H th ng ti t ni u
64
Map 4.5 H i ch ng viêm c u th n và h i ch ng th n hư
Tăng sinh khu trú
Tăng sinh lan t a
B nh th n IgA
Viêm c u th n ti n tri n nhanh. ví d :
h i ch ng Goodpasture
Lupus ban đ h
th ng (SLE)
SLE
Ban Henoch–Schönlein
Viêm c u th n tăng sinh màng
H i ch ng Alport
Ch ng cryoglobulin huy t
H I CH NG VIÊM C U TH N
H i ch ng viêm c u th n là gì?
Đây là m t nhóm tri u ch ng có nhi u b nh khác nhau.
D u hi u
Nh PHUTATT:
•
Protein ni u.
•
H ng c u ni u.
•
Tăng Ure máu.
•
Tr h ng c u.
•
Hi u giá kháng th Antistreptolysin O.
•
Ti u ít.
•
Tăng huy t áp.
Nguyên nhân
Có th đư c chia thành 2 lo i: Nguyên nhân tăng sinh khu trú và nguyên nhân
tăng sinh lan t a.
H I CH NG TH N HƯ
H i ch ng th n hư là gì?
Đây là m t nhóm tri u ch ng có nhi u b nh khác nhau.
D u hi u
Nh PALP:
•
Protein ni u > 3g/ngày.
•
Gi m Albumin máu < 30g/L.
•
Tăng Lipid máu, vì:
Gi m protein máu gây kích thích gan s n xu t nhi u protein hơn, k t qu là
t ng h p nhi u lipoprotein hơn.
Gi m m c đ c a lipoprotein lipase đ ng nghĩa v i gi m chuy n hóa lipid.
•
Phù.
Nguyên nhân
•
B nh c u th n thay đ i t i thi u.
•
Viêm c u th n xơ hóa khu trú t ng ph n.
•
Viêm c u th n màng.
•
B nh th n đái tháo đư ng.
•
Thoái hóa tinh b t.
•
Mesangial proliferative glomerulonephritis.
•
SLE.
Investigations
•
Bloods: FBC, WCC and platelets, U&Es, LFTs, creatinine, urea, CRP, ESR,
glucose, lipid profile.
•
Urinalysis: blood, protein, glucose, leucocytes, nitrites and Bence Jones protein.
•
Nephritic screen: serum complement (C3 and C4), ANA, dsDNA, ANCA, anti-
GBM, HIV serology, HBV and HCV serology, blood cultures, VDRL for syphilis.
•
Renal biopsy.
•
Radiology: ultrasound scan.
Treatment
•
Conservative: lifestyle advice, low salt diet.
•
Medical: treatment depends on cause:
○
Treat hypertension.
○
Treat proteinuria.
○
Treat hypercholesterolaemia.
○
Give prophylactic anticoagulation therapy.
○
Immunotherapy regimen, e.g. prednisolone, cyclophosphamide and
azathioprine.
○
Dialysis if severe.
Complications
•
Hypertension.
•
Acute kidney injury.
•
Chronic kidney injury.
•
Infection.
Investigations
•
Bloods: FBC, WCC and platelets, U&Es, LFTs, creatinine, urea, CRP, ESR,
glucose, lipid profile.
•
Urinalysis: blood, protein, glucose, leucocytes, nitrites and Bence Jones
protein.
•
Nephritic screen: serum complement (C3 and C4), antinuclear antibody
(ANA), double stranded DNA, antineutrophil cytoplasmic antibody
(ANCA), antiglomerular basement membrane (GBM), HIV serology, HBV
and HCV serology, blood cultures, Venereal Disease Research Laboratory
Test (VDRL) for syphilis.
•
Renal biopsy.
•
Radiology: ultrasound scan.
Treatment
•
Conservative: lifestyle advice, low salt diet.
•
Medical: treatment depends on cause:
○
Treat hypertension.
○
Treat proteinuria.
○
Treat hypercholesterolaemia.
○
Give prophylactic anticoagulation therapy.
○
Immunotherapy regimen, e.g. prednisolone, cyclophosphamide and
azathioprine.
○
Dialysis if severe.
Complications
•
Nephrotic syndrome.
•
Chronic glomerulonephritis.
•
Heart failure.
MAP 4.5 HC viêm c u th n và HC th n hư
Chapter_04.indd 64
08/12/14 5:56 PM
