Nephrotic Syndrome

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Nephrotic Syndrome

• Written By Sarah Gobbell

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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).

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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

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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

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

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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

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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

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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!)

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The End