{"id":32879,"date":"2023-05-09T21:22:59","date_gmt":"2023-05-09T14:22:59","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=32879"},"modified":"2023-05-09T21:22:59","modified_gmt":"2023-05-09T14:22:59","slug":"xo-chai-cau-than-khu-tru-tung-vung-dieu-tri-theo-kdigo","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/09\/xo-chai-cau-than-khu-tru-tung-vung-dieu-tri-theo-kdigo\/","title":{"rendered":"X\u01a1 chai c\u1ea7u th\u1eadn khu tr\u00fa t\u1eebng v\u00f9ng: \u0111i\u1ec1u tr\u1ecb theo KDIGO"},"content":{"rendered":"<p><strong>X\u01a1 chai c\u1ea7u th\u1eadn khu tr\u00fa t\u1eebng v\u00f9ng (FSGS) l\u00e0 m\u1ed9t th\u1ec3 b\u1ec7nh th\u01b0\u1eddng g\u1eb7p, ch\u1ec9 \u0111\u1ee9ng sau b\u1ec7nh th\u1eadn IgA theo k\u1ebft qu\u1ea3 m\u1ed9t nghi\u00ean c\u1ee9u th\u1ed1ng k\u00ea k\u1ebft qu\u1ea3 sinh thi\u1ebft th\u1eadn \u1edf M\u1ef9. B\u1ec7nh nh\u00e2n FSGS lu\u00f4n c\u00f3 ti\u1ec3u \u0111\u1ea1m, c\u00f3 th\u1ec3 ng\u01b0\u1ee1ng th\u1eadn h\u01b0 ho\u1eb7c kh\u00f4ng. B\u1ec7nh c\u00f3 th\u1ec3 nguy\u00ean ph\u00e1t ho\u1eb7c th\u1ee9 ph\u00e1t li\u00ean quan nhi\u1ec5m virus, thu\u1ed1c, b\u1ea5t th\u01b0\u1eddng gen. \u0110i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n (ACEi) ho\u1eb7c ch\u1eb9n th\u1ee5 th\u1ec3 (ARB) \u0111\u01b0\u1ee3c cho t\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n, ch\u1ec9 d\u00f9ng thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch cho FSGS nguy\u00ean ph\u00e1t (v\u00f4 c\u0103n).\u00a0<\/strong><\/p>\n<h2>1. M\u1ed9t s\u1ed1 l\u01b0u \u00fd trong ch\u1ea9n \u0111o\u00e1n th\u1ec3 x\u01a1 chai c\u1ea7u th\u1eadn khu tr\u00fa t\u1eebng v\u00f9ng.<\/h2>\n<p>T\u1ed5n th\u01b0\u01a1ng FSGS c\u1ea7n ch\u1ea9n \u0111o\u00e1n d\u1ef1a v\u00e0o h\u00ecnh \u1ea3nh t\u1ed5n th\u01b0\u01a1ng tr\u00ean sinh thi\u1ebft th\u1eadn: x\u01a1 chai khu tr\u00fa t\u1eebng v\u00f9ng ho\u1eb7c \u0111\u00f4ng \u0111\u1eb7c c\u1ea7u th\u1eadn. X\u01a1 chai c\u1ea7u th\u1eadn b\u1eaft ngu\u1ed3n t\u1eeb nh\u1eefng \u1ed5 \u0111\u00f4ng \u0111\u1eb7c c\u1ea7u th\u1eadn g\u00e2y ra do l\u1eafng \u0111\u1ecdng protein d\u1eabn t\u1edbi hyalin h\u00f3a, t\u00edch t\u1ee5 foam cell, ph\u00f9 n\u1ed9i m\u00f4, x\u1eb9p mao m\u1ea1ch g\u00e2y b\u00edt l\u00f2ng mao m\u1ea1ch. C\u00f3 th\u1ec3 k\u00e8m theo t\u0103ng sinh m\u00f4 \u0111\u1ec7m gian m\u1ea1ch.<\/p>\n<p id=\"hl0002397\">C\u1ea7n ph\u00e2n bi\u1ec7t FSGS nguy\u00ean ph\u00e1t (v\u00f4 c\u0103n) v\u00e0 FSGS th\u1ee9 ph\u00e1t d\u1ef1a v\u00e0o m\u1ed9t s\u1ed1 g\u1ee3i \u00fd:<\/p>\n<p>FSGS ngh\u0129 nguy\u00ean ph\u00e1t khi:<\/p>\n<ul>\n<li>K\u00e8m <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> (NS), \u0111\u1ea1m ni\u1ec7u &gt;3.5 g\/ng\u00e0y v\u00e0 albumin huy\u1ebft thanh &lt;30g\/L c\u00f3 th\u1ec3 k\u00e8m theo ph\u00f9 ho\u1eb7c kh\u00f4ng.<\/li>\n<li>M\u00f4 h\u1ecdc c\u00f3 h\u00ecnh \u1ea3nh x\u00f3a m\u1edd c\u00e1c tua ch\u00e2n gi\u1ea3.<\/li>\n<\/ul>\n<p>Ng\u01b0\u1eddi l\u1edbn c\u00f3 t\u1ed5n th\u01b0\u01a1ng FSGS tr\u00ean m\u00f4 h\u1ecdc m\u00e0 kh\u00f4ng k\u00e8m h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 c\u1ea7n t\u00ecm nguy\u00ean nh\u00e2n th\u1ee9 ph\u00e1t kh\u00e1c. Bao g\u1ed3m nh\u1eefng b\u1ec7nh nh\u00e2n:<\/p>\n<ul>\n<li>Ti\u1ec3u \u0111\u1ea1m ng\u01b0\u1ee1ng th\u1eadn h\u01b0 &gt;3.5g\/ng\u00e0y nh\u01b0ng albumin huy\u1ebft thanh &gt;30g\/L. Ho\u1eb7c<\/li>\n<li>\u0110\u1ea1m ni\u1ec7u &lt;3.5g\/ng\u00e0y c\u00f3 th\u1ec3 k\u00e8m gi\u1ea3m albumin ni\u1ec7u ho\u1eb7c kh\u00f4ng.<\/li>\n<\/ul>\n<p>C\u00e1c nguy\u00ean nh\u00e2n th\u1ee9 ph\u00e1t c\u1ea7n lo\u1ea1i tr\u1eeb:<\/p>\n<ul>\n<li>Nhi\u1ec5m virus: HIV (ch\u1eafc ch\u1eafn), CMV (c\u00f3 th\u1ec3), Parvovirus B19, EBV, HCV (c\u00f3 kh\u1ea3 n\u0103ng li\u00ean quan).<\/li>\n<li>Thu\u1ed1c: kh\u00e1ng virus, \u1ee9c ch\u1ebf mTOR, \u1ee9c ch\u1ebf calcineurin, anthracyclines, heroin, lithium, interferon, steroid \u0111\u1ed3ng h\u00f3a, NSAID.<\/li>\n<\/ul>\n<p>C\u00f3 th\u1ec3 th\u1ee9 ph\u00e1t do th\u00edch nghi v\u1edbi t\u0103ng \u00e1p l\u1ef1c c\u1ea7u th\u1eadn trong:<\/p>\n<ul>\n<li>B\u1ec7nh l\u00fd gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng nephron: b\u1ec7nh th\u1eadn tr\u00e0o ng\u01b0\u1ee3c, lo\u1ea1n s\u1ea3n th\u1eadn, nephron kh\u1ed5ng l\u1ed3, b\u1ec7nh h\u1ed3ng c\u1ea7u h\u00ecnh li\u1ec1m, FSGS li\u00ean quan tu\u1ed5i.<\/li>\n<li>Nh\u1eefng b\u1ec7nh c\u00f3 s\u1ed1 l\u01b0\u1ee3ng nephron b\u00ecnh th\u01b0\u1eddng: b\u1ec7nh c\u1ea7u th\u1eadn li\u00ean quan b\u00e9o ph\u00ec, b\u1ec7nh c\u1ea7u th\u1eadn nguy\u00ean ph\u00e1t kh\u00e1c, b\u1ec7nh h\u1ec7 th\u1ed1ng (b\u1ec7nh th\u1eadn \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, x\u01a1 chai c\u1ea7u th\u1eadn do t\u0103ng huy\u1ebft \u00e1p).<\/li>\n<\/ul>\n<p>Khi x\u00e1c \u0111\u1ecbnh l\u00e0 FSGS nguy\u00ean ph\u00e1t, c\u00f3 th\u1ec3 ch\u1ec9 \u0111\u1ecbnh thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch, n\u1ebfu kh\u00f4ng \u0111\u00e1p \u1ee9ng c\u1ea7n x\u00e9t nghi\u1ec7m gen. \u0110\u1ed1i v\u1edbi FSGS th\u1ee9 ph\u00e1t, c\u00f3 th\u1ec3 xem x\u00e9t x\u00e9t nghi\u1ec7m gen \u0111\u1ec3 lo\u1ea1i tr\u1eeb bi\u1ebfn th\u1ec3 di truy\u1ec1n v\u00e0 kh\u00f4ng d\u00f9ng thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch; m\u00e0 ch\u1ec9 \u0111i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 v\u00e0 ki\u1ec3m so\u00e1t \u0111\u1ea1m ni\u1ec7u, albumin huy\u1ebft thanh.<\/p>\n<p>X\u00e9t nghi\u1ec7m gen gi\u00fap x\u00e1c \u0111\u1ecbnh c\u00e1c bi\u1ebfn th\u1ec3 di truy\u1ec1n c\u1ee7a FSGS nh\u01b0 th\u1ec3 gia \u0111\u00ecnh, th\u1ec3 theo m\u00f9a, th\u1ec3 h\u1ed9i ch\u1ee9ng. Nh\u1edd vi\u1ec7c ph\u00e1t hi\u1ec7n \u0111\u1ed9t bi\u1ebfn c\u1ee7a c\u00e1c protein ch\u00e2n gi\u1ea3, m\u00e0ng \u0111\u00e1y c\u1ea7u th\u1eadn. C\u00e2n nh\u1eafc khi:<\/p>\n<ul>\n<li>C\u00f3 ti\u1ec1n s\u1eed gia \u0111\u00ecnh m\u1ea1nh v\u00e0\/ho\u1eb7c \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng g\u1ee3i \u00fd n\u00f3 l\u00e0 h\u1ed9i ch\u1ee9ng c\u1ee7a m\u1ed9t b\u1ec7nh.<\/li>\n<li>H\u1ed7 tr\u1ee3 ch\u1ea9n \u0111o\u00e1n khi l\u00e2m s\u00e0ng kh\u00f4ng \u0111i\u1ec3n h\u00ecnh cho ki\u1ec3u h\u00ecnh n\u00e0o.<\/li>\n<li>Gi\u1ea3m \u0111i\u1ec1u tr\u1ecb \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch, khi b\u1ec7nh nh\u00e2n d\u1ec5 \u0111\u1ec1 kh\u00e1ng.<\/li>\n<li>T\u00ecm nguy c\u01a1 t\u00e1i ph\u00e1t trong gh\u00e9p th\u1eadn.<\/li>\n<li>\u0110\u00e1nh gi\u00e1 nguy c\u01a1 s\u1ed1ng c\u1ee7a th\u1eadn hi\u1ebfn.<\/li>\n<li>Ch\u1ea9n \u0111o\u00e1n tr\u01b0\u1edbc sinh.<\/li>\n<\/ul>\n<h2>2. \u0110i\u1ec1u tr\u1ecb x\u01a1 chai c\u1ea7u th\u1eadn khu tr\u00fa FSGS.<\/h2>\n<h3>2.1. Qu\u1ea3n l\u00fd th\u1ec3 x\u01a1 chai c\u1ea7u th\u1eadn khu tr\u00fa t\u1eebng v\u00f9ng ch\u01b0a t\u00ecm nguy\u00ean nh\u00e2n ho\u1eb7c nguy\u00ean nh\u00e2n th\u1ee9 ph\u00e1t.<\/h3>\n<ul>\n<li>Kh\u00f4ng s\u1eed d\u1ee5ng li\u1ec7u ph\u00e1p \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch.<\/li>\n<li>Ch\u1ec9 \u0111i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3: ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p, s\u1eed d\u1ee5ng ACEi\/ARB, <a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/benh-viem-cau-nen-uong-nhu-nao\/\">thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng<\/a>.<\/li>\n<\/ul>\n<h3>2.2. \u0110i\u1ec1u tr\u1ecb FSGS nguy\u00ean ph\u00e1t.<\/h3>\n<ul>\n<li>Khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng <a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/corticoid-la-gi-corticoid-co-loi-hay-co-hai\/\">glucocorticoid<\/a> li\u1ec1u cao l\u00e0 \u0111i\u1ec1u tr\u1ecb \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch \u0111\u1ea7u tay.<\/li>\n<li>\u00a0S\u1eed d\u1ee5ng ch\u1ebf \u0111\u1ed9 li\u1ec1u glucocorticoid nh\u01b0 sau:<\/li>\n<\/ul>\n<p>Li\u1ec1u kh\u1edfi \u0111\u1ea7u: glucocorticoid li\u1ec1u cao v\u1edbi prednisone li\u1ec1u 1mg\/kg 1 l\u1ea7n\/ng\u00e0y (t\u1ed1i \u0111a 80mg) ho\u1eb7c \u0111i\u1ec1u tr\u1ecb c\u00e1ch nh\u1eadt m\u1ed7i l\u1ea7n 2mg\/kg (t\u1ed1i \u0111a 120mg).<\/p>\n<p>Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb: duy tr\u00ec li\u1ec1u cao \u00edt nh\u1ea5t 4 tu\u1ea7n cho t\u1edbi khi lui b\u1ec7nh ho\u00e0n to\u00e0n, ho\u1eb7c t\u1ed1i \u0111a 16 tu\u1ea7n. B\u1ec7nh nh\u00e2n c\u00f3 kh\u1ea3 n\u0103ng kh\u1ecfi s\u1ebd cho th\u1ea5y gi\u1ea3m \u0111\u1ea1m ni\u1ec7u tr\u01b0\u1edbc tu\u1ea7n 16. Kh\u00f4ng c\u1ea7n ti\u1ebfp t\u1ee5c \u0111\u1ebfn 16 tu\u1ea7n n\u1ebfu \u0111\u1ea1m ni\u1ec7u kh\u00f4ng gi\u1ea3m, \u0111\u1eb7c bi\u1ec7t n\u1ebfu ng\u01b0\u1eddi b\u1ec7nh c\u00f3 t\u00e1c d\u1ee5ng ph\u1ee5.<\/p>\n<p>Gi\u1ea3m li\u1ec1u: N\u1ebfu lui b\u1ec7nh nhanh, ti\u1ebfp t\u1ee5c li\u1ec1u cao trong 2 tu\u1ea7n ho\u1eb7 sau khi m\u1ea5t \u0111\u1ea1m ni\u1ec7u. Gi\u1ea3m li\u1ec1u prednisone m\u1ed7i 5mg m\u1ed7i 1 &#8211; 2 tu\u1ea7n \u0111\u1ec3 \u0111\u1ea1t t\u1ed5ng th\u1eddi gian \u0111i\u1ec1u tr\u1ecb 6 th\u00e1ng. N\u1ebfu b\u1ec7nh nh\u00e2n lui b\u1ec7nh m\u1ed9t ph\u1ea7n trong 8 &#8211; 12 tu\u1ea7n \u0111i\u1ec1u tr\u1ecb glucocorticoid, ti\u1ebfp t\u1ee5c \u0111\u1ebfn tu\u1ea7n 16. Sau \u0111\u00f3, gi\u1ea3m li\u1ec1u prednisone m\u1ed7i 5mg m\u1ed7i 1 &#8211; 2 tu\u1ea7n \u0111\u1ec3 ho\u00e0n th\u00e0nh th\u1eddi gian \u0111i\u1ec1u tr\u1ecb 6 th\u00e1ng. N\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u1ec1 kh\u00e1ng steroid ho\u1eb7c \u0111\u1ed9c t\u00ednh do thu\u1ed1c, glucocorticoid n\u00ean gi\u1ea3m li\u1ec1u nhanh \u0111\u1ebfn khi dung n\u1ea1p v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch thay th\u1ebf nh\u01b0 \u1ee9c ch\u1ebf calcineurin.<\/p>\n<p>\u1ee8c ch\u1ebf calcineurin \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh n\u1ebfu ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh ho\u1eb7c kh\u00f4ng dung n\u1ea1p v\u1edbi glucocorticoid.<\/p>\n<p>Li\u1ec1u kh\u1edfi \u0111\u1ea7u:<\/p>\n<ul>\n<li><a href=\"https:\/\/www.vinmec.com\/vi\/thong-tin-duoc\/su-dung-thuoc-toan\/cong-dung-thuoc-cyclosporine\/\">Cyclosporine<\/a> 3 &#8211; 5mg\/kg\/ng\u00e0y chia 2 l\u1ea7n HO\u1eb6C <a href=\"https:\/\/www.vinmec.com\/vi\/thong-tin-duoc\/su-dung-thuoc-toan\/thuoc-tacrolimus-cong-dung-chi-dinh-va-luu-y-khi-dung\/\">tacrolimus<\/a> 0.05 &#8211; 0.1mg\/kg\/ng\u00e0y chia 2 li\u1ec1u.<\/li>\n<li>C\u00f3 th\u1ec3 \u0111o n\u1ed3ng \u0111\u1ed9 m\u1ee5c ti\u00eau trong m\u00e1u \u0111\u1ec3 gi\u1ea3m \u0111\u1ed9c t\u00ednh tr\u00ean th\u1eadn.<\/li>\n<li>N\u1ed3ng \u0111\u1ed9 \u0111\u00edch c\u1ee7a cyclosporine: 100 &#8211; 175 ng\/ml. Tacrolimus 5 &#8211; 10 ng\/ml<\/li>\n<\/ul>\n<p>Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3:\u00a0Cyclosporine ho\u1eb7c tacrolimus n\u00ean ti\u1ebfp t\u1ee5c li\u00eau \u0111\u1ec3 \u0111\u1ea1t n\u1ed3ng \u0111\u1ed9 \u0111\u00edch \u00edt nh\u1ea5t 4 &#8211; 6 th\u00e1ng, tr\u01b0\u1edbc khi \u0111\u00e1nh gi\u00e1 b\u1ec7nh nh\u00e2n \u0111\u1ec1 kh\u00e1ng.<\/p>\n<p>T\u1ed5ng th\u1eddi gian \u0111i\u1ec1u tr\u1ecb:<\/p>\n<ul>\n<li>\u1ede ng\u01b0\u1eddi b\u1ec7nh lui b\u1ec7nh ho\u00e0n to\u00e0n ho\u1eb7c m\u1ed9t ph\u1ea7n, cyclosporine ho\u1eb7c tacrolimus n\u00ean ti\u1ebfp t\u1ee5c \u1edf li\u1ec1u \u0111\u1ea1t n\u1ed3ng \u0111\u1ed9 \u0111\u00edch \u00edt nh\u1ea5t 12 th\u00e1ng \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 t\u00e1i ph\u00e1t.<\/li>\n<li>Li\u1ec1u cyclosporine ho\u1eb7c tacrolimus n\u00ean gi\u1ea3m ch\u1eadm trong 6 &#8211; 12 th\u00e1ng n\u1ebfu dung n\u1ea1p.<\/li>\n<li>D\u1eebng \u0111i\u1ec1u tr\u1ecb n\u1ebfu eGFR d\u01b0\u1edbi 30ml\/ph\u00fat\/1.73m2.<\/li>\n<\/ul>\n<p>Tr\u01b0\u1eddng h\u1ee3p dung n\u1ea1p k\u00e9m ho\u1eb7c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh \u1ee9c ch\u1ebf calcineurin:<\/p>\n<ul>\n<li>Thi\u1ebfu b\u1eb1ng ch\u1ee9ng ch\u1ea5t l\u01b0\u1ee3ng v\u1ec1 c\u00e1c thu\u1ed1c thay th\u1ebf.<\/li>\n<li>Mycophenolate mofetil v\u00e0 li\u1ec1u cao dexamethasone, rituximab, v\u00e0 ACTH \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc.<\/li>\n<li>\u0110i\u1ec1u tr\u1ecb c\u1ea7n c\u00e1 th\u1ec3 h\u00f3a theo ng\u01b0\u1eddi b\u1ec7nh v\u00e0 ph\u1ee5 thu\u1ed9c v\u00e0 t\u00ednh s\u1eb5n c\u00f3 c\u1ee7a thu\u1ed1c v\u00e0 ngu\u1ed3n l\u1ef1c c\u0169ng nh\u01b0 l\u1ee3i \u00edch c\u1ee7a \u0111i\u1ec1u tr\u1ecb ti\u1ebfp theo v\u00e0 nguy c\u01a1 t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n c\u1ee7a \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch.<\/li>\n<li>B\u1ec7nh nh\u00e2n n\u00ean \u0111\u01b0\u1ee3c chuy\u1ec3n \u0111\u1ebfn trung t\u00e2m chuy\u00ean s\u00e2u \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c thay th\u1ebf ho\u1eb7c d\u1eebng \u0111i\u1ec1u tr\u1ecb.<\/li>\n<\/ul>\n<p>Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb \u1ee9c ch\u1ebf calcineurin: Ng\u01b0\u1eddi l\u1edbn m\u1eafc FSGS nguy\u00ean ph\u00e1t \u0111\u1ec1 kh\u00e1ng steroid c\u00f3 \u0111\u00e1p \u1ee9ng \u1ee9c ch\u1ebf calcineurin n\u00ean duy tr\u00ec thu\u1ed1c \u00edt nh\u1ea5t 12 th\u00e1ng \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 t\u00e1i ph\u00e1t.<\/p>\n<p>\u0110\u1ed1i v\u1edbi ng\u01b0\u1eddi l\u1edbn m\u1eafc FSGS nguy\u00ean ph\u00e1t \u0111\u1ec1 kh\u00e1ng steroid c\u00f3 \u0111\u1ec1 kh\u00e1ng ho\u1eb7c kh\u00f4ng dung n\u1ea1p \u1ee9c ch\u1ebf calcineurin n\u00ean \u0111\u01b0\u1ee3c chuy\u1ec3n \u0111\u1ebfn trung t\u00e2m chuy\u00ean s\u00e2u \u0111\u1ec3 xem x\u00e9t sinh thi\u1ebft th\u1eadn l\u1ea1i, \u0111i\u1ec1u tr\u1ecb thay th\u1ebf, \u0111\u01b0a v\u00e0o th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng.<\/p>\n<p><strong>Ngu\u1ed3n:\u00a0<\/strong><\/p>\n<p>KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases. Kidney Int. 2021;100(4S):S1\u2013S276.<\/p>\n<p>Brenner and Rector&#8217;s the kidney, eleventh edition.<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>X\u01a1 chai c\u1ea7u th\u1eadn khu tr\u00fa t\u1eebng v\u00f9ng (FSGS) l\u00e0 m\u1ed9t th\u1ec3 b\u1ec7nh th\u01b0\u1eddng g\u1eb7p, ch\u1ec9 \u0111\u1ee9ng sau b\u1ec7nh th\u1eadn IgA theo k\u1ebft qu\u1ea3 m\u1ed9t nghi\u00ean c\u1ee9u th\u1ed1ng k\u00ea k\u1ebft qu\u1ea3 sinh thi\u1ebft th\u1eadn \u1edf M\u1ef9. B\u1ec7nh nh\u00e2n FSGS lu\u00f4n c\u00f3 ti\u1ec3u \u0111\u1ea1m, c\u00f3 th\u1ec3 ng\u01b0\u1ee1ng th\u1eadn h\u01b0 ho\u1eb7c kh\u00f4ng. B\u1ec7nh c\u00f3 th\u1ec3 nguy\u00ean ph\u00e1t [&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>X\u01a1 chai c\u1ea7u th\u1eadn khu tr\u00fa t\u1eebng v\u00f9ng: \u0111i\u1ec1u tr\u1ecb theo KDIGO - Vinmec<\/title>\n<meta name=\"description\" content=\"Ch\u1ea9n \u0111o\u00e1n x\u01a1 chai c\u1ea7u th\u1eadn FSGS d\u1ef1a v\u00e0o sinh thi\u1ebft th\u1eadn. 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