LOGO BS. TRN KIM CC

Mc Tiu

2

5

3

4

1

Trnh by 4 CN

ca thn

GT c ch hnh

thnh NT

Nu TC l ha &

t/phn ca NT

ngi

Nu ng/tc &

ngha 1 s PP

thm d CN

thn

P/bit cc cht

b/thng & bt

thng trong NT

MC TIU BI GING

NI DUNG

2

I CNG 1

CC CHC NNG CA THN

NC TIU NGI 3

MT S XN THM D CHC NNG THN 4

XN HA SINH TRONG 1 S BNH THN 5 5

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

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

A. CHC NNG BI TIT

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

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

III. NC TIU NGI

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 CHT HU C

Anion Cation Ur 20,0 - 30,0

Cl- 6,0 - 12,0 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- 2,0 - 3,5 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 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

thanh thi (clearance): c th nh gi

chc nng cu thn v ng thn

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)

1. Thm d chc nng o thi

U VC

P

Cc: HSTT sau

iu chnh

S: din tch da

1.73CCc

Sc

Cht 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

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,...

2. Thm d chc nng bi tit cht mu

3. Thm d chc nng c c NT

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

Nc vo t : NT c, d cao 1,030

Nu suy thn :

d do kh nng c c

d do tn thng cu thn

V. XN HA SINH TRONG 1 S

BNH V THN

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

1. Suy thn cp

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.

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

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

1. Protein niu

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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