–The syndrome is apparent in any condition that seriously damage the glomerular capillary membrane that results in increase glomerular capillary permeability to plasma proteins. Although liver is capable of increasing the production of protein. It can’t keep up with the daily loss of albumin through the kidney. Thus hypoalbuminemia results.

1. Presented by:
Mr. Abhay rajpoot

2. The syndrome is apparent in any condition that seriously damage
the glomerular capillary membrane that results in increase
glomerular capillary permeability to plasma proteins. Although
liver is capable of increasing the production of protein. It can’t
keep up with the daily loss of albumin through the kidney. Thus
hypoalbuminemia results.

3. Nephrotic syndrome is a collection of symptoms due
to kidney damage. This includes protein in the urine, low
blood albumin levels, high blood lipids, and
significant swelling.

4. Nephrotic syndrome is quite rare but has an important role to
play in the development of kidney disease. In adults, the
incidence of the condition is approximately 3 cases per 100,000
per year. The incidence of minimal change disease in Caucasian
children is reported to be 2 per 100,000.

5.  Medical conditions that can damage the kidneys
 Certain medications.
 Certain infections.

6. Nephrotic syndrome is usually caused by damage to the
clusters of tiny blood vessels (glomeruli) of the
kidneys.

7.  Auto immune reaction
 Diabetic kidney disease.
 Minimal change disease
 Renal disorder
 Membranous nephropathy.
 Systemic lupus erythematosus
 Blood clot in a kidney vein.

9.  Proteinuria
 Hypoalbuminemia
 Edema – Periorbital edema, pitting edema, ankle edema,
Ascites, pleural effusion, Weight gain, hypertension
 Fatigue, headache, malaise and irritability
 Foamy appearance of urine (decrease surface tension by
severe proteinuria)
 Haematuria
 Thrombophilia (clot formation)
 Lipiduria
 Dyspnoea
 Anaemia

12. .

13.  Blood clots
 High blood cholesterol and elevated blood triglycerides
 Poor nutrition
 High blood pressure
 Acute kidney failure
 Chronic kidney disease
 Infections

14. Cholesterol-reducing medications.
Medications called statins can help lower cholesterol
levels.
Ex.
-Atorvastatin
-Fluvastatin

15. Blood thinners. Medications called anticoagulants help
decrease blood's ability to clot.
Ex.
-Heparin
-Warfarin

16. Immune system-suppressing medications.
Medications to control the immune system, such as –
Ex.
-Corticosteroids

17. Nursing Assessment
 Edema. Observe for edema when performing physical
examination of the child with nephrotic syndrome.
 Weight and measure. Weight the child and record the
abdominal measurements to serve as a baseline.
 Vital signs. Obtain vital signs, including blood pressure.
 Pitting edema. Note any swelling about the eyes or the ankles
and other dependent parts.
 Skin. Inspect the skin for pallor, irritation, or breakdown;
examine the scrotal area of the male child for swelling,
redness, and irritation.

18. 1) Nursing diagnosis – excessive fluid volume related to damage
glomeruli as evidence by I/O chart, edema and weight gain.
Nursing goal – To maintain fluid volume
Intervention –
 Assess fluid status, Monitor I/O ratio.
 Limit fluid and sodium intake to prescribed volume.
 Explain to patient and family rational for fluid resuscitation.
 Oral hygiene is to be encouraged.
 To provide the diuretics

19. 2) Nursing diagnosis – risk of infection related to edema & altered
immune response as evidence by weight gain, I/O chart, taking
temperature.
Nursing goal – To prevent from infection
Intervention-
 Limited fluid intake
 Provide meticulous skin care
 To monitor I/O chart.
 To check daily weight.
 To check the TPR.
 Use strict aseptic technique
 To provide the diuretics and antipyretics.

20. 3) Nursing diagnosis – Disturbed thought process related to effect
of uremic toxin on CNS as evidence by confusion, LOC, impair
ability to process external stimuli.
Nursing goal – To stabilize the thought process Intervention –
 Assess the extent of impairment in thought process.
 Orient to time, place and person.
 To provide diuretic, antibiotics to the patient.
 Preserving neurological functioning.
 Use seizure precaution. Encourage the patient to turn & in any
type of activity as due to drowsiness and lethargy.
 Give psychological support.
 Prepare for hemodialysis

21.  Goals are met as evidenced by:
 Relief from edema.
 Improvement of nutritional status.
 Maintenance of skin integrity.
 Conservation of energy.
 Prevention of infection.

22. Chlorambucil, in combination with prednisone, was compared
with prednisone alone in a randomized controlled trial in 21
children to assess its effect on the duration of remission
(improvement) and the rate of relapse (deterioration after
improvement). All control patients treated with prednisone alone
continued to relapse at the same rate, with all patients
experiencing a return of proteinuria by seven months.
Conversely, those who received the same prednisone therapy
along with chlorambucil for six to 12 weeks remained in
complete remission, without further medication, during 12 to 34
months of follow-up observation.

23.  https://emedicine.medscape.com/article/244631-
overview
 https://en.wikipedia.org/wiki/Nephrotic_syndrome
 https://www.mayoclinic.org/diseases-
conditions/nephrotic-syndrome/symptoms-
causes/syc-20375608
 http://www.renalmed.co.uk/database/nephrotic-
syndrome
 http://www.kidneyfund.org/kidney-disease/other-
kidney-conditions/nephrotic-syndrome.html
 https://nurseslabs.com/nephrotic-syndrome/