Nguyen Huu Toan

Tiểu máu ở trẻ em

 

Tiểu máu ở trẻ em

TT – Tháng 5-2007 con gái tôi tiểu ra máu. Bác sĩ kết luận cháu bị viêm cầu thận cấp. Sau xuất viện, xét nghiệm nước tiểu cháu có ít đạm và máu. Vài tháng sau nước tiểu cháu không còn đạm, chỉ còn máu (có khi 2+, 3+, 1+). Gần một năm sau xét nghiệm nước tiểu không còn máu.

Tư vấn sức khỏe

Tiểu máu ở trẻ em

Thế nhưng ba tháng sau, xét nghiệm nước tiểu có máu 2+. Ba tháng sau xét nghiệm nước tiểu cháu lại không còn máu. Đến tháng 9-2009 xét nghiệm nước tiểu lại có máu (Blood: trace). Như thế có nguy hiểm không, thưa bác sĩ?

H.N.

- Tiểu máu là bệnh lý tiết niệu thường gặp ở phòng khám chuyên khoa thận trẻ em. Tiểu máu thấy rõ bằng mắt thường gọi là tiểu máu đại thể, nước tiểu có thể đỏ như máu, có cục máu đông, nhưng đôi khi màu như nước trà sậm hay như nước thịt bò. Dạng tiểu máu không thấy bằng mắt thường nhưng tình cờ phát hiện khi xét nghiệm nước tiểu gọi là tiểu vi thể.

Tiểu máu có thể có triệu chứng đi kèm hoặc âm thầm không có dấu hiệu nào báo động cả, có thể kéo dài nhiều ngày, có thể thoáng qua. Tiểu máu đôi khi đơn thuần nhưng có lúc lại kèm với tiểu đạm (Proteinuria).

Tiểu máu ở trả em

* Trường hợp nào tiểu máu đơn giản, ít nguy hiểm?

- Tiểu máu do viêm nhiễm đường tiết niệu dưới, không kèm với dị dạng tiết niệu. Thông thường trẻ bị viêm bàng quang, điều trị bằng kháng sinh và theo dõi trong vòng 1 tuần đến 10 ngày.

Tiểu máu vi thể đơn thuần, thoáng qua, không kèm với tiểu đạm, không kèm những triệu chứng khác như đau bụng, sốt, đau khớp.

* Trường hợp nào tiểu máu phức tạp, nguy hiểm?

- Trẻ có tiểu máu đại thể số lượng nhiều; trẻ có kèm cao huyết áp, phù, tiểu ít; trẻ có sốt, đau khớp, tổn thương da, phù, thiếu máu; trẻ tiểu máu kéo dài kèm với tiểu đạm; tiểu máu kèm với chức năng thận suy giảm; tiểu máu kèm bị điếc thường ở trẻ nam, có đặc tính di truyền; tiểu máu kèm khối u ở thận; tiểu máu kèm dị dạng đường tiết niệu; tiểu máu kèm xuất huyết dưới da.

* Những nguyên nhân thường gặp của tiểu máu:

- Nguyên nhân ngoài cầu thận:

Sốt cao; vận động gắng sức; chấn thương; nhiễm trùng tiểu; sỏi hệ tiết niệu; dị vật đường tiết niệu (thận ứ nước, thận đa nang). Tiểu máu cũng có thể xảy ra khi trẻ dùng thuốc kháng viêm nonsteroids, thuốc kháng đông, cyclophosphamides.

- Nguyên nhân cầu thận:

+ Viêm cầu thận cấp hậu nhiễm liên cầu trùng: là bệnh thường gặp ở trẻ em từ 3-15 tuổi do viêm họng hoặc viêm da do liên cầu vi trùng bêta tan huyết nhóm A gây ra. Trẻ không được điều trị viêm họng hay viêm da dẫn đến viêm cầu thận. Trẻ sẽ phù, tiểu ít, tiểu máu, cao huyết áp, có thể xảy ra biến chứng suy thận cấp, suy tim và phù phổi cấp. Cần nhập viện theo dõi. Thường sau khi qua giai đoạn cấp tính trẻ sẽ phục hồi và không để lại di chứng ở thận. Tuy vậy tiểu máu vi thể có thể kéo dài khoảng sáu tháng.

+ Tiểu máu lành tính gia đình (bệnh lý màng cơ bản cầu thận mỏng).

+ Bệnh Lupus đỏ hệ thống, là bệnh tổn thương đa cơ quan. Trẻ có sốt, đau khớp, tổn thương hệ tạo máu, tổn thương thận hay gặp ở trẻ gái.

+ Một số bệnh lý khác (hội chứng thận hư, hội chứng Alport…).

Tóm lại, khi trẻ có tiểu máu cha mẹ cần đưa trẻ đi khám ở cơ sở có chuyên khoa nhi để kịp thời chẩn đoán và điều trị chuẩn xác cho trẻ.

Trường hợp con chị tiểu máu chỉ có trace, tức là vết, không kèm tiểu đạm, chị không nên quá lo lắng. Nếu thử nước tiểu của cháu vẫn còn hồng cầu tái đi tái lại chị nên theo dõi với bác sĩ chuyên khoa thận trẻ em.

BS ĐỖ NGỌC ĐỨC

Source: Báo Tuổi Trẻ

 

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