kindly check this slide for nephrotic syndrome. in this slide i covered all the points regarding this topic. if any suggestion give comment on this topic

1. NEPHROTIC
SYNDROME
Mr. Abhijit Bhoyar
Lecturer

2. DEFINITION
Nephrotic syndrome is characterized
by massive protinuria
hypoalbuminemia, edema &
hyperlipidemia.

3. GENETIC DISORDER
• Nephrotic syndrome typical
• Finnish type congenital nephrotic syndrome.
• Focal segmental glomeurlo sclerosis.
• Diffuse mesangial sclerosis.
• Denys – drash syndrome.
• Schimke immuno ossesous dysplasia.
Etiology & Risk Factors

4. • Multisystem syndromes with or without nephritic
syndrome.
• Metabolic disorders with OR without nephritic syndrome.
• Idiopathic nephritic syndrome.
• Minimal change disease.
• Membranous nephropathy
• May also be consequence of inflammatory glomerular
disorder & features of nephritis.

5. SECONDARY CAUSES
 Infection
 Hepatitis B.C. HIV-1, malaria syphylis & toxoplasmosis.
 Drug
 Pencillamine gold non steroiodal anti-Inflammatory
drugs. Predominant infection, mercury heroin lithium.
 Immunological and allergic disorders

6. Ct---SECONDARY CAUSES
• Malignant disease
• Lymphoma
• leukemia

7. TYPES ( based on etiological factors)
It is classified by primary /idiopathic, secondary and congenital.
1. Primary Nephrotic Syndrome : When the syndrome is associated
with
• primary glomerular diseases.It is the most common type. It is again in
three
• forms ie minimal change nephritic syndrome, mesangial proliferative
• nephrotic syndrome and focal sclerosis nephrotic syndrome.

8. 2. Secondary Nephrotic Syndrome :
• When the syndrome occurs as a part of any systemic diseases like
DM, SLE, HTN , malignant malaria ,HIV/AIDS, drug toxicity etc
3. Congenital Nephrotic Syndrome:
• it is caused by a recessive gene on anautosome. it is associated with
other congenital anomalies of kidney.
• Severe renal insufficiency and urinary infections along with this
condition results in poor prognosis.

9. PATHOPHISIOLOGY
Due to etiological factors such as
idiopathic, Secondary & genetic
Glomerular damage
Increased glomerular
permeability
Protenuria
&
Hypoalbumenemi

10. Decreased oncotic
pressure
Extravasations of fluid into the interstitial
space
Hypovolemia
Increased secretion of the RENNIN by the
kidney (RAAS stimulated)
Increased retention of sodium & water in
distal tubule caused edema

11. • Onset is insidious ”thought to be caused by immune system
disturbances because it commonly occurs after a mild URI.
• Edema is typically the presenting symptom.
– Edema may be minimal or massive.
– Edema is usually first apparent around the eyes.
– Dependent edema occurs in areas of the body, such as the hands,
ankles, feet, and genitalia.
– Fluid that accumulates in the body spaces may give rise to ascites
and pleural effusions.
– Striae may appear on the skin from overstretching.
CLINICAL MANIFESTATION

13. • Profound weight gain caused by edema; the child may
actually double normal weight.
• Decreased urine output during the edematous phase ”urine
appears concentrated and frothy.
• Pallor,
• Irritability,
• Lethargy,
• Fatigue.

14. • GI disturbances, including vomiting, diarrhea, and
anorexia caused by edema of intestinal mucosa.
• Hematuria and Oliguria
• Ascites
• Pleural effusion and respiratory distress
• Hepatomegaly
• Anaemia and infections

15. DIAGNOSTIC EVALUATION
• .History and physical examination
• Urine examination: it shows gross proteinuria ( 2-20 g/day ),
presence of cast, slight hematuria, and increased specific gravity.
• Blood examination :- it shows reduced serum protein
concentrations, albumin less than 2.5 g/dl and cholesterol more than
200 mg/dl. Lipoproteins and BUN are increased. There is less serum
sodium and Mg concentrations.

16. • Renal biopsy - it provides information regarding the
glomerular status and the type of nephrotic syndrome, the
response to drugs and the probable course of disease.It is
indicated in case of poor response to steroid therapy.
• Others : it includes low ASO titre and IgM, raised IgG and
IgE

17. MANAGEMENT
• Medical management:
• General Measures :- It is principally supportive. During the
edema phase the child is placed on bed rest, bur activity is
not restricted during remission.
• Diet : It should include high protein , salt restricted diet and
fluid is also restricted. Diet should be adjusted to the child’s
appetite and should not interfere with nutrient intake.

18. • Steroid therapy :- It should begin as soon as the diagnosis has been
determined. Oral prednisone is the drug of choice which is given 2
mg/kg/day in 2-3 divided dose for atleast 4-6 wks. Antacids are also
given along with prednisone to prevent gastric complications.
• Antibiotic therapy:- It is indicated in the presence of any infection.
• Diuretics:-It is prescribed in the presence of massive edema and
ascites. Loop diuretics, frusemide( 1-3 mg/kg/day in 2 doses ) in
combination with metolazone is given. Pottasium supplementation to
be given along with diuretics.

19. ALBUMIN INFUSION
• May be given in case of massive
edema and ascites. It help to shift the
fluid from interstitial space into the
vascular system . diuretic therapy
system. Diuretic therapy is given in
combination of albumin infusion
plasma or blood transfusion may be
given is some cases to treat
hypoalbuminemia.

20. IMMUNOSUPPRESSIVE DRUGS
• May be administered along with Predinosolone in
case of frequent relapses and in steroid dependent
cases

21. SURGICAL MANAGEMENT
• Renal transplantation is indicated in end stage
renal failure due to steroid resistant glomerolo
sclerosis (focal and segmental)

22. 1. Fluid volume excess related to fluid accumulation in
tissue.
2. Difficulty in breathing related disease condition.
3. Risk for infection related to urinary loss of protein
and chronic steroid use.
NURSING MANAGEMENT
Assessment
Nursing diagnosis

23. Nursing diagnosis
4. Altered nutrition less than body requirement related
to loss of proteins through urine and anorexia.
5. Anxiety related to disease condition.

24. COMPLICATIONS
• Coagulation disorders
• Thrombosis
• Recurrent infections of various system
• Renal failure
• Growth retardation
• PEM
• Calcium and Vit D deficiency