SUY THN CP

i tng: Y4
ThS BS Hynh Ngc Phng Tho
Ging vin B mn Ni i hc Y Dc

MC TIU
1.Nu c nh ngha suy thn cp, tn
thng thn cp (TTTC) v tiu chun RIFLE.
2. Trnh by c ch sinh l bnh ca TTTC
chc nng, hai t ng thn cp, TTTC sau
thn.
3. Trnh by cc nguyn nhn ca STC.
4. Trnh by cch tip cn STC, v cc yu t
gip phn bit STC v STM.
5. Bit nghi v phn tch cc xt nghim
trong chn an phn bit STC trc thn v
ti thn.

NH NGHA
SUY THN CP (ACUTE RENAL FAILURE)
- S gim chc nng thn mt cch t ngt v thng hi phc din ra
trong vng vi gi, n vi ngy
- Thut ng lch s, khng phn nh c nhng thay i ca nhng giai
an khc nhau trong qu trnh tn thng thn cp.
- Vn cn dng trn lm sng.
- Suy thn cp c th din ra trn thn trc bnh thng hoc trn thn

NH NGHA
TN THNG THN CP l mt hi chng c trng

gim nhanh lc cu thn trong vi gi n vi ngy.

Dn n ng nhng sn phm bi tit c ngun gc nit nh Ur v

Creatinin

Lm sng din tin qua nhiu giai an khc nhau v thi gian v mc
nng, t khi u, suy thn tin trin v hi phc.

Hi phc chc nng ty thuc vo cn nguyn, bnh thn c trc v iu

PHN BIT CC KHI NIM

V niu (khng to ra nc tiu), B tiu (Tc nghn ng tiu di).

Suy thn cp (vi gi, vi ngy, thng hi phc), Suy thn mn (nhiu
thng, nhiu nm, khng hi phc)

Suy thn cp v suy thn cp trn nn mn (khng c hoc c bnh thn

mn gy suy thn mn lm nn tng)

Tn thng thn cp (chc nng), Hai t ng thn cp (bnh hc)

CC TIU CHUN V TH TCH NT

TRONG SUY THN CP

Thiu niu: Th tch NT < 400 mL/24 gi.

Khng thiu niu: Th tch NT > 400mL/24 gi.

V niu: Th tch NT < 100mL /24 gi.

V niu han tan < 50mL/24 gi.

SUY THN CP TH KHNG THIU NIU

Th tch NT > 500mL/24 gi..

Gim lc cu thn nhanh (BUN, Creatinin tng nhanh trong

vng vi gi, vi ngy)

Nguyn nhn: Khng sinh, thuc cn quang, vim OTMK cp,

bnh thn do tc nghn mt phn, vim cu thn cp, ly gii c vn.

CC MARKERS DNG TRONG TN

THNG THN CP

Creatinin huyt thanh.

BUN, Ur

Cystatin C

Cc Biomarkers trong tn thng thn cp

Cratinine HT v suy thn cp

Stars R, Kidney Intern (1998), 54, 1817-1831

CREATININ HUYT THANH

c lc qua cu thn, c bi tit OT v khng c ti
hp thu.
Cc yu t gy nh hng Creatinin m khng nh hng chc nng
thn:
- Tng Creatinin mu do c ch bi tit Creatinin: Trimethoprim,
Cimetidine..
- Tng Creatinin mu do nh hng o lng Creatinin: Ascorbic
acid, Cephalosporins
- Cc yu t khc: tnh trng dinh dng, th tch phn b, tui, gii,

BUN:

Tng ti hp thu khi thiu nc

Tng BUN m khng nh hng chc nng thn: tng d ha, nhp
nhiu protein, xut huyt tiu ha, liu cao corticoid.

BUN thp gp trong: ch n t protein,, suy dinh dng, bnh gan

Cystatin C: l 1 protein to ra bi t bo c nhn, c lc t do cu thn,
nng.
ti hp thu han tan ng thn gn, khng c bi tit.

-Khc phc nhng nhc im ca Creatinin: lin quan n khi c.

CC BIOMARKERS CA AKI:

c bi tit trong mu v nc tiu khi c tn thng thn cp,

tng t Troponin t tb c tim sau nhi mu c tim cp.

nhy v c hiu i vi AKI hn so vi BUN, Creatinin.

ang c nghin cu: Urinary Interleukin 18 (IL-18), Neutrophil

gelatinase associated lipocalin (NGAL), kidney nury molecule 1
(Kim-1)tng sm hn BUN, Creatinin 1-2 ngy trong trng hp

Tiu chun R.I.F.L.E. trong tn thng thn cp

Suy(ADQI
thn2004)
cp

TIU CHUN RIFLE

Nguy c (Risk): Creatinin mu tng 1,5 ln hoc nc tiu < 0,5 mL/Kg/gi trong 6 gi.

Tn thng (Injury): Creatinin mu tng gp 2 ln hoc nc tiu < 0,5 mL/Kg/gi trong 12
gi.

Suy thn (Failure): Creatinin mu tng 3 ln hoc Creatinin >355mol/L hoc nc tiu <
0,3 mL/Kg/gi trong 24 gi.

Mt chc nng thn (Loss): STC ko di hoc mt han tan chc nng thn trong hn 4
tun.

Bnh thn giai an cui (End Stage renal disease): mt han tan chc nng thn trong hn
3 thng.

DCH T HC

1. Mc phi trong cng ng: chim khang 1% BN nhp vin, hn

phn na s BN c bnh thn mn i km. Nhng nguyn nhn
thng gp: trc thn (70%), sau thn (17%). T l t vong tan
b l 15%.

2. Mc phi trong bnh vin: Dng tiu chun RIFLE, c 20% BN

nhp vin c kh nng b AKI. Cc nguyn nhn thng gp:
thiu mu cc b, nhim trng huyt, thuc, thuc cn quang.
AKI trc thn thng gp bnh phng nhng hai t ng thn

AKI mc phi trong cng

ng

TIP CN BNH NHN SUY THN CP

Xem k h s bnh n (trong BV, thuc)

Hi bnh s v khm lm sng

Th tch nc tiu v TPTNT

Xt nghim: BUN, Creatinin HT, Ion mu,, CTM.

Kho st cc ch s sinh ha Nc tiu

Siu m bng lai tr tc nghn ng tiu.

PHN BIT SUY THN CP V SUY THN MN

1. Ghi nhn tin cn: cc ch s BUN, creatinin trc y, hoc tin cn

bnh thn gi suy thn mn nn tng.

2. Siu m thy thn teo, mt ranh gii v ty gi STM.

3. Thiu mu mn ng sc ng bo khng gii thch c bng cc
nguyn nhn khc BN c GFR < 30mL/pht gi suy thn mn.

4. H Canxi mu

NGUYN NHN

1. Tng azote mu trc thn (55 - 60%)

2. Tn thng thn cp ti thn (35 - 40%).
3. Tn thng thn cp sau thn (<5%).

TN THNG THN CP TRC THN

(Tng azote mu trc thn)
(Suy thn cp trc thn)

SUY THN CP TRC THN

1. GIM TH TCH NI MCH THC S:
- Xut huyt.
- Mt dch qua ng tiu ha: i, tiu chy, ht dch d dy.
- Mt dch qua thn: thuc li tiu, i tho ng (li tiu thm
thu), i tho nht, suy thng thn, bnh thn mt mui.
- Mt nc qua khang th ba: bng, vim ty, vim phc mc, gim

Trieu chng mat nc

SUY THN CP TRC THN

2. GIM TH TCH NI MCH HIU QU:
a/ Gim cung lng tim: suy tim sung huyt, chang tim, trn dch
mng ngai tim vi chn p tim cp, thuyn tc phi nng.
b/ Dn mch ngai bin: nhim trng huyt, chang phn v, thuc h
p, thuc gy m, x gan v cc bnh l gan khc..

SUY THN CP TRC THN

3. THAY I HUYT NG HC TI THN:
a/ Co tiu M n.

Thuc khng vim NSAID (prostagandin inhibition)

Cyclo-oxygenase 2 (Cox-2) inhibitors (prostaglandin inhibition)

Cyclosporin, Tacrolimus

Tng Canxi mu

C CH BNH SINH

P NG CA CU THN V C TH
KHI GIM TH TCH TUN HAN
Kch thch h giao cm
Kch thch h renin Angiotensin Aldosterone
Tng phng thch ADH
Phng thch cc cht gy co mch ni tng
C ch t iu ha ti cu thn: Khi HA gim (70-80 mmHg), dn
tiu M vo, co tiu M ra duy tr GFR.

BNH CNH LM SNG

BNH CNH LM SNG

CHN AN STC TRC THN

1. Bnh cnh lm sng gi , du mt nc, suy tim
2. CLS:

BUN/Creatinin mu > 20

U Na < 20 meq/L, FE Na < 1%

Nc tiu c c

T trng > 1,018

TN THNG THN CP SAU THN

(Suy thn cp sau thn)

SUY THN CP SAU THN

1. TC NGHN NQ HAI BN HOC TC NGHN MT BN
TRN THN DUY NHT:
a/ Trong lng niu qun

Si

Cc mu ng

M, hoc nh thn trong hai t nh thn

Ph n sau chp NQ ngc dng

SUY THN CP SAU THN

2. TC NGHN NIU O HOC VNG C BQ:

Bu lnh TLT

K BQ hoc TLT

BQ thn kinh hoc dng thuc anticholinergic gy ng NT

Co tht N

Si BQ

CHN AN STC SAU THN

Bnh cnh lm sng gi

Hnh nh hc:

Siu m: thn nc, nguyn nhn tc nghn.

CT Scanner khng cn quang.

MRI h niu.

CHN AN STC SAU THN

TN THNG THN CP TI THN

(Suy thn cp ti thn)

TN THNG THN CP TI THN

1. MCH MU
2. CU THN
3. M K
4. NG THN

SUY THN CP TI THN

1. MCH MU
a/ Mch mu kch thc ln v trung bnh
- Thuyn tc hoc huyt khi M thn,Kp M thn.
- Thuyn tc TM thn hai bn.
- Polyarthritis nodosa
b/ Mch mu nh
- Atheroembolic disease

SUY THN CP TI THN

2. CU THN
a/ Hi chng thn h
b/ vim cu thn cp, vim cu thn tin trin nhanh

SUY THN CP TI THN

3.. M K:
a/ Vim thn k cp do thuc

Khng sinh: methicillin, cephalosporin, rifampicin, sulfonamides,

erythromycin, ciprofloxacin

Li tiu: furosemide, thiazide, chlorthalidone

NSAIDS

Thuc chng co git: phenytoin, carbamazepine

SUY THN CP TI THN

4. NG THN (HAI T NG THN CP)
a/ Thiu mu cc b thn

Chang

Xut huyt

Chn thng

Nhim trng huyt Gram m

Vim ty cp

THUC GY HAI T NG THN CP

Aminoglycoside

Amphotericin B

Pentamidine

Foscarnet

Acyclovir

Indinavir

Thuc iu tr K (Cisplastin)

CHN AN PHN BIT AKI TRC THN V TI THN

C CH GIM LC CU THN
TRONG HAI T ng thn cp

1. Tn thng ng thn: that dch ph n m k, xp ng thn, tc

nghn lng ng thn

2. Ri lan huyt ng hc trong thn

3. Phn ng vim trong thn
4. Co mch trong thn.

Muddy brown cast

LM SNG HAI T ng thn cp

Qua 4 giai on
Giai on khi pht ( initiation phase)
Giai on tn thng lan ta (extension phase)
Giai on duy tr (maintenance phase)
Giai on hi phc (recovery phase)

SINH BNH HC AKI

DIN TIN CA HTOTC

DIN TIN HTOTC

1. Giai an khi pht: vi gi, vi ngy.
- lc cu thn do gim ti mu thn
2. Giai an tn thng lan ta:
- Thiu mu ko di gy ri lan phn cc t bo, apotosis, hai t tb ng
thn.
- tb bong trc, dnh vo nhau, gy bt tc lng ng, ph n m k, phn ng
vim, tp trung BC.

BIN CHNG SUY THN CP

KT LUN

Chn an sm, ngn nga suy thn trc thn tin trin thnh ti thn.

Chn an nguyn nhn gii quyt nhm phc hi chc nng thn.

Pht hin sm bin chng trnh li hu qu nghim trng.