{"id":32677,"date":"2023-05-08T23:36:19","date_gmt":"2023-05-08T16:36:19","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=32677"},"modified":"2023-05-08T23:36:19","modified_gmt":"2023-05-08T16:36:19","slug":"benh-cau-than-nguyen-phat-dich-te-hoc-va-dieu-tri","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/08\/benh-cau-than-nguyen-phat-dich-te-hoc-va-dieu-tri\/","title":{"rendered":"B\u1ec7nh c\u1ea7u th\u1eadn nguy\u00ean ph\u00e1t: d\u1ecbch t\u1ec5 h\u1ecdc v\u00e0 \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"

B\u1ec7nh c\u1ea7u th\u1eadn<\/a> \u0111\u01b0\u1ee3c xem l\u00e0 nguy\u00ean ph\u00e1t khi b\u1ec7nh ch\u1ec9 c\u00f3 bi\u1ec3u hi\u1ec7n c\u1ee7a t\u1ed5n th\u01b0\u01a1ng th\u1eadn, khi t\u1ed5n th\u01b0\u01a1ng th\u1eadn l\u00e0 m\u1ed9t ph\u1ea7n c\u1ee7a b\u1ec7nh l\u00fd h\u1ec7 th\u1ed1ng, b\u1ec7nh c\u1ea7u th\u1eadn \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 th\u1ee9 ph\u00e1t. \u0110\u00f4i khi kh\u00f3 ph\u00e2n bi\u1ec7t gi\u1eefa nguy\u00ean ph\u00e1t v\u00e0 th\u1ee9 ph\u00e1t. B\u1ec7nh bi\u1ec3u hi\u1ec7n tr\u00ean l\u00e2m s\u00e0ng b\u1edfi ti\u1ec3u m\u00e1u, ti\u1ec3u \u0111\u1ea1m, ph\u00f9, t\u0103ng huy\u1ebft \u00e1p, h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 ho\u1eb7c h\u1ed9i ch\u1ee9ng th\u1eadn vi\u00eam. B\u00e0i n\u00e0y \u0111\u1ec1 c\u1eadp v\u1ec1 c\u00e1c y\u1ebfu t\u1ed1 d\u1ecbch t\u1ec5 g\u1ee3i \u00fd b\u1ec7nh v\u00e0 h\u01b0\u1edbng \u0111i\u1ec1u tr\u1ecb c\u1ee7a t\u1eebng th\u1ec3 b\u1ec7nh.<\/strong><\/p>\n

1. D\u1ecbch t\u1ec5 h\u1ecdc c\u1ee7a c\u00e1c th\u1ec3 b\u1ec7nh c\u1ea7u th\u1eadn nguy\u00ean ph\u00e1t.<\/h2>\n

1.1. Th\u1ec3 sang th\u01b0\u01a1ng t\u1ed1i thi\u1ec3u (MCD).<\/h3>\n

MCD th\u01b0\u1eddng g\u1eb7p nh\u1ea5t \u1edf tr\u1ebb em, chi\u1ebfm 70 – 90% h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0<\/a> (NS) \u1edf tr\u1ebb em d\u01b0\u1edbi 10 tu\u1ed5i v\u00e0 chi\u1ebfm 50% \u1edf ng\u01b0\u1eddi l\u1edbn. MCD c\u0169ng g\u00e2y 10 – 15% h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 nguy\u00ean ph\u00e1t \u1edf ng\u01b0\u1eddi l\u1edbn.<\/p>\n

T\u1ec9 l\u1ec7 m\u1edbi m\u1eafc thay \u0111\u1ed5i t\u00f9y theo v\u00f9ng \u0111\u1ecba l\u00fd, g\u1eb7p nhi\u1ec1u \u1edf Ch\u00e2u \u00c1 h\u01a1n B\u1eafc M\u1ef9 hay Ch\u00e2u \u00c2u. \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 do s\u1ef1 kh\u00e1c bi\u1ec7t v\u1ec1 t\u1ec9 l\u1ec7 sinh thi\u1ebft th\u1eadn v\u00e0 m\u00f4i tr\u01b0\u1eddng, y\u1ebfu t\u1ed1 gen.<\/p>\n

B\u1ec7nh c\u0169ng c\u00f3 th\u1ec3 g\u1eb7p \u1edf ng\u01b0\u1eddi cao tu\u1ed5i, v\u00e0 th\u01b0\u1eddng k\u00e8m t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p.<\/p>\n

B\u1ec7nh chi\u1ebfm \u01b0u th\u1ec3 \u1edf nam v\u1edbi t\u1ec9 l\u1ec7 nam:n\u1eef t\u1eeb 2:1 \u0111\u1ebfn 3:1 theo c\u00e1c nghi\u00ean c\u1ee9u.<\/p>\n

1.2. Th\u1ec3 x\u01a1 chai c\u1ea7u th\u1eadn khu tr\u00fa t\u1eebng v\u00f9ng (FSGS).<\/h3>\n

Trong v\u00f2ng 2 th\u1eadp k\u1ec9 qua, t\u1ec9 l\u1ec7 m\u1eafc m\u1edbi c\u1ee7a FSGS ng\u00e0y c\u00e0ng t\u0103ng, bi\u1ec3u hi\u1ec7n b\u1edfi s\u1ed1 b\u1ec7nh nh\u00e2n tuy\u1ec7t \u0111\u1ed1i ho\u1eb7c t\u1ec9 l\u1ec7 trong nh\u00f3m b\u1ec7nh th\u1eadn giai \u0111o\u1ea1n cu\u1ed1i<\/a> (ESKD). S\u1ef1 t\u0103ng t\u1ec9 l\u1ec7 m\u1eafc n\u00e0y c\u00f3 th\u1ec3 do t\u0103ng m\u1ee9c \u0111\u1ed9 ch\u1ea9n \u0111o\u00e1n nh\u1edd sinh thi\u1ebft th\u1eadn. M\u1ed9t nghi\u00ean c\u1ee9u th\u1ed1ng k\u00ea k\u1ebft qu\u1ea3 sinh thi\u1ebft th\u1eadn t\u1eeb 1974 – 2003 \u1edf bang Minnesota (90% l\u00e0 ng\u01b0\u1eddi da tr\u1eafng), cho t\u1ec9 l\u1ec7 FSGS l\u00e0 17% trong c\u00e1c vi\u00eam c\u1ea7u th\u1eadn, \u0111\u1ee9ng th\u1ee9 hai sau b\u1ec7nh th\u1eadn IgA (22%) v\u00e0 th\u01b0\u1eddng g\u1eb7p h\u01a1n b\u1ec7nh c\u1ea7u th\u1eadn m\u00e0ng (10%). Nghi\u00ean c\u1ee9u c\u0169ng cho th\u1ea5y t\u1ec9 l\u1ec7 FSGS t\u0103ng g\u1ea5p 13 l\u1ea7n, so v\u1edbi g\u1ea5p \u0111\u00f4i \u0111\u1ed1i v\u1edbi c\u00e1c b\u1ec7nh c\u1ea7u th\u1eadn n\u00f3i chung.<\/p>\n

1.3. B\u1ec7nh c\u1ea7u th\u1eadn m\u00e0ng (MN).<\/h3>\n

MN l\u00e0 nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p nh\u1ea5t g\u00e2y NS \u1edf ng\u01b0\u1eddi l\u1edbn. MN l\u00e0 nguy\u00ean nh\u00e2n c\u1ee7a 25% ng\u01b0\u1eddi l\u1edbn c\u00f3 NS. M\u1ed9t nghi\u00ean c\u1ee9u c\u1ee7a H\u1ed9i \u0111\u1ed3ng nghi\u00ean c\u1ee9u Y khoa c\u1ee7a Anh th\u1ed1ng k\u00ea t\u1ea7n su\u1ea5t ng\u01b0\u1eddi c\u00f3 ti\u1ec3u \u0111\u1ea1m >1g\/24h t\u1eeb n\u0103m 1978 – 1990, cho th\u1ea5y c\u00f3 20% trong s\u1ed1 \u0111\u00f3 c\u00f3 MN.<\/p>\n

\u0110\u1ec9nh tu\u1ed5i m\u1eafc b\u1ec7nh cao nh\u1ea5t v\u00e0o 40 – 50 tu\u1ed5i. B\u1ec7nh th\u01b0\u1eddng g\u1eb7p \u1edf nam h\u01a1n n\u1eef, t\u1ec9 l\u1ec7 nam: n\u1eef l\u00e0 2:1. T\u1ec9 s\u1ed1 gi\u1eefa ng\u01b0\u1eddi l\u1edbn v\u00e0 tr\u1ebb em l\u00e0 26:1. B\u1ec7nh g\u1eb7p \u1edf m\u1ecdi ch\u1ee7ng t\u1ed9c.<\/p>\n

M\u1eb7c d\u00f9 \u0111a s\u1ed1 b\u1ec7nh nh\u00e2n MN c\u00f3 NS, c\u00f3 10 – 20% b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u1ea1m ni\u1ec7u <2g\/ng\u00e0y. \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 do t\u1ea7n s\u1ed1t\u00ednh to\u00e1n th\u1ea5p h\u01a1n MN trong d\u00e2n s\u1ed1 do b\u1ec7nh kh\u00f4ng tri\u1ec7u ch\u1ee9ng.<\/p>\n

MN c\u00f3 li\u00ean quan v\u1edbi b\u1ec7nh \u00e1c t\u00ednh \u0111ang m\u1eafc. \u0110\u00f4i khi ung th\u01b0 kh\u00f4ng tri\u1ec7u ch\u1ee9ng m\u00e0 ng\u01b0\u1eddi b\u1ec7nh \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n nh\u1edd MN. Y\u1ebfu t\u1ed1 d\u1ef1 \u0111o\u00e1n b\u1ec7nh \u00e1c t\u00ednh \u1edf b\u1ec7nh nh\u00e2n MN g\u1ed3m: tu\u1ed5i cao, ti\u1ec1n s\u1eed h\u00fat thu\u1ed1c.<\/p>\n

1.4. B\u1ec7nh c\u1ea7u th\u1eadn t\u0103ng sinh m\u00e0ng (MPGN).<\/h3>\n

Ph\u1ea7n l\u1edbn b\u1ec7nh nh\u00e2n MPGN l\u00e0 tr\u1ebb em t\u1eeb 8 – 16 tu\u1ed5i, chi\u1ebfm 90% tr\u01b0\u1eddng h\u1ee3p MPGN type I. T\u1ec9 l\u1ec7 nam n\u1eef b\u1eb1ng nhau.<\/p>\n

MPGN type III hi\u1ebfm h\u01a1n, g\u1eb7p \u1edf tr\u1ebb em v\u00e0 v\u1ecb th\u00e0nh ni\u00ean.<\/p>\n

MPGN type II chi\u1ebfm 25% MPGN \u1edf tr\u1ebb em nh\u01b0ng \u00edt g\u1eb7p \u1edf ng\u01b0\u1eddi l\u1edbn. Ph\u1ea7n l\u1edbn b\u1ec7nh nh\u00e2n l\u00e0 tr\u1ebb em t\u1eeb 8 – 16 tu\u1ed5i, chi\u1ebfm 70% tr\u01b0\u1eddng h\u1ee3p. S\u1ed1 ng\u01b0\u1eddi m\u1eafc kho\u1ea3ng 2 – 3 tri\u1ec7u ng\u01b0\u1eddi, t\u1ec9 l\u1ec7 nam n\u1eef g\u1ea7n t\u01b0\u01a1ng \u0111\u01b0\u01a1ng nhau.<\/p>\n

1.5. Vi\u00eam c\u1ea7u th\u1eadn h\u1eadu nhi\u1ec5m li\u00ean c\u1ea7u<\/a> (PSGN).<\/h3>\n

PSGN l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd \u1ea3nh h\u01b0\u1edfng ch\u1ee7 y\u1ebfu \u1edf tr\u1ebb em, t\u1ec9 l\u1ec7 m\u1eafc m\u1edbi cao nh\u1ea5t g\u1eb7p t\u1eeb 2 – 6 tu\u1ed5i. Tr\u1ebb em d\u01b0\u1edbi 2 tu\u1ed5i v\u00e0 ng\u01b0\u1eddi l\u1edbn tr\u00ean 40 ch\u1ec9 chi\u1ebfm 15%. Nam th\u01b0\u1eddng g\u1eb7p m\u1eafc vi\u00eam c\u1ea7u th\u1eadn r\u00f5 h\u01a1n n\u1eef. PSGN c\u1ea5p c\u00f3 th\u1ec3 x\u1ea3y ra theo m\u00f9a ho\u1eb7c b\u1ec7nh l\u01b0u h\u00e0nh. Trong \u0111\u1ee3t b\u1ec7nh l\u01b0u h\u00e0nh, nhi\u1ec5m streptococci \u0111\u01b0\u1ee3c xem l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y b\u1ec7nh, t\u1ec9 l\u1ec7 b\u1ec7nh to\u00e0n ph\u00e1t kho\u1ea3ng 12%, c\u00f3 th\u1ec3 \u0111\u1ebfn 33% ho\u1eb7c 38%.<\/p>\n

T\u1ec9 l\u1ec7 PSGN hi\u1ec7n \u0111ang gi\u1ea3m \u1edf c\u00e1c n\u01b0\u1edbc ph\u00e1t tri\u1ec3n v\u00e0 v\u1eabn \u0111ang t\u0103ng \u1edf nh\u1eefng n\u01b0\u1edbc k\u00e9m ph\u00e1t tri\u1ec3n. T\u1ec9 l\u1ec7 m\u1eafc m\u1edbi trung b\u00ecnh \u1edf tr\u1ebb em kho\u1ea3ng 24 ca\/100,000 ng\u01b0\u1eddi – n\u0103m.<\/p>\n

1.6. B\u1ec7nh th\u1eadn IgA.<\/h3>\n

B\u1ec7nh th\u1eadn IgA<\/a> v\u1eabn l\u00e0 th\u1ec3 th\u01b0\u1eddng g\u1eb7p nh\u1ea5t c\u1ee7a vi\u00eam c\u1ea7u th\u1eadn, \u0111\u1eb7c bi\u1ec7t \u1edf c\u00e1c n\u01b0\u1edbc ph\u00e1t tri\u1ec3n c\u00f3 t\u1ec9 l\u1ec7 b\u1ec7nh truy\u1ec1n nhi\u1ec5m th\u1ea5p.<\/p>\n

B\u1ec7nh \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 \u0111\u1ea7u ti\u00ean n\u0103m 1960 b\u1edfi Berger v\u00e0 Hinglais, r\u1ed1i lo\u1ea1n \u0111\u1eb7c tr\u01b0ng b\u1edfi l\u1eafng \u0111\u1ecdng IgA \u1edf gian m\u1ea1ch, k\u00e8m t\u0103ng sinh gian m\u1ea1ch v\u00e0 bi\u1ec3u hi\u1ec7n \u0111a d\u1ea1ng t\u1eeb \u0111\u00e1i m\u00e1u kh\u00f4ng tri\u1ec7u ch\u1ee9ng t\u1edbi vi\u00eam c\u1ea7u th\u1eadn ti\u1ebfn tri\u1ec3n nhanh.<\/p>\n

L\u00e0 b\u1ec7nh l\u00e0nh t\u00ednh, nh\u01b0ng c\u00f3 th\u1ec3 c\u00f3 t\u1edbi 40% b\u1ec7nh nh\u00e2n di\u1ec5n ti\u1ebfn \u0111\u1ebfn b\u1ec7nh th\u1eadn giai \u0111o\u1ea1n cu\u1ed1i.<\/p>\n

B\u1ec7nh g\u1eb7p \u1edf m\u1ecdi nh\u00f3m tu\u1ed5i, nh\u01b0ng th\u01b0\u1eddng g\u1eb7p h\u01a1n \u1edf \u0111\u1ed9 tu\u1ed5i t\u1eeb 20 – 30 v\u00e0 nhi\u1ec1u h\u01a1n \u1edf nam so v\u1edbi n\u1eef. B\u1ec7nh \u00edt g\u1eb7p \u1edf tr\u1ebb <10 tu\u1ed5i. C\u00f3 80% b\u1ec7nh nh\u00e2n tu\u1ed5i t\u1eeb 16 – 35 t\u1ea1i l\u00fac sinh thi\u1ebft th\u1eadn.<\/p>\n

L\u00e0 th\u1ec3 b\u1ec7nh c\u1ea7u th\u1eadn nguy\u00ean ph\u00e1t th\u01b0\u1eddng g\u1eb7p nh\u1ea5t \u1edf Ch\u00e2u \u00c1, chi\u1ebfm t\u1edbi 30 – 40% c\u00e1c ca sinh thi\u1ebft th\u1eadn.<\/p>\n

2. H\u01b0\u1edbng \u0111i\u1ec1u tr\u1ecb c\u00e1c th\u1ec3 t\u1ed5n th\u01b0\u01a1ng c\u1ee7a b\u1ec7nh.<\/h2>\n

2.1. Th\u1ec3 sang th\u01b0\u01a1ng t\u1ed1i thi\u1ec3u (MCD).<\/h3>\n

Li\u1ec7u ph\u00e1p corticosteroid l\u00e0 ti\u1ebfp c\u1eadn \u0111i\u1ec1u tr\u1ecb chung cho MCD. \u1ede tr\u1ebb em, li\u1ec1u prednisone is 60\u202fmg\/m\u00a02<\/sup> \/day; \u1edf ng\u01b0\u1eddi l\u1edbn, li\u1ec1u prednisone l\u00e0 1mg\/kg\/ng\u00e0y kh\u00f4ng qu\u00e1 80mg\/ng\u00e0y.<\/p>\n

\u1ede tr\u1ebb em li\u1ec7u ph\u00e1p n\u00e0y c\u00f3 th\u1ec3 \u0111\u1ea1t lui b\u1ec7nh ho\u00e0n to\u00e0n, 90% m\u1ea5t \u0111\u1ea1m ni\u1ec7u sau 4 – 6 tu\u1ea7n \u0111i\u1ec1u tr\u1ecb. \u0110\u00e1p \u1ee9ng prednisone n\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u1ea1m ni\u1ec7u \u00e2m t\u00ednh qua que nh\u00fang ho\u1eb7c t\u1ed5ng ph\u00e2n t\u00edch n\u01b0\u1edbc ti\u1ec3u trong 3 ng\u00e0y.<\/p>\n

\u0110i\u1ec1u tr\u1ecb c\u1ea7n k\u00e9o d\u00e0i \u00edt nh\u1ea5t 6 tu\u1ea7n, sau 6 tu\u1ea7n n\u00e0y, li\u1ec1u c\u00f3 th\u1ec3 thay \u0111\u1ed5i c\u00e1ch nh\u1eadt ho\u1eb7c gi\u1ea3m li\u1ec1u h\u1eb1ng ng\u00e0y t\u1eebng b\u01b0\u1edbc. Khi \u0111\u1ea1t lui b\u1ec7nh, c\u00f3 th\u1ec3 gi\u1ea3m li\u1ec1u c\u00f2n 40\u202fmg\/m\u00a02<\/sup> \/day \u1edf tr\u1ebb em.<\/p>\n

V\u1edbi ng\u01b0\u1eddi l\u1edbn m\u1eafc MCD, \u0111\u00e1p \u1ee9ng corticoid c\u1ea7n t\u1edbi 15 tu\u1ea7n.<\/p>\n

\u1ede tr\u1ebb em ch\u01b0a \u0111\u01b0\u1ee3c sinh thi\u1ebft th\u1eadn tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb, n\u00ean c\u00e2n nh\u1eafc sinh thi\u1ebft th\u1eadn n\u1ebfu th\u1ea5t b\u1ea1i v\u1edbi \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb 4 – 6 tu\u1ea7n prednisone. B\u00e1c s\u0129 c\u0169ng c\u1ea7n xem x\u00e9t sinh thi\u1ebft th\u1eadn l\u00fac kh\u1edfi ph\u00e1t b\u1ec7nh n\u1ebfu c\u00f3 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng g\u1ee3i \u00fd ch\u1ea9n \u0111o\u00e1n th\u1ec3 b\u1ec7nh kh\u00e1c MCD nh\u01b0 c\u00f3 t\u0103ng huy\u1ebft \u00e1p, tr\u1ee5 h\u1ed3ng c\u1ea7u n\u01b0\u1edbc ti\u1ec3u, gi\u1ea3m b\u1ed5 th\u1ec3 ho\u1eb7c h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 (NS) kh\u1edfi ph\u00e1t trong n\u0103m \u0111\u1ea7u \u0111\u1eddi, sau 6 tu\u1ed5i.<\/p>\n

Sau \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng ban \u0111\u1ea7u v\u1edbi \u0111i\u1ec1u tr\u1ecb, kho\u1ea3ng 25% s\u1ebd lui b\u1ec7nh k\u00e9o d\u00e0i v\u00e0 25 – 30% t\u00e1i ph\u00e1t kh\u00f4ng th\u01b0\u1eddng xuy\u00ean (kh\u00f4ng qu\u00e1 1 l\u1ea7n\/n\u0103m) v\u00e0 s\u1ed1 c\u00f2n l\u1ea1i t\u00e1i ph\u00e1t th\u01b0\u1eddng xuy\u00ean, ph\u1ee5 thu\u1ed9c steroid, \u0111\u1ec1 kh\u00e1ng steroid.<\/p>\n

\u0110\u1ec3 \u0111\u1ea1t lui b\u1ec7nh, sau li\u1ec7u ph\u00e1p prednisone ng\u01b0\u1eddi ta d\u00f9ng cyclophosphamide u\u1ed1ng li\u1ec1u 2mg\/kg\/ng\u00e0y trong 8 – 12 tu\u1ea7n, 75% b\u1ec7n nh\u00e2n h\u1ebft \u0111\u1ea1m ni\u1ec7u trong \u00edt nh\u1ea5t 2 n\u0103m. \u0110\u00e1p \u1ee9ng cyclophosphamide c\u00f3 th\u1ec3 d\u1ef1 \u0111o\u00e1n khi c\u00f3 \u0111\u00e1p \u1ee9ng corticosteroid.<\/p>\n

Cyclosporine \u0111\u01b0\u1ee3c xem l\u00e0 li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb thay th\u1ebf cho cyclophosphamide. Cyclosporine c\u00f3 th\u1ec3 \u0111\u1ea1t lui b\u1ec7nh v\u1edbi t\u1ec9 l\u1ec7 cao >80%, t\u1ec9 l\u1ec7 \u0111\u1ec1 kh\u00e1ng ch\u1ec9 chi\u1ebfm 10 – 15% b\u1ec7nh nh\u00e2n. T\u00e1c d\u1ee5ng ph\u1ee5 nh\u01b0 t\u0103ng creatinine huy\u1ebft thanh, r\u1eadm l\u00f4ng, t\u0103ng s\u1ea3n l\u1ee3i. T\u00e1i ph\u00e1t r\u1ea5t th\u01b0\u1eddng g\u1eb7p sau ng\u1eebng cyclosporine. C\u00f3 th\u1ec3 thay th\u1ebf cho cyclophosphamide \u0111\u1ed1i v\u1edbi MCD ph\u1ee5 thu\u1ed9c corticoid ho\u1eb7c t\u00e1i ph\u00e1t.<\/p>\n

Thu\u1ed1c \u1ee9c ch\u1ebf calcineurin c\u1ea7n d\u00f9ng trong 18 – 24 th\u00e1ng \u1edf li\u1ec1u th\u1ea5p nh\u1ea5t \u0111\u1ec3 gi\u1eef cho b\u1ec7nh nh\u00e2n lui b\u1ec7nh l\u00e2m s\u00e0ng.<\/p>\n

C\u00f3 kho\u1ea3ng 5% tr\u1ebb em MCD \u0111\u1ec1 kh\u00e1ng steroid, ch\u1ea9n \u0111o\u00e1n d\u1ef1a v\u00e0o sinh thi\u1ebft th\u1eadn. Ph\u00e1c \u0111\u1ed3 s\u1eed d\u1ee5ng \u1ee9c ch\u1ebf calcineurin (cyclosporine ho\u1eb7c tacrolimus) sau \u0111\u00f3 d\u00f9ng mycophenolate mofetil v\u00e0 truy\u1ec1n cyclophosphamide h\u00e0ng th\u00e1ng cho t\u1ec9 l\u1ec7 lui b\u1ec7nh cao. Prednisone c\u00f3 th\u1ec3 cho li\u1ec1u 3 – 5mg\/kg chia 2 li\u1ec1u,<\/p>\n

2.2. \u0110i\u1ec1u tr\u1ecb th\u1ec3 FSGS.<\/h3>\n

Thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n (ACEi) v\u00e0 ch\u1eb9n th\u1ee5 th\u1ec3 angiotensin II (ARB) \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 trong \u0111i\u1ec1u tr\u1ecb FSGS. ACEi cho th\u1ea5y gi\u1ea3m \u0111\u1ea1m ni\u1ec7u v\u00e0 ti\u1ebfn tri\u1ec3n \u0111\u1ebfn b\u1ec7nh th\u1eadn giai \u0111o\u1ea1n cu\u1ed1i (ESKD). \u1ede b\u1ec7nh nh\u00e2n ph\u00ec \u0111\u1ea1i c\u1ea7u th\u1eadn, ACEi ho\u1eb7c ARB gi\u1ea3m \u0111\u01b0\u1ee3c \u0111\u1ea1m ni\u1ec7u v\u00e0 lipid m\u00e1u, ph\u00f9 c\u0169ng nh\u01b0 bi\u1ec3u hi\u1ec7n m\u1ea5t protein k\u00e9o d\u00e0i qua n\u01b0\u1edbc ti\u1ec3u.<\/p>\n

\n

Glucocorticoid v\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch d\u00f9ng trong FSGS v\u00f4 c\u0103n ho\u1eb7c h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0. V\u1edbi tr\u1ebb em, c\u1ea7n d\u00f9ng prednisone li\u1ec1u 60mg\/ng\u00e0y\/ m\u00a02<\/sup>\u00a0 t\u1edbi 80\u202fmg\/day trong 4 tu\u1ea7n, sau \u0111\u00f3 d\u00f9ng li\u1ec1u 40\u202fmg\/day\/m\u00a02 <\/sup>\u1ede ng\u01b0\u1eddi l\u1edbn c\u1ea7n d\u00f9ng li\u1ec1u cao h\u01a1n v\u00e0 l\u00e2u h\u01a1n, t\u1eeb 3 – 4 th\u00e1ng \u0111\u1ec3 \u0111\u1ea1t lui b\u1ec7nh. M\u1ed9t nghi\u00ean c\u1ee9u cho th\u1ea5y corticoid c\u00f3 th\u1ec3 \u0111\u1ea1t lui b\u1ec7nh 40% \u1edf b\u1ec7nh nh\u00e2n tr\u00ean 60 tu\u1ed5i b\u1eb1ng c\u00e1ch d\u00f9ng t\u1edbi 100mg prednisone c\u00e1ch nh\u1eadt trong 3 – 5 th\u00e1ng.<\/p>\n<\/section>\n

\n

M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n \u0111\u00e1p \u1ee9ng v\u1edbi corticoid c\u00f3 th\u1ec3 s\u1ebd t\u00e1i ph\u00e1t. Khuy\u1ebfn c\u00e1o v\u1ec1 \u0111i\u1ec1u tr\u1ecb t\u00e1i ph\u00e1t t\u01b0\u01a1ng t\u1ef1 nh\u01b0 MCD. \u1ede b\u1ec7nh nh\u00e2n l\u1ec7 thu\u1ed9c steroid t\u00e1i ph\u00e1t th\u01b0\u1eddng xuy\u00ean, vi\u1ec7c l\u1eadp l\u1ea1i li\u1ec1u cao corticosteroid c\u00f3 th\u1ec3 g\u00e2y \u0111\u1ed9c t\u00edch l\u0169y. Do \u0111\u00f3 c\u00f3 th\u1ec3 thay th\u1ebf b\u1eb1ng th\u00eam cyclosporine.<\/p>\n

Cyclophosphamide:<\/p>\n<\/section>\n

\n

\u1ede ng\u01b0\u1eddi l\u1edbn, d\u00f9ng corticoid cho ph\u00e9p lui b\u1ec7nh l\u00e2u h\u01a1n v\u00e0 \u00edt t\u00e1i ph\u00e1t h\u01a1n. Tuy nhi\u00ean m\u1ed9t nghi\u00ean c\u1ee9u \u1edf tr\u1ebb em cho th\u1ea5y khi d\u00f9ng cyclophosphamide li\u1ec1u 2.5mg\/kg c\u00f9ng prednisone trong 12 th\u00e1ng so v\u1edbi ch\u1ec9 prednisone kh\u00f4ng th\u1ea5y kh\u00e1c bi\u1ec7t v\u1ec1 hi\u1ec7u qu\u1ea3 gi\u1ea3m \u0111\u1ea1m ni\u1ec7u, lui b\u1ec7nh, gi\u1ea3m ti\u1ebfn tri\u1ec3n ESKD.<\/p>\n

Cyclosporine: FSGS \u0111\u1ec1 kh\u00e1ng v\u1edbi prednisone c\u00f3 th\u1ec3 \u0111\u1ea1t lui b\u1ec7nh b\u1edfi cyclosporine.<\/p>\n<\/section>\n

\n

Mycophenolate mofetil: cho th\u1ea5y c\u1ea3i b\u1edbt \u0111\u01b0\u1ee3c li\u1ec1u corticoid, mau \u0111\u1ea1t lui b\u1ec7nh.<\/p>\n<\/section>\n

\n

2.3. \u0110i\u1ec1u tr\u1ecb th\u1ec3 MN.<\/h3>\n

\u0110i\u1ec1u tr\u1ecb cho b\u1ec7nh m\u1edbi kh\u1edfi ph\u00e1t b\u1eb1ng: (1) \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n v\u1edbi ACEi\/ARB; (2) li\u1ec7u ph\u00e1p corticosteroid (th\u01b0\u1eddng d\u00f9ng prednisone ho\u1eb7c methylprednisolone); (3) c\u00e1c thu\u1ed1c alkyl h\u00f3a nh\u01b0 chlorambucil ho\u1eb7c cyclophosphamide, c\u00f3 th\u1ec3 k\u00e8m corticoid.<\/p>\n

2.4. \u0110i\u1ec1u tr\u1ecb th\u1ec3 PSGN.<\/h3>\n

Ch\u1ee7 y\u1ebfu l\u00e0 \u0111i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3: gi\u1ea3m ph\u00f9, ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p.<\/p>\n

2.5. \u0110i\u1ec1u tr\u1ecb b\u1ec7nh th\u1eadn IgA.<\/h3>\n
    \n
  • D\u00f9ng ACEi\/ARB.<\/li>\n
  • Corticoid u\u1ed1ng ho\u1eb7c t\u0129nh m\u1ea1ch.<\/li>\n
  • D\u00f9ng thu\u1ed1c \u0111\u1ed9c t\u1ebf b\u00e0o.<\/li>\n<\/ul>\n

    T\u00e0i li\u1ec7u tham kh\u1ea3o:\u00a0<\/strong><\/p>\n

    Brenner and Rector’s the kidney eleventh edition.<\/p>\n<\/section>\n

    <\/section>\n

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

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