NEPHROSIS/NEPHROTIC SYNDROME
Nephrotic Syndrome is a clinical disorder characterized by
1. Marked of protein in the urine (Proteinuria)
2. Decreased albumin in the blood (hypo albuminemia )
3. Edema
4. Excess cholesterol in the blood (hypercholesteremia).
Causes
Chronic glomerulonephritis, Diabetes Mellitus with inter capillary glomerular sclerosis, amyloidosis of the kidney, systemic lupus erythematosus and renal vein thrombosis, secondary to malignancy (older adults).
Pathophysiology
Etiological factors
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increased permeability of the glomerular capillary membrane.
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Excessive leakage of plasma proteins into the urine.
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Hypo albuminemia
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Decreased oncotic Pressure
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Fluid moves out of the vascular space (edema)
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Decreased circulating volume
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Activation of renin-angiotensin system
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Retention of Na and further edema, Mechanism for increased lipids
Clinical Manifestations
1. Insidious onset of pitting edema:/weight gain.
2 Marked proteinuria - leading to depletion of body proteins,
3. Hyperlipidemia-[may lead to accelerated atherosclerosis).
Diagnostic Evaluation
1. Urinalysis - marked proteinuria, microscopic haematuria, urinary casts, appears foamy.
2. 24 hr. urine for protein (Wed) and creatinine clearance (ed).
3. Needle biopsy of kidney for histologic examination of renal tissue to confirm diagnosis.
4. Serum chemistry Jed total protein albumin, normal (or) observed ed creatinine, Increased
triglycerides of altered lipid profile.
Medical Management
1. Treatment of causative glomerular disease
2. Corticosteroids or immunosuppressant agents to proteinuria.
3. General Management of edema
a Fluid & Salt Restriction (Na+)
b. Diuretics if Renal insufficiency is not severe.
C. Infusion of salt poor albumin.
d. Dietary protein supplements.
Complications
1. Hypovolemia
2. Thromboembolic complications - renal vein thrombosis, venous and arterial thrombosis in extremities pulmonary embolism, coronary artery thrombosis cerebral artery thrombosis.
3. Altered drug metabolism due to I in plasma proteins.
4. Progression to end-stage renal failure
Nursing Management
1. Monitor daily wt. 1/0 and urine specific gravity.
2. Monitor CVP (if indicated), vital signs orthostatic BP and HR to detect hypovolemia.
3. Monitor serum, BUN and creatinine to assess renal function.
4. Adm. Diuretics or immunosuppressants as prescribed, and evaluate Patients response.
5. Infuse I.V albumin as ordered.
6. Encourage Bed rest for a few days to help mobilize edema, some ambulation is necessary to reduce the risk of thromboembolic complication.
7. Enforce mild to moderate Salt and Fluid restriction and if edema is severe, provide a high protein diet.
8. Monitor for s/s of infection. Monitor temperature and lab. Values for neutropenia.
9. Use aseptic technique for all invasive procedures and strict handwashing by Pt and all contacts; prevent contact by Pt with persons who may transmit infection.
10. Discuss the importance of maintaining exercise, decreasing cholesterol and fat intake a changing other risk factors such as smoking, obesity and stress to reduce risk of severe thromboembolic complication.
11. In Pts with severe disease, prepare for dialysis and possible transplantation.
