Hpl NGHj KHOA HOC LAN THLf Vll, HOI T | £ T NlgU - THAN HQC VIET NAM (VUNA)
MOT SO DAC DIEM LAM SANG, CAN LAM SANG
VA TON THirOTNG MO BENH HOC THAN AT 148 BENH NHAN BENH CAU THAN
T 6 M TAT:
D^t van de: Chung toi tien hanh nghien cii'u nhSm mgc tieu: nh^n xet mot so dSc diem ISm sang, c|in lam sang va ton thUOng mo b§nh hpc than d 148 b|nh nhan benh <^u than. Ddi tu'<^ng va phu't^ng phap: Nghien ciiu tien cufu du'dc thu'c hi^n tren 148 b?nh nhan du'dc chan doan xac dinh benh cau th?n va thi/c hien smh thiet than tai khoa Than-Tiet meu, Benh vien Bach Mai tu" 12/
2011 deh 6/2012. Ket qua: Tuoi bung binh ciia cac doi tutfng nghien ciiU la 30,3 ± 10,6 tuoi (16-61 tuoi) ty le nij/nam xap xi 1,8/1. Phu la tneu chimg thu'dng gSp chiem ty le 83,2% (n=123). Dai mau chiem ty le 6,1%
(n=9). Phan loai huyet ap tam thu: nhom benh nhan co chi so HA tam thu < 140 mmHg chiem ty le cao nhat la 74,3%, 140-160 mmHg la 9,5% va >160 mmHg chiem ty le 16,2%. Cac chi so xet nghiem can lam sang co su' chenh lech Idn giij'a chi so toi da va toi thieu cho thay su"
da dang ciia bieu hien benh. Ket qua mo benh hpc than CO chan doan VCJ lupus co ty le cao nhat la 43,2%%, Benh than IgA vdi ty le thap 2%, benh than thay doi toi thieu chiem t / le 18,2% va VCT tang smh gian mach ty le kha cao 15,9%. Viem cau than mang chiem ty le 7,6%, Xd hoa cau than 6-cuc bp vdi ty le 4,5%, Viem cau than man co ty le la 6,1%. Ket luan: Ket qua nghien ciiU ciia chimg toi cho thay tneu chirng lam sang hay g3p nhat la phiJ va tang huyet ap. Cac chi so xet nghiem can lam sang co si/ giao dong nhieu giiJa chi so' toi da va toi thieu cho thay su" da dang cua bieu hien benh. Ket qua mo benh hpc; \/CJ lupus chiem ty le cao nhat, sau do la benh than thay doi toi thieu va VCY t3ng smh gian mach.
Tir khoa: Sinh thiet than, viem cau thin.
SUMMARY:
EVALUATE THE CLINICAL. PARACLINICAL MANIFESTATIONS, AND HISTOPATHOLOGICAL FEATURES OF THE KIDNEYS IN 148 PATIENTS
WITH GLOIWERULAR DISEASES
• Bo mon Ngi Tdng Hgp - Dai hoc Y Ha Ngi
** Khoa Than - Tiet Nieu, Benh vien Bach Mai Phan bien khoa hpc: PGS.TS. Ha Phan Hai An 348
Vu'dng T u y e t M a i * * , D i n h Thj Kim Dung**
Introduction: We conducted this study witti fte aim: to evaluate the clinica, paradinical manifestations, and histopathological features of the kidneys in 148 patients with glomerular diseases.
Patients and methods. The prospective study was performed on 148 patients who were diagnosed Glomerular diseases and perfomed renal biopsies at the Neph-Urology Department, Bach Mai Hospital from 9/2011 to 8/2012. Results. Mean age of patienia were 30.3 ± 10.6 years old (16-61 years), the female/male ratio was approximately 1.8/1. Edema was the most common sign accounting for 83.2%
(n=123). Hematuria rate was 6 . 1 % (n=9). Systolic blood pressure classifications: the patient group witti SBP < 140 mmHg was highest pnaportion: 74.3%, 140- 160 mmHg: 9.5% and >160 mmHg accounted for 16.2%. The paradinical features showed the mean values with high standard deviation that indicated the data were spread out over a large range of values that possibly suggested the diversity of disease manifestations. In the histopathological results, diagnosis for lupus glomerulonephntis was the most' common: 43.2%; IgA Nephropathy was the low rate with 2%; the minimal change disease (MOIS) accounting for 18.2%; the mesangical proliferation glomerulonephritis (MspGN) was high percentage witfi 15.9%; focal segmental glomerulosclerosis (FSGS)was 4.5% and chronic glomerulonephritis accounted for 6.1%. Conclusion: In our results, the most common clinical signs were edema and hypertension! The paradinical features showed the mean values with high standard deviation that indicated the data were spread out over a large range of values that possibly suggested the diversity of disease manifestations. In the histopathological results, lupus nephritis was highest rate, followed by minimal changes disease and mesangica! proliferation glomerulonephritis.
Keywords: renal biopsy, glomerulonephr^
Y HOC VIET NAM THANG 8 - SO P A C BlgT/2013 { . D A T V A N D E :
„ Viem rau than (yCT) co bieu hien lam sang rat da dang, co the rat Itin dao nhu" vo tinh phat hien tang huyet ap, phu, dai mau hoac protein nieu khi kliam siic Ichoe djnh l<y den Ithcfi benh l<ich phat vcfi ton thu'dng than cap va co the de dpa tinh mang.
Jon thu'dng mo benh hpc 6 than thong thu'dng (JuHc quan sat tren beu ban sinh thiet than. Hien nay viec chan doan, dieu trj va tien lu'dng benh phy thupc nhieu vao Itet qua mo benh hpc ciia ton thu'dng cau than. Vi vay chung tei tien hanh nghien cutJ nham muc t i e u : nhan xet mpt so dac diem lam sang, can lam sang va ^ ' n thu'dng mo benh hpc than d 148 benh nhan viem cau than.
II. oo'l TUpNG VA PHUONG PHAP NGHIEN t(Hi:
Nghien cu'u t i e n c i h i diTdc thiTc h i e n tren 148 benh nhan da du'dc chan doan xac dinh benh cau than, co chi dinh va thu'c hien sinh thiet than tai Khoa Than-Tiet nieu, Benh vien Bach I^ai tLf thang 12/ 2011 den thang 6/2012. Benh nhan tren 16 tuoi va tu" nguyen tham gia nghien cihj.
Sinh thiet than qua da thi/c hien bang sung tu" dpng Sling Bard® Magnum®
(http://www.bardbiopsy.a)m/products/magnum.php) du'cfi hu'dng dan sieu am du'dc tien hanh tai Khoa Than-Tiet nieu, Benh vien Bach I^lai.
Cac mau sinh thiet du'dc co djnh trong dung dich formalin 10% va dung djch nu'dc muoi sinh Iy0,9% va chuyen den trung tam Giai phau benh vaTe bao hpc, Benh vien Bach Mai.
Cac thong tin thu thap theo mau benh an nghien culi vdi cac thong so thong nhat. Cac so lieu (Jutfc ma hoa va xii ly bang chu'dng trinh SPSS 17.0.
»!• K f r QUA NGHIEN djTU:
3.1. Dac d i e m c h u n g c u a cac d o i tu'dng nghien cii'u.
Trong tong so 148 benh nhan, ty le nij"
chiem 64,9% (n=96) va nam la 3 5 , 1 % (n=52).
Tuoi trung binh cua cac doi tu'dng nghien ziisx la 30,3 ± 10,6, tuoi thap nhat la 16, cao nhat la 6 1 .
Nhom 21-30 tuoi chiem ty le cao nhat la 44,6% trong tong so benh nhan, nhom 21-30 tuoi chiem ty le 44,6%, nhom 31-40 tuoi chiem ty le 23,6% va nhom <20 tudi chiem ty le 15,5%. Trong nghien ciru cua chiing toi benh nhan >50 tuoi du'dc tien hanh sinh thiet vdi ty le thap nhat la 7,4%. Tiep theo do nhom 41-50 tuoi cung chiem ty le thap: 8,8%.
3.2. D a c d i e m l a m s a n g va can lam s a n g cua cac d o i tu'dng n g h i e n cii'u
Phu la trieu chiJTng tu'dng doi thu'dng gap chiem ty le 83,2% (n=123), so benh nhan khong CO phu chi chiem 16,9% (n=25).
The tich nu'dc tieu 24h la 1,0±0,4 lit trong dd CO benh nhan vo nieu (the tfch nu'dc tieu 24h=0) va benh nhan co the ti'ch nu'dc tieu Idn nhat la 2,2 lit.
Trieu chu'ng dai mau chiem ty le 6 , 1 % (n=9). Khong co benh nhan bj dai due. Dai buot chiem ty le 2 % , dai rat 1,4%. Benh nhan khdng CO dai I<h6ng tu' chii va bf dai tru'dc Ichi vao vien.
Tn so trung binh ciia huyet ap tam thu la 132 ± 24 mmHg trong do tri so nho nhat la 85 mmHg va cao nhat la 220 mmHg. Trj so trung binh cua huyet ap tam tru'dng la 81,1 ± 14,1 mmHg trong dd tri so nhd nhat la 40 mmHg va cao nhat la 140 mmHg.
Phan loai huyet ap tam thu: nhdm cd chi so HA tam thu < 140 mmHg chiem ty le cao nhat la 110/148 (74,3%), nhom cd chi sd HA tam thu 140- 160 mmHg la 14/148 (9,5%) va nhdm cd chi so HA tam thu >160 la 24/148 chiem ty le 16,2%.
sang i ; Mo ta dac Thanh ph^n H6nq cau (T/L) Hemofflobin (q/L .Hematocrit
Bach cau (G/L) .Tieu cau (G/L)
fiem cac te bao Benh nhan
148 148 148 148 148
mau nqoai vi T h i p nhit
1,63 45 0,13 2,83 18
Cao n h i t 6,87
177 0,51 30.61 510
Trung binh 3,88 109,16
0,33 9,85 248,79
Dp Ipch 1,00 28,21 0,08 4,73 90,11
HOI NGHI KHOA HQC Lfa THiJ Vll, HQI TlgT NI$U • THAN HpC VIET NAM (VUNA) Nhan xet; Miit gi6i han chung cua cac te bao mau giao dong tu'dng doi nhieu. So iuBng hong cau tif 1,63 -6,87 T/L tu'dng tiT theo do la chi so Hemoglobin va Hematocrit cung dao dong trong khoang tu'dng doi rpng. Oieu nay cho thay su' da dang trong bieu hien lam sang cua benh nhan benli cau than.
So lu'dng bach cau cung giao dong tu'dng doi nhieu, chi so nho nhat la 2,83G/L va ngu'dc lai a nhohg b^nh nhan co bach cau mau rat cao, chi so Idn nhat den 30,61 G/L.
So lu'dng tieu cau co tri so trung binh la 248,79 ±90,11 G/L, co do lech tu'dng doi Idn.
Bang 2; Mo ta dac diem mot so chi so sinh hda huyet thanh
Thanh phinUre Glucose Creatinine Acid Uric Protein TP Albumin Cholesterol Triqivcerid HDL Cho LDL Cho Na mau Kali mau Clo mau
Thip nhit 2,2 2,9 41 163 20,2 7,9 2,67 0,52 0,10 0,60 118 2 88
Cao nhit 56,6 15,1 1262 1100 99,50 46,40 22,26 12,50 9,50 12,30 147 7 119
Trung binh 16,6 5,3 250,4 520,3 53,03 23.61 9.22 4.39 2.19 5.49 136,31
4,07 103,21
Dp Ipch 11,7
1,6 287.6 192,7 11,0 7.47 4.30 2.47 9.21 2.81 4,59 0,80 6.71
Nhan xet: Chi so sinh hda cho thay cd sy giao dpng Idn. Tri so toi thieu va tdi da chenh lech nhau Icha nhieu, dieu nay cho thay bieu hien lam sang cua benh nhan tu'dng ddi da dang ve trieu chu'ng can lam sang.
Bang 3: Mo ta dac diem mot so xet nghiem mien dich
Khdng the khdnq nhanKet qua Am tinh Du'cynq tinh Tonq so Khonq xet nqhipm T6ng so KT khSng DNA Kit qua Am tinh
Du-anq tinh Tonq so Khonq xet nqhiem Tonq so
Sd bpnh nhan 39 62 101 47 148 Sd bpnh nhSn
60 42 102 46 148
Ty Ip •/.
26.4 41.9 68,2 31,8 100 Ty Ip %
40,5 28.4 68.9 31.1 100
Ty Ip % 38.6 61.4 100
Tv Ip •/.
58.8 41,2 100
Nhan xet; Ty le benh nhan du'dc xet nghiem khang the khang nhan va khang the khang DNA kha cao chiem 68,2% vdi KTKN va 68,9 vdi KT khang DNA trong tong so benh nhan. Ty le du'dng tinh vdi KTKN kha cao 61,4% tren tong so lam xet nghiem, cao hdn so lu'dng benh nhan du'dng tinh vdi W khang DNA la 41,2%.
fianh gia chii'c nSng man theo MDRD: Mu'c Ipc cau than u'dc tinh (MLCT) trung binh la 57,74±40,51 ml/phijt/l,73m', MLCT nho nhat la 3,13 ml/phijt/l,73m' va cao nhat la 175,74 ml/phut/l,73m^
350
Y Hpc VIET NAM THANG 8 - S6 D A C BIET/2013 3.3. Dac diem t o n thu'dng ton thu'dng than t r e n k€t qua mo benh hpc
43,2%
VCTM e ^ n h VCT VCT VCT X o hoa B^'ih thgn thay Lupus lang smh mang c9u thgn thgn IgA
dOi l6i gian ''
Bieu do 1: Phan bo cac doi tu'dng nghien cu'u theo chan doan mo benh hpc
Nhan xet: Mau benh pham co chan doan viem cau than lupus la nhieu nhat: 57 benh nhan, chiem ty le cao nhat 4 3 , 2 % (n=57). Benh than IgA chi phat hien du'dc d 02 mau smh thiet, ty ie thap 2%. Phan bo ciia benh than thay doi toi thieu (n=24) chiem ty le 18,2% va VCT tang sinh gian mach (n=21) chiem ty le icha cao 15,9%. Viem cau than mang co d 10 mau sinh thiet, chiem ty le 7,6%. Xd hoa cau than 6-cuc bp du'dc chan doan d 6 mau sinh thiet, chiem ty le 4,5%; Viem cau than man (VCTM) phat hien d 8 mau sinh thiet, chiem ty le 6 , 1 % .
IV. BAN LUAN:
4 . 1 . Oac diem chung cua doi tu'dng ngtiien cu^u.
Trong td/jg so' 148 benh nhan nghien cthi, ty le nff/nam xap xi 1,8/1. Phan bo gidi tinh trong nghien ciiu cua chung toi cijng tu'dng W ket qua nghien CLTU cua Abel Torres M. va cong su" (2011) thi/c hien tren 623 benh nhan, ty le nD" chiem 70,5% [ 1 ] .
TUOI trung binh cua cac doi tu'dng nghien cihi la 30,3 ± 10,6, tu'dng ty* nhu" Icet qua nghien cifu cua Abel Torres M. va cpng s i / (2011) tuoi tnjng binh cac doi tu'dng nghien cu'u la
•34,t±14,2 [1]. Doi tu'dng nghien cuTu cua chung toi Ithong cd tre em va cung khong co nhieu benh nhan gia. Sd benh nhan tren 50 tuoi chi chiem ty le 7,4% trong tong so nhCitig benh nhan sinh thiet than.
4.2. Dac diem lam sang va can lam sang cua cac doi tu'dng nghien curu.
Trieu chu'ng lam sang thu'dng gap nhat Ichi benh nhan vao vien trong nghien ciiu cua chung toi la trieu chutig phCi chiem ty le 83,2 % (n=123). The tich nu'dc tieu 24h trung binh la 1,0±0,4 lit.. Rdi loan tieu tien chiem ty le Ichong cao trong nghien cu'u cua chung toi. Khong cd benh nhan bi dai due. Dai buot chiem ty le 2%, dai rat 1,4%. Khong cd benh nhan xuat hien trieu chirng dai khong tu" chii va bi dai. Trieu chirng dai mau chiem ty le 6 , 1 % (n=9).
Tn so trung binh ciia huyet ap tam thu la 132 ± 24 mmHg thap hdn trj so trung binh ciia trong nghien cu'u ciia Abel Torres M. va cdng sir (2011) la 168 ±27,1 [ 1 ] . Phan loai huyet ap tam thu: nhdm cd chi so HA tam thu < 140 mmHg chiem ty le cao nhat la 110/148 (74,3%), nhom 351
Hpl NGHj KHOA HQC L^^N T H g Vll. HQI T|6'T NlgU - TH^N HpC VIET NAM (VUNA) CO chi so HA tam thu 140-160 mmHg la 14/148
(9,5%) va nhom cd chi so HA tam thu >160 la 24/148 chiem ty le 16,2%.
Gia tri tri trung binh ciJa cac chi so sinh hoa mau giao dpng tuOng doi nhieu. So lu'dng hong cau, chi sd Hemoglobin va Hematocrit giao dpng trong khoang tu'dng ddi rong. Sd lu'dng bach cau, tieu cau khong cd thay doi nhieu trong trj so trung binh cua ca nhdm nghien cu'u so vdl gidi han binh thl/dng nhiTng co nhieu benh nhan cd chi so thap nhat va cao nhat rat chenh lech, dieu nay cho thay da dang trong bieu h i | n huyet hqc ciJa benh nhan benh ly cau than.
MLCT u'dc tinh trung binh la 57,74±40,51 m l / p h u t / l , 7 3 m ^ MLCT nhd nhat la 3,13 ml/phut/l,73m^ va cao nhat la 175,74 ml/phut/l,73m^ Ty le phan bo benh nhan co miJc Ipc cau than tu'dng du'dng benh than man giai doan 5 kha cao la 18,9%. Nhdm benh nhan nay chi dinh smh thiet cho nhifng tru'dng hdp chLTc nang than suy giam nhanh trong thdi gian ngan nhiTng tren sieu am ki'ch thu'dc va nhu mo than cdn tu'dng ddi tot.
4 . 3 . Oac diem t o n thu'dng t o n t h i f d n g t h a n t r e n l<et qua m o benh hoc.
Nhan xet mo hinh chan ddan md benh hoc cua benh cau than trong cac doi tifdng nghien cu'u cua Chung toi cho thay: ty le benh nhan chu yeu la viem cau than thiJ phat sau lupus ban do he thong vdi ty le VCT lupus chiem ty le 43,2%
(n=57), benh than thay doi toi thieu chiem ty le 18,2% (n=24), VCT t^ng sinh gian mach la 15,9% (n=21), VCT mang chiem ty le 7,6% ( n = 10), VCT xo hda cue bd chiem ty le 4 , 5 % ( n = 6 ) , VCTM chiem ty le 6 , 1 % ( n = 8 ) , benh than Ig/V chiem ty le thap nhat 1,5% (n= 2).
Nghien cifu ciJa chijng tdi cOng phu hdp vdi nghien cuu ciia Oinh Thi Kim Dung VCT Lupus 48 trifdng hdp chiem 46,6%, ton thu'dng toi thieu gap 11 tru'dng hdp chiem 11,8.%, VCT gian mach cd 28 tru'dng hdp chiem 3 0 , 1 % VCT 6 cd 8
tru'dng hdp chiem 8,8.%, VCT tang s i n h ^ ^ ^ cd 24 tru'dng hdp chiem 25,8%, VCT mang oi 12 tru'dng hdp chiem 12,9%, VCT mang tang sinh cd 10 tru'dng hdp chiem 10,8% [ 2 ] .
Ket qua nghien ciru ciia chiing tcl c6 diem tu'dng ddng vdl Choi I.J.va C S . phan tich 2361 tru'dng hdp sinh thiet than tai Han Qudc tif 1973 den 1988. Benh cau than la 97,8% trong do viem cau than (GN): 59,8%. Benh than, thay doi tS thieu (MCNS):24,2%, VCT mang (MGN): 7,9%.
Tuy nhien ty le benh than IgA (IgAN): 17,8%) nhieu hdn trong nghien curlj ciia Chung toi. VCT sau nhiem lien cau (APSGN) chiem ty le 7,3%
trong nghien ciu cua Choi I.J. nhuhg khong du'dc chan doan trong nghien diu ciia chung toi, VCT tang sinh gian mach (MspGN) cd ty le thap hdn trong nghien ciru ciia chung toi 5,5%, X(J hda cau than o-cuc bo (FSGS) la 2,7% chieiti ty le thap hdn trong nghien ciru. Mot so khac bit CO the do dd tuoi ciia cac doi tu'dng nghien cifu Han Quoc thap hdn trong nghien ciru ciia Chung tdi, cd ca nhiing benh nhi. Ooi tu'dng nghien cuti trong nghien cifu cua Choi I.J. vdi tuoi trung binh la 21,1 tuoi doi vdi nam va 23,7 tuoi ddi vdi ni?.
Trong nghien citu cua Chung toi tuoi trung binh
la 30,3 ± 10,6 [ 3 ] . .|
Phan tich ciia 490 sinh thiet than ciia Yahya T.M. va cdng sir t i f nam 1978 den thang 6 nam 1996 cho ket qua: Chi djnh sinh thiet than pho bien nhat trong lam sang la cho hoi chulng than hu' (54,0%), tiep theo la bat thu'dng nifdc Beu theo doi benh cau than (29,7%), va viem cau than man (12,7%). VCT tien phat gom co: VCT mang tang sinh (36,2%), VCT mang (20,1%), xd hda cau than 6-cuc bo (18,3%), viem cau than man (18,3%), va benh than IgA (6,3%). Trong so cac benh nhan VCT thir phat bao gom VCT lupus cd 33 BN (40,7%), thoai hda dang tinh bot CO 27 BN(33,3%), 14 BN benh than ke, va 7 BN benh than dai thad du'dng. Nghien cuU cho thay xd hda cau than o'-cyc bq chiem ty le tiTdng dffl
Y HQC VigT NAM THANG 8 - SO PAC BIET/2013 cao 18,3% trong khi trong nghien cirli cua chung
toi la t / l e nay la 4,5% [4].
|. Nghien CU\J cua chiing toi cung co diem tu'dng dong vdi mot so nghien ciili Ithac nhu"
nghien ciTu cua Oinh Thj Kim Dung va cpng sy"
chi djnh iam sang cho sinh thiet than pho bien la VCT-HCTH cd 46 tru'dng hdp chiem 44,7%, va VCT Lupus CO 48/54 tru'dng hdp chiem 46,6%, suy than cap do ngo dgc cd 8 tru'dng hdp chiem 7,8%, u than chiem 1 tru'dng hdp chiem 0,9%
[2] tuy nhien trong nghien cCrli ciia chimg toi khong gap tru'dng hdp nao chi djnh sinh thiet cho suy than cap do ngo dpc va u than nhulig lai g§p chi dinh sinh thiet cho chan doan lam sang la ddt cap ciJa suy than man va benh than IgA. Theo Ta Phu'dng Dung (2010) thi chi djnh lam sang cho sinh thiet than hay gap nhat la VCT-HCTH va VCT Lupus [5].
T
V. KET LUAN:
I Ket qua nghien ciiu ciia chiing toi cho thay trieu chu'ng lam sang hay gap nhat la phCi chiem ty le 83,2%. Ty le benh nhan cd huyet ap tam thu 140-150 mmHg la 9,5% va >160 mmHg 'chiem t / le 16,2%. Cac chi so xet nghiem can lam sang c6 gia tri trung binh ichong khac biet nhieu vdi chi so binh thu'dng nhu'ng cd sir chenh lech nhieu giO^ chi so tdi da va tdi thieu cho thay SLT da dang ciia bieu hien benh. Ket qua mo benh
|lioc VCT lupus chiem ty le cao nhat 43,2% sau do la benh than thay doi toi thieu chiem ty le 18,2% va ^CT tang sinh gian mach chiem ty le kha cao 15,9%.
LOI CAM ON:
Tdi xin giii Idi cam dn ban chii nhiem, cac bac sy, k9 thuat vien va dieu duSng trung tam Giai phau benh va Te bao hpc, Khoa Than-Tiet nieu, Benh vien Bach Mai da tao dieu kien cho Chung toi trong qua trinh nghien cifu.
TAI Ll|U T H A M K H A O :
1. Abel Torres Munozl, Rafael Valdez-Ortizl, Carlos Gonzalez-Pa r r a l , EIvy Espinoza- Davila, Luis E. Morales-Buenrostrol, Ricardo Correa-Rotterl. Percutaneous renal biopsy of native kidneys: efficiency, safety and risk factors associated with major complications. Arch Med Sci 2011; /, 5: 823-831. OOI:
10.5114/aoms.2011.25557
t.. Dinh Thj Kim Dung Do Thj Lieu Phan Thj Xuan Hu'dng Do Gia Tuyen va Ngo Thi SuTu.
1998. Gidi Thieu ky Thu|t Smh Thiet Than du'di hu'dng dan cua sieu am. Ky yeu khoa hoc Benh
vien Bach Mai Tap 2. Tr 35-42
3. Choi U , Jeong HJ, Han DS, Lee JS, Lee HY, Kim PK, 1991. An analysis of 2361 cases of renal biopsy in Korea. Yonsel Med J 32: 9-].5 1. Yahya TM, Pingle A, Boobes Y, Pingle S. 1998.
Analysis of 490 kidney biopsies: data from the United Arab Emirates Renal Diseases Registry. J Nephtvlll: 148-50
5. Ta Phu'dng Dung va Nguyen Hong Sdn. 2010.
Ket qua smh thiet bang kim cat tu dong du'di hu'dng dan cua sieu am. Tap chiy dwoc lam sang 108. Tr 38-42
