NEPHROTIC SYNDROME

2. NEPHROTIC SYNDROME
PREPARED BY:
PRAJNASUBEDI
B.SC.NSG 4TH YR
6TH BATCH

3. INTRODUCTION:
Nephrotic syndrome is a group of symptoms which is
seen in any condition that seriously damages the
glomerular capillary membrane , causing increased
glomerular permeability with loss of protein in urine.

4. DEFINITION:
Nephrotic syndrome is a group of symptoms
characterized by proteinuria ( > 3.5 grams per
day), low blood protein levels , high cholesterol
levels , and edema.

5. INCIDENCE:
▶All ages can be affected.
▶Most common during 2 to 6 years.
▶Affects male more than female.

6. CAUSES:
▶Autoimmune diseases such as systemic lupus
erythematosus.
▶Diabetes Mellitus
▶Hypertension
▶Drug toxicity : excessive use of NSAIDS
▶Malaria , hepatitis infection etc.

7. Types:
• 90% of cases
Primary /
Idiopathic
Nephrotic
syndrome
• 10% of cases
Secondary
Nephrotic
Syndrome
• Serious and rare
Congenital
Nephrotic
syndrome

8. Primary / Idiopathic Nephrotic
syndrome:
▶Most common in children.
▶Exact cause is unknown but are mainly associated
with autoimmune cause.
▶It is also known as minimal change disease : This
disorder results in abnormal kidney function , but
when the kidney tissue is examined under a
microscope , it appears normal , or nearly normal.

9. Secondary Nephrotic Syndrome:
▶Causes may be various disorders that can damage the
glomerulus of the kidneys.
▶Diseases such as Diabetes Mellitus , Hypertension , Systemic
Lupus Erythematosus and other infections might be the cause.

10. Congenital Nephrotic Syndrome:
▶It is serious and rare condition caused by
autosomal recessive disorder.
▶No therapies are effective usually.
▶Infants die under 1 or 2 years of age.

11. PATHOPHISIOLOGY:
▶The glomerular basement membrane is
negatively charged layer .
▶Due to antibody attack or other causes , this
property is lost which allows proteins
especially albumin to pass through
glomerular membrane.

12. Increased synthesis
of lipids and proteins
by liver
Hyperlipidemia
oncotic pressure
Extravasations
of
intracellular
fluid
Damaged glomerular capillary membrane
Loss of plasma protein
Hypoalbuminemia
Decreased plasma

13. Decreased renal blood flow
Increased secretion ofADH
and aldosterone
Na+ and water reabsorption in
distal tubules
Increased hydrostatic pressure
Renin release
vasoconstriction
Low renal perfusion
hypovolemia

14. Low urine
output
Fluid
retention
edema

16. CLINICAL FEATURES:
 Excessive weight gain , edema – peri-orbital
initially , then in extremities , increases in the
morning.
 Ascites , scrotal/labial swelling may be
present.
 Urine changes ;
 decreased volume
 Frothy and pallor
 Edema of intestinal mucosa may lead to loss
of appetite , poor intestinal absorption.

19. Contd..
 Fatigue , lethargic, irritability.
may be normal
to decreased
or slightly
intravascular
 Blood pressure
decreased due
volume
 Susceptibility to infection increases
 Dyspnea may be seen due to pleural effusion ,
ascites and other type of fluid.

20. DIAGNOSIS:
HISTORYTAKING:
• Family history
• Birth history
• Antenatal history
PHYSICAL EXAMINATION:
• Edema can be seen

21. INVESTIGATIONS:
• Urinalysis
• Serum tests
• Hematology
• Kidney biopsy
• KUB X-ray
• USG

22. INVESTIGATION AND FINDINGS:
 Urinalysis:
 Shows marked proteinuria , cast ,few RBCs ,
increased urine specific gravity
 24 hrs urinary protein excretion : >50 mg/kg/day
 Serum:
 Markedly decreased serum protein (albumin)
 High cholesterol (450-1500 mg/dl)
 Hyponatremia

23. CONTD:
 Hematology:
 Normal or increased hemoglobin level
 High platelet count
 Kidney biopsy
 Done if there is recurrent relapses , non responsive
to treatment

24. COMPLICATIONS:
▶Blood clots / venous thrombosis
▶Poor nutrition
▶High blood pressure
▶Acute kidney failure
▶Chronic kidney failure
▶Infections

25. TREATMENT:
Goals of management:
 Reduce urinary protein excretion.
 Reduce fluid retention.
 Prevent infections and complications.

26. Pharmacological treatment:
▶Diuretics : Frusemide , spironolactone
▶Corticosteroids : Prednisolone
▶Albumin Infusion :
▶Immune suppressant therapy : For child who
continue to have proteinuria (+2 or more) after 8
weeks of steroid therapy are treated with immune
suppresant therapy such as cyclophosphamide.

27. Nursing managements:
▶Monitor edema urine characteristics , albumin , I/O
, abdominal girth , daily weight , etc.
▶Administer medications such as diuretics ,
antibiotics and corticosteroid as ordered.
▶Improve nutritional status.
• Low sodium diet
• High calorie and high protein diet
• Small and frequent feeding

28. Contd..
▶Encourage activities and exercise.
▶Maintain skin integrity
• Provide skin care.
• Change position every 2 hrs.
• Check for skin break down.
 Prevent and manage side effects of steroid therapy.
 Discharge plan and home care teaching.

29. SUMMARY

31. ASSIGNMENT:
▶Develop a nursing care plan of child with
NEPHROTIC SYNDROME.