THAY I CA H NIU TRONG THAI K

GII PHU
Tng th tch mch mu trong thn Tng dung lng h gp Thn ph i

Dn i thn, b thn v niu qun.

Xut him sm trong 3 thng u, ko di 12 tun sau sanh

HUYT NG TON THN

HA = cung lng tim x khng lc ngoi bin
Gim dn vo u thai k tng dn vo cui thai k
Tng nhp tim

Tng Estrogen & Progesteron gin c trn Tng tng hp Prostaglandin (PGI2) >< AGII &Norepinephrin

Tng th tch mu

HUYT NG TI THN

Tng thi: Creatinin Protein Glucose Aminoacid Vitamin

Tng

IU HA TH TCH 12,5kg

oTh tch dch ngoi bo

o30-50% V huyt tng oTch t Natri ngoi bo
oPh lnh tnh

oThng gp chn
oDo nguyn nhn c hc (gim khi ngh v nm nghing tri)

IU HA TOAN KIM
Tng thng kh pCO2 gim (30 mmHg) Thn b tr bng gim 4 mcmol (trung bnh 22 mcmol)

PCO2

HCO3-

pH
Kim mu nh

THAI K TRN BNH NHN C BNH THN MN

THAI K TRN BN C BNH THN MN

Kh nng th thai gim do : o V kinh, ri lon chu k kinh ( chu k kinh khng rng trng), mn kinh sm. o Suy chc nng bung trng BN lc mu o S thay i hormon sinh sn o Thiu mu

THAI K TRN BN C BNH THN MN

Cc yu t tin lng kh nng th thai v

duy tr thai:

Mc suy thn Tng huyt p m niu

MC SUY THN
Da vo nng creatinin trong mu: - Nh: creatinin 1,4 mg/dl - Trung bnh: creatinin 1,5 2,5 mg/dl - Nng: creatinin > 2,5 mg/dl

Trnh c thai

MC SUY THN

MC TNG HUYT P
THA trong thai k (HA 140/90 mmHg)
THA do thai Xut hin sau 20w V bnh thng trong vng 3 thng sau sanh THA mn tnh THA trc tun l th 20 thai k, tn ti 12 tun hu sn

Khng ri lon chng nng cc c quan m

Tin sn git THA + m niu+ Ph (+/-) + xy ra sau tun l th 20

THA v cn

THA th pht

M NIU
- Bnh thng : < 300 mg/ngy - Tng:
- S nng ln ca bnh thn trc

- Tin sn git

T VN TRC KHI MANG THAI

THEO DI THAI K

Khm thai/ 2 tun Sau 28 tun/ mi tun

iu tr THA

Tm sot nguy c NT tiu Xem xt ch nh lc mu sm

Dinh dng v thiu mu

THEO DI THAI K
XN nh gi din tin thai k gm: Chc nng thn Huyt thanh hc Siu m thn v thai Sinh thit thn t dng

THEO DI THAI K
MC TIU iU TR

TNG HUYT P

< 140/90 mmHg

Bng thuc - St, acid folic, erythropoietin.

THIU MU

Hgb 10 g/dl

- Erythropoetin (Tng 50-100% liu BN lc mu)

- Cung cp y protein,
DINH DNG dinh dng cho m v thai vitamin. - Tng cung cp Kali nu lc mu 5-6 ngy/tun

THUC IU TR THA
Chn th th 2 Methyldopa l thuc thng cc s dng Atenolol & Propanolol an ton vo cui thai k, chm pht trin thai v u v gia thai k. Gy nhp chm thai k. Labetolol > methyldopa c tnh gan cho m Hydralazin h tr cho methyldopa v chn An ton v hu hiu cho ph n c thai Chng ch nh trong thai k gy cht thai, thiu i, suy thn s sinh. Khng c khuyn dng

Chn th th
Chn v Gin tiu ng mch c ch Calci c ch men chuyn Chn th th AT II Li tiu

TIN LNG DIN TIN BNH

- Suy gim chc nng thn c th xy ra trong qu

trnh mang thai or hu sn

- Tin lng thai k tt hn nu: o Creatinin mu 1,4 mg/dl, o HA c kim sot Creatinin > 2mg/dl: suy chc nng thn nng, c th dn n ESRD trong 1 nm sau sanh

TIN LNG THAI

T l thai sng:
- C thai trc khi bt u lc mu : 73%
- C thai sau khi lc mu : 40%

84% sanh non, thai chm pht trin, nh cn

6% thai cht lu
32% sy thai t pht, 10% sy thai do iu tr

TIN LNG THAI

Trc y: c thai l chng ch nh BN lc mu. T l thai sng 25% Hin nay: t l thai sng 30- 50% nu t n tam c nguyt 2 v t l sanh thnh cng l 70- 75% Khng c bng chng v s nh hng ca cc PP lc mu ln tin lng thai v m

Brenner the kidney 1994-1998

TIN LNG THAI

- Tin lng thai k ty thuc: o Thi im tin hnh lc mu o Chc nng thn cn li o Nng mi trng ure Xem xt lc mu sm khi oCreatinin mu 300 mmol/l oUre mu 18 mmol/l oGFR < 20 ml/ph

PHNG PHP LC MU
Chy thn nhn to: Mc tiu ure mu <= 15

mmol/l o Thi gian > 20 gi/ tun trong 5-7 ngy/ tun o UF chm o Khng ng Heparin
Thm phn phc mc: o Gim th tch dch lc v tng tn s trao i o Chng ch nh BN T

THI IM CHM DT THAI K

Chuyn d t nhin: o Thai ph c CKD n nh o Khng c biu hin suy thai Chm dt thai k cn: o nh gi ton din (HA, mc creatinin, tui thai, tin lng m - thai,..) o S phi hp sn khoa, thn, nhi

KHUYN CO C THAI SAU GHP THN

- 2 nm sau ghp vi sc khe tt , creatinin < 2 mg/dl

- Khng c s thi ghp

- HA c kim sot tt - Tiu m t/ (-)

- Khng biu hin dn i b thn trn siu m

- iu tr thuc :
- Pred <= 15 mg/d

- Azathiorprine <= 2 mg/kg/d

- Cyclosporin <= 5mg/kg/d - Mycophenolate mofetil : ngng sdng 6ws trc khi c thai

KHUYN CO C THAI SAU GHP THN

nh gi chc nng thn trc khi c thai khng

ch lin quan n nguy c suy gim chc nng thn m cn vi t l sng ca thai T l thai sng khong 74% BN c creatinin > 1,4 mg/dl, v t 96% BN c creatinin 1,4 mg/dl. Nguy c thi ghp trong thai k khng khc bit so vi BN khng c thai

 Reference :
- Manual of nephrology - Oxford textbook of clinical nephrology - Current diagnosis & treatment nephrology - Comprehensive clinical of nephrology - Brenner the kidney - http://www.ncbi.nlm.nih.gov/pubmed/16515231