BS V HONG NGHA

MC TIU:1. Trnh by c nh ngha Vim cu thn cp2. K cc nguyn nhn ca vim cu thn cp3. Trnh by c chn on vim cu thn cp.4. Trnh by lm sng v cn lm sng ca vim cu thn cp hu nhim lin cu trng5. Trnh by c nguyn tc iu tr vim cu thn cp.

Vim cu thn cp l qu trnh vim lan ta cu thn ng thn vi hi chng c trng bi khi pht t ngt tiu mu, tiu m, gim lc cu thn. Tiu mu c xem l triu chng quan trng v cn thit chn on.

Bnh hc ca HC VCT cp 1-

Thay i cu trcC ch bnh sinhVim cu thn tng sinh lan taBt gi phc hp khng nguyn- khng th lu thng v thnh lp phc hp khng nguyn khng th ti lp di ni m ca mng y cu thn v ti t bo trung mVim cu thn tng sinh mng

Cu thn bnh thng

Diffuse endocapillary proliferative (exudative) GN

Fibrinoid necrosis and cellular crescents

Nhim trng:Vim cu thn hu nhim lin cu trngKhng hu nhim lin cu trng: vi khun, vim ni tm mc, st thng hn, Pneumococci, giang mai, vim mng noSiu vi: vim gan siu vi B, quai b, thy uK sinh trng: st rt, toxoplasmosis

Bnh h thng: Lupus , vim mch, hi chng Henoch-Scholein, Hi chng GoodpastureBnh cu thn nguyn pht: vim cu thn tng sinh mng, bnh thn IgA, Vim cu thn tng sinh trung m.Cc nguyn nhn khc: Hi chng Guilain- Barre, x tr, chng nga

Chn on xc nh:- Tiu mu, tr hng cu- Thiu niu- Tng huyt p- Ph- Tng sn phm nit mu.

Chn on nguyn nhn:

Xt nghim mu ( b th v cc xt nghim khc) b nh cu thnBNH CU THNC4C3ASO, ADN-BCryo, IgANTI-GBMANCABnh cu thn sang thng ti thiu NNX cu thn khu tr tng vng NNBnh cu thn mng NNVim cu thn tng sinh mng Type IN/+++ Type IIN+Vim cu thn t huyt NN Bnh thn IgA NNVim cu thn cp hu nhim lin cu trng N/+++++Vim cu thn lim Hi chng GoodpastureNN+++ Immune complexN/N/N/++ Vim nt quanh ng mch NN+++ADN-B, antideoxyribonuclease B; Cryo, cryoglobulins; Ig, immunoglobulins.ASO: Anti- Streptolysine O (> 250 n v Todd), Anti- GMB: anti- glomerular basement membrane: Khng th khng mng y cu thn. ANCA: anti- neutrophil cytoplasmic antibodies ( khng th khng t bo cht ca bch cu a nhn trung tnh).

Chn on phn bit:Cn chn on phn bit vi cc bnh thn cng c tiu mu, tiu m, tng huyt p, suy thn nh : Nhim trng tiu, vim cu thn mn, vim thn k cp, bnh thn a nang

4.1. Nguyn nhn Bnh l hu qu ca nhiu loi nhim trng (staphylococci, pneumococci, siu vi) nhng thng gp nht l streptococcus beta tn huyt nhm A.

4.2. Nhim trng tin pht: Nhim trng tin pht c th hu hng, da. Nhim trng hu hng c triu chng st, khc m, hch c to, thi gian t vim hng n vim cu thn cp l 1-2 tun. Thi gian t lc nhim trng da n khi c biu hin vim cu thn cp l 2-6 tun.

4.3. Triu chng lm sng: Tiu mu vi th 2/3 trng hp Ph 80-90% trng hp Tng huyt p 75-80% Suy tim sung huyt i khi bnh nhn c biu hin lm sng ca vim cu thn tin trin nhanh, suy thn cp

Tru Hong Cau

Viem cau than hau nhiem lien cau trungdo mot so t chung Streptocci -tan huyet nhom A gay viem than (nephritogenic)

Viem cau than hau nhiem lien cau trung

Sau nhim trng hngSau nhim trng daChng streptococi pyogenesM types 1,2,4,12M types 47,49,55,57Thi gian bnh 8-12 ngy10-14 ngy

4.4. Xt nghim cn lm sng Tng phn tch nc tiu:tiu mu i th hoc vi th gn nh lun lun hin din trong vim cu thn cp hu nhim lin cu trng. Cn lng c tr hng cu v hng cu bin dng, i khi c tr bch cu. Tiu m gn nh lun lun dng tnh, di ngng hi chng thn h

4.4. Xt nghim cn lm sng Xt nghim mu: BUN, creatinin mu tng, suy gim chc nng thn thng gp bnh nhn ln tui.ASO (antistreptolysin): 90% trng hp > 200 n vnh lng b th C3, CH50, C4 gn nh lun lun gim trong giai on cp, tr v bnh thng trong vng 4-6 tun sau khi pht.Yu t thp RF (+) 30-40%Ri lon ng mu

4.4. Xt nghim cn lm sngPht cy hng v m da: pht hin streptococcus (+) 10-70%.

iu tr triu chngiu tr nng iu tr nguyn nhn

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