Written By: Sarah Gobbell Nephrotic Syndrome Written By: Sarah Gobbell

Etiology/ Pathophysiology Syndrome- a complex of signs and symptoms resulting from a common cause. Damaged glomeruli as a result of certain diseases cause proteins to perfuse into the urine Characterized by marked proteinuria (protein in urine), hypoalbuminemia (loss of serum protein), edema (caused by decreased osmotic pressure).

Clinical Manifestations General edema, mainly located around the eyes and extremities; especially around the feet and ankles. Swollen abdomen/ facial swelling Foamy appearance of urine Unintentional weight gain Poor appetite High blood pressure Decreased urine output

Labs/ Diagnostics Blood chemistry shows hypoalbuminemia and hyperlipidemia- Urinalysis reveals urine protein Renal biopsy identifies type and extent of tissue change Other Tests to Rule Out Cause Glucose tolerance test -- Complement levels Antinuclear antibody -- Hepatitis B/C antibodies Rheumatoid factor --VDRL serology Cryoglobulins -- Serum protein electrophoresis

Glucose Tolerance Test Renal Biopsy Glucose Tolerance Test Blood Chemistry Test Urinalysis Cryoglobulins VDRL Serology

Medical Management Treatment may be required for life Corticosteroids, immunosuppressive, antihypertensive, and diuretic medications Antibiotics are used to control infection Angiotensin converting enzyme (ACE) inhibitors may reduce degree of protein loss in the urine Medications to reduce cholesterol and triglycerides may be recommended

Nursing Interventions Monitor I& O, weight, measure abdominal girth, BP Bed rest if pt has extreme edema Assess for electrolyte imbalance Skin care/ gradual increase of activity as edema resolves Diet- protein replacement with foods that provide high biologic value ( meat, fish, poultry, cheese, eggs) Sodium restriction

Patient Teaching Medication regimen- type, dosage, side effects, the need to take meds as prescribed Nutrition- high protein, low sodium Self-assessment of fluid status- monitor weight, presence of edema Signs/ symptoms indicating need for medical attention (edema, fatigue, headache, infection) Need for follow-up care

Prognosis 25% of children and 50%-75% of adults will progress to renal failure within 5 years May be remission or nephrotic syndrome will exist in chronic form Besides treating the underlying problem, little can be done to prevent recurrence of nephrotic syndrome (permanent!)

The End