{"id":324,"date":"2025-04-24T20:16:38","date_gmt":"2025-04-24T13:16:38","guid":{"rendered":"https:\/\/tietnieunamkhoa.pro.vn\/wp\/?p=324"},"modified":"2025-04-24T20:16:39","modified_gmt":"2025-04-24T13:16:39","slug":"chan-doan-va-dieu-tri-benh-than-man-giai-doan-iii-huong-dan-moi-va-cap-nhat","status":"publish","type":"post","link":"https:\/\/tietnieunamkhoa.pro.vn\/wp\/chan-doan-va-dieu-tri-benh-than-man-giai-doan-iii-huong-dan-moi-va-cap-nhat\/","title":{"rendered":"Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh th\u1eadn m\u1ea1n giai \u0111o\u1ea1n III: H\u01b0\u1edbng d\u1eabn m\u1edbi v\u00e0 c\u1eadp nh\u1eadt"},"content":{"rendered":"\n<div class=\"wp-block-group is-vertical is-layout-flex wp-container-core-group-is-layout-8cf370e7 wp-block-group-is-layout-flex\">\n<h2 class=\"wp-block-heading\">T\u1eeb kh\u00f3a ch\u00ednh:<\/h2>\n\n\n\n<p>h\u01b0\u1edbng d\u1eabn KDIGO<\/p>\n\n\n\n<p>b\u1ec7nh th\u1eadn m\u1ea1n giai \u0111o\u1ea1n III<\/p>\n\n\n\n<p>ch\u1ea9n \u0111o\u00e1n b\u1ec7nh th\u1eadn m\u1ea1n<\/p>\n\n\n\n<p>\u0111i\u1ec1u tr\u1ecb b\u1ec7nh th\u1eadn m\u1ea1n<\/p>\n\n\n\n<p>qu\u1ea3n l\u00fd CKD stage 3<\/p>\n<\/div>\n\n\n\n<div class=\"wp-block-group is-vertical is-layout-flex wp-container-core-group-is-layout-8cf370e7 wp-block-group-is-layout-flex\">\n<h2 class=\"wp-block-heading\">Gi\u1edbi thi\u1ec7u v\u1ec1 b\u1ec7nh th\u1eadn m\u1ea1n<\/h2>\n\n\n\n<p>B\u1ec7nh th\u1eadn m\u1ea1n (Chronic Kidney Disease &#8211; CKD) l\u00e0 t\u00ecnh tr\u1ea1ng suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn k\u00e9o d\u00e0i \u2265 3 th\u00e1ng, \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn l\u1ecdc c\u1ea7u th\u1eadn v\u00e0\/ho\u1eb7c c\u00f3 t\u1ed5n th\u01b0\u01a1ng c\u1ea5u tr\u00fac th\u1eadn. Giai \u0111o\u1ea1n III l\u00e0 th\u1eddi \u0111i\u1ec3m quan tr\u1ecdng \u0111\u1ec3 can thi\u1ec7p nh\u1eb1m l\u00e0m ch\u1eadm ti\u1ebfn tri\u1ec3n \u0111\u1ebfn suy th\u1eadn giai \u0111o\u1ea1n cu\u1ed1i.<\/p>\n<\/div>\n\n\n\n<h2 class=\"wp-block-heading\">Ch\u1ea9n \u0111o\u00e1n b\u1ec7nh th\u1eadn m\u1ea1n giai \u0111o\u1ea1n III<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Ph\u00e2n lo\u1ea1i giai \u0111o\u1ea1n theo GFR<\/h3>\n\n\n\n<figure class=\"wp-block-image\"><img loading=\"lazy\" decoding=\"async\" width=\"1248\" height=\"701\" src=\"https:\/\/tietnieunamkhoa.pro.vn\/wp\/wp-content\/uploads\/2025\/04\/Anh-man-hinh-2025-04-24-luc-20.06.54.png\" alt=\"\" class=\"wp-image-325\" srcset=\"https:\/\/tietnieunamkhoa.pro.vn\/wp\/wp-content\/uploads\/2025\/04\/Anh-man-hinh-2025-04-24-luc-20.06.54.png 1248w, https:\/\/tietnieunamkhoa.pro.vn\/wp\/wp-content\/uploads\/2025\/04\/Anh-man-hinh-2025-04-24-luc-20.06.54-300x169.png 300w, https:\/\/tietnieunamkhoa.pro.vn\/wp\/wp-content\/uploads\/2025\/04\/Anh-man-hinh-2025-04-24-luc-20.06.54-1024x575.png 1024w, https:\/\/tietnieunamkhoa.pro.vn\/wp\/wp-content\/uploads\/2025\/04\/Anh-man-hinh-2025-04-24-luc-20.06.54-768x431.png 768w\" sizes=\"auto, (max-width: 1248px) 100vw, 1248px\" \/><\/figure>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\">\n<p><strong>Giai \u0111o\u1ea1n III (G3a v\u00e0 G3b)<\/strong>: Ch\u1ee9c n\u0103ng th\u1eadn suy gi\u1ea3m v\u1eeba ph\u1ea3i, th\u01b0\u1eddng kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng r\u00f5 r\u00e0ng nh\u01b0ng \u0111\u00e3 b\u1eaft \u0111\u1ea7u c\u00f3 nguy c\u01a1 bi\u1ebfn ch\u1ee9ng chuy\u1ec3n h\u00f3a, tim m\u1ea1ch v\u00e0 ti\u1ebfn tri\u1ec3n b\u1ec7nh.<\/p>\n<\/blockquote>\n\n\n\n<div class=\"wp-block-group is-vertical is-layout-flex wp-container-core-group-is-layout-8cf370e7 wp-block-group-is-layout-flex\">\n<h3 class=\"wp-block-heading\">C\u00e1c ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n CKD:<\/h3>\n\n\n\n<p>Sinh thi\u1ebft th\u1eadn: x\u00e1c \u0111\u1ecbnh t\u1ed5n th\u01b0\u01a1ng m\u00f4 h\u1ecdc<\/p>\n\n\n\n<p>eGFR &lt; 60 ml\/ph\u00fat\/1.73m\u00b2 k\u00e9o d\u00e0i \u2265 3 th\u00e1ng<\/p>\n\n\n\n<p>Albumin ni\u1ec7u (ACR \u2265 30 mg\/g ho\u1eb7c protein ni\u1ec7u \u2265 150 mg\/ng\u00e0y)<\/p>\n\n\n\n<p>H\u00ecnh \u1ea3nh h\u1ecdc b\u1ea5t th\u01b0\u1eddng: th\u1eadn teo nh\u1ecf, th\u1eadn \u0111a nang&#8230;<\/p>\n<\/div>\n\n\n\n<h2 class=\"wp-block-heading\">Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng v\u00e0 c\u1eadn l\u00e2m s\u00e0ng<\/h2>\n\n\n\n<div class=\"wp-block-group is-vertical is-layout-flex wp-container-core-group-is-layout-8cf370e7 wp-block-group-is-layout-flex\">\n<h3 class=\"wp-block-heading\">Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>M\u1ec7t m\u1ecfi, ch\u00e1n \u0103n<\/li>\n\n\n\n<li>T\u0103ng huy\u1ebft \u00e1p<\/li>\n\n\n\n<li>Ph\u00f9 nh\u1eb9 m\u1eaft c\u00e1 ho\u1eb7c b\u00e0n ch\u00e2n<\/li>\n\n\n\n<li>Chu\u1ed9t r\u00fat, r\u1ed1i lo\u1ea1n gi\u1ea5c ng\u1ee7<\/li>\n\n\n\n<li>Ng\u1ee9a da<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">C\u1eadn l\u00e2m s\u00e0ng c\u1ea7n thi\u1ebft:<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Creatinine huy\u1ebft thanh, eGFR<\/li>\n\n\n\n<li>ACR (albumin\/creatinine ni\u1ec7u)<\/li>\n\n\n\n<li>C\u00f4ng th\u1ee9c m\u00e1u: thi\u1ebfu m\u00e1u CKD<\/li>\n\n\n\n<li>Canxi, phosphate, PTH<\/li>\n\n\n\n<li>Si\u00eau \u00e2m b\u1ee5ng: \u0111\u00e1nh gi\u00e1 k\u00edch th\u01b0\u1edbc, c\u1ea5u tr\u00fac th\u1eadn<\/li>\n<\/ul>\n<\/div>\n\n\n\n<div class=\"wp-block-group is-vertical is-layout-flex wp-container-core-group-is-layout-8cf370e7 wp-block-group-is-layout-flex\">\n<h2 class=\"wp-block-heading\">\u0110i\u1ec1u tr\u1ecb b\u1ec7nh th\u1eadn m\u1ea1n giai \u0111o\u1ea1n III<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">M\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>L\u00e0m ch\u1eadm ti\u1ebfn tri\u1ec3n CKD<\/li>\n\n\n\n<li>Ki\u1ec3m so\u00e1t c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1<\/li>\n\n\n\n<li>Gi\u1ea3m bi\u1ebfn ch\u1ee9ng tim m\u1ea1ch<\/li>\n\n\n\n<li>T\u1ed1i \u01b0u ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng ng\u01b0\u1eddi b\u1ec7nh<\/li>\n<\/ul>\n<\/div>\n\n\n\n<div class=\"wp-block-group is-vertical is-layout-flex wp-container-core-group-is-layout-8cf370e7 wp-block-group-is-layout-flex\">\n<h3 class=\"wp-block-heading\">1. Ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>M\u1ee5c ti\u00eau: &lt; 130\/80 mmHg (KDIGO 2021)<\/li>\n\n\n\n<li>Thu\u1ed1c \u01b0u ti\u00ean: <strong>\u1ee9c ch\u1ebf men chuy\u1ec3n (ACEi)<\/strong> ho\u1eb7c <strong>\u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 angiotensin (ARB)<\/strong>, \u0111\u1eb7c bi\u1ec7t n\u1ebfu c\u00f3 protein ni\u1ec7u<\/li>\n<\/ul>\n<\/div>\n\n\n\n<div class=\"wp-block-group is-vertical is-layout-flex wp-container-core-group-is-layout-8cf370e7 wp-block-group-is-layout-flex\">\n<h3 class=\"wp-block-heading\">2. Ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft (n\u1ebfu c\u00f3 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng)<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>HbA1c m\u1ee5c ti\u00eau: ~7%<\/li>\n\n\n\n<li>S\u1eed d\u1ee5ng thu\u1ed1c c\u00f3 l\u1ee3i cho th\u1eadn: <strong>SGLT2 inhibitors<\/strong> nh\u01b0 dapagliflozin, empagliflozin<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n<\/div>\n\n\n\n<div class=\"wp-block-group is-vertical is-layout-flex wp-container-core-group-is-layout-8cf370e7 wp-block-group-is-layout-flex\">\n<h3 class=\"wp-block-heading\">3. Qu\u1ea3n l\u00fd r\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a<\/h3>\n\n\n\n<p><strong>Thi\u1ebfu m\u00e1u CKD<\/strong>: b\u1ed5 sung s\u1eaft, Erythropoietin (ESA)<\/p>\n\n\n\n<p><strong>T\u0103ng phosphate<\/strong>: ch\u1ebf \u0111\u1ed9 \u0103n h\u1ea1n ch\u1ebf phosphate, phosphate binders<\/p>\n\n\n\n<p><strong>H\u1ea1 canxi, t\u0103ng PTH<\/strong>: b\u1ed5 sung vitamin D, calcitriol<\/p>\n<\/div>\n\n\n\n<div class=\"wp-block-group is-vertical is-layout-flex wp-container-core-group-is-layout-8cf370e7 wp-block-group-is-layout-flex\">\n<h3 class=\"wp-block-heading\">4. Dinh d\u01b0\u1ee1ng v\u00e0 l\u1ed1i s\u1ed1ng<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Gi\u1ea3m protein: ~0.6\u20130.8 g\/kg\/ng\u00e0y<\/li>\n\n\n\n<li>Gi\u1ea3m mu\u1ed1i: &lt; 5 g\/ng\u00e0y<\/li>\n\n\n\n<li>Ng\u01b0ng thu\u1ed1c \u0111\u1ed9c th\u1eadn: NSAIDs, contrast agents&#8230;<\/li>\n\n\n\n<li>T\u1eadp th\u1ec3 d\u1ee5c \u0111\u1ec1u \u0111\u1eb7n, kh\u00f4ng h\u00fat thu\u1ed1c<\/li>\n<\/ul>\n<\/div>\n\n\n\n<h3 class=\"wp-block-heading\">5. Theo d\u00f5i \u0111\u1ecbnh k\u1ef3<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>M\u1ed7i 3\u20136 th\u00e1ng: eGFR, creatinine, ACR<\/li>\n\n\n\n<li>Theo d\u00f5i huy\u1ebft \u00e1p, \u0111\u01b0\u1eddng huy\u1ebft, c\u00f4ng th\u1ee9c m\u00e1u<\/li>\n\n\n\n<li>\u0110i\u1ec1u ch\u1ec9nh thu\u1ed1c theo GFR<\/li>\n<\/ul>\n\n\n\n<div class=\"wp-block-group is-vertical is-layout-flex wp-container-core-group-is-layout-8cf370e7 wp-block-group-is-layout-flex\">\n<h2 class=\"wp-block-heading\">Khi n\u00e0o c\u1ea7n chuy\u1ec3n kh\u00e1m chuy\u00ean khoa th\u1eadn?<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>eGFR &lt; 30 ml\/ph\u00fat\/1.73m\u00b2<\/li>\n\n\n\n<li>Albumin ni\u1ec7u \u2265 300 mg\/g<\/li>\n\n\n\n<li>T\u0103ng creatinine nhanh (>5 ml\/ph\u00fat\/n\u0103m)<\/li>\n\n\n\n<li>T\u0103ng huy\u1ebft \u00e1p kh\u00e1ng tr\u1ecb<\/li>\n\n\n\n<li>B\u1ea5t th\u01b0\u1eddng \u0111i\u1ec7n gi\u1ea3i kh\u00f3 ki\u1ec3m so\u00e1t<\/li>\n<\/ul>\n<\/div>\n\n\n\n<div class=\"wp-block-group is-vertical is-layout-flex wp-container-core-group-is-layout-8cf370e7 wp-block-group-is-layout-flex\">\n<h2 class=\"wp-block-heading\">K\u1ebft lu\u1eadn<\/h2>\n\n\n\n<p>B\u1ec7nh th\u1eadn m\u1ea1n giai \u0111o\u1ea1n III l\u00e0 th\u1eddi \u0111i\u1ec3m \u201cv\u00e0ng\u201d \u0111\u1ec3 can thi\u1ec7p v\u00e0 ng\u0103n ng\u1eeba ti\u1ebfn tri\u1ec3n \u0111\u1ebfn suy th\u1eadn m\u1ea1n giai \u0111o\u1ea1n cu\u1ed1i. Vi\u1ec7c ph\u1ed1i h\u1ee3p ch\u1eb7t ch\u1ebd gi\u1eefa b\u00e1c s\u0129 \u0111a khoa v\u00e0 chuy\u00ean khoa th\u1eadn trong qu\u1ea3n l\u00fd huy\u1ebft \u00e1p, \u0111\u01b0\u1eddng huy\u1ebft, ch\u1ebf \u0111\u1ed9 \u0103n v\u00e0 thu\u1ed1c l\u00e0 y\u1ebfu t\u1ed1 then ch\u1ed1t gi\u00fap ng\u01b0\u1eddi b\u1ec7nh duy tr\u00ec ch\u1ea5t l\u01b0\u1ee3ng s\u1ed1ng.<\/p>\n<\/div>\n\n\n\n<div class=\"wp-block-group is-vertical is-layout-flex wp-container-core-group-is-layout-8cf370e7 wp-block-group-is-layout-flex\">\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\n<\/div><\/div>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>KDIGO 2021 Clinical Practice Guideline for the Management of CKD<\/strong><\/li>\n\n\n\n<li>Levey AS, et al. <em>Definition and classification of chronic kidney disease: a position statement<\/em>. Kidney Int. 2005<\/li>\n\n\n\n<li>National Kidney Foundation: <a class=\"\" href=\"https:\/\/www.kidney.org\" target=\"_blank\" rel=\"noopener\">www.kidney.org<\/a><\/li>\n\n\n\n<li>Mayo Clinic: Chronic kidney disease \u2013 Symptoms and causes<\/li>\n\n\n\n<li>Cheung AK, et al. <em>Chronic Kidney Disease Management<\/em>. NEJM 2021<\/li>\n<\/ol>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>T\u1eeb kh\u00f3a ch\u00ednh: h\u01b0\u1edbng d\u1eabn KDIGO b\u1ec7nh th\u1eadn m\u1ea1n giai \u0111o\u1ea1n III ch\u1ea9n \u0111o\u00e1n b\u1ec7nh th\u1eadn m\u1ea1n \u0111i\u1ec1u tr\u1ecb b\u1ec7nh th\u1eadn m\u1ea1n qu\u1ea3n l\u00fd CKD stage 3 Gi\u1edbi thi\u1ec7u v\u1ec1 b\u1ec7nh th\u1eadn m\u1ea1n B\u1ec7nh th\u1eadn m\u1ea1n (Chronic Kidney Disease &#8211; CKD) l\u00e0 t\u00ecnh tr\u1ea1ng suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn k\u00e9o d\u00e0i \u2265 3 th\u00e1ng, \u1ea3nh [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":326,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"pagelayer_contact_templates":[],"_pagelayer_content":"","footnotes":""},"categories":[3,4,6,22],"tags":[],"class_list":["post-324","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-doctors","category-expert","category-health","category-loi-khuyen-tu-chuyen-gia"],"_links":{"self":[{"href":"https:\/\/tietnieunamkhoa.pro.vn\/wp\/wp-json\/wp\/v2\/posts\/324","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tietnieunamkhoa.pro.vn\/wp\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tietnieunamkhoa.pro.vn\/wp\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tietnieunamkhoa.pro.vn\/wp\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/tietnieunamkhoa.pro.vn\/wp\/wp-json\/wp\/v2\/comments?post=324"}],"version-history":[{"count":1,"href":"https:\/\/tietnieunamkhoa.pro.vn\/wp\/wp-json\/wp\/v2\/posts\/324\/revisions"}],"predecessor-version":[{"id":327,"href":"https:\/\/tietnieunamkhoa.pro.vn\/wp\/wp-json\/wp\/v2\/posts\/324\/revisions\/327"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tietnieunamkhoa.pro.vn\/wp\/wp-json\/wp\/v2\/media\/326"}],"wp:attachment":[{"href":"https:\/\/tietnieunamkhoa.pro.vn\/wp\/wp-json\/wp\/v2\/media?parent=324"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tietnieunamkhoa.pro.vn\/wp\/wp-json\/wp\/v2\/categories?post=324"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tietnieunamkhoa.pro.vn\/wp\/wp-json\/wp\/v2\/tags?post=324"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}