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i tng: Y4

ThS BS Hynh Ngc Phng ThoThS BS Hynh Ngc Phng ThoGing vin B mn Ni i hc Y DcGing vin B mn Ni i hc Y Dc

SUY THN !"P

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#$N% &c &'nh ngh() *%y +h,n c-./ +0n+hng +h,n c-. 1TTT!2 v3 +i% ch%4n 56789$:$ T; *inh ?@ =Anh c) TTT!chCc nng/ h)i +E Fng +h,n c-./ TTT! *)%

+h,n$$ T;% +FgiK. .hIn =iA+ ST! v3 STL$

M$ Bi>+ & nghi v3 .hIn +Och cc Q+ nghiAm+;ong ch4n &R)n .hIn =iA+ ST! +;c +h,n v3+i +h,n$

L! T6U

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VNH NGHWX

SUY THN CP (ACUTE RENAL FAILURE)

- S gim chc nng thn m!t c"ch #!t ng!t $% th&'ng hi h*c +i,n .

t/ng $0ng $%i gi'1 #2n $%i ng%3

- Th4t ng5 67ch 891 :h;ng hn "nh #&. nh5ng gi.i

#?.n :h"c nh.4 t/ng @4" tnh t=n th&Bng thn cD

- n c0n +Gng tn 6m 8%ngD

- S43 thn c cJ thK +i,n . tn thn t&c #J Mnh th&'ng h/c tn thn

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VNH NGHWX

TQN THN THN CP 6% m!t h!i chng #c t&ng

gim nh.nh #! 6?c cX4 thn t/ng $%i gi' #2n $%i ng%3D

Vn #2n #?ng nh5ng 8n h]m M%i ti2t cJ ng4n g^c nitB nh& U $%

C\.tinin

Lm 8%ng +i,n ti2n @4. nhi4 gi.i #?.n :h"c nh.4 $ th'i gi.n $% mc #!

nng1 t_ :h`i #X41 843 thn ti2n tiKn $% hi h*cD

Hi h*c chc nng tG3 th4!c $%/ cn ng43n1 MOnh thn cJ t&c $% #i4

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PHN B6ZT ![! \H[6 N6ZL

; niO4(:h;ng ta/ . n&c tiK4)1 [b tiK4(Tc nghdn #&'ng tiK4 +&i)D

S43 thn c($%i gi'1 $%i ng%31 th&'ng hi h*c)1 S43 thn man(nhi4

th"ng1 nhi4 nm1 :h;ng hi h*c)

S43 thn c$% 843 thn c tn nn man(:h;ng cJ h/c cJ MOnh thn

man g3 843 thn mn 6%m nn tng)

T=n th&Bng thn c(chc nng)1 H?.i t9 ^ng thn c(MOnh h?c)

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![! T6U !HU]N ^_ TH` Ta!H NT

T5bNG SUY THN !"P

ThiK4 niO4e ThK tbch NT f mLj gi'D

h;ng thiK4 niO4e ThK tbch NT k mLj gi'D

; niO4e ThK tbch NT f lmL j gi'D

; niO4 h0.n t0.n f mLj gi'D

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SUY THN !"P TH` \HNG TH6`U N6ZU

ThK tbch NT k mLj gi'DD

im #! 6?c cX4 thn nh.nh ([UN1 C\.tinin tng nh.nh t/ng

$0ng $%i gi'1 $%i ng%3)

Ng43n nhne h"ng 8inh1 th4^c cn @4.ng1 $im To c1

MOnh thn +/ tc nghdn m!t hXn1 $im cX4 thn c1 63 gii cB $nD

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![! LX5\95S DdNG T5bNG TeN

THfNG THN !"P

C\.tinin h432t th.nhD

[UN1 U

C38t.tin C

C"c [i/m.:\8 t/ng t=n th&Bng thn c

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!;Q)+inin HT v3 *%y +h,n c-.!;Q)+inin HT v3 *%y +h,n c-.

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

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!59XT6N6N HUYT THXNHc ?c j%) ck% +h,n/ &c =3i +i>+ l bT v3 hng &c +i

h-. +h%$

C"c 324 t^ g3 nh h&`ng C\.tinin m% :h;ng nh h&`ng chc nng

thn:

- Tng Creatinin mu do c ch bi tit Creatinin: Trimethoprim,

Cimetidine..

- Tng Creatinin mu do nh hng o !ng Creatinin: "#corbic

acid, Cephao#porin#

- Cc $u t% &hc: t'nh tr(ng dinh d)ng, th* t+ch phn b%, tui, gii,

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[UNe

- Tng ti h5p thu &hi thiu nc

- Tng 678 m &h9ng nh hng chc nng thn: tng d; h1a, nhp

nhiu h1a, in 2uan n &h%i cI.

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CpC [IoARERS CqA AIe

- JBc bi tit trong mu K nc ti*u &hi c1 tn thIng thn c5p,

tIng tD Troponin tL tb cI tim #au nhMi mu cI tim c5p.

- J0 nh($ K J?c hi@u %i Ki "GN hIn #o Ki 678, Creatinin.

- Jang Bc nghi>n cu: 7rinar$ Nntereu&in AO PNQ-AOR, 8eutrophigeatina#e a##ociated ipocain P8S"QR, &idne$ ;nur$ moecue A

PGim-ARtng #m hIn 678, Creatinin A-U ng$ trong tr!ng hBp

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Suy thn !"Suy thn !"Ti% ch%4n 5$6$7$8$9$ +;ong +0n +hng +h,n c-.

1XD6 :J2

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#$%& '&* R$+

V Ng43 cB (Ri8:)e C\.tinin m"4 tng l1 6Xn h/c n&c tiK4 f 1 mLggi' t/ng r gi'DV T=n th&Bng (Ins43)e C\.tinin m"4 tng g j 6Xn h/c n&c tiK4 f 1 mLggi' t/ng lj

gi'D

V S43 thn (F.i64\)e C\.tinin m"4 tng 6Xn h/c C\.tinin kum/6L h/c n&c tiK4 f

1 mLggi' t/ng j gi'D

V ot chc nng thn (L/88)e STC :v/ +%i h/c mt h0.n t0.n chc nng thn t/ng hBn

t4XnD

V [Onh thn gi.i #?.n c4^i (En+ St.g\ \n.6 +i8\.8\)e mt h0.n t0.n chc nng thn t/ng hBn th"ngD

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DV!H T` Hp!

lD oc hi t/ng c!ng #ngechi2m :hw.ng lx [N nh $iOn1 hBnhn n9. 8^ [N cJ MOnh thn mn #i :ymD Nh5ng ng43n nhn

th&'ng ge t&c thn (zx)1 8.4 thn (lzx)D T{ 6O t9 $/ng t0.n

M! 6% lxD

jD oc hi t/ng MOnh $iOneVGng ti4 ch4]n RIFLE1 cJ jx [Nnh $iOn cJ :h nng M7 AID C"c ng43n nhn th&'ng ge

thi24 m"4 c*c M!1 nhi,m tGng h432t1 th4^c1 th4^c cn @4.ngD

AI t&c thn th&'ng g ` MOnh h0ng nh&ng h?.i t9 ^ng thn

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T6P !N BANH NHN SUY THN !"P

V Wem &X hM #I b@nh n Ptrong 6Y, thu%cR

V Z[i b@nh #\ K &hm m #ng

V Th* t+ch nc ti*u K T]T8T

V W^t nghi>m: 678, Creatinin ZT, Non M mu,, CT_.

V Gho #t cc ch` #% #inh h1a 8c ti*u

V i>u m b4ng ai trL t3c nghn !ng ti*u.

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PHN B6ZT SUY THN !"P ^q SUY THN LrN

A. Shi nhn ti

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NGUYN NHN

#$ Tng )so+ m% +;c +h,n 1MM t u2

:$ T0n +hng +h,n c-. +i +h,n 1M t J2$

$ T0n +hng +h,n c-. *)% +h,n 1wM2$

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TeN THfNG THN !"P T5fx! THN

1Tng )so+ m% +;c +h,n2

1S%y +h,n c-. +;c +h,n2

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SUY THN !"P T5fx! THN

lD I|o TH} T~CH NI oCH THC S:

- Wu5t hu$t.

- _5t d;ch 2ua !ng ti>u h1a: 1i, ti>u ch$, ht d;ch d( d$.

- _5t d;ch 2ua thn: thu%c Bi ti*u, i tho !ng PBi ti*u thm

th5uR, i tho nh(t, #u$ thBng thn, b@nh thn m5t mu%i.

- _5t nc 2ua &h[ang th ba: b[ng, Ki>m t4$, Ki>m phc m(c, gim

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Trieu chng mat ncTrieu chng mat nc

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jD I|o TH} T~CH NI oCH HIU U|:

a Sim cung Bng tim: #u$ tim #ung hu$t, ch1ang tim, trn d;ch

mng ngFai tim Ki chsn ^p tim c5p, thu$>n t3c phi n?ng.

b n m(ch ngai bi>n: nhim trng hu$t, ch1ang phn K@, thu%c h(

p, thu%c g$ m>, =I gan K cc b@nh f gan &hc..

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D THAY QI HUYT N HC TI THN:

a Co ti*u J_ n.

Thu%c &hng Ki>m 8"N Ppro#tagandin inhibitionR

C$co-o=$gena#e U PCo=-UR inhibitor# Ppro#tagandin inhibitionR

C$co#porin, Tacroimu#

Tng Can=i mu

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C CH [NH SINH

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[P NG !zX !{U THN ^q ! TH`\H6 G6|L TH` Ta!H TU{N H}XN

\Och +hOch hA gi)o cm

\Och +hOch hA ;nin Xngio+n*in X?~o*+;on

Tng .hRng +hOch XDH

PhRng +hOch cc ch-+ gIy co mch ni +ng

! ch> + &i% h) +i ck% +h,n \hi HX gim 1t mmHg2/ ~n

+i% L v3o/ co +i% L ;) & ~%y +;< G75$

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BZNH !|NH 8L SqNG

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BZNH !|NH 8L SqNG

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!H]N XN ST! T5fx! THN

#$ BAnh cnh ?Im *3ng gi @/ ~-% m-+ nc/ *%y +im

:$ !8S

BUN!;)+inin m% :

U N) w : mj8/ 79 N) w #

Nc +i% c &c

T +;ng #/#

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TeN THfNG THN !"P SXU THN

1S%y +h,n c-. *)% +h,n2

SUY THN !"P SXU THN

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SUY THN !"P SXU THN

lD TC NHN N HAI [N HC TC NHN oT [N

TRN THN VUY NHT:

a Trong Fng ni@u 2un

[i

C4c mu 9ng

_/, ho?c nh thn trong hai t\ nh thn

]h n< #au ch4p 8 ngBc dFng

SUY THN !"P SXU THN

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SUY THN !"P SXU THN

jD TC NHN NIU HC N CQ [:

6u nh TQT

G 6 ho?c TQT

6 thEn &inh ho?c dng thu%c antichoinergic g$ ng 8T

Co th3t 8J

[i 6

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!H]N XN ST! SXU THN

[Onh cnh 6m 8%ng g

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!H]N XN ST! SXU THN

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TeN THfNG THN !"P Tr6 THN

1S%y +h,n c-. +i +h,n2

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TeN THfNG THN !"P Tr6 THN

#$Lr!H L[U

:$!{U TH,N

$L \

J$NG THN

SUY THN !"P Tr6 THN

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SUY THN !"P Tr6 THNlD oCH opU

a _(ch mu &+ch thc n K trung b'nh

- Thu$>n t3c ho?c hu$t &h%i J_ thn,Gvp J_ thn.

- Thu$>n t3c T_ thn hai b>n.

- ]o$arthriti# nodo#a

b _(ch mu nh[

- "theroemboic di#ea#e

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SUY THN !"P Tr6 THN

jD CU THN

a Z0i chng thn h

b Ki>m cEu thn c5p, Ki>m cEu thn tin tri*n nhanh

SUY THN !"P Tr6 THN

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SUY THN !"P Tr6 THN

DD o :

a Yi>m thn & c5p do thu%c

Ghng #inh: methiciin, cephao#porin, rixampicin, #uxonamide#,

er$throm$cin, ciproxo=acin

QBi ti*u: xuro#emide, thiayide, chorthaidone

8"N

Thu%c ch%ng co git: phen$toin, carbamayepine

SUY THN !"P Tr6 THN

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SUY THN !"P Tr6 THN

D N THN (HAI T N THN CP)

a Thiu mu c4c b0 thn

Ch1ang

Wu5t hu$t

Ch5n thIng

8him trng hu$t Sram m

Yi>m t4$ c5p

THUC Y HAI T N THN CP

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THUC YHAI T N THN CP

"minog$co#ide

"mphotericin 6

]entamidine

ko#carnet

"c$coKir

NndinaKir

Thu%c i

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C Z r

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! !H G6|L 8p! !{U THNT5bNG HpX6 T ng +h,n c-.

lD T=n th&Bng ^ng thne thJ.t +7ch hG n m; :d1 #y ^ng thn1 tc

nghdn 60ng ^ng thn

jD R^i 6?.n h432t #!ng h?c t/ng thn

D Phn ng $im t/ng thn

D C/ mach t/ng thnD

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o4++3 M/n c.8t

8L SqNG HpX6 T ng +h,n c-.

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8L SqNG HpX6 T ng +h,n c-.

.ua 4 giai /0n.ua 4 giai /0n

2iai /0n hi "ht ( initiati0n "has6)2iai /0n hi "ht ( initiati0n "has6)

2iai /0n tn thng an ta (6;t6nsi0n "has6)2iai /0n tn thng an ta (6;t6nsi0n "has6)

2iai /0n aint6nan6 "has6)2iai /0n aint6nan6 "has6) 2iai /0n h?i "h@ (r60A6ry "has6)2iai /0n h?i "h@ (r60A6ry "has6)

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S6NH BZNH Hp! X\6

D6N T6N !zX HTbT!

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D6N T6N !zX HTbT!

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D6N T6N HTbT!

lD i.i #?.n :h`i h"te $%i gi'1 $%i ng%3D

- ! 6?c cX4 thn +/ gim t&i m"4 thn

jD i.i #?.n t=n th&Bng 6.n tw.e

- Thi24 m"4 :v/ +%i g3 ^i 6?.n hn cc t2 M%/1 ./t/8i81 h?.i t9 tM ^ng

thnD

- tM M/ng tJc1 +bnh $%/ nh.41 g3 Mbt tc 60ng ^ng1 hG n m; :d1 hn ng

$im1 t t4ng [CD

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BIN CHNG SUY THN !"P

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\T 8UN

V Ch]n #J.n 8m1 ngn ng_. 843 thn t&c thn ti2n tiKn th%nh tai thnD

V Ch]n #J.n ng43n nhn #K gii @432t nhZm h*c hi chc nng thnD

V Ph"t hiOn 8m Mi2n chng #K t"nh #K 6ai h4 @4 nghim t?ngD

suy than cap y4 2011

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