e1p \u1ee9ng t\u1ed1t v\u1edbi corticosteroid v\u00e0 c\u00e1c thu\u1ed1c alkyl h\u00f3a gi\u00fap lui b\u1ec7nh MCD.<\/p>\n<p>Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng v\u00e0 di\u1ec5n ti\u1ebfn c\u1ee7a b\u1ec7nh:<\/p>\n<ul>\n<li>Kh\u1edfi ph\u00e1t ti\u1ec3u \u0111\u1ea1m nhi\u1ec1u \u0111\u1ed9t ng\u1ed9t.<\/li>\n<li>Gi\u1ea3m albumin m\u00e1u.<\/li>\n<li>T\u0103ng lipid m\u00e1u.<\/li>\n<li>Ph\u00f9.<\/li>\n<li>\u0110\u00e1i m\u00e1u v\u00e0 ph\u00f9 \u00edt g\u1eb7p \u1edf tr\u1ebb em.<\/li>\n<li>\u1ede ng\u01b0\u1eddi l\u1edbn th\u01b0\u1eddng g\u1eb7p t\u0103ng huy\u1ebft, suy th\u1eadn.<\/li>\n<li>Ng\u01b0\u1eddi tr\u00ean 60 tu\u1ed5i chi\u1ebfm h\u01a1n 1\/4 MCD \u1edf ng\u01b0\u1eddi l\u1edbn.<\/li>\n<li id=\"hl0002223\">Li\u00ean quan v\u1edbi nhi\u1ec5m tr\u00f9ng, thu\u1ed1c, b\u1ec7nh \u00e1c t\u00ednh, d\u1ecb nguy\u00ean.<\/li>\n<li>Bi\u1ebfn ch\u1ee9ng t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p (AKI) th\u01b0\u1eddng g\u1eb7p \u1edf b\u1ec7nh nh\u00e2n &gt;40 tu\u1ed5i.<\/li>\n<li>MCD c\u00f3 th\u1ec3 g\u00e2y gi\u1ea3m m\u1eadt \u0111\u1ed9 x\u01b0\u01a1ng, do s\u1eed d\u1ee5ng corticoid v\u00e0 thi\u1ebfu vitamin D. S\u1eed d\u1ee5ng statin c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n.<\/li>\n<\/ul>\n<h3>3.2. Th\u1ec3 x\u01a1 chai khu tr\u00fa t\u1eebng v\u00f9ng (FSGS).<\/h3>\n<p>X\u01a1 chai c\u1ea7u th\u1eadn khu tr\u00fa t\u1eebng v\u00f9ng (FSGS) l\u00e0 m\u1ed9t thu\u1eadt ng\u1eef ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng &#8211; b\u1ec7nh h\u1ecdc g\u00e2y ra do nhi\u1ec1u nguy\u00ean nh\u00e2n v\u00e0 c\u01a1 ch\u1ebf b\u1ec7nh sinh h\u01a1n l\u00e0 m\u1ed9t b\u1ec7nh ri\u00eang l\u1ebb. \u0110\u1eb7c tr\u01b0ng c\u1ee7a b\u1ec7nh l\u00e0 \u0111\u1ea1m ni\u1ec7u, c\u00f3 th\u1ec3 ng\u01b0\u1ee1ng th\u1eadn h\u01b0 ho\u1eb7c kh\u00f4ng. \u0110\u1eb7c tr\u01b0ng v\u1ec1 b\u1ec7nh h\u1ecdc l\u00e0 c\u00f3 s\u1ef1 \u0111\u00f4ng \u0111\u1eb7c, x\u01a1 h\u00f3a c\u1ea7u th\u1eadn khu tr\u00fa t\u1eebng v\u00f9ng.<\/p>\n<p>FSGS c\u00f3 th\u1ec3 nguy\u00ean ph\u00e1t nh\u01b0: FSGS kh\u00f4ng \u0111\u1eb7c hi\u1ec7u, FSGS v\u00f9ng \u0111\u1ec9nh, d\u1ea1ng t\u1ebf b\u00e0o, d\u1ea1ng x\u1eb9p, d\u1ea1ng quanh r\u1ed1n c\u1ea7u th\u1eadn.<\/p>\n<p>FSGS th\u1ee9 ph\u00e1t nh\u01b0 k\u00e8m HIV, l\u1ea1m d\u1ee5ng thu\u1ed1c t\u0129nh m\u1ea1ch, steroid \u0111\u1ed3ng h\u00f3a, interferon, gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng nephron.<\/p>\n<h3>3.3. B\u1ec7nh c\u1ea7u th\u1eadn do b\u1ed5 th\u1ec3 C1q.<\/h3>\n<p id=\"hl0002138\">L\u00e0 b\u1ec7nh hi\u1ebfm, c\u00f3 th\u1ec3 g\u00e2y \u0111\u1ea1m ni\u1ec7u v\u00e0 h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0.<\/p>\n<p>Ch\u1ea9n \u0111o\u00e1n d\u1ef1a v\u00e0o s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a l\u1eafng \u0111\u1ecdng ph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch \u1edf gian m\u1ea1ch, v\u00e0 b\u1eaft m\u00e0u C1q \u1edf b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng c\u1ee7a lupus.<\/p>\n<p>B\u1ec7nh c\u1ea7u th\u1eadn C1q c\u00f3 \u0111\u1ea1m ni\u1ec7u, c\u00f3 th\u1ec3 ng\u01b0\u1ee1ng th\u1eadn h\u01b0 ho\u1eb7c kh\u00f4ng, \u0111\u00e1i m\u00e1u g\u1eb7p 50% tr\u01b0\u1eddng h\u1ee3p. B\u1ec7nh \u0111a s\u1ed1 kh\u00f4ng tri\u1ec7u ch\u1ee9ng, \u0111\u1ea1m ni\u1ec7u ph\u00e1t hi\u1ec7n t\u00ecnh c\u1edd. B\u1ec7nh c\u00f3 th\u1ec3 t\u1ef1 kh\u1ecfi t\u1eeb t\u1eeb.<\/p>\n<h3>3.4. B\u1ec7nh c\u1ea7u th\u1eadn m\u00e0ng (MN).<\/h3>\n<p>MN l\u00e0 nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p nh\u1ea5t g\u00e2y h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 \u1edf ng\u01b0\u1eddi l\u1edbn. MN c\u00f3 th\u1ec3 l\u00e0 b\u1ec7nh c\u1ea7u th\u1eadn nguy\u00ean ph\u00e1t n\u1ebfu g\u00e2y ra do autoantibodies specific for M-type phospholipase A2 receptor (PLA2R), ho\u1eb7c th\u1ee9 ph\u00e1t do b\u1ec7nh t\u1ef1 mi\u1ec5n ngo\u00e0i th\u1eadn nh\u01b0 SLE, vi\u00eam gi\u00e1p t\u1ef1 mi\u1ec5n, nhi\u1ec5m tr\u00f9ng (hepatitis B, hepatitis C, s\u1ed1t r\u00e9t), thu\u1ed1c (nh\u01b0 penicillamine, v\u00e0ng), ung th\u01b0 (\u0111\u1ea1i tr\u00e0ng, ph\u1ed5i). MN th\u1ee9 ph\u00e1t th\u01b0\u1eddng g\u1eb7p nh\u1ea5t do vi\u00eam gan B v\u00e0 lupus, g\u1eb7p nhi\u1ec1u \u1edf tr\u1ebb em h\u01a1n ng\u01b0\u1eddi l\u1edbn. \u1ede ng\u01b0\u1eddi tr\u00ean 60 tu\u1ed5i, MN li\u00ean quan v\u1edbi b\u1ec7nh \u00e1c t\u00ednh trong 20 &#8211; 30% tr\u01b0\u1eddng h\u1ee3p.<\/p>\n<p>Soi hi\u1ec3n vi cho th\u1ea5y h\u00ecnh \u1ea3nh l\u1eafng \u0111\u1ecdng ph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch nh\u1ecf, gi\u00e0u electron \u1edf v\u00f9ng d\u01b0\u1edbi bi\u1ec3u m\u00f4 gi\u1eefa m\u00e0ng \u0111\u00e1y v\u00e0 ch\u00e2n gi\u1ea3.<\/p>\n<h3>3.5. Vi\u00eam c\u1ea7u th\u1eadn t\u0103ng sinh m\u00e0ng.<\/h3>\n<section id=\"hl0002141\">Vi\u00eam c\u1ea7u th\u1eadn m\u00e0ng nguy\u00ean ph\u00e1t (MPGN) l\u00e0 th\u1ec3 b\u1ec7nh t\u1eadp h\u1ee3p c\u1ee7a nhi\u1ec1u t\u1ed5n th\u01b0\u01a1ng kh\u00e1c nhau v\u1ec1 c\u01a1 ch\u1ebf. MPGN ph\u00e2n lo\u1ea1i d\u1ef1a tr\u00ean k\u00ednh hi\u1ec3u vi \u0111i\u1ec7n t\u1eed th\u00e0nh 3 lo\u1ea1i: type I (l\u1eafng \u0111\u1ecdng d\u01b0\u1edbi n\u1ed9i m\u00f4 v\u00e0 gian m\u1ea1ch), type II (l\u1eafng \u0111\u1ecdng d\u01b0\u1edbi m\u00e0ng \u0111\u00e1y) v\u00e0 type III (l\u1eafng \u0111\u1ecdng d\u01b0\u1edbi n\u1ed9i m\u00f4 v\u00e0 d\u01b0\u1edbi m\u00e0ng \u0111\u00e1y).\u00a0<\/section>\n<h3><a href=\"https:\/\/vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/viem-cau-cap-sau-nhiem-lien-cau-khuan-nhung-dieu-can-biet\/\">3.6. Vi\u00eam c\u1ea7u th\u1eadn h\u1eadu nhi\u1ec5m li\u00ean c\u1ea7u.\u00a0<\/a><\/h3>\n<p>Th\u01b0\u1eddng g\u1eb7p \u1edf tr\u1ebb em, \u0111\u1ec9nh tu\u1ed5i t\u1eeb 2 &#8211; 6 tu\u1ed5i. B\u1ec7nh kh\u1edfi ph\u00e1t \u0111\u1ed9t ng\u1ed9t ti\u1ec3u m\u00e1u, ti\u1ec3u \u0111\u1ea1m, t\u0103ng huy\u1ebft \u00e1p, t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p.<\/p>\n<h3>3.7. <a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/benh-iga-co-nguy-hiem-khong-dieu-tri-nhu-nao\/\">B\u1ec7nh th\u1eadn IgA.<\/a><\/h3>\n<p>B\u1ec7nh th\u1eadn IgA c\u00f3 th\u1ec3 nguy\u00ean ph\u00e1t ho\u1eb7c th\u1ee9 ph\u00e1t li\u00ean quan v\u1edbi vi\u00eam m\u1ea1ch m\u00e1u IgA, toxoplasma, HIV,&#8230;Th\u01b0\u1eddng g\u1eb7p \u1edf \u0111\u1ed9 tu\u1ed5i t\u1eeb 20- 30.<\/p>\n<h3>3.8. Vi\u00eam c\u1ea7u th\u1eadn ti\u1ebfn tri\u1ec3n nhanh.<\/h3>\n<p>B\u1ec7nh \u0111\u1eb7c tr\u01b0ng b\u1edfi m\u1ea5t ch\u1ee9c n\u0103ng th\u1eadn nhanh, c\u00f3 th\u1ec3 k\u00e8m theo thi\u1ec3u ni\u1ec7u ho\u1eb7c v\u00f4 ni\u1ec7u v\u00e0 vi\u00eam c\u1ea7u th\u1eadn nh\u01b0 h\u1ed3ng c\u1ea7u ni\u1ec7u bi\u1ebfn d\u1ea1ng, tr\u1ee5 h\u1ed3ng c\u1ea7u, ti\u1ec3u \u0111\u1ea1m.<\/p>\n<p>T\u00e0i li\u1ec7u tham kh\u1ea3o:<\/p>\n<p>Brenner and Rector&#8217;s the kidney, eleventh edition.<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>B\u1ec7nh c\u1ea7u th\u1eadn \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i th\u00e0nh nh\u00f3m c\u00e1c b\u1ec7nh ch\u1ec9 t\u1ed5n th\u01b0\u01a1ng \u1edf th\u1eadn (b\u1ec7nh c\u1ea7u th\u1eadn nguy\u00ean ph\u00e1t) v\u00e0 nh\u00f3m t\u1ed5n th\u01b0\u01a1ng \u1edf th\u1eadn ch\u1ec9 l\u00e0 m\u1ed9t ph\u1ea7n c\u1ee7a r\u1ed1i lo\u1ea1n h\u1ec7 th\u1ed1ng (b\u1ec7nh c\u1ea7u th\u1eadn th\u1ee9 ph\u00e1t). B\u00e0y vi\u1ebft n\u00e0y ch\u1ec9 \u0111\u1ec1 c\u1eadp \u0111\u1ebfn b\u1ec7nh c\u1ea7u th\u1eadn nguy\u00ean ph\u00e1t.\u00a0 1. C\u00e1c h\u1ed9i [&hellip;]<\/p>\n","protected":false},"author":69,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[29,33],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>B\u1ec7nh c\u1ea7u th\u1eadn nguy\u00ean ph\u00e1t: c\u00e1c t\u1ed5n th\u01b0\u01a1ng b\u1ec7nh h\u1ecdc - Vinmec<\/title>\n<meta name=\"description\" content=\"B\u1ec7nh c\u1ea7u th\u1eadn nguy\u00ean ph\u00e1t g\u1ed3m c\u00e1c th\u1ec3: sang th\u01b0\u01a1ng t\u1ed1i thi\u1ec3u, x\u01a1 chai khu tr\u00fa, b\u1ec7nh th\u1eadn m\u00e0ng, b\u1ec7nh th\u1eadn IgA, h\u1eadu nhi\u1ec5m li\u00ean c\u1ea7u.\" \/>\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 c\u1ea7u th\u1eadn nguy\u00ean ph\u00e1t: c\u00e1c t\u1ed5n th\u01b0\u01a1ng b\u1ec7nh h\u1ecdc - 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