Trong \u0111\u00f3, hai tri\u1ec7u ch\u1ee9ng:<\/u><\/b> ti\u1ec3u \u0111\u1ea1m ng\u01b0\u1ee1ng th\u1eadn h\u01b0 v\u00e0 gi\u1ea3m \u0111\u1ea1m m\u00e1u b\u1eaft bu\u1ed9c ph\u1ea3i c\u00f3 h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0\u00a0tr\u1ebb em hi\u1ebfm khi c\u00f3 ti\u1ec3u m\u00e1u v\u00e0 t\u0103ng huy\u1ebft \u00e1p \u0111i k\u00e8m.<\/span><\/p>\n

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\u0110\u1eb7c \u0111i\u1ec3m c\u1ee7a h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 \u1edf tr\u1ebb em:<\/b><\/p>\n
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HCTH tr\u1ebb em l\u00e0 m\u1ed9t trong ba b\u1ec7nh th\u1eadn th\u01b0\u1eddng g\u1eb7p nh\u1ea5t \u1edf khoa l\u00e2m s\u00e0ng<\/li>\n
HCTH tr\u1ebb em th\u01b0\u1eddng l\u00e0 nguy\u00ean ph\u00e1t, th\u01b0\u1eddng g\u1eb7p nh\u1ea5t l\u00e0 sang th\u01b0\u01a1ng t\u1ed1i thi\u1ec3u (MCD – Minimal Change Disease) 80 – 90%<\/li>\n
Th\u01b0\u1eddng c\u00f3 ti\u00ean l\u01b0\u1ee3ng t\u1ed1t: \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb corticoid trong 80 – 90% c\u00e1c tr\u01b0\u1eddng h\u1ee3p v\u00e0 hi\u1ebfm khi d\u1eabn t\u1edbi suy th\u1eadn m\u1ea1n<\/li>\n
Tuy nhi\u00ean, HCTH tr\u1ebb em l\u1ea1i th\u01b0\u1eddng di\u1ec5n ti\u1ebfn m\u1ea1n t\u00ednh v\u1edbi c\u00e1c \u0111\u1ee3t t\u00e1i ph\u00e1t, trong \u0111\u00f3 t\u00e1i ph\u00e1t th\u01b0\u1eddng xuy\u00ean c\u00f3 th\u1ec3 g\u1eb7p 40% c\u00e1c tr\u01b0\u1eddng h\u1ee3p<\/li>\n<\/ul>\n
M\u1ed8T S\u1ed0 THU\u1eacT NG\u1eee\u00a0<\/b><\/h2>\n<\/div>\n<\/div>\n
1. Lui b\u1ec7nh ho\u00e0n to\u00e0n:<\/strong>
\nH\u1ebft ph\u00f9, protein m\u00e1u >2,5g\/dl v\u00e0 protein\/creatinin ni\u1ec7u < 20mg\/mmol ho\u1eb7c \u0111\u1ea1m ni\u1ec7u tr\u00ean gi\u1ea5y nh\u00fang \u00e2m t\u00ednh\/v\u1ebft trong 3 ng\u00e0y li\u00ean t\u1ee5c.<\/p>\n
2. Lui b\u1ec7nh m\u1ed9t ph\u1ea7n:<\/strong><\/p>\n
H\u1ebft ph\u00f9, albumin m\u00e1u >2,5g\/dl v\u00e0 protein\/creatinin ni\u1ec7u 20 – 200mg\/mmol ho\u1eb7c \u0111\u1ea1m ni\u1ec7u 24 gi\u1edd gi\u1ea3m > 50% gi\u00e1 tr\u1ecb ban \u0111\u1ea7u.<\/p>\n
3. HCTH t\u00e1i ph\u00e1t:<\/strong><\/p>\n
Khi c\u00f3 \u0111\u1ea1m\/creatinin ni\u1ec7u >=200mg\/mmol ho\u1eb7c \u0111\u1ea1m ni\u1ec7u tr\u00ean gi\u1ea5y nh\u00fang >= 3+ trong 3 ng\u00e0y li\u00ean t\u1ee5c.<\/p>\n
4.T\u00e1i ph\u00e1t kh\u00f4ng th\u01b0\u1eddng xuy\u00ean:<\/strong><\/p>\n
T\u00e1i ph\u00e1t < 2 l\u1ea7n trong v\u00f2ng 6 th\u00e1ng sau l\u1ea7n \u0111\u00e1p \u1ee9ng \u0111\u1ea7u ti\u00ean hay < 4 l\u1ea7n t\u00e1i ph\u00e1t trong 12 th\u00e1ng.<\/p>\n
5.T\u00e1i ph\u00e1t th\u01b0\u1eddng xuy\u00ean:<\/strong><\/p>\n
T\u00e1i ph\u00e1t >= 2 l\u1ea7n trong v\u00f2ng 6 th\u00e1ng sau l\u1ea7n \u0111\u00e1p \u1ee9ng \u0111\u1ea7u ti\u00ean hay >= 4 l\u1ea7n t\u00e1i ph\u00e1t trong v\u00f2ng 12 th\u00e1ng.<\/p>\n
6. Ph\u1ee5 thu\u1ed9c steroid:<\/strong><\/p>\n
2 l\u1ea7n t\u00e1i ph\u00e1t li\u00ean t\u1ee5c khi gi\u1ea3m li\u1ec1u hay trong v\u00f2ng 14 ng\u00e0y sau khi ng\u01b0ng corticoid.<\/p>\n
7. HCTH nh\u1ea1y c\u1ea3m steroid:<\/strong><\/p>\n
B\u1ec7nh nh\u00e2n thuy\u00ean gi\u1ea3m \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb corticoid \u0111\u01a1n \u0111\u1ed9c.<\/p>\n
8. HCTH kh\u00e1ng steroid:<\/strong><\/p>\n
Kh\u00f4ng lui b\u1ec7nh khi \u0111i\u1ec1u tr\u1ecb \u0111\u1ee7 6 -8 tu\u1ea7n Prednisolon 2mg\/kg\/ng\u00e0y ho\u1eb7c Prednisolon 2mg\/kg\/ng\u00e0y x 4 tu\u1ea7n + Methylprednisolon 1g\/1,73m2\u00a0da\/c\u00e1ch ng\u00e0y x 3 li\u1ec1u TTM.<\/p>\n
NGUY\u00caN NH\u00c2N<\/h2>\n
1. H\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 nguy\u00ean ph\u00e1t<\/strong><\/p>\n
Chi\u1ebfm 80 – 90 % c\u00e1c tr\u01b0\u1eddng h\u1ee3p HCTH tr\u1ebb em t\u1eeb 1 -10 tu\u1ed5i. Sang th\u01b0\u01a1ng tr\u00ean gi\u1ea3i ph\u1eabu b\u1ec7nh \u0111\u01b0\u1ee3c chia th\u00e0nh ba lo\u1ea1i:<\/p>\n
Sang th\u01b0\u01a1ng t\u1ed1i thi\u1ec3u (Minimal Change Disease – MCD)<\/p>\n
X\u01a1 chai c\u1ea7u th\u1eadn khu tr\u00fa t\u1eebng ph\u1ea7n<\/p>\n
T\u0103ng sinh trung m\u00f4<\/p>\n
2. H\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 th\u1ee9 ph\u00e1t<\/strong><\/p>\n
L\u00e0 c\u00e1c tr\u01b0\u1eddng h\u1ee3p HCTH li\u00ean quan \u0111\u1ebfn c\u00e1c b\u1ec7nh l\u00fd h\u1ec7 th\u1ed1ng, hay th\u1ee9 ph\u00e1t sau m\u1ed9t b\u1ec7nh l\u00fd kh\u00e1c g\u00e2y t\u1ed5n th\u01b0\u01a1ng c\u1ea7u th\u1eadn. C\u00e1c nguy\u00ean nh\u00e2:<\/p>\n
Nhi\u1ec5m tr\u00f9ng: li\u00ean c\u1ea7u khu\u1ea9n tan huy\u1ebft nh\u00f3m A, vi\u00eam gan si\u00eau vi B, rubella, HIV, s\u1ed1t r\u00e9t…<\/p>\n
B\u1ec7nh h\u1ec7 th\u1ed1ng: lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng, ban xu\u1ea5t huy\u1ebft Henoch- Schonlein…<\/p>\n
B\u1ec7nh \u00e1c t\u00ednh: c\u00e1 ung th\u01b0 h\u1ea1ch Hodgkin, non- Hodgkin, Lymphoma.<\/p>\n
B\u1ec7nh di truy\u1ec1n v\u00e0 chuy\u1ec3n h\u00f3a: \u0111\u00e1i th\u00e1i \u0111\u01b0\u1eddng, h\u1ed9i ch\u1ee9ng Alport…<\/p>\n
C\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c: ong \u0111\u1ed1t, b\u1ec7nh huy\u1ebft thanh, do thu\u1ed1c.<\/p>\n
3. H\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 b\u1ea9m sinh<\/b><\/div>\n
Kh\u1edfi ph\u00e1t tr\u01b0\u1edbc 3 th\u00e1ng tu\u1ed5i th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn \u0111\u1ed9t bi\u1ebfn gen<\/p>\n
C\u00e1c gen th\u01b0\u1eddng g\u1eb7p g\u00e2y HCTH tr\u1ebb em: NPHS1, NPHS2, NPHS3<\/p>\n
C\u00e1c b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng c\u1ee7a HCTH b\u1ea9m sinh:<\/p>\n
+ HCTH b\u1ea9m sinh th\u1ec3 Ph\u1ea7n lan.<\/p>\n
+ X\u01a1 h\u00f3a trung m\u00f4 lan t\u1ecfa.<\/p>\n
+ Th\u1eadn h\u01b0 nguy\u00ean ph\u00e1t kh\u00e1ng corticoid.<\/p>\n
4. H\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 nh\u0169 nhi<\/strong><\/p>\n
Kh\u1edfi ph\u00e1t t\u1eeb 3 th\u00e1ng t\u1edbi d\u01b0\u1edbi 1 tu\u1ed5i<\/p>\n
HCTH nh\u0169 nhi c\u00f3 th\u1ec3 do \u0111\u1ed9t bi\u1ebfn gen, do nhi\u1ec5m tr\u00f9ng hay nguy\u00ean ph\u00e1t:<\/p>\n
– HCTH do gen: 2 gen NPHS1 v\u00e0 NPHS2 th\u01b0\u1eddng g\u1eb7p nh\u1ea5t<\/p>\n
– HCTH do nhi\u1ec5m tr\u00f9ng: li\u00ean quan \u0111\u1ebfn c\u00e1c nhi\u1ec5m tr\u00f9ng trong b\u00e0o thai hay chu sinh. T\u00e1c nh\u00e2n th\u01b0\u1eddng g\u1eb7p nh\u00f3m TORCH (toxoplasma, rubella, cetomegalovirus, herpes simples), HIV, giang mai….<\/p>\n
– HCTH nguy\u00ean ph\u00e1t: c\u00f3 th\u1ec3 l\u00e0 sang th\u01b0\u01a1ng t\u1ed1i thi\u1ec3u (MCD), x\u01a1 chai c\u1ea7u th\u1eadn c\u1ee5c b\u1ed9 t\u1eebng v\u00f9ng, hay t\u0103ng sinh trung m\u00f4 lan t\u1ecfa. HCTH nguy\u00ean ph\u00e1t kh\u1edfi ph\u00e1t s\u1edbm tr\u01b0\u1edbc 1 tu\u1ed5i th\u01b0\u1eddng k\u00e9m \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb.<\/p>\n
SINH L\u00dd B\u1ec6NH<\/h2>\n
1. C\u01a1 ch\u1ebf g\u00e2y ph\u00f9 to\u00e0n th\u00e2n trong h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0<\/h3>\n
– Do gi\u1ea3m albumin m\u00e1u g\u00e2y ra gi\u1ea3m \u00e1p l\u1ef1c keo d\u1eabn \u0111\u1ebfn tho\u00e1t n\u01b0\u1edbc ra m\u00f4 k\u1ebd g\u00e2y ph\u00f9<\/p>\n
– N\u01b0\u1edbc tho\u00e1t ra m\u00f4 k\u1ebd n\u00ean th\u1ec3 t\u00edch trong l\u00f2ng m\u1ea1ch gi\u1ea3m g\u00e2y k\u00edch th\u00edch h\u1ec7 Renin-angiotenssin gi\u00fap gia t\u0103ng h\u1ea5p thu Na+ v\u00e0 n\u01b0\u1edbc tr\u1edf l\u1ea1i.<\/p>\n
C\u01a1 ch\u1ebf g\u00e2y ph\u00f9 trong HCTH v\u1eabn ch\u01b0a r\u00f5 h\u1ebft, c\u00f3 l\u1ebd do t\u00e1c \u0111\u1ed9ng c\u1ee7a nhi\u1ec1u y\u1ebfu t\u1ed1: gi\u1ea3m \u00e1p l\u1ef1c keo, t\u0103ng ho\u1ea1t \u0111\u1ed9ng aldosterol v\u00e0 vasopressin, gi\u1ea3m ho\u1ea1t y\u1ebfu t\u1ed1 b\u00e0i ni\u1ec7u nh\u0129, vai tr\u00f2 tr\u1ef1c ti\u1ebfp c\u1ee7a c\u00e1c cytokin….g\u00e2y gi\u1eef mu\u1ed1i n\u01b0\u1edbc.<\/p>\n
2. C\u01a1 ch\u1ebf ti\u1ec3u \u0111\u1ea1m trong h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0<\/h3>\n
2.1. M\u1ea5t \u0111i\u1ec7n t\u00edch \u00e2m c\u1ee7a m\u00e0ng \u0111\u00e1y c\u1ea7u th\u1eadn<\/h4>\n
– Albumin trong huy\u1ebft t\u01b0\u01a1ng mang \u0111i\u1ec7n t\u00edch \u00e2m, b\u00ecnh th\u01b0\u1eddng r\u1ea5t kh\u00f3 l\u1ecdt qua \u0111\u01b0\u1ee3c m\u00e0ng l\u1ecdc c\u1ee7a c\u1ea7u th\u1eadn v\u00ec l\u1edbp \u0111i\u1ec7n t\u00edch \u00e2m c\u1ee7a m\u00e0ng l\u1ecdc c\u1ea7u th\u1eadn ng\u0103n c\u1ea3n. Trong h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0, l\u1edbp \u0111i\u1ec7n t\u00edch \u00e2m c\u1ee7a m\u00e0ng n\u1ec1n c\u1ea7u th\u1eadn b\u1ecb t\u1ed5n th\u01b0\u01a1ng, m\u00e0ng l\u1ecdc c\u1ea7u th\u1eadn \u0111\u1ec3 l\u1ecdt nhi\u1ec1u albumin. Khi l\u01b0\u1ee3ng Protein (ch\u1ee7 y\u1ebfu albumin) \u0111\u01b0\u1ee3c b\u00e0i xu\u1ea5t trong m\u1ed9t ng\u00e0y l\u01b0\u1edbn h\u01a1n 3,5g th\u00ec th\u01b0\u1eddng k\u1ebft h\u1ee3p v\u1edbi gi\u1ea3m albumin m\u00e1u.<\/p>\n
2.2. Vai tr\u00f2 c\u1ee7a slit diaphragm<\/h4>\n
– Trong h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0, c\u00e1c t\u1ebf b\u00e0o ngo\u1ea1i b\u00ec c\u00f3 ch\u00e2n gi\u1ea3 (podocyte)b\u1ecb d\u1eb9t, x\u00f3a m\u1edd \u0111i -> g\u00e2y n\u00ean ti\u1ec3u \u0111\u1ea1m.<\/p>\n
2.3. R\u1ed1i lo\u1ea1n mi\u1ec5n d\u1ecbch<\/h4>\n
– K\u00edch ho\u1ea1t h\u1ec7 mi\u1ec5n d\u1ecbch, tr\u00ecnh di\u1ec7n kh\u00e1ng nguy\u00ea, r\u1ed1i lo\u1ea1n \u0111i\u1ec1u h\u00f2a t\u1ebf b\u00e0o T v\u00e0 s\u1ef1 s\u1ea3n xu\u1ea5t c\u1ee7a y\u1ebfu t\u1ed1 t\u0103ng t\u00ednh th\u1ea5m l\u01b0u h\u00e0nh.<\/p>\n
– S\u1ef1 bi\u1ebfn \u0111\u1ed5i ch\u1ee9c n\u0103ng c\u1ee7a c\u00e1c t\u1ebf b\u00e0o ch\u00e2n c\u00f3 th\u1ec3 li\u00ean quan m\u1eadt thi\u1ebft t\u1edbi h\u1ec7 mi\u1ec5n d\u1ecbch. Khi ph\u01a1i nhi\u1ec5m v\u1edbi c\u00e1c t\u00e1c nh\u00e2n g\u00e2y stress \u0111\u1eb7c hi\u1ec7u , c\u00e1 t\u1ebf b\u00e0o ch\u00e2n gi\u1ea3 t\u0103ng th\u1ef1c b\u00e0o, k\u00edch ho\u1ea1t t\u1ebf b\u00e0o T, s\u1ea3n xu\u1ea5t cytokin, nh\u01b0 TGF – B, IL6, IL8 d\u1eabn \u0111\u1ebfn ti\u1ec3u \u0111\u1ea1m v\u00e0 x\u00f3a c\u00e1c t\u1ebf b\u00e0o ch\u00e2n gi\u1ea3.<\/p>\n
– C\u00e1c y\u1ebfu t\u1ed1 t\u0103ng t\u00ednh th\u1ea5m l\u01b0u h\u00e0nh: cytokin, globulin mi\u1ec5n d\u1ecbch, kh\u00e1ng th\u1ec3 CD40, hemopexin…<\/p>\n
3. C\u01a1 ch\u1ebf g\u00e2y r\u1ed1i lo\u1ea1n lipid m\u00e1u<\/h3>\n
– Khi \u00e1p l\u1ef1c keo trong m\u00e1u gi\u1ea3m, s\u1ebd k\u00edch th\u00edch c\u00e1c t\u1ebf b\u00e0o gan t\u0103ng t\u1ed5ng h\u1ee3p c\u00e1c lipoprotein trong \u0111\u00f3 c\u00f3 apolipoproteinB, v\u00e0 l\u00e0m t\u0103ng t\u1ed5ng h\u1ee3p cholesterol. Ngo\u00e0i ra hi\u1ec7n t\u01b0\u1ee3ng gi\u1ea3m tho\u00e1i bi\u1ebfn cholesterol c\u0169ng g\u00f3p ph\u1ea7n trong hi\u1ec7n t\u01b0\u1ee3ng t\u0103ng cholesterol m\u00e1u \u1edf b\u1ec7nh nh\u00e2n h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0.
\n– T\u0103ng tryglycerid m\u00e1u ch\u1ee7 y\u1ebfu do hi\u1ec7n t\u01b0\u1ee3ng gi\u1ea3m tho\u00e1i bi\u1ebfn m\u1ee1. \u1ede b\u1ec7nh nh\u00e2n b\u1ecb h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0, qu\u00e1 tr\u00ecnh tho\u00e1i bi\u1ebfn m\u1ee1 do men lipoprotein lipase b\u1ecb \u1ee9c ch\u1ebf.<\/p>\n
4. C\u01a1 ch\u1ebf t\u0103ng \u0111\u00f4ng m\u00e1u<\/h3>\n
– T\u00ecnh tr\u1ea1ng t\u0103ng \u0111\u00f4ng m\u00e1u th\u01b0\u1eddng th\u1ea5y trong h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 m\u1ee9c d\u1ed9 n\u1eb7ng l\u00e0 do m\u1ea5t qua n\u01b0\u1edbc ti\u1ec3u antithrombin III (AT III), gi\u1ea3m n\u00f4ng \u0111\u1ed9 protein C, protein S trong huy\u1ebft thanh, t\u0103ng fibrinogen m\u00e1u v\u00e0 t\u0103ng ng\u01b0ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u.<\/p>\n
M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n m\u1ea5t IgG n\u1eb7ng c\u00f3 th\u1ec3 d\u1eabn t\u1edbi h\u1eadu qu\u1ea3 gi\u1ea3m kh\u1ea3 n\u0103ng mi\u1ec5n d\u1ecbch v\u00e0 d\u1ec5 b\u1ecb nhi\u1ec5m khu\u1ea9n.<\/p>\n
L\u00c2M S\u00c0NG<\/h2>\n
B\u1ec7nh nhi b\u1ecb h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 th\u01b0\u1eddng \u0111\u1ebfn kh\u00e1m v\u00ec tri\u1ec7u ch\u1ee9ng ph\u00f9 to\u00e0n th\u00e2n. Tr\u1ebb b\u1ecb sang th\u01b0\u01a1ng t\u1ed1i thi\u1ec3u th\u01b0\u1eddng r\u1ea5t hi\u1ebfm khi c\u00f3 tri\u1ec7u ch\u1ee9ng ti\u1ec3u m\u00e1u v\u00e0 t\u0103ng huy\u1ebft \u00e1p.<\/p>\n
Ph\u00f9<\/h3>\n
Ph\u00f9 c\u00f3 \u0111\u1eb7c \u0111i\u1ec3m: ph\u00f9 to\u00e0n th\u00e2n, ph\u00f9 tr\u1eafng m\u1ec1m, \u1ea5n l\u00f5m, gi\u1eef d\u1ea5u \u1ea5n (Godet +), ti\u1ebfn tri\u1ec3n nhanh v\u00e0 n\u1eb7ng, c\u00f3 th\u1ec3 c\u00f3 tr\u00e0n d\u1ecbch \u0111a m\u00e0ng: m\u00e0ng b\u1ee5ng, tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i, tr\u00e0n d\u1ecbch m\u00e0ng tinh ho\u00e0n…Tr\u1ebb th\u01b0\u1eddng m\u1ec7t m\u1ecfi, c\u00f3 th\u1ec3 kh\u00f3 th\u1edf khi tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i hay b\u00e1ng b\u1ee5ng nhi\u1ec1u.<\/p>\n
Ti\u1ec3u \u00edt<\/h3>\n
Ti\u1ec3u \u00edt: l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u trong ng\u00e0y \u0111\u01b0\u1ee3c ghi nh\u1eadn gi\u1ea3m \u0111i nh\u01b0ng hi\u1ebfm khi tr\u1ebb b\u1ecb thi\u1ec3u ni\u1ec7u hay v\u00f4 ni\u1ec7u.<\/p>\n
Tri\u1ec7u ch\u1ee9ng kh\u00e1c<\/h3>\n
– Ti\u1ec3u m\u00e1u: th\u01b0\u1eddng \u00edt g\u1eb7p trong sang th\u01b0\u01a1ng t\u1ed1i thi\u1ec3u. Ti\u1ec3u m\u00e1u \u0111\u1ea1i th\u1ec3 ch\u1ec9 g\u1eb7p 3-4% c\u00e1c tr\u1ebb b\u1ecb h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 sang th\u01b0\u01a1ng t\u1ed1i thi\u1ec3u, tuy nhi\u00ean ti\u1ec3u m\u00e1u vi th\u1ec3 c\u00f3 th\u1ec3 g\u1eb7p trong 20-30%. Tri\u1ec7u ch\u1ee9ng ti\u1ec3u m\u00e1u \u0111\u1ea1i th\u1ec3 th\u01b0\u1eddng g\u1eb7p h\u01a1n \u1edf sang th\u01b0\u01a1ng vi\u00eam c\u1ea7u th\u1eadn t\u0103ng sinh m\u00e0ng.<\/p>\n
– T\u0103ng huy\u1ebft \u00e1p: ch\u1ec9 5-7% c\u00e1c tr\u01b0\u1eddng h\u1ee3p sang th\u01b0\u01a1ng t\u1ed1i thi\u1ec3u b\u1ecb t\u0103ng huy\u1ebft \u00e1p. Tri\u1ec7u ch\u1ee9ng t\u0103ng huy\u1ebft \u00e1p th\u01b0\u1eddng g\u1eb7p h\u01a1n \u1edf th\u1ec3 x\u01a1 h\u00f3a c\u1ee5c b\u1ed9 t\u1eebng v\u00f9ng v\u00e0 n\u1eb7ng nh\u1ea5t \u1edf th\u1ec3 vi\u00eam c\u1ea7u th\u1eadn t\u0103ng sinh m\u00e0ng, c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn b\u1ec7nh n\u00e3o do t\u0103ng huy\u1ebft \u00e1p.<\/div>\n
C\u1eacN L\u00c2M S\u00c0NG<\/h2>\n
\n
\u0110\u1ec1 ngh\u1ecb c\u1eadn l\u00e2m s\u00e0ng:<\/b><\/li>\n
– TPTNT, \u0111\u1ea1m ni\u1ec7u 24 gi\u1edd hay \u0111\u1ea1m ni\u1ec7u\/creatinin ni\u1ec7u.<\/li>\n
– \u0110\u1ea1m m\u00e1u, albumin m\u00e1u.<\/li>\n
– Cholesterolm\u00e1u, tryglycerid m\u00e1u.<\/li>\n
– Ure, creatinin, \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3 m\u00e1u.<\/li>\n
– C3,C4, ANA, HBsAg, Anti HCV (nghi ng\u1edd h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 th\u1ee9 ph\u00e1t).<\/li>\n
– Huy\u1ebft thanh ch\u1ea9n \u0111o\u00e1n CMV, Rubella, Toxoplasma, VDRL, HIV test nhanh (tr\u1ebb < 1 tu\u1ed5i).<\/li>\n
– X\u00e9t nghi\u1ec7m t\u00ecm \u0111\u1ed9t bi\u1ebfn Gen.<\/li>\n
– Sinh thi\u1ebft th\u1eadn.<\/li>\n
<\/li>\n<\/ul>\n
M\u1ee5c \u0111\u00edch<\/div>\n
– Gi\u00fap ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh<\/p>\n
– Gi\u00fap ch\u1ea9n \u0111o\u00e1n nguy\u00ean nh\u00e2n<\/div>\n
– T\u1ea7m so\u00e1t bi\u1ebfn ch\u1ee9ng<\/div>\n
X\u00e9t nghi\u1ec7m n\u01b0\u1edbc ti\u1ec3u<\/h3>\n
N\u00ean l\u1ea5y n\u01b0\u1edbc ti\u1ec3u \u0111\u1ea7u ti\u00ean v\u00e0o bu\u1ed5i s\u00e1ng n\u00ean th\u1eed n\u01b0\u1edbc ti\u1ec3u m\u1ed9t th\u1eddi \u0111i\u1ec3m<\/p>\n
\u0110\u1ea1m ni\u1ec7u<\/b><\/p>\n
\n
– Th\u1eed que nh\u00fang: Disptick (t\u1ed5ng ph\u00e2n t\u00edch n\u01b0\u1edbc ti\u1ec3u): th\u01b0\u1eddng Pro 3+ hay 4+<\/p>\n
– \u0110\u1ea1m ni\u1ec7u 24 gi\u1edd: protein > 50 mg\/kg c\u00e2n n\u1eb7ng\/ng\u00e0y hay > 40 mg\/m3 da\/gi\u1edd (>1g\/m2 da\/24 gi\u1edd)<\/div>\n
– T\u1ec9 l\u1ec7 \u0111\u1ea1m\/creatinin ni\u1ec7u > 2 (mg\/mg), hay >200 (mg\/mmol)<\/p>\n<\/div>\n
– Th\u1ec3 t\u0103ng sinh t\u1ed1i thi\u1ec3u v\u00e0 th\u1ec3 b\u1ec7nh c\u1ea7u th\u1eadn t\u0103ng sinh m\u00e0ng th\u01b0\u1eddng ti\u1ec3u \u0111\u1ea1m nhi\u1ec1u.<\/p>\n
Ti\u1ec3u m\u00e1u vi th\u1ec3<\/b><\/p>\n
– Th\u1ec3 t\u1ed1i thi\u1ec3u: g\u1eb7p trong 20-30% (th\u01b0\u1eddng ch\u1ec9 c\u00f3 trong nh\u1eefng ng\u00e0y \u0111\u1ea7u)
\n– Th\u1ec3 x\u01a1 h\u00f3a c\u1ee5c b\u1ed9 t\u1eebng ph\u1ea7n th\u01b0\u1eddng c\u00f3 ti\u1ec3u m\u00e1u vi th\u1ec3<\/p>\n
– Th\u1ec3 vi\u00eam c\u1ea7u th\u1eadn t\u0103ng sinh m\u00e0ng: ti\u1ec3u m\u00e1u vi th\u1ec3 g\u1eb7p \u1edf 80-100% c\u00e1c ca<\/p>\n
– B\u1ec7nh c\u1ea7u th\u1eadn m\u00e0ng: g\u1eb7p \u1edf 80% c\u00e1c tr\u01b0\u1eddng h\u1ee3p.<\/p>\n
X\u00e9t nghi\u1ec7m m\u00e1u<\/h3>\n
Ch\u1ea9n \u0111o\u00e1n h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0<\/b><\/p>\n
– \u0110\u1ea1m ni\u1ec7u 24 gi\u1edd: protein > 50 mg\/kg c\u00e2n n\u1eb7ng\/ ng\u00e0y hay > 40 mg\/m^{2<\/sup>\u00a0da\/gi\u1edd (>1g\/m2 da\/ 24 gi\u1edd)
\n– T\u1ec9 l\u1ec7 \u0111\u1ea1m\/creatinin ni\u1ec7u > 2(mg\/mg), hay >200(mg\/mmol).<\/p>\n}
– \u0110\u1ea1m m\u00e1u: Protid m\u00e1u to\u00e0n ph\u1ea7n <5,5g\/dl, albumin m\u00e1u gi\u1ea3m <2,5g\/dl.<\/p>\n
– T\u1ef7 l\u1ec7 A\/G (albumin\/globulin)<1.<\/p>\n
– Bilan Lipid m\u00e1u: th\u01b0\u1eddng t\u0103ng c\u1ea3 hai th\u00e0nh ph\u1ea7n, cholesterol m\u00e1u > 200mg% (+-)<\/p>\n
– \u0110i\u1ec7n di m\u00e1u c\u00f3 th\u1ec3 th\u1ea5y: gi\u1ea3m nh\u1eb9 alpha-1 globulin, t\u0103ng apha-2 globulin v\u00e0 beta globulin.<\/p>\n
Ch\u1ea9n \u0111o\u00e1n nguy\u00ean nh\u00e2n h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0<\/b><\/p>\n
– Xem c\u00f3 nguy\u00ean nh\u00e2n th\u1ee9 ph\u00e1t n\u00e0o kh\u00f4ng? Lupus, Hnoch-Scholein, s\u1ed1t r\u00e9t, vi\u00eam gan B,C, b\u1ec7nh chuy\u1ec3n h\u00f3a…
\n– B\u1ed5 th\u1ec3: C3,C4 th\u01b0\u1eddng b\u00ecnh th\u01b0\u1eddng trong h\u1ed9i ch\u1ee9ng sang th\u01b0\u01a1ng t\u1ed1i thi\u1ec3u. B\u1ed5 th\u1ec3 c\u00f3 th\u1ec3 gi\u1ea3m trong vi\u00eam c\u1ea7u th\u1eadn t\u0103ng sinh m\u00e0ng hay trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 th\u1ee9 ph\u00e1t (sau nhi\u1ec5m tr\u00f9ng hay lupus).<\/p>\n
– T\u1ea7m so\u00e1t nhi\u1ec5m tr\u00f9ng: vi\u00eam gan si\u00eau vi: HBsAg, anti HBs, anti HCV…<\/p>\n
– T\u1ea7m so\u00e1t b\u1ec7nh h\u1ec7 th\u1ed1ng: kh\u00e1ng th\u1ec3 kh\u00e1ng nh\u00e2n (ANA), antidsDNA.<\/p>\n
– X\u00e9t nghi\u1ec7m t\u00ecm \u0111\u1ed9t bi\u1ebfn Gen: ch\u1ee7 y\u1ebfu \u1edf 5 gen NPHS1, NPHS2, NPHS3, WT1 v\u00e0 LAMB2 (nghi ng\u1edd \u0111\u1ed9t bi\u1ebfn gen: th\u1eadn h\u01b0 < 1 tu\u1ed5i, cha m\u1eb9 \u0111\u1ed3ng huy\u1ebft th\u1ed1ng, gia \u0111\u00ecnh c\u00f3 ng\u01b0\u1eddi b\u1ecb HCTH kh\u00e1ng corticoid, HCTH k\u00e8m c\u00e1c b\u1ea5t th\u01b0\u1eddng ngo\u00e0i th\u1eadn, HCTH kh\u00e1ng Cyclosporin\/Tacrolimus).<\/p>\n
T\u1ea7m so\u00e1t bi\u1ebfn ch\u1ee9ng<\/b><\/p>\n
– \u0110\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng c\u01a1 quan, t\u1ea7m so\u00e1t bi\u1ebfn ch\u1ee9ng hay b\u1ec7nh k\u00e8m theo c\u1ee7a b\u1ec7nh nh\u00e2n
\n– T\u1ed5ng ph\u00e2n t\u00edch t\u1ebf b\u00e0o m\u00e1u: dung t\u00edch h\u1ed3ng c\u1ea7u (Hct) v\u00e0 n\u1ed3ng \u0111\u1ed9 Hb trong m\u00e1u t\u0103ng, do t\u00ecnh tr\u1ea1ng c\u00f4 \u0111\u1eb7c m\u00e1u. Ti\u1ec3u c\u1ea7u th\u01b0\u1eddng t\u0103ng, c\u00f3 th\u1ec3 l\u00ean \u0111\u1ebfn 500.000 hay 1 tri\u1ec7u\/mm^{3<\/sup>. T\u00ecnh tr\u1ea1ng c\u00f4 \u0111\u1eb7c m\u00e1u v\u00e0 t\u0103ng ti\u1ec3u c\u1ea7u g\u00f3p ph\u1ea7n l\u00e0m t\u0103ng nguy c\u01a1 tao huy\u1ebft kh\u1ed1i.<\/p>\n}
– Ch\u1ee9c n\u0103ng th\u1eadn: th\u01b0\u1eddng b\u00ecnh th\u01b0\u1eddng. Creatinin c\u00f3 th\u1ec3 t\u0103ng nh\u1eb9-v\u1eeba trong m\u1ed9t s\u1ed1 \u00edt tr\u01b0\u1eddng h\u1ee3p do gi\u1ea3m th\u1ec3 t\u00edch n\u1ed9i m\u1ea1ch n\u1eb7ng, s\u1ebd h\u1ed3i ph\u1ee5c khi th\u1ec3 t\u00edch n\u1ed9i m\u1ea1ch t\u0103ng l\u00ean.<\/p>\n
– Ch\u1ee9c n\u0103ng gan: khi c\u1ea7n ph\u00e2n bi\u1ec7t gi\u1ea3m albumin m\u00e1u do gan.<\/p>\n
– Ion \u0111\u1ed3: Natri m\u00e1u c\u00f3 th\u1ec3 gi\u1ea3m do t\u00ecnh tr\u1ea1ng t\u0103ng ti\u1ebft ADH kh\u00f4ng th\u00edch h\u1ee3p. Kali m\u00e1u c\u00f3 th\u1ec3 gi\u1ea3m do t\u00e1c d\u1ee5ng ph\u1ee5 khi \u0111i\u1ec1u tr\u1ecb corticoid hay t\u0103ng do suy th\u1eadn. Calci m\u00e1u to\u00e0n ph\u1ea7n th\u01b0\u1eddn gi\u1ea3m do gi\u1ea3m protein m\u00e1u, nh\u01b0ng calci ion h\u00f3a v\u1eabn b\u00ecnh th\u01b0\u1eddng.<\/p>\n
-Bilan t\u0103ng \u0111\u00f4ng: t\u1ea7m so\u00e1t nguy c\u01a1 huy\u1ebft kh\u1ed1i do t\u0103ng \u0111\u00f4ng: ch\u1ee9c n\u0103ng \u0111\u00f4ng m\u00e1u t\u00ecan b\u1ed9 (\u0111\u1ecbnh l\u01b0\u1ee3ng fibrinogen m\u00e1u), \u0111\u1ecbnh l\u01b0\u1ee3ng antithrombin III, \u0111\u1ecbnh l\u01b0\u1ee3ng protein S v\u00e0 protein C trong m\u00e1u.<\/p>\n
Ch\u1ec9 \u0111\u1ecbnh sinh thi\u1ebft th\u1eadn<\/h3>\n
Ch\u1ec9 th\u1ef1c hi\u1ec7n trong c\u00e1c tr\u01b0\u01a1ng h\u1ee3p:
\n– Nghi ng\u1edd, hay c\u00f3 b\u1eb1ng ch\u1ee9ng th\u1eadn h\u01b0 th\u1ee9 ph\u00e1t.<\/p>\n
– H\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 c\u00f3 c\u00e1c b\u1eb1ng ch\u1ee9ng kh\u00f4ng ph\u00f9 h\u1ee3p v\u1edbi sang th\u01b0\u01a1ng t\u1ed1i thi\u1ec3u.<\/p>\n
Tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb<\/b><\/p>\n
– Kh\u1edfi b\u1ec7nh qu\u00e1 s\u1edbm: sinh thi\u1ebft th\u1eadn cho t\u1ea5t c\u1ea3 tr\u01b0\u1eddng h\u1ee3p h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 kh\u1edfi b\u1ec7nh tr\u01b0\u1edbc 3 th\u00e1ng tu\u1ed5i, v\u00e0 c\u0169ng n\u00ean sinh thi\u1ebft cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p kh\u1edfi b\u1ec7nh t\u1eed 3-12 th\u00e1ng tu\u1ed5i.
\n– Kh\u1edfi b\u1ec7nh tr\u1ec5: tr\u00ean 12 tu\u1ed5i.<\/p>\n
– Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng: t\u0103ng huy\u1ebft \u00e1p, ti\u1ec3u m\u00e1u \u0111\u1ea1i th\u1ec3, suy th\u1eadn.<\/p>\n
– C\u00f3 b\u1eb1ng ch\u1ee9ng nghi h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 th\u1ee9 ph\u00e1t: b\u1ed5 th\u1ec3 C3, C4 gi\u1ea3m, ANA d\u01b0\u01a1ng t\u00ednh, b\u1eb1ng ch\u1ee9ng vi\u00eam gan si\u00eau vi \u0111ang ho\u1ea1t \u0111\u1ed9ng…<\/p>\n
Sau \u0111i\u1ec1u tr\u1ecb<\/b><\/p>\n
– H\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 kh\u00e1ng corrticoid.
\n– \u0110\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 l\u1ec7 thu\u1ed9c corticoid li\u1ec1u cao ch\u1ec9 sinh thi\u1ebft th\u1eadn khi \u0111i\u1ec1u tr\u1ecb v\u1edbi thu\u1ed1c \u1ee9c ch\u1ebf calcineurin.<\/p>\n
X\u00e9t nghi\u1ec7m Gen trong h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0<\/h3>\n
X\u00e9t nghi\u1ec7m t\u00ecm \u0111\u1ed9t bi\u1ebfn gen c\u00f3 th\u1ec3 gi\u00fap b\u00e1c s\u0129 \u0111i\u1ec1u tr\u1ecb quy\u1ebft \u0111\u1ecbnh ng\u01b0ng c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch, tr\u00e1nh cho b\u1ec7nh nh\u00e2n b\u1ecb c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a thu\u1ed1c m\u1ed9t c\u00e1ch v\u00f4 \u00edch, gi\u00fap t\u01b0 v\u1ea5n ti\u1ec1n s\u1ea3n v\u00e0 gi\u00fap th\u00eam th\u00f4ng tin cho qu\u00e1 tr\u00ecnh gh\u00e9p th\u1eadn sau \u0111\u00f3.
\nCh\u1ec9 \u0111\u1ecbnh t\u1ea7m so\u00e1t c\u00e1c \u0111\u1ed9t bi\u1ebfn Gen<\/b><\/p>\n
– Th\u1eadn h\u01b0 b\u1ea9m sinh <= 3 th\u00e1ng tu\u1ed5i
\n– Th\u1eadn h\u01b0 kh\u1edfi ph\u00e1t s\u1edbm 4 – 12 th\u00e1ng<\/p>\n
– Th\u1eadn h\u01b0 kh\u00e1ng corticoid c\u00f3 t\u00ednh gia \u0111\u00ecnh<\/p>\n
– Th\u1eadn h\u01b0 kh\u00e1ng corticoid c\u00f3 cha m\u1eb9 \u0111\u1ed3ng huy\u1ebft th\u1ed1ng.<\/p>\n
– Th\u1eadn h\u01b0 n\u1eb1m trong c\u00e1c h\u1ed9i ch\u1ee9ng Fraiser (gen WT1), h\u1ed9i ch\u1ee9ng Pierson (LAMB2)….<\/p>\n
– Th\u1eadn h\u01b0 kh\u00e1ng corticoid, kh\u00e1ng cyclosporin.<\/p>\n
CH\u1ea8N \u0110O\u00c1N<\/h2>\n
Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0<\/h3>\n
C\u00f3 \u0111\u1ee7 c\u00e1c ti\u00eau chu\u1ea9n sau:
\n– Ph\u00f9<\/p>\n
– \u0110\u1ea1m ni\u1ec7u >= 50mg\/kg\/ng\u00e0y ho\u1eb7c \u0111\u1ea1m ni\u1ec7u\/creatinin ni\u1ec7u (mg\/mg) >2 ho\u1eb7c \u0111\u1ea1m ni\u1ec7u\/creatinin ni\u1ec7u (mg\/mmol)>200.<\/p>\n
– Albumin m\u00e1u < 2,5g%<\/p>\n
– Cholesterol m\u00e1u > 200mg% (+-)<\/p>\n
Ch\u1ea9n \u0111o\u00e1n c\u00f3 th\u1ec3<\/h3>\n
– Ph\u00f9
\n– Albumin m\u00e1u < 2,5g%, ti\u1ec3u \u0111\u1ea1m \u0111\u00e1ng k\u1ec3 nh\u01b0ng ch\u01b0a \u0111\u1ea1t ng\u01b0\u1ee1ng h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0.<\/p>\n
Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t<\/h3>\n
Vi\u00eam c\u1ea7u th\u1eadn c\u1ea5p<\/b><\/p>\n
– Ph\u00f9
\n– T\u0103ng huy\u1ebft \u00e1p<\/p>\n
– Ti\u1ec3u m\u00e1u<\/p>\n
– \u0110\u1ea1m m\u00e1u v\u00e0 cholesterol m\u00e1u b\u00ecnh th\u01b0\u1eddng.<\/p>\n
Ph\u00f9 do gi\u1ea3m \u0111\u1ea1m m\u00e1u<\/b><\/p>\n
– Ph\u00f9, gi\u1ea3m albumin m\u00e1u, n\u01b0\u1edbc ti\u1ec3u b\u00ecnh th\u01b0\u1eddng.<\/p>\n
Ch\u1ea9n \u0111o\u00e1n bi\u1ebfn ch\u1ee9ng<\/h3>\n
1. Nhi\u1ec5m tr\u00f9ng<\/b><\/p>\n
Tr\u1ebb b\u1ecb h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 r\u1ea5t hay b\u1ecb nhi\u1ec5m tr\u00f9ng. Trong \u0111\u00f3, b\u1ec7nh c\u1ea3nh vi\u00eam ph\u00fac m\u1ea1c nguy\u00ean ph\u00e1t l\u00e0 bi\u1ebfn ch\u1ee9ng nhi\u1ec5m tr\u00f9ng th\u01b0\u1eddng hay g\u1eb7p nh\u1ea5t. T\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh th\u01b0\u1eddng l\u00e0 Streptococucs pneumoniae, ngo\u00e0i ra c\u00f2n c\u00f3 c\u00e1c vi tr\u00f9ng gram \u00e2m nh\u01b0: E.coli, Haemophilus influenza.
\nNgo\u00e0i ra tr\u1ebb b\u1ecb h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 c\u00f2n b\u1ecb c\u00e1c nhi\u1ec5m tr\u00f9ng kh\u00e1c nh\u01b0: vi\u00eam ph\u1ed5i, vi\u00eam m\u00f4 t\u1ebf b\u00e0o, nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng ti\u1ec3u, vi\u00eam m\u00e0ng n\u00e3o m\u1ee7,…
\nB\u1ec7nh nh\u00e2n h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 d\u1ec5 b\u1ecb nhi\u1ec5m tr\u00f9ng l\u00e0 do: gi\u1ea3m t\u1ed5ng h\u1ee3p IgG, gi\u1ea3m ch\u1ee9c n\u0103ng lympho T, m\u1ea5t y\u1ebfu t\u1ed1 B qua n\u01b0\u1edbc ti\u1ec3u (l\u00e0 cofactor c\u1ee7a C3b trong con \u0111\u01b0\u1eddng ho\u1ea1t h\u00f3a b\u1ed5 th\u1ec3, \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng trong vi\u1ec7c opsonin h\u00f3a vi tr\u00f9ng). Ngo\u00e0i ra, t\u00ecnh tr\u1ea1ng ph\u00f9 to\u00e0n th\u00e2n, b\u00e1ng b\u1ee5ng, tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i l\u00e0 do m\u00f4i tr\u01b0\u1eddng cho vi tr\u00f9ng d\u1ec5 x\u00e2m nh\u1eadp v\u00e0 ph\u00e1t tri\u1ec3n.<\/p>\n
2. T\u0103ng \u0111\u00f4ng<\/b><\/p>\n
B\u1ec7nh nh\u00e2n h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 d\u1ec5 b\u1ecb bi\u1ebfn ch\u1ee9ng t\u0103ng \u0111\u00f4ng d\u1eabn \u0111\u1ebfn huy\u1ebft kh\u1ed1i. Bi\u1ebfn ch\u1ee9ng n\u00e0y th\u01b0\u1eddng g\u1eb7p trong 3 th\u00e1ng \u0111\u1ea7u sau kh\u1ecfi b\u1ec7nh. Th\u01b0\u1eddng g\u1eb7p tr\u1ebb l\u1edbn > 12 tu\u1ed5i v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c h\u1eadu qu\u1ea3 n\u1eb7ng n\u1ec1.
\nC\u00e1c y\u1ebfu t\u1ed1 thu\u1eadn l\u1ee3i g\u00e2y bi\u1ebfn ch\u1ee9ng t\u0103ng \u0111\u00f4ng:<\/p>\n
– T\u0103ng c\u00e1c y\u1ebfu t\u1ed1 \u0111\u00f4ng m\u00e1u: fibrinogen, y\u1ebfu t\u1ed1 V, y\u1ebfu t\u1ed1 VIII, t\u0103ng s\u1ed1 l\u01b0\u1ee3ng v\u00e0 \u0111\u1ed9 k\u1ebft d\u00ednh ti\u1ec3u c\u1ea7u.<\/p>\n
– Gi\u1ea3m c\u00e1c y\u1ebfu t\u1ed1 ch\u1ed1ng \u0111\u00f4ng m\u00e1u: gi\u1ea3m antithrombine III<\/p>\n
– Gi\u1ea3m ho\u1ea1t \u0111\u1ed9ng ph\u00e2n h\u1ee7y fibrin do t\u0103ng n\u1ed3ng \u0111\u1ed9 alpha -2 macroglobulin v\u00e0 lipoprotein.<\/p>\n
\u0110a ph\u1ea7n l\u00e0 c\u00e1c bi\u1ebfn ch\u1ee9ng thuy\u00ean t\u1eafc t\u0129nh m\u1ea1ch, hi\u1ebfm khi thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch. V\u1ecb tr\u00ed thuy\u00ean t\u1eafc bao g\u1ed3m: t\u0129nh m\u1ea1ch th\u1eadn, t\u0129nh m\u1ea1ch n\u00e3o, t\u0129nh m\u1ea1ch ngo\u1ea1i\u00a0 bi\u00ean, hay \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i,…<\/p>\n
3. T\u00ecnh tr\u1ea1ng gi\u1ea3m th\u1ec3 t\u00edch<\/b><\/p>\n
Th\u01b0\u1eddng x\u1ea3y ra\u00a0 trong giai \u0111o\u1ea1n kh\u1edfi ph\u00e1t b\u1ec7nh hay t\u00e1i ph\u00e1t. S\u1eed d\u1ee5ng thu\u1ed1c l\u1ee3i ti\u1ec3u, nhi\u1ec5m tr\u00f9ng, ti\u00eau ch\u1ea3y c\u1ea5p c\u00f3 th\u1ec3 l\u00e0m cho t\u00ecnh tr\u1ea1ng gi\u1ea3m th\u1ec3 t\u00edch n\u1eb7ng h\u01a1n v\u00e0 v\u00e0o b\u1ec7nh c\u1ea3nh s\u1ed1c v\u1edbi chi l\u1ea1nh, t\u1ee5t huy\u1ebft \u00e1p, m\u1ea1ch nhanh nh\u1eb9, dung t\u00edch h\u1ed3ng c\u1ea7u (Hct) t\u0103ng cao.<\/p>\n
4. R\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i<\/b><\/p>\n
H\u1ea1 natri m\u00e1u, h\u1ea1 calci m\u00e1u.<\/p>\n
5. T\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p<\/b><\/p>\n
Tr\u1ebb b\u1ecb h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 c\u00f3 th\u1ec3 b\u1ecb\u00a0 gi\u1ea3m GFR do c\u00e1c nguy\u00ean nh\u00e2n sau \u0111\u00e2y: gi\u1ea3m th\u1ec3 t\u00edch, nhi\u1ec5m tr\u00f9ng, ho\u1ea1i t\u1eed \u1ed1ng th\u1eadn c\u1ea5p (th\u1ee9 ph\u00e1t sau t\u00ecnh tr\u1ea1ng gi\u1ea3m th\u1ec3 t\u00edch), vi\u00eam th\u1eadn k\u1ebd do thu\u1ed1c, ng\u1ed9 \u0111\u1ed9c thu\u1ed1c \u1ee9c ch\u1ebf calcineurin (cyclosporin, tacrolimus), hay do thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n.
\nSuy th\u1eadn c\u1ea5p do b\u1ea3n th\u00e2n b\u1ec7nh th\u1eadn m\u1ea1n trong MCD th\u01b0\u1eddng r\u1ea5t hi\u1ebfm, t\u1ec9 l\u1ec7 gi\u1ea3m GFR t\u01b0\u01a1ng quan v\u1edbi m\u1ee9c \u0111\u1ed9 d\u1eb9t ch\u00e2n g\u1ea3i c\u1ee7a podocyte.<\/p>\n
6. Suy dinh d\u01b0\u1ee1ng<\/b><\/p>\n
Do m\u1ea5t \u0111\u1ea1m qua n\u01b0\u1edbc n\u01b0\u1edbc ti\u1ec3u.<\/p>\n
7. Bi\u1ebfn ch\u1ee9ng do \u0111i\u1ec1u tr\u1ecb<\/b><\/p>\n
Tr\u1ebb c\u00f3 th\u1ec3 b\u1ecb c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a corticoid:
\n– D\u1ec5 nhi\u1ec5m tr\u00f9ng<\/p>\n
– H\u1ed9i ch\u1ee9ng Cushing do thu\u1ed1c.<\/p>\n
– T\u0103ng huy\u1ebft \u00e1p<\/p>\n
– Ch\u1eadm ph\u00e1t tri\u1ec3n chi\u1ec1u cao.<\/p>\n
– Vi\u00eam lo\u00e9t d\u1ea1 d\u00e0y, t\u00e1 tr\u00e0ng.<\/p>\n
– Lo\u00e3ng x\u01b0\u01a1ng<\/p>\n
– \u0110\u1ee5c th\u1ee7y tinh th\u1ec3<\/p>\n
– R\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n<\/p>\n
Ngo\u00e0i ra, c\u00f3 th\u1ec3 c\u00f3 c\u00e1c bi\u1ebfn ch\u1ee9ng do c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch kh\u00e1c.<\/p>\n
\u0110I\u1ec0U TR\u1eca<\/h2>\n
A. H\u1ed8I CH\u1ee8NG TH\u1eacN H\u01af NGUY\u00caN PH\u00c1T<\/h3>\n
1. Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb<\/b><\/p>\n
\n
\u0110i\u1ec1u tr\u1ecb\u00a0\u0111\u1eb7c hi\u1ec7u b\u1eb1ng thu\u1ed1c\u00a0\u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch.<\/li>\n
\u0110i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng v\u00e0 bi\u1ebfn ch\u1ee9ng.<\/li>\n<\/ul>\n
2. \u0110i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u b\u1eb1ng thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch:<\/b><\/p>\n
\n
a.\u00a0\u0110i\u1ec1u tr\u1ecb ban\u00a0\u0111\u1ea7u:<\/b>
\n4 tu\u1ea7n\u00a0\u0111\u1ea7u: Predn\u00edone 2mg\/kg\/ng\u00e0y (t\u1ed1i\u00a0\u0111a 60mg\/ng\u00e0y).<\/p>\n<\/div>\n
b.\u00a0\u0110i\u1ec1u tr\u1ecb ti\u1ebfp theo<\/b><\/p>\n
\n
N\u1ebfu c\u00f3\u00a0\u0111\u00e1p\u00a0\u1ee9ng: h\u1ebft ph\u00f9,\u00a0\u0111\u1ea1m ni\u1ec7u\u00a0\u00e2m t\u00ednh li\u00ean ti\u1ebfp trong 3 ng\u00e0y.<\/li>\n<\/ul>\n
8 tu\u1ea7n k\u1ebf: Prednisone 1,5mg\/kg\/c\u00e1ch ng\u00e0y.<\/p>\n
6 tu\u1ea7n k\u1ebf: Prednisone d\u00f9ng c\u00e1ch ng\u00e0y gi\u1ea3m li\u1ec1u d\u1ea7n, m\u1ed7i tu\u1ea7n gi\u1ea3m 1\/6 li\u1ec1u cho\u00a0\u0111\u1ebfn khi ng\u01b0ng thu\u1ed1c.<\/p>\n
\n
N\u1ebfu tr\u1ebb t\u00e1i ph\u00e1t trong qu\u00e1 tr\u00ecnh gi\u1ea3m li\u1ec1u:<\/li>\n<\/ul>\n
–\u00a0\u0110\u1ed1i v\u1edbi th\u1ec3 t\u00e1i ph\u00e1t kh\u00f4ng th\u01b0\u1eddng xuy\u00ean:<\/p>\n
Prednisone 2mg\/kg\/ng\u00e0y, cho\u00a0\u0111\u1ebfn khi\u00a0\u0111\u1ea1m ni\u1ec7u\u00a0\u00e2m t\u00ednh trong 3 ng\u00e0y li\u00ean ti\u1ebfp (th\u01b0\u1eddng trong 2 tu\u1ea7n). Sau\u00a0\u0111\u00f3, Prednisone 1,5mg\/kg\/c\u00e1ch ng\u00e0y trong 4-8 tu\u1ea7n, gi\u1ea3m li\u1ec1u d\u1ea7n trong 6 tu\u1ea7n r\u1ed3i ng\u01b0ng.<\/p>\n
–\u00a0\u0110\u1ed1i v\u1edbi th\u1ec3 t\u00e1i ph\u00e1t th\u01b0\u1eddng xuy\u00ean hay th\u1ec3 ph\u1ee5 thu\u1ed9c Corticoid:<\/p>\n
+ Prednisone 2mg\/kg\/ng\u00e0y cho\u00a0\u0111\u1ebfn khi\u00a0\u0111\u1ea1m ni\u1ec7u\u00a0\u00e2m t\u00ednh 3 ng\u00e0y li\u00ean ti\u1ebfp. K\u1ebf\u00a0\u0111\u1ebfn, Prednisone 1,5mg\/kg\/c\u00e1ch ng\u00e0y trong 8 tu\u1ea7N. Sau\u00a0\u0111\u00f3 gi\u1ea3m d\u1ea7n li\u1ec1u Prednisone v\u00e0 duy tr\u00ec li\u1ec1u th\u1ea5p nh\u1ea5t c\u00f3 hi\u1ec7u qu\u1ea3 trong 9-18 th\u00e1ng.<\/p>\n
+ N\u1ebfu li\u1ec1u Prednisone duy tr\u00ec cao > 1mg\/kg\/c\u00e1ch ng\u00e0y hay 0,5 mg\/kg\/c\u00e1ch ng\u00e0y k\u00e8m theo bi\u1ebfn ch\u1ee9ng\u00a0\u0111\u00e1ng k\u1ec3 do d\u00f9ng corticoid k\u00e9o d\u00e0i nh\u01b0 Cushing n\u1eb7ng, cao huy\u1ebft\u00a0\u00e1p, ti\u1ec3u\u00a0\u0111\u01b0\u1eddng, xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a…s\u1ebd ph\u1ed1i h\u1ee3p th\u00eam m\u1ed9t trong c\u00e1c thu\u1ed1c sau (khi\u00a0\u0111\u00e3\u00a0\u0111\u1ea1t\u00a0\u0111\u01b0\u1ee3c lui b\u1ec7nh):<\/p>\n\n\n\n\n\n\n\n\n
T\u00ean thu\u1ed1c<\/th>\n Li\u1ec1u d\u00f9ng<\/th>\n Th\u1eddi gian<\/th>\n T\u00e1c d\u1ee5ng ph\u1ee5<\/th>\n Ghi ch\u00fa<\/th>\n<\/tr>\n
Cyclophosphamide<\/td>\n 2mg\/kg\/ng\u00e0y, (t\u1ed1i\u00a0\u0111a 125mg\/ng\u00e0y)<\/td>\n 8-12 tu\u1ea7n (li\u1ec1u t\u00edch l\u0169y t\u1ed1i\u00a0\u0111a 168 mg\/kg)<\/td>\n gi\u1ea3m b\u1ea1ch c\u1ea7u, r\u1ee5ng t\u00f3c c\u00f3 h\u1ed3i ph\u1ee5c, vi\u00eam b\u00e0ng quang xu\u1ea5t huy\u1ebft, v\u00f4 sinh (khi li\u1ec1u t\u00edch l\u00fay > 250mg\/kg,\u00a0\u0111\u1eb7c bi\u00eat\u00a0\u1edf b\u1ec7nh nh\u00e2n d\u00e2y th\u00ec), b\u1ec7nh\u00a0\u00e1c t\u00ednh.<\/td>\n TPTTBM m\u1ed7i 2-4 tu\u1ea7n: ng\u01b0ng cyclophosphamide khi b\u1ea1ch c\u1ea7u <3.000\/mm3 ho\u1eb7c neutrophil <1.500\/mm3 ho\u1eb7c khi s\u1ed1t.<\/td>\n<\/tr>\n
Mycophenolate mofetil<\/td>\n 0,8-1,2g\/m2 da\/ng\u00e0y (t\u1ed1i\u00a0\u0111a 2g\/ng\u00e0y), chia 2 l\u1ea7n, duy tr\u00ec n\u1ed3ng\u00a0\u0111\u1ed9 mycophenolic acid trong m\u00e1u th\u1ea5p nh\u1ea5t 2,5-5ug\/ml.<\/td>\n T\u1ed1i thi\u1ec3u 12 th\u00e1ng (tr\u01b0\u1edbc khi xem x\u00e9t gi\u1ea3m li\u1ec1u d\u1ea7n v\u00e0 ng\u01b0ng v\u00ec c\u00f3 nguy c\u01a1 t\u00e1i ph\u00e1t cao sau ng\u01b0ng thu\u1ed1c)<\/td>\n Tr\u00ean\u00a0\u0111\u01b0u\u00f2ng ti\u00eau h\u00f3a (vi\u00eam lo\u00e9t d\u1ea1 d\u00e0y,\u00a0\u0111au qu\u1eb7n b\u1ee5ng, ti\u00eau ch\u1ea3y, xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a), gi\u1ea3m b\u1ea1ch c\u1ea7u h\u1ea1t.<\/td>\n TPTTBM m\u1ed7i 4 tu\u1ea7n: ng\u01b0ng khi neutrophil < 1,500\/mm3.<\/td>\n<\/tr>\n
Cyclosporin<\/td>\n 4-5mg\/kg\/ng\u00e0y chia 2 l\u1ea7n\/ng\u00e0y, duy tr\u00ec n\u1ed3ng\u00a0\u0111\u1ed9 thu\u1ed1c th\u1ea5p nh\u1ea5t trong m\u00e1u 100-200ng\/ml<\/td>\n T\u1ed1i thi\u1ec3u 12 th\u00e1ng (tr\u01b0\u1edbc khi xem x\u00e9t gi\u1ea3m li\u1ec1u d\u1ea7n v\u00e0 ng\u01b0ng v\u00ec nguy c\u01a1 t\u00e1i ph\u00e1t cao sau ng\u01b0ng thu\u1ed1c).<\/td>\n \u0110\u1ed9c t\u00ednh tr\u00ean th\u1eadn (x\u01a1 h\u00f3a\u00a0\u1ed1ng th\u1eadn m\u00f4 k\u1ebd kh\u00f4ng h\u1ed3i ph\u1ee5), t\u0103ng cretinin m\u00e1u, r\u1eadm l\u00f4ng, ph\u00ec\u00a0\u0111\u1ea1i n\u01b0\u1edbu r\u0103ng, t\u0103ng Kali, h\u1ea1 Magne m\u00e1u.<\/td>\n Theo d\u00f5i n\u1ed3ng\u00a0\u0111\u1ed9 cyclosporin v\u00e0 creatinin m\u00e1u khi b\u1eaft\u00a0\u0111\u1ea7u\u00a0\u0111i\u1ec1u tr\u1ecb ho\u1eb7c khi t\u0103ng li\u1ec1u thu\u1ed1c sau 2-4 tu\u1ea7n ho\u1eb7c nghi ng\u1edd ng\u1ed9\u00a0\u0111\u1ed9c cyclosporine. Khi creatinin m\u00e1u t\u0103ng 25% v\u00e0 nghi ng\u1edd\u00a0\u0111\u1ed9c th\u1eadn do cyclosporine, gi\u1ea3m li\u1ec1u thu\u1ed1c 20% v\u00e0 theo d\u00f5i trong 2 tu\u1ea7n. N\u1ebfu ch\u1ee9c n\u0103ng th\u1eadn kh\u00f4ng h\u1ed3i ph\u1ee5c v\u00e0kh\u00f4ng c\u00f3 nguy\u00ean nh\u00e2n kh\u00e1c, xem x\u00e9t ng\u01b0ng thu\u1ed1c. Sinh thi\u1ebft th\u00e1nau\u00a0\u0111i\u1ec1u tr\u1ecb cyclosporine li\u00ean t\u1ee5c trong 2 n\u0103m\u00a0\u0111\u1ec3\u00a0\u0111\u00e1nh gi\u00e1\u00a0\u0111\u1ed9c t\u00ednh c\u1ee7a thu\u1ed1c tr\u00ean th\u1eadn.<\/td>\n<\/tr>\n
Tacrolimus (th\u1ea5t b\u1ea1i v\u1edbi\u00a0\u0111i\u1ec1u tr\u1ecb Cyclosporine)<\/td>\n 0,1-0,2mg\/kg\/ng\u00e0y, chia 2 l\u1ea7n\/ng\u00e0y, duy tr\u00ec n\u1ed3ng\u00a0\u0111\u1ed9 thu\u1ed1c th\u1ea5p nh\u1ea5t trong m\u00e1u 5-10ng\/ml.<\/td>\n T\u1ed1i thi\u1ec3u 12 th\u00e1ng (tr\u01b0\u1edbc khi xem x\u00e9t gi\u1ea3m li\u1ec1u d\u1ea7n v\u00e0 ng\u01b0ng v\u00ec nguy c\u01a1 t\u00e1i ph\u00e1t cao sau ng\u01b0ng thu\u1ed1c).<\/td>\n \u0110\u1ed9c t\u00ednh tr\u00ean th\u1eadn (x\u01a1 h\u00f3a\u00a0\u1ed1ng th\u1eadn m\u00f4k\u1ebd kh\u00f4ng h\u1ed3i ph\u1ee5c), t\u0103ng Kali, t\u0103ng creatinin, h\u1ea1 Magne m\u00e1u, ti\u1ec3u\u00a0\u0111\u01b0\u1eddng.<\/td>\n Theo d\u00f5i\u00a0\u0111i\u1ec1u tr\u1ecb t\u01b0\u01a1ng t\u1ef1 Cyclosporin v\u00e0 th\u1eed Hba1c m\u1ed7i 6-12 th\u00e1ng.<\/td>\n<\/tr>\n
Rituximub (h\u1ed9i ch\u1ea9n to\u00e0n vi\u1ec7n tr\u01b0\u1edbc khi s\u1eed d\u1ee5ng)<\/td>\n 375 mg\/m2 da\/ li\u1ec1u TTM<\/td>\n m\u1ed7i 2 tu\u1ea7n, t\u1ed1i\u00a0\u0111a 2 li\u1ec1u<\/td>\n C\u00e1c ph\u1ea3n\u00a0\u1ee9ng li\u00ean quan ti\u00eam truy\u1ec1n nh\u01b0 h\u1ea1 huy\u1ebft\u00a0\u00e1p, s\u1ed1t l\u1ea1nh run, ph\u00e1t ban, co th\u1eaft ph\u1ebf qu\u1ea3n (1-2 gi\u1edd khi b\u1eaft\u00a0\u0111\u1ea7u truy\u1ec1n thu\u1ed1c). gi\u1ea3m b\u1ea1ch c\u1ea7u v\u00e0\/ho\u1eb7c gammaglobulin m\u00e1u, b\u1ec7nh n\u00e3o ch\u1ea5t tr\u1eafng\u00a0\u0111a\u00a0\u1ed5 ti\u1ebfn tri\u1ec3n, b\u1ec7nh ph\u1ed5i k\u1ebd.<\/td>\n Ch\u1ec9\u00a0\u0111\u1ecbnh cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p l\u1ec7 thu\u1ed9c Steroid v\u00e0 Cyclosporine v\u00e0 t\u00e1c d\u1ee5ng ph\u1ee5\u00a0\u0111\u00e1ng k\u1ec3 c\u1ee7a thu\u1ed1c (\u0111\u1ed9c th\u1eadn do thu\u1ed1c Cyclosporine)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
\n
N\u1ebfu sau 4 tu\u1ea7n v\u1eabn ch\u01b0a\u00a0\u0111\u00e1p\u00a0\u1ee9ng Prednisone:<\/li>\n<\/ul>\n
– Prednisone 2mg\/kg\/ng\u00e0y th\u00eam 2-4 tu\u1ea7n ho\u1eb7c Methylprednisolone 1g\/1,73 m2 da\/c\u00e1ch ng\u00e0y (t\u1ed1i\u00a0\u0111a 1g) truy\u1ec1n t\u0129nh m\u1ea1ch x 3 l\u1ea7n. N\u1ebfu v\u1eabn kh\u00f4ng lui b\u1ec7nh, xem nh\u01b0 kh\u00e1ng steroid, c\u1ea7n sinh thi\u1ebft th\u1eadn\u00a0\u0111\u1ec3 lo\u1ea1i tr\u1eeb c\u00e1c nguy\u00ean nh\u00e2n th\u1ee9 ph\u00e1t c\u1ee7a HCTH v\u00e0 ph\u00e2n t\u00edch\u00a0\u0111\u1ed9t bi\u1ebfn Gen (n\u1ebfu\u00a0\u0111\u01b0\u1ee3c) tr\u01b0\u1edbc khi\u00a0\u0111i\u1ec1u tr\u1ecb t\u1ebfp.<\/p>\n
– Thu\u1ed1c\u00a0\u1ee9c ch\u1ebf Calcineurine (Cyclosporine ho\u1eb7c Tacrolimus)\u00a0\u0111\u01b0\u1ee3c\u00a0\u0111i\u1ec1u tr\u1ecb li\u00ean t\u1ee5c\u00a0\u00edt nh\u1ea5t 6 th\u00e1ng, ph\u1ed1i h\u1ee3p Prednisone 1mg\/kg\/c\u00e1ch ng\u00e0y gi\u1ea3m li\u1ec1u d\u1ea7n.<\/p>\n
+ N\u1ebfu lui b\u1ec7nh ho\u00e0n to\u00e0n ho\u1eb7c m\u1ed9t ph\u1ea7n:<\/i><\/b>\u00a0ti\u1ebfp t\u1ee5c thu\u1ed1c\u00a0\u1ee9c ch\u1ebf Calcineurine\u00a0\u00edt nh\u1ea5t 12 th\u00e1ng\u00a0 tr\u01b0\u1edbc khi xem x\u00e9t gi\u1ea3m li\u1ec1u v\u00e0 duy tr\u00ec t\u1eeb 2-5 n\u0103m.<\/p>\n
+ N\u1ebfu kh\u00f4ng lui b\u1ec7nh:\u00a0<\/i><\/b><\/p>\n
– C\u00f3\u00a0\u0111\u1ed9t bi\u1ebfn Gen: xem x\u00e9t ng\u01b0ng thu\u1ed1c\u00a0\u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch,\u00a0\u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng.<\/p>\n
– Kh\u00f4ng c\u00f3\u00a0\u0111\u1ed9t bi\u1ebfn Gen ho\u1eb7c kh\u00f4ng th\u1ef1c hi\u1ec7n\u00a0\u0111\u01b0\u1ee3c: c\u00e2n nh\u1eafc\u00a0\u0111\u1ed5i sang Tacrolimus (n\u1ebfu\u00a0\u0111\u00e3 s\u1eed d\u1ee5ng Cyclosporine tr\u01b0\u1edbc\u00a0\u0111\u00f3) 6 th\u00e1ng, tr\u01b0\u1edbc khi th\u00eam Mycophenoltate mofetil,\u00a0\u0111\u00e1nh gi\u00e1 l\u1ea1i sau 6 th\u00e1ng:
\n+ Lui b\u1ec7nh: ti\u1ebfp t\u1ee5c\u00a0\u1ee9c ch\u1ebf Calcineurine v\u00e0 Mycophenolate\u00a0\u00edt nh\u1ea5t 12 th\u00e1ng.<\/p>\n
+ Kh\u00f4ng lui b\u1ec7nh: c\u1ea7n h\u1ed9i ch\u1ea9n b\u1ec7nh vi\u1ec7n xem x\u00e9t ch\u1ec9\u00a0\u0111\u1ecbnh Rituximab TTM 375mg\/m2 da\/li\u1ec1u m\u1ed7i 2 tu\u1ea7n x 2-4 li\u1ec1u.<\/p>\n
3. \u0110i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng<\/b><\/p>\n
a. Ph\u00f9<\/b><\/p>\n
\n
H\u1ea1n ch\u1ebf mu\u1ed1i v\u00e0 n\u01b0\u1edbc trong giai\u00a0\u0111o\u1ea1n ph\u00f9.<\/li>\n
L\u1ee3i ti\u1ec3u: h\u1ea1n ch\u1ebf d\u00f9ng l\u1ee3i ti\u1ec3u trong h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0. Ch\u1ec9 d\u00f9ng trong tr\u01b0\u1eddng h\u1ee3p ph\u00f9 n\u1eb7ng, b\u00e1ng b\u1ee5ng hay tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i nhi\u1ec1u g\u00e2y kh\u00f3 th\u1edf, n\u1ee9t da do ph\u00f9 hay ph\u00f9\u00a0\u0111i k\u00e8m v\u1edbi nhi\u1ec5m tr\u00f9ng n\u1eb7ng. Thu\u1ed1c l\u1ee3i ti\u1ec3u d\u00f9ng trong HCTH: Furosmide +- Spir\u00f4nlactone.<\/li>\n
Truy\u1ec1n Albumine:\u00a0 khi Albumine m\u00e1u d\u01b0\u1edbi 1,5g\/dl k\u00e8m theo m\u1ed9t trong hai ti\u00eau chu\u1ea9n sau:<\/li>\n<\/ul>\n
– S\u1ed1c gi\u1ea3m th\u1ec3 t\u00edch kh\u00f4ng\u00a0\u0111\u00e1p\u00a0\u1ee9ng v\u1edbi dung d\u1ecbch\u00a0\u0111i\u1ec7n gi\u1ea3i.<\/p>\n
– Ph\u00f9 n\u1eb7ng c\u00f3 nguy c\u01a1 suy h\u00f4 h\u1ea5p kh\u00f4ng\u00a0\u0111\u00e1p\u00a0\u1ee9ng v\u1edbi thu\u1ed1c l\u1ee3i ti\u1ec3u.<\/p>\n
C\u00e1ch d\u00f9ng Albumine:<\/p>\n
+ Truy\u1ec1n\u00a0\u0111\u1ec3 gi\u1ea3m ph\u00f9: Albumine 20% 1-2g\/kg\/li\u1ec1u, truy\u1ec1n ch\u1eadm trong\u00a0\u00a0\u00edt nh\u1ea5t 4 gi\u1edd. Ph\u1ed1i h\u1ee3p v\u1edbi Furosemide:<\/p>\n
Li\u1ec1u 1: 2mg\/kg TMC, sau khi truy\u1ec1n\u00a0\u0111\u01b0\u1ee3c ph\u00e2n n\u1eeda th\u1ec3 t\u00edch Albumine.<\/p>\n
L\u1ec1u 2: 2mg\/kg TMC, sau khi k\u1ebft th\u00fac truy\u1ec1n Albumine.<\/p>\n
Ch\u00fa\u00a0\u00fd theo d\u00f5i s\u00e1t d\u1ea5u hi\u1ec7u sinh t\u1ed3n khi truy\u1ec1n Albumine.<\/p>\n
+ Truy\u1ec1n\u00a0\u0111\u1ec3 ch\u1ed1ng s\u1ed1c:<\/p>\n
Li\u1ec1u d\u00f9ng Albumine 20%: 1-2g\/kg\/li\u1ec1u.<\/p>\n
Pha lo\u00e3ng l\u00e0 Albumine\/Normal saline t\u1ef7 l\u1ec7 1:3\u00a0\u0111\u1ec3\u00a0\u0111\u1ea1t\u00a0\u0111\u01b0\u1ee3c n\u1ed3ng\u00a0\u0111\u1ed9 Albumine 5%.<\/p>\n
T\u1ed1c\u00a0\u0111\u1ed9 truy\u1ec1n t\u1eeb 7,5 -15 ml\/kg\/gi\u1edd, t\u00f9y theo t\u00ecnh tr\u1ea1ng huy\u1ebft\u00a0\u0111\u1ed9ng h\u1ecdc c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n
b. gi\u1ea3m\u00a0\u0111\u1ea1m ni\u1ec7u (HCTH kh\u00e1ng steroid)<\/b><\/p>\n
\n
\u1ee8c ch\u1ebf me chuy\u1ec3n angiotensin: Enalapril 0,1-1mg\/kg\/ng\u00e0y (t\u1ed1i\u00a0\u0111a 40mg\/ng\u00e0y), chia 1 ho\u1eb7c 2 l\u1ea7n v\u00e0\/ho\u1eb7c<\/li>\n
\u1ee8c ch\u00e9 sth\u1ee5 th\u1ec3 angitensin II: Losartan 0,7 – 1,4 mg\/kg\/ng\u00e0y (t\u1ed1i\u00a0\u0111a 100mg\/ng\u00e0y), 1l\u1ea7n\/t\u1ed1i.<\/li>\n<\/ul>\n
c. Bi\u1ec7n ph\u00e1p h\u1ed7 tr\u1ee3 kh\u00e1c<\/b><\/p>\n
\n
Cho th\u00eam vitamin D v\u00e0 calcium.<\/li>\n
Ch\u1ec9 c\u1ea7n\u00a0\u0103n nh\u1ea1t trong giai\u00a0\u0111o\u1ea1n ph\u00f9.<\/li>\n
Dinh d\u01b0\u1ee1ng h\u1ed7 tr\u1ee3 (ph\u00e1c\u00a0\u0111\u1ed3\u00a0\u0111i\u1ec1u tr\u1ecb dinh d\u01b0\u1ee1ng).<\/li>\n
Tr\u1ebb c\u00f3 th\u1ec3 sinh ho\u1ea1t b\u00ecnh th\u01b0\u1eddng.<\/li>\n<\/ul>\n
4. \u0110i\u1ec1u tr\u1ecb bi\u1ebfn ch\u1ee9ng<\/b><\/p>\n
a. Nhi\u1ec5m tr\u00f9ng<\/b>
\n– Th\u01b0\u1eddng g\u1eb7p vi\u00eam ph\u00fac m\u1ea1c nguy\u00ean ph\u00e1t, vi\u00eam m\u00f4 t\u00ea b\u00e0o, vi\u00ea ph\u1ed5i, nhi\u1ec5m tr\u00f9ng ni\u1ec7u, nhi\u1ec5m tr\u00f9ng huy\u1ebft. C\u00f3 ch\u1ec9\u00a0\u0111\u1ecbnh d\u00f9ng kh\u00e1ng sinh ph\u1ed5 r\u1ed9ng s\u1edbm. Tr\u01b0\u1edbc khi d\u00f9ng kh\u00e1ng sinh ph\u1ea3i c\u1ea5y m\u00e1u, c\u1ea5y d\u1ecbch m\u00e0ng b\u1ee5ng v\u00e0 c\u00e1c d\u1ecbch c\u01a1 th\u1ec3 kh\u00e1c. N\u1ebfu c\u00f3 vi\u00eam ph\u00fac m\u1ea1c nguy\u00ean ph\u00e1t, t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh th\u01b0\u1eddng do ph\u1ebf c\u1ea7u v\u00e0 gram\u00a0\u00e2m, kh\u00e1ng sinh th\u01b0\u1eddng\u00a0\u0111\u01b0\u1ee3c ch\u1ecdn ban\u00a0\u0111\u1ea7u l\u00e0: Cefotaxime 150-200mg\/kg\/ng\u00e0y TM chia 4 l\u1ea7n ho\u1eb7c Ceftriaxone 100mg\/kg\/ng\u00e0y TM trong 7-10 ng\u00e0y.<\/p>\n
b. T\u0103ng\u00a0\u0111\u00f4ng<\/b><\/p>\n
– Ch\u00fa\u00a0\u00fd ph\u00f2ng ng\u1eeba c\u00e1c y\u1ebfu t\u1ed1 thu\u1eadn l\u1ee3i cho t\u0103ng\u00a0\u0111\u00f4ng: t\u00ecnh tr\u1ea1ng gi\u1ea3m th\u1ec3 t\u00edch, d\u00f9ng l\u1ee3i ti\u1ec3u, l\u1ea5y m\u00e1u t\u0129nh m\u1ea1ch (tr\u00e1nh l\u1ea5y m\u00e1u t\u0129nh m\u1ea1ch\u00a0\u0111\u00f9i), t\u00ecnh tr\u1ea1ng b\u1ea5t\u00a0\u0111\u1ed9ng.<\/p>\n
– Khi c\u00f3 huy\u1ebft kh\u1ed1i ->\u00a0\u0111i\u1ec1u tr\u1ecb thu\u1ed1c kh\u00e1ng\u00a0\u0111\u00f4ng.<\/p>\n
5. Theo d\u00f5i v\u00e0 t\u00e1i kh\u00e1m<\/b><\/p>\n
\n
H\u1eb9n t\u00e1i kh\u00e1m m\u1ed7i 2-4 tu\u1ea7n.<\/li>\n
Theo d\u00f5i: TPTNT ho\u1eb7c\u00a0\u0111\u1ea1m ni\u1ec7u\/creatinin ni\u1ec7u ho\u1eb7c\u00a0\u0111\u1ea1m ni\u1ec7u 24h m\u1ed7i 2-4 tu\u1ea7n, Creatinin m\u00e1u m\u1ed7i 3-12 th\u00e1ng; bi\u1ebfn ch\u1ee9ng c\u1ee7a HCTH, t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a thu\u1ed1c.<\/li>\n<\/ul>\n
B. H\u1ed8I CH\u1ee8NG TH\u1eacN H\u01af D\u01af\u1edaI 1 TU\u1ed4I<\/h3>\n
1. Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb<\/b><\/p>\n
\n
\u0110i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng.<\/li>\n
\u0110i\u1ec1u tr\u1ecb nguy\u00ean nh\u00e2n th\u1ee9 ph\u00e1t.<\/li>\n
\u0110i\u1ec1u tr\u1ecb thu\u1ed1c\u00a0\u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch n\u1ebfu nguy\u00ean nh\u00e2n v\u00f4 c\u0103n.<\/li>\n
Gh\u00e9p th\u1eadn khi\u00a0\u0111\u1ee7\u00a0\u0111i\u1ec1u ki\u1ec7n.<\/li>\n<\/ul>\n
2. \u0110i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng<\/b><\/p>\n
\n
Gi\u1ea3m\u00a0\u0111\u1ea1m ni\u1ec7u: thu\u1ed1c\u00a0\u1ee9c ch\u1ebf men chuy\u1ec3n ho\u1eb7c\u00a0\u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 angiotensin, ch\u00fa\u00a0\u00fd theo d\u00f5i ch\u1ee9c n\u0103ng th\u1eadn.<\/li>\n
Truy\u1ec1n Albumin: xem x\u00e9t khi ti\u1ec3u\u00a0\u0111\u1ea1m n\u1eb7ng d\u1eabn\u00a0\u0111\u1ebfn ph\u00f9 n\u1eb7ng\u00a0\u0111e d\u1ecda t\u00ednh m\u1ea1ng, ch\u1eadm t\u0103ng tr\u01b0\u1edfng ho\u1eb7c bi\u1ebfn ch\u1ee9ng th\u1ee9 ph\u00e1t kh\u00e1c. Ch\u1ec9 t\u0103ng Albumin m\u00e1u t\u1ea1m th\u1eddi, do\u00a0\u0111\u00f3 kh\u00f4ng c\u00f3 m\u1ee5c ti\u00eau c\u1ee5 th\u1ec3\u00a0\u0111\u1ec3 x\u00e1c\u00a0\u0111\u1ecbnh li\u1ec1u Albumin, c\u00f3 th\u1ec3 b\u1eaft\u00a0\u0111\u1ea7u li\u1ec1u 1g\/kg\/ng\u00e0y, k\u1ebft h\u1ee3p v\u1edbi Furosemide\u00a0\u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch.<\/li>\n
Ch\u1ebf\u00a0\u0111\u1ed9\u00a0\u0103n gi\u00e0u n\u0103ng l\u01b0\u1ee3ng, gi\u00e0u Protein, gi\u1ea3m mu\u1ed1i. B\u1ed5 sung vitamin, thyroxin d\u1ef1a tr\u00ean TSH m\u00e1u.<\/li>\n
C\u1eaft 1 ho\u1eb7c 2 b\u00ean th\u1eadn: gi\u1ea3m l\u01b0\u1ee3ng\u00a0\u0111\u1ea1m m\u1ea5t qua n\u01b0\u1edbc ti\u1ec3u, th\u1ea9m ph\u00e2n ph\u00fac m\u1ea1c thay th\u1ebf trong khi ch\u1edd gh\u00e9p th\u1eadn (khi tr\u1ebb\u00a0\u0111\u01b0\u1ee3c 8-9kg).<\/li>\n<\/ul>\n
3. \u0110i\u1ec1u tr\u1ecb nguy\u00ean nh\u00e2n th\u1ee9 ph\u00e1t<\/b><\/p>\n
\n
Giang mai: Penicillin.<\/li>\n
CMV: Valganciclovir.<\/li>\n<\/ul>\n
4. \u0110i\u1ec1u tr\u1ecb thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch<\/b><\/p>\n
\n
H\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 do\u00a0\u0111\u1ed9t bi\u1ebfn Gen: h\u1ea7u nh\u01b0 kh\u00f4ng\u00a0\u0111\u00e1p\u00a0\u1ee9ng\u00a0\u00e0 c\u00f3 th\u1ec3 g\u00e2y t\u00e1c d\u1ee5ng ph\u1ee5 n\u1eb7ng n\u1ec1, do\u00a0\u0111\u00f3 kh\u00f4ng khuy\u1ebfn c\u00e1o\u00a0\u0111i\u1ec1u tr\u1ecb thu\u1ed1c\u00a0\u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch.<\/li>\n
H\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 v\u00f4 c\u0103n:\u00a0\u0111i\u1ec1u tr\u1ecb nh\u01b0\u00a0\u1edf tr\u1ebb l\u1edbn. Trong\u00a0\u0111i\u1ec1u ki\u1ec7n kh\u00f4ng th\u1ec3 x\u00e9t nghi\u1ec7m\u00a0\u0111\u1ed9t bi\u1ebfn Gen, c\u00e1c y\u1ebfu t\u1ed1 sau c\u00f3 th\u1ec3 g\u1ee3i\u00a0\u00fd nguy\u00ean nh\u00e2n v\u00f4 c\u0103n: kh\u1edfi ph\u00e1t tr\u1ec5 trong n\u0103m\u00a0\u0111\u1ea7u, kh\u00f4ng c\u00f3 ti\u1ec1n c\u0103n gia\u00a0\u0111\u00ecnh, bi\u1ec3u hi\u1ec7n ngo\u00e0i th\u1eadn v\u00e0 kh\u00f4ng c\u00f3 h\u00ecnh\u00a0\u1ea3nh g\u1ee3i\u00a0\u00fd\u00a0\u0111\u1ed9t bi\u1ebfn Gen tr\u00ean sinh thi\u1ebft th\u1eadn (th\u1eadn h\u01b0 th\u1ec3 Ph\u1ea7n Lan, x\u01a1 h\u00f3a trung m\u00f4 lan t\u1ecfa).<\/li>\n<\/ul>\n
5. Gh\u00e9p th\u1eadn<\/b><\/p>\n
L\u00e0\u00a0\u0111i\u1ec1u tr\u1ecb l\u00fd t\u01b0\u1edfng, d\u1ef1 h\u1eadu 5 n\u0103m th\u01b0\u1eddng t\u1ed1t.<\/p>\n
C. H\u1ed8I CH\u1ee8NG TH\u1eacN H\u01af K\u00c8M VI\u00caM GAN SI\u00caU VI B<\/h3>\n
Khi b\u00eah nh\u00e2n\u00a0\u0111\u01b0\u1ee3c ch\u1ea9n\u00a0\u0111o\u00e1n H\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 v\u00e0 HBsAg (+), c\u1ea7n l\u00e0m th\u00eam c\u00e1c x\u00e9t nghi\u1ec7m sau:<\/p>\n
\n
HBeAg, Anti HBe,\u00a0\u0111\u1ecbnh l\u01b0\u1ee3ng HBV-DNA.<\/li>\n
ALT\/AST.<\/li>\n
Sinh thi\u1ebft th\u1eadn tr\u01b0\u1edbc khi quy\u1ebft\u00a0\u0111\u1ecbnh\u00a0\u0111i\u1ec1u tr\u1ecb HCTH.<\/li>\n<\/ul>\n
1. HCTH th\u1ee9 ph\u00e1t do vi\u00eam gaN si\u00eau vi B<\/b><\/p>\n
a. Ch\u1ea9n\u00a0\u0111o\u00e1n c\u00f3 th\u1ec3: khi th\u1ecfa\u00a0\u0111\u1ee7 c\u00e1c ti\u00eau chu\u1ea9n sau:
\n– HCTH kh\u00f4ng k\u00e8m bi\u1ec3u hi\u1ec7n c\u1ee7a b\u1ec7nh h\u1ec7 th\u1ed1ng nh\u01b0: Lupus, Henoch-Schonlein.<\/p>\n
-Vi\u00eam gan si\u00eau vi B: HBsAg (+) v\u00e0 t\u1ea3i l\u01b0\u1ee3ng si\u00eau vi trong m\u00e1u cao:<\/p>\n
+ HBV – DNA >= 10^5 copies\/ml (20.000 UI\/ml) n\u1ebfu HBsAg (+).<\/p>\n
+ HBV – DNA >= 10^4 copies\/ml (2.000UI\/ml) n\u1ebfu HBeAg (-).<\/p>\n
– Sinh thi\u1ebft th\u1eadn: vi\u00eam c\u1ea7u th\u1eadn do ph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch tr\u00ean k\u00ednh hi\u1ec3n vi hu\u1ef3nh quang v\u00e0\/ho\u1eb7c s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a c\u00e1c kh\u00e1ng nguy\u00ean si\u00eau vi B (HBsAg, HbcAg, HBeAg) tr\u00ean m\u1eabu sinh thi\u1ebft th\u1eadn.<\/p>\n
b.\u00a0\u0110i\u1ec1u tr\u1ecb<\/p>\n
1. \u0110i\u1ec1u tr\u1ecb b\u1eb1ng\u00a0\u0111\u1ed3ng ph\u00e2n nucleoside u\u1ed1ng nh\u01b0 c\u00e1c khuy\u1ebfn c\u00e1o tr\u1ebb vi\u00eam gan vi rus B.<\/p>\n
– C\u00e1c thu\u1ed1c\u00a0\u0111i\u1ec1u tr\u1ecb: l\u1ef1a ch\u1ecdn m\u1ed9t trong c\u00e1c lo\u1ea1i thu\u1ed1c sau theo th\u1ee9 t\u1ef1:<\/p>\n
+\u00a0Tenofovir 0,3g:<\/i><\/b><\/p>\n
tr\u1ebb >= 12 tu\u1ed5i: 0,3 g\/ng\u00e0y.<\/p>\n
>Tr\u1ebb >= 2 tu\u1ed5i: 8mg\/kg\/ng\u00e0y.<\/p>\n
+ Lamivudin 0,1g:<\/i><\/b>\u00a03mg\/kg\/ng\u00e0y (t\u1ed1i\u00a0\u0111a 0,1g\/ng\u00e0y), tr\u1ebb > 2 tu\u1ed5i.<\/p>\n
+ Entecavir 0,5mg:<\/i><\/b><\/p>\n
Tr\u1ebb >= 2 tu\u1ed5i v\u00e0 >= 10kg: li\u1ec1u l\u01b0\u1ee3ng d\u1ef1a theo c\u00e2n n\u1eb7ng.<\/p>\n
Tr\u1ebb > 30 kg: 0,5mg\/ng\u00e0y.<\/p>\n
– Ch\u1ec9nh li\u1ec1u theo\u00a0\u0111\u1ed9 l\u1ecdc c\u1ea7u th\u1eadn cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p suy th\u1eadn.<\/p>\n
– Theo d\u00f5i\u00a0\u0111i\u1ec1u tr\u1ecb:\u00a0AST, ALT, creatinin m\u00e1u, HBeAg, AntiHBe, HBV-DNA m\u1ed7i 3-6 th\u00e1ng.<\/p>\n
– Ng\u01b0ng\u00a0\u0111i\u1ec1u tr\u1ecb:<\/p>\n
+ N\u1ebfu HBeAg (+): 6-12 th\u00e1ng sau khi c\u00f3 s\u1ef1 chuy\u1ec3n\u00a0\u0111\u1ed5i ph\u1ea3n\u00a0\u1ee9ng huy\u1ebft thanh HBeAg-\/Anti HBe + v\u00e0 HBV -DNA d\u01b0\u1edbi ng\u01b0\u1ee1ng ph\u00e1t hi\u1ec7n.<\/p>\n
+ N\u1ebfu HBeAg (-): HBV-DNA d\u01b0\u1edbi ng\u01b0\u1ee1ng ph\u00e1t hi\u1ec7n 3 l\u1ea7n li\u00ean ti\u1ebfp c\u00e1ch nhau m\u1ed7i 6 th\u00e1ng.<\/p>\n
– Th\u1ea5t b\u1ea1i\u00a0\u0111i\u1ec1u tr\u1ecb: HBV-DNA gi\u1ea3m <1ln10 (10 l\u1ea7n) sau 12 tu\u1ea7n ho\u1eb7c d\u01b0\u1edbi 2ln10 sau 24 tu\u1ea7n b\u1eaft\u00a0\u0111\u1ea7u\u00a0\u0111i\u1ec1u tr\u1ecb ho\u1eb7c HBV-DNA\u00a0 t\u0103ng tr\u1edf l\u1ea1i > 1ln10 so v\u1edbi gi\u00e1 tr\u1ecb th\u1ea5p nh\u1ea5t: c\u1ea7n\u00a0\u0111\u00e1nh g\u00e1i tu\u00e2n th\u1ee7\u00a0\u0111i\u1ec1u tr\u1ecb, ph\u00e2n t\u00edch gen si\u00eau vi t\u00ecm\u00a0\u0111\u1ed9t bi\u1ebfn kh\u00e1ng thu\u1ed1c\u00a0\u0111\u1ec3 h\u01b0\u1edbng d\u1eabn\u00a0\u0111i\u1ec1u tr\u1ecb ti\u1ebfp theo.
\nb.\u00a0\u0110i\u1ec1u tr\u1ecb HCTH: gi\u1ea3m ph\u00f9, thu\u1ed1c gi\u1ea3m\u00a0\u0111\u1ea1m ni\u1ec7u (Enalapril\/Losartan).<\/p>\n
c. HCTH k\u00e9o d\u00e0i ho\u1eb7c ti\u1ebfn tri\u1ec3n x\u1ea5u sau s\u1ef1 bi\u1ebfn m\u1ea5t c\u1ea3u si\u00eau vi trong m\u00e1u (HBV-DNA kh\u00f4ng ph\u00e1t hi\u1ec7n, chuy\u1ec3n\u00a0\u0111\u1ed5i ph\u1ea3n\u00a0\u1ee9ng huy\u1ebft thanh HBeAg -\/AntiHBe (+) c\u00e2n nh\u1eafc\u00a0\u0111i\u1ec1u tr\u1ecb thu\u1ed1c\u00a0\u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch nh\u01b0 HCTH nguy\u00ean ph\u00e1t song song thu\u1ed1c kh\u00e1ng si\u00eau vi.<\/p>\n
2. HCTH nguy\u00ean ph\u00e1t tr\u00ean ng\u01b0\u1eddi mang HBV<\/b><\/p>\n
1. Ch\u1ea9n\u00a0\u0111o\u00e1n c\u00f3 th\u1ec3: khi th\u1ecfa c\u00e1c\u00a0\u0111i\u1ec1u ki\u1ec7n sau<\/b>
\n– HCTH kh\u00f4ng k\u00e8m bi\u1ec3u hi\u1ec7n c\u1ee7a b\u1ec7nh h\u1ec7 th\u1ed3ng nh\u01b0: Lupus, Henoch-Scholein.<\/p>\n
– HBsAg m\u00e1u (+) v\u00e0 Anti HBe (+), HBV-DNA < 2.000UI\/ml.<\/p>\n
– Sinh thi\u1ebft th\u1eadn: kh\u00f4ng c\u00f3 s\u1ef1u l\u1eafng\u00a0\u0111\u1ecdng c\u1ee7a ph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch trong c\u1ea7u th\u1eadn.<\/p>\n
2.\u00a0\u0110i\u1ec1u tr\u1ecb<\/b><\/p>\n
–\u00a0\u0110i\u1ec1u tr\u1ecb thu\u1ed1c\u00a0\u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch nh\u01b0 HCTH nguy\u00ean ph\u00e1t.<\/p>\n
–\u00a0\u0110i\u1ec1u tr\u1ecb thu\u1ed1c kh\u00e1ng si\u00eau vi d\u1ef1 ph\u00f2ng\u00a0\u0111\u1ee3t b\u00f9ng ph\u00e1t vi\u00eam gan B: khi b\u1eaft\u00a0\u0111\u1ea7u v\u00e0 ti\u1ebfp t\u1ee5c\u00a0\u00edt nh\u1ea5t 12 th\u00e1ng sau khi ng\u01b0ng thu\u1ed1c\u00a0\u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch. C\u1ea7n h\u00f4i ch\u1ea9n th\u00eam khoa nhi\u1ec5m v\u1ec1\u00a0\u0111i\u1ec1u tr\u1ecb thu\u1ed1c kh\u00e1ng si\u00eau vi sau khi ng\u1eebng thu\u1ed1c\u00a0\u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch.<\/p>\n
– Lamividine c\u00f3 th\u1ec3\u00a0\u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng n\u1ebfu th\u1eddi gian\u00a0\u0111i\u1ec1u tr\u1ecb d\u1ef1 ki\u1ebfn <= 12 th\u00e1ng v\u00e0 l\u01b0\u1ee3ng HBV-DNA trong huy\u1ebft thanh ban\u00a0\u0111\u1ea7u d\u01b0\u1edbi ng\u01b0\u1ee1ng ph\u00e1t hi\u1ec7n.<\/p>\n
– Tenofovir ho\u1eb7c Entecavir n\u00ean \u0111\u01b0\u1ee3c ch\u1ecdn l\u1ef1a n\u1ebfu kho\u1ea3ng th\u1eddi gian \u0111i\u1ec1u tr\u1ecb d\u1ef1 ki\u1ebfn l\u00e2u h\u01a1n.<\/p>\n
T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/h2>\n
\n
\n
Ph\u00e1c \u0111\u1ed3 Nhi \u0110\u1ed3ng 1<\/li>\n
S\u00e1ch \u0110\u1ea1i H\u1ecdc Y D\u01b0\u1ee3c TP.HCM B\u1ed9 M\u00f4n NHI<\/li>\n<\/ol>\n<\/div>\n","protected":false},"excerpt":{"rendered":"
GI\u1edaI THI\u1ec6U H\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0 (HCTH) l\u00e0 m\u1ed9t nh\u00f3m c\u00e1c b\u1ec7nh c\u1ea7u th\u1eadn c\u00f3 t\u0103ng t\u00ednh th\u1ea5m m\u00e0ng l\u1ecdc c\u1ea7u th\u1eadn, bao g\u1ed3m c\u00e1c tri\u1ec7u ch\u1ee9ng sau: Ph\u00f9 to\u00e0n th\u00e2n Ti\u1ec3u \u00edt Ti\u1ec3u \u0111\u1ea1m ng\u01b0\u1ee1ng th\u1eadn h\u01b0: protein ni\u1ec7u >= 50mg\/kg\/ng\u00e0y, hay > 40mg\/m2 da\/gi\u1edd, hay \u0111\u1ea1m ni\u1ec7u >200mg\/mmol Gi\u1ea3m \u0111\u1ea1m m\u00e1u : albumin […]\n","protected":false},"author":1,"featured_media":35241,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-35240","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/35240","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=35240"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/35240\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/35241"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=35240"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=35240"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=35240"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}

2. C\u01a1 ch\u1ebf ti\u1ec3u \u0111\u1ea1m trong h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0<\/h3>\n

2.2. Vai tr\u00f2 c\u1ee7a slit diaphragm<\/h4>\n– Trong h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0, c\u00e1c t\u1ebf b\u00e0o ngo\u1ea1i b\u00ec c\u00f3 ch\u00e2n gi\u1ea3 (podocyte)b\u1ecb d\u1eb9t, x\u00f3a m\u1edd \u0111i -> g\u00e2y n\u00ean ti\u1ec3u \u0111\u1ea1m.<\/p>\n

Ti\u1ec3u \u00edt<\/h3>\nTi\u1ec3u \u00edt: l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u trong ng\u00e0y \u0111\u01b0\u1ee3c ghi nh\u1eadn gi\u1ea3m \u0111i nh\u01b0ng hi\u1ebfm khi tr\u1ebb b\u1ecb thi\u1ec3u ni\u1ec7u hay v\u00f4 ni\u1ec7u.<\/p>\n

Ch\u1ea9n \u0111o\u00e1n c\u00f3 th\u1ec3<\/h3>\n– Ph\u00f9\n– Albumin m\u00e1u < 2,5g%, ti\u1ec3u \u0111\u1ea1m \u0111\u00e1ng k\u1ec3 nh\u01b0ng ch\u01b0a \u0111\u1ea1t ng\u01b0\u1ee1ng h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0.<\/p>\n

2.2. Vai tr\u00f2 c\u1ee7a slit diaphragm<\/h4>\n
– Trong h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0, c\u00e1c t\u1ebf b\u00e0o ngo\u1ea1i b\u00ec c\u00f3 ch\u00e2n gi\u1ea3 (podocyte)b\u1ecb d\u1eb9t, x\u00f3a m\u1edd \u0111i -> g\u00e2y n\u00ean ti\u1ec3u \u0111\u1ea1m.<\/p>\n

Ti\u1ec3u \u00edt<\/h3>\n
Ti\u1ec3u \u00edt: l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u trong ng\u00e0y \u0111\u01b0\u1ee3c ghi nh\u1eadn gi\u1ea3m \u0111i nh\u01b0ng hi\u1ebfm khi tr\u1ebb b\u1ecb thi\u1ec3u ni\u1ec7u hay v\u00f4 ni\u1ec7u.<\/p>\n

Ch\u1ea9n \u0111o\u00e1n c\u00f3 th\u1ec3<\/h3>\n
– Ph\u00f9
\n– Albumin m\u00e1u < 2,5g%, ti\u1ec3u \u0111\u1ea1m \u0111\u00e1ng k\u1ec3 nh\u01b0ng ch\u01b0a \u0111\u1ea1t ng\u01b0\u1ee1ng h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0.<\/p>\n