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MC TIU BI GING
2
Trnh by 4 CN
ca thn

GT c ch hnh
thnh NT

Nu TC l ha &
t/phn ca NT
3
ngi

Mc Tiu
Nu ng/tc &
ngha 1 s PP
thm d CN
thn

P/bit cc cht
b/thng & bt
thng trong NT

NI DUNG
1

I CNG

CC CHC NNG CA THN

NC TIU NGI

MT S XN THM D CHC NNG THN

5
5

XN HA SINH TRONG 1 S BNH THN

I. I CNG
Thn l mt c quan hot ng mnh.
1000 -1500l mu i qua thn / 24h (10% cung cp E
cho thn hat ng), 90% to thnh nc tiu
(nhim v bi tit).
Thn c 4 chc nng:
Bi tit cc cht cn b: c ch lc v ti hp thu
iu ha TBKT

Chuyn ha cc cht
Ni tit

II. CC CHC NNG

CA THN

A. CHC NNG BI TIT

1. Chc nng lc ca mng cu thn
Cu to mng lc: L nh d # 75 - 100 A
TLPT>70.000 ko qua c
S lc ca protein qua mng cu thn ph
thuc 3 yu t:
+ Cu trc v tnh cht ca mng cu thn
+ Cu trc v tnh cht vt l ca phn t c
lc: cht c kch thc cng nh d b lc
(HSTT cng ln)
+ Lu lng mu

CU TO N V THN (NEPHRON)

2. Chc nng ti hp thu ca ng thn

Ti hp thu hon ton: Glucose - ngng thn 1,8g/L

Ti hp thu hu ht:
Nc 99%, Kali 98%, Phosphat 95%,
Bicarbonat >90%, AA, Protid, Glucid, Lipid, Vit,

Ti hp thu phn ln: Na+, Cl Ti hp thu 1 phn: Ur, urat, Vit C < 50%
Ko c ti hp thu (ch lc n thun): Mannitol, innulin,
Natri hyposulfid dng n/cu

Bi tit cu thn, ng thn, ti hp thu ng thn: Acid

uric v Creatinin.

C ch ca QT ti hp thu
4 v d:
Ty theo bn cht ha hc ca cht c ti hp
thu m c nhng c ch ti khc nhau. Lng ti
a ca mt cht c ti hp thu trong mt pht
gi l ti hp thu ti a ca ng thn i vi
cht .

Ti HT nc ng ln gn theo c ch th
ng trn nguyn tc cn bng p sut thm
thu, nhng ng ln xa th theo nguyn tc
ch ng.

 Ti HT Na+ theo c ch vc tch cc. duy tr s

trung ha 2 pha ca mng TB i hi s i qua
cng chiu ca mt anion (Cl-, HCO3-,) v chiu
ngc li ca mt cation (H+, K+,) cho nn s ti
HT Na+ ph thuc nhiu y/t nh nng ca cc ion
trn, B 2 yu t corticoid, aldosteron,c t/dng
tng cng ti HT Na+ v bi xut K+.
C ch ti HT tch cc xy ra i vi Glucose, aa,
a.uric. Nu 2 cht khc nhau c ti HT theo cng
mt c ch th lc nng ca mt cht tng cao s
ngn cn ti HT cht kia.

3. Chc nng bi tit ca ng thn:

Cc sn phm chuyn ha c nng cao
trong mu c bi tit vo ng thn:

K+, H+, NH4+, Acid uric,

B. VAI TR TRONG THNG BNG

KIM TOAN
3 c ch iu ha ca thn
Ti hp thu HCO3-: 90% ng ln gn
o thi H+ di dng mui acid v acid ko bay
hi: ng ln xa

o thi H+ di dng mui amon: ng ln xa

(Sau khi gn ion H+, NH3 bin thnh NH4+).
C # 30-50 mEq ion H+ o thi di dng mui
amon v # 10-30 mEq di dng cc mui acid
khc qua NT 24h.

C. CHC NNG NI TIT

Thng qua h thng renin - angiotensin aldosteron:
iu ha s hng nh ni mi
Thng bng nc in gii v huyt p.

D. CHC NNG CHUYN HA CHT

Chuyn ha cht xy ra rt mnh thn

cung cp E cho h/ng ca thn (Thn s

dng 10% O2 ca ton c th)
T bo thn giu enzym ca CT Krebs, nn
nhng p/ng ca CT Krebs xy ra rt mnh

III. NC TIU NGI

1. Tnh cht chung ca nc tiu
1.1.Th tch nc tiu:
1.000 1.400 ml / 24h (18 - 20 ml/kg)
+ Tui: tr em tiu nhiu hn ngi ln
(tnh theo kg thn trng)
+ Ch n ung

+ Hot ng c th

1.2. Cc tnh cht vt l ca NT

Mu sc
trong sut
Mi
Sc cng b mt ca NT< Nc
T trng: NT 24 h
BT: 1,005 1,030 (1,018 1,022)
pH nc tiu: NT 24h
BT: T 5 - 6 (TB 5,8)

1.3.Thnh phn ha hc ca NT
Cn kh NT( # 55 - 70 g/24h)
CHT V C
Anion

CHT HU C
Cation

Ur

Na+

4,0 - 6,0

Creatinin

1,0 - 1,8

PO43- 2,5 - 4,0

K+

2,0 - 3,0

Acid uric

0,4 - 0,8

SO42-

Ca2+

0,15 - 0,25

Acid amin

2,0 - 4,0

NH4+

0,3 - 1,2

Acid hippuric 0,1 - 1,0

Mg2+

0,10 - 0,20

Cl-

6,0 - 12,0

2,0 - 3,5

20,0 - 30,0

Cc Hormon, Vit, Enz

2. Nhng cht bt thng trong nc tiu

Glucid: Glucose niu (ngoi ra c th c
Fructose, Galactose do bnh ri lon enzyme
bm sinh).
Protein

Cht cetonic
Sc t mt, Mui mt
HC v hemoglobin

 Porphyrin
Dng chp
Nitrit: do Reductase ca 1 s VK kh
Nitrat Nitrite

Cn v si

IV. MT S XT NGHIM
THM D CHC NNG THN

1. Thm d chc nng o thi

thanh thi (clearance): c th nh gi
chc nng cu thn v ng thn

U V
C
P
C: thanh lc l th tch huyt tng c
thanh lc hon ton, tnh theo ml/ph.
U: Nng cht nghin cu/NT (mg/ml)
V: Th tch nc tiu tnh bng ml/ph
P: Nng cht nghin cu/HT (mg/ml)

Cht

C 1.73
Cc
Sc
Cc: HSTT sau
iu chnh
S: din tch da

Nng
( ml /ph)

Ur

60 - 100

Creatinin

90 - 130

Inulin

100 - 130

PAH

400 - 700

 Thm d chc nng lc cu thn

Innulin, Creatinin, Mannitol.

HSTT 120 ml/ph
Thm d chc nng ti hp thu ca ng thn

Ur, glucose, acid amin, acid uric.

HSTT< 120 ml/ph
C ur 75 ml/ph
Thm d chc nng bi tit ca ng thn

PAH (acid para amino hippuric)

PSP (phenol sulfo phtalein)
HSTT > 120 ml/ph
CPAH = 650 ml/ph

2. Thm d chc nng bi tit cht mu

NP. PSP (Phenolsulfon phtalein): Tim TM dd
PSP 6%. Sau 15 v 70 pht ly NT nh lng.

Bnh thng: 25% v 75%.

Thp hn : do suy thn hoc kh nng bi
tit ca thn b ri lon,...

3. Thm d chc nng c c NT

Nc vo nhiu: NT long, d thp 1,003
Nc vo t

: NT c,

Nu suy thn

d cao 1,030

d do kh nng c c

d do tn thng cu thn

V. XN HA SINH TRONG 1 S
BNH V THN

1. Suy thn cp
TC: - V niu (100 ml /24 h)
- Thiu niu (400 ml /24 h)
- Ur mu, Creatinin /mu tng cao
- Creatinin Clearance 0,166 ml /giy

Giai on u:

Nc tiu t,

Protein /nc tiu ( + )

Ur v Creatinin mu bt u

 Giai on suy thn duy tr:

Nc tiu: c, protein ( + )

Na+ > 40 mEq/l

Mu: ur v creatinin 10 - 20 mg%
Giai on bnh phc:
Ur v creatinin bt u
Chc nng thn ci thin nhanh
Chc nng c c tr li bnh thng

Hng cu:

2. Suy thn mn
CN lc ca cu thn t t
o thanh thi Creatinin:
>100ml/ph: coi nh BT
> 50ml/ph: Suy thn c th phc hi.
50 - 30ml/ph: 50% nephron b h: thiu mu, cao
huyt p du hiu bo ng

30 - 10ml/ph: bnh trm trng, du hiu sinh ha

r, ko hy vng hi phc.
<10ml/ph: 95% nephron b h.
iu tr: chy thn nhn to, thm phn phc mc,
ghp thn

3. Hi chng thn h
Mu
- Protein mu .
- in di: Albumin gim, 2 Globulin .
- Lipid ri lon: C ; TG ; LP ; PL
Nc tiu
- t, 500 ml /24h
- Protein: 3 - 10 g /24 h (30 - 40)
- Th chit quang
- Tr trong, tr m

CC THNG S XNHS THNG DNG

CHN ON V THEO DI
CC BNH THN
1. Protein niu
2. Ur
3. Creatinin
4. thanh thi Creatinin

1. Protein niu
L 1 trong ~ XN hng lot k/tra SK nh k
NT ngi BT: c # 50-150 mg /24h coi nh
ko c protein.

Protein niu >150 mg /24h khi u bnh l.

in di protein - NT xc nh v tr tn thng:

Protein niu cu thn: thng c y cc

t/phn nh protein HT.

Protein niu ng thn: c protein TLPT < alb,

c bit l c 2 v 2 microglobulin du
hiu chc chn c tn thng ng thn

2. Ur
L 1 trong nhng XN c bn

Ur M: 1,7- 8,3mmol/l
>8,33 mmol/l bnh (thiu nng thn)
Nng ur : him gp
Ur NT: 333 - 583 mmol/l.

3. Creatinin
Creatinin /HT: Nam 53-97mmol/l
N

44-80 mmol/l

Khi cu thn b tn thng nng creatinin

mu sm hn so vi ur.

L mt thng s nhy v c hiu nh gi

CN thn.

4. thanh thi Creatinin

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