Nephrotic Syndrome

A primary glomerular disease – it appears in any condition that seriously damages the glomerular capillary membrane and results in increased glomerular permeability Characterized by : - Marked increase in protein in the urine (proteinuria) Decrease in albumin in the blood (hypoalbuminemia) Oedema High serum cholesterol and low density lipoproteins (hyperlipidemia)

Pathophysiology Generally seen in children Occurs in adults also Causes : Chronic glomerulonephritis, Diabetes mellitus with intercapillary glomerulosclerosis Amyloidosis of the kidney Systemic lupus erythematosus Multiple myeloma Renal vein thrombosis Loss of plasma protein, particularly albumin in the urine Liver produces enough But loss is excessive Hypoalbuminemia results

Clinical Manifestations Oedema : the major manifestation Soft and pitting Around the eye, in dependent areas(sacrum, ankles, and hands) Ascites Malaise Head ache Irritability Fatigue

Assessment and diagnostic findings Albuminuria of 3 to 3.5 gms / day WBC casts Granular casts Epithelial casts Protein electrophoresis Immunoelectrophoresis Renal biopsy Serum markers – lupus nephritis – Anti-C1q antibodies

Complications Infection due to immune deficiency Thromboembolism esp of the renal vein Pulmonary emboli Acute renal failure Accelerated atherosclerosis due to hyperlipidemia

Medical management Diuresis with caution Diuretics combined with ACE inhibitors  reduces the degree of proteinuria in 4 to 6 weeks Cyclophosphamide (cytoxan) Immunosuppressant medications (azathioprine) Chlorambucil (Leukeran) Cyclosporine Corticosteroids Low sodium, liberal potassium diet Protein intake 0.8 gms / kg / day; dairy products, eggs, meats Low saturated fats

Nursing management I / O chart – urine measurement Fluid and electrolyte balance Monitoring of blood values of protein, and electrolytes Dietary management Patient education : the importance of diet and follow up care Teaching the symptoms and signs of renal failure or infection Drug management Inform about complications and side effects of drugs Psychological support