{"id":6301,"date":"2019-04-05T09:47:57","date_gmt":"2019-04-05T02:47:57","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=6301"},"modified":"2019-04-05T09:47:57","modified_gmt":"2019-04-05T02:47:57","slug":"ca-lam-sang-benh-nhan-nam-ton-thuong-than-cap","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/ca-lam-sang-benh-nhan-nam-ton-thuong-than-cap\/","title":{"rendered":"Ca l\u00e2m s\u00e0ng b\u1ec7nh nh\u00e2n nam t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p"},"content":{"rendered":"<h2>Ca l\u00e2m s\u00e0ng<\/h2>\n<p>B\u1ec7nh nh\u00e2n nam, 20 tu\u1ed5i, l\u00e0 sinh vi\u00ean \u0111\u1ea1i h\u1ecdc, \u0111\u1ebfn kh\u00e1m v\u00ec xu\u1ea5t hi\u1ec7n ban t\u0103ng d\u1ea7n di\u1ec5n bi\u1ebfn 3 ng\u00e0y nay. Hai tu\u1ea7n tr\u01b0\u1edbc \u0111\u00f3, b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb vi\u00eam h\u1ecdng do li\u00ean c\u1ea7u b\u1eb1ng amoxicillin trong v\u00f2ng 10 ng\u00e0y. Kh\u00f4ng s\u1eed d\u1ee5ng th\u00eam thu\u1ed1c g\u00ec kh\u00e1c. Ti\u1ec1n s\u1eed b\u1ea3n th\u00e2n kh\u00f4ng ph\u00e1t hi\u1ec7n g\u00ec \u0111\u1eb7c bi\u1ec7t. Gia \u0111\u00ecnh c\u00f3 ch\u00fa m\u1eafc h\u1ed9i ch\u1ee9ng Alport.<\/p>\n<p>Kh\u00e1m: huy\u1ebft \u00e1p 140\/85 mmHg, nh\u1ecbp tim 100 l\u1ea7n\/ph\u00fat, th\u00e2n nhi\u1ec7t 37,5 \u0111\u1ed9 C. Th\u1ef1c th\u1ec3: h\u1ed3ng ban d\u1ea1ng d\u00e1t s\u1ea9n lan to\u1ea3, ch\u1ee7 y\u1ebfu \u1edf v\u00f9ng th\u00e2n m\u00ecnh.<\/p>\n<p>X\u00e9t nghi\u1ec7m c\u1eadn l\u00e2m s\u00e0ng cho k\u1ebft qu\u1ea3 nh\u01b0 sau (gi\u00e1 tr\u1ecb tham chi\u1ebfu \u0111\u1eb7t trong d\u1ea5u ngo\u1eb7c \u0111\u01a1n): Hemoglobin 13,5 g\/dL (13,5-17,5), s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u 9,6 G\/L (4,5-11,0), creatinine 212 \u00b5mol\/L (71-115), urea 11,4 mmol\/L (3,6-7,1), C3 b\u1ed5 th\u1ec3 92 mg\/dL (86-184), C4 b\u1ed5 th\u1ec3 36 mg\/dL (20-58).<\/p>\n<p>S\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u v\u00e0 c\u00f4ng th\u1ee9c b\u1ea1ch c\u1ea7u b\u00ecnh th\u01b0\u1eddng. T\u1ed5ng ph\u00e2n t\u00edch n\u01b0\u1edbc ti\u1ec3u th\u1ea5y protein 1+, h\u1ed3ng c\u1ea7u 1-3 t\u1ebf b\u00e0o\/ vi tr\u01b0\u1eddng (gi\u00e1 tr\u1ecb tham chi\u1ebfu 0-2), b\u1ea1ch c\u1ea7u 10-20 t\u1ebf b\u00e0o\/ vi tr\u01b0\u1eddng (gi\u00e1 tr\u1ecb tham chi\u1ebfu 0-2). Nhu\u1ed9m Gram soi n\u01b0\u1edbc ti\u1ec3u \u00e2m t\u00ednh.<\/p>\n<p>Si\u00eau \u00e2m th\u1eadn cho th\u1ea5y h\u00ecnh \u1ea3nh th\u1eadn k\u00edch th\u01b0\u1edbc b\u00ecnh th\u01b0\u1eddng, kh\u00f4ng \u1ee9 n\u01b0\u1edbc th\u1eadn.<\/p>\n<p>\u0110\u00e2u l\u00e0 nguy\u00ean nh\u00e2n ngh\u0129 t\u1edbi nhi\u1ec1u nh\u1ea5t \u0111\u1ec3 gi\u1ea3i th\u00edch cho t\u00ecnh tr\u1ea1ng t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p \u1edf b\u1ec7nh nh\u00e2n n\u00e0y?<\/p>\n<p>A. Vi\u00eam c\u1ea7u th\u1eadn c\u1ea5p sau nhi\u1ec5m li\u00ean c\u1ea7u.<br \/>\nB. H\u1ed9i ch\u1ee9ng Alport.<br \/>\nC. B\u1ec7nh th\u1eadn IgA.<br \/>\nD. Ho\u1ea1i t\u1eed \u1ed1ng th\u1eadn c\u1ea5p<br \/>\nE. Vi\u00eam th\u1eadn k\u1ebd c\u1ea5p.<\/p>\n<h3>\u0110\u00e2u l\u00e0 nguy\u00ean nh\u00e2n ngh\u0129 t\u1edbi nhi\u1ec1u nh\u1ea5t \u0111\u1ec3 gi\u1ea3i th\u00edch cho c\u00e1c tri\u1ec7u ch\u1ee9ng ban, b\u1ea1ch c\u1ea7u ni\u1ec7u v\u00f4 khu\u1ea9n v\u00e0 t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p \u1edf m\u1ed9t b\u1ec7nh nh\u00e2n nam tr\u1ebb, 2 tu\u1ea7n tr\u01b0\u1edbc \u0111\u00f3 \u0111i\u1ec1u tr\u1ecb vi\u00eam h\u1ecdng do li\u00ean c\u1ea7u b\u1eb1ng amoxicillin?<\/h3>\n<p>A. Vi\u00eam c\u1ea7u th\u1eadn c\u1ea5p sau nhi\u1ec5m li\u00ean c\u1ea7u.<br \/>\nB. H\u1ed9i ch\u1ee9ng Alport.<br \/>\nC. B\u1ec7nh th\u1eadn IgA.<br \/>\nD. Ho\u1ea1i t\u1eed \u1ed1ng th\u1eadn c\u1ea5p<br \/>\nE. Vi\u00eam th\u1eadn k\u1ebd c\u1ea5p.<\/p>\n<p>\u0110\u00e1p \u00e1n: E.<\/p>\n<p>\u0110i\u1ec3m then ch\u1ed1t: Hai tu\u1ea7n sau khi b\u1eaft \u0111\u1ea7u d\u00f9ng amoxicillin \u0111i\u1ec1u tr\u1ecb vi\u00eam h\u1ecdng do li\u00ean c\u1ea7u, nguy\u00ean nh\u00e2n nhi\u1ec1u kh\u1ea3 n\u0103ng nh\u1ea5t g\u00e2y ban v\u00e0 t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p \u1edf b\u1ec7nh nh\u00e2n nam tr\u1ebb tu\u1ed5i, v\u1edbi tri\u1ec7u ch\u1ee9ng b\u1ea1ch c\u1ea7u ni\u1ec7u v\u00f4 khu\u1ea9n l\u00e0 vi\u00eam th\u1eadn k\u1ebd c\u1ea5p.<\/p>\n<h2>Gi\u1ea3i th\u00edch chi ti\u1ebft:<\/h2>\n<p>B\u1ec7nh nh\u00e2n n\u00e0y bi\u1ec3u hi\u1ec7n ban v\u00e0 t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p 2 tu\u1ea7n sau khi b\u1eaft \u0111\u1ea7u d\u00f9ng kh\u00e1ng sinh nh\u00f3m beta-lactam, \u0111\u1ed3ng th\u1eddi xu\u1ea5t hi\u1ec7n b\u1ea1ch c\u1ea7u ni\u1ec7u v\u00f4 khu\u1ea9n. T\u1ed5ng h\u1ee3p l\u1ea1i, c\u00e1c tri\u1ec7u ch\u1ee9ng n\u00e0y h\u01b0\u1edbng t\u1edbi ch\u1ea9n \u0111o\u00e1n nhi\u1ec1u kh\u1ea3 n\u0103ng nh\u1ea5t l\u00e0 vi\u00eam th\u1eadn k\u1ebd c\u1ea5p. Tam ch\u1ee9ng s\u1ed1t, ph\u00e1t ban v\u00e0 t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan m\u00e1u ngo\u1ea1i vi x\u1ea3y ra \u1edf &lt;10% s\u1ed1 b\u1ec7nh nh\u00e2n.<\/p>\n<p>Vi\u00eam c\u1ea7u th\u1eadn c\u1ea5p sau nhi\u1ec5m li\u00ean c\u1ea7u c\u0169ng bi\u1ec3u hi\u1ec7n \u00edt nh\u1ea5t 2 tu\u1ea7n sau nhi\u1ec5m. \u1ede th\u1eddi \u0111i\u1ec3m n\u00e0y, nhi\u1ec5m tr\u00f9ng \u0111\u00e3 h\u1ebft v\u00e0 qu\u00e1 tr\u00ecnh vi\u00eam c\u1ea7u th\u1eadn gi\u1edbi h\u1ea1n \u1edf th\u1eadn, do c\u00e1c ch\u1ee7ng li\u00ean c\u1ea7u beta tan huy\u1ebft nh\u00f3m A g\u00e2y vi\u00eam c\u1ea7u th\u1eadn ho\u1ea1t ho\u00e1 mi\u1ec5n d\u1ecbch t\u1ebf b\u00e0o v\u00e0 d\u1ecbch th\u1ec3. \u0110i\u1ec3n h\u00ecnh s\u1ebd th\u1ea5y gi\u1ea3m b\u1ed5 th\u1ec3. B\u1ec7nh nh\u00e2n bi\u1ec3u hi\u1ec7n t\u0103ng huy\u1ebft \u00e1p, ph\u00f9 v\u00e0 c\u1eb7n ni\u1ec7u ho\u1ea1t t\u00ednh trong \u0111\u00f3 c\u00f3 h\u1ed3ng c\u1ea7u ni\u1ec7u, v\u00e0 protein ni\u1ec7u xu\u1ea5t hi\u1ec7n 2 \u0111\u1ebfn 3 tu\u1ea7n sau kh\u1edfi ph\u00e1t nhi\u1ec5m tr\u00f9ng. \u0110\u00f4i khi, c\u00e1c tri\u1ec7u ch\u1ee9ng r\u1ea5t nh\u1eb9, b\u1ec7nh nh\u00e2n ch\u1ec9 \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n sau nhi\u1ec1u tu\u1ea7n \u0111\u1ebfn nhi\u1ec1u th\u00e1ng v\u1edbi tri\u1ec7u ch\u1ee9ng h\u1ed3ng c\u1ea7u ni\u1ec7u v\u00e0 protein ni\u1ec7u nh\u1eb9 m\u00e0 kh\u00f4ng b\u1ecb thay \u0111\u1ed5i ch\u1ee9c n\u0103ng th\u1eadn. N\u1ed3ng \u0111\u1ed9 b\u1ed5 th\u1ec3 huy\u1ebft thanh n\u1ebfu gi\u1ea3m, s\u1ebd tr\u1edf l\u1ea1i b\u00ecnh th\u01b0\u1eddng trong v\u00f2ng 3 th\u00e1ng. Trong b\u1ec7nh l\u00ed n\u00e0y kh\u00f4ng c\u00f3 ph\u00e1t ban v\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng to\u00e0n th\u00e2n kh\u00e1c.<\/p>\n<p>\u1ede b\u1ec7nh nh\u00e2n vi\u00eam th\u1eadn IgA, nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean c\u00f3 th\u1ec3 k\u00edch th\u00edch \u0111\u00e1i m\u00e1u n\u1eb7ng v\u00e0 t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p \u0111\u1ed3ng th\u1eddi; c\u00e1c b\u1ea5t th\u01b0\u1eddng n\u00e0y \u0111i\u1ec3n h\u00ecnh xu\u1ea5t hi\u1ec7n trong v\u00e0 1 \u0111\u1ebfn 2 ng\u00e0y sau kh\u1edfi ph\u00e1t tri\u1ec7u ch\u1ee9ng nhi\u1ec5m tr\u00f9ng h\u00f4 h\u1ea5p tr\u00ean. C\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n ban khi b\u1ec7nh th\u1eadn IgA l\u00e0 m\u1ed9t ph\u1ea7n c\u1ee7a b\u1ec7nh l\u00ed h\u1ec7 th\u1ed1ng g\u1ecdi l\u00e0 ban Sch\u00f6lein-Henoch. N\u1ed3ng \u0111\u1ed9 b\u1ed5 th\u1ec3 th\u01b0\u1eddng l\u00e0 b\u00ecnh th\u01b0\u1eddng.<\/p>\n<p>Ho\u1ea1i t\u1eed \u1ed1ng th\u1eadn c\u1ea5p s\u1ebd kh\u00f4ng th\u1ec3 x\u1ea3y ra n\u1ebfu kh\u00f4ng c\u00f3 ti\u1ec1n s\u1eed v\u1ec1 y\u1ebfu t\u1ed1 ti\u1ec1n ph\u00e1t (nh\u1ed3i m\u00e1u ho\u1eb7c nhi\u1ec5m \u0111\u1ed9c), v\u00e0 s\u1ebd kh\u00f4ng g\u1eb7p b\u1ea1ch c\u1ea7u ni\u1ec7u v\u00f4 khu\u1ea9n.<\/p>\n<p>H\u1ed9i ch\u1ee9ng Alport c\u00f3 nguy\u00ean nh\u00e2n do \u0111\u1ed9t bi\u1ebfn collagen type IV (th\u00e0nh ph\u1ea7n c\u1ea5u tr\u00fac quan tr\u1ecdng c\u1ee7a m\u00e0ng \u0111\u00e1y c\u1ea7u th\u1eadn), g\u00e2y \u0111\u00e1i m\u00e1u vi th\u1ec3, protein ni\u1ec7u v\u00e0 b\u1ec7nh th\u1eadn m\u1ea1n t\u00ednh ti\u1ebfn tri\u1ec3n h\u01a1n l\u00e0 \u0111\u1ee3t t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p. H\u01a1n n\u1eefa, b\u1ec7nh n\u00e0y di truy\u1ec1n tr\u1ed9i tr\u00ean nhi\u1ec5m s\u1eafc th\u1ec3 X; do \u0111\u00f3 ti\u1ec1n s\u1eed gia \u0111\u00ecnh c\u00f3 ch\u00fa m\u1eafc h\u1ed9i ch\u1ee9ng Alport kh\u00f4ng gi\u00fap g\u00ec cho ch\u1ea9n \u0111o\u00e1n.<\/p>\n<h2>T\u00e0i li\u1ec7u tham kh\u1ea3o:<\/h2>\n<p>Grad YH et al. Clinical problem-solving. Bitter pills. N Engl J Med 2010 Nov 5; 363:1847. Link\u00a0<a href=\"https:\/\/www.nejm.org\/medical-articles\/clinical-problem-solving?date=completeArchive&amp;articletype=clinical-problem-solving&amp;topic=28&amp;sort=date&amp;page=5\" rel=\"noopener\">https:\/\/www.nejm.org\/medical-articles\/clinical-problem-solving?date=completeArchive&amp;articletype=clinical-problem-solving&amp;topic=28&amp;sort=date&amp;page=5<\/a><\/p>\n<p>Praga M and Gonz\u00e1lez E. Acute interstitial nephritis. Kidney Int 2010 Mar 26; 77:956. Link\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20336051\" rel=\"noopener\">https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20336051<\/a><\/p>\n<p>Ngu\u1ed3n: NEJM.<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Ca l\u00e2m s\u00e0ng B\u1ec7nh nh\u00e2n nam, 20 tu\u1ed5i, l\u00e0 sinh vi\u00ean \u0111\u1ea1i h\u1ecdc, \u0111\u1ebfn kh\u00e1m v\u00ec xu\u1ea5t hi\u1ec7n ban t\u0103ng d\u1ea7n di\u1ec5n bi\u1ebfn 3 ng\u00e0y nay. Hai tu\u1ea7n tr\u01b0\u1edbc \u0111\u00f3, b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb vi\u00eam h\u1ecdng do li\u00ean c\u1ea7u b\u1eb1ng amoxicillin trong v\u00f2ng 10 ng\u00e0y. Kh\u00f4ng s\u1eed d\u1ee5ng th\u00eam thu\u1ed1c g\u00ec kh\u00e1c. Ti\u1ec1n s\u1eed [&#8230;]\n","protected":false},"author":1,"featured_media":6302,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-6301","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\/6301","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=6301"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/6301\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/6302"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=6301"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=6301"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=6301"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}