The kidney pathology is well described and all the necessary information like the etiology pathophysiology clinical manifestation diagnosis prognosis medical management is well explained

1. NEPHROTIC SYNDROME

2. INTRODUCTION
• Common cause for hospitalization among
children.
• It’s a syndrome caused by renal disease that
increases the permeability across the
glomerular filtration barrier.

3. DEFINITION
A group of clinical findings characterized by-
• Proteinuria
• Hypoalbuminemia
• Hyperlipidemia
• Edema
Sometimes – hematuria, hypertension &
reduced glomerular filtration rate.

4. INCIDENCE
• 2-7 cases per 100,000 children per year
• Higher in underdeveloped countries (South
east Asia)
• Occurs at all ages but prevalent in children
between the ages 1.5-6 years.
• It affects more boys than girls, 2:1 ratio.

5. CLASSIFICATION
1. Idiopathic Nephrotic Syndrome-
• Majority cases in childhood.
• Autoimmune phenomenon
• Two types-
a. Minimal change NS
b. Significant change NS-
i. Focal segmental glomerulosclerosis
ii. Membranous glomerulonephritis
iii. Membranoproliferative glomerulonephritis
iv. Rapidly progressive glomerulonephritis

6. 2. Secondary Nephrotic Syndrome-
• About 10% in children of all cases.
• Secondary to disease condition like
glomerulonephritis, DM , SLE, malaria,
hepatitis B, HIV, etc.

7. 3. Congenital Nephrotic Syndrome-
• Rare but serious condition.
• Associated with congenital anomalies of
kidney.
• Autosomal recessive disease
• Severe renal insufficiency and urinary
infections.

8. 4. Infantile Nephrotic Syndrome-
• Major causes-
• NPHS2
• Diffuse mesengial sclerosis

9. ETIOLOGY & RISK FACTORS
Primary Renal cause-
• Minimal change nephropathy
• Glomerulosclerosis
• Acute post streptococcal glomerulonephritis
• Immune complex glomerulonephritis.

10. Systemic cause-
• Infections
• Toxins- Hg, Bi, Au
• Allergic- pollen, food allergy
• CVS- SCD,CHF, renal vein thrombosis
• Malignancies- Leukemia
• Others- systemic lupus erythematosus

11. PATHOPHYSIOLOGY
Alteration in glomerular basement membrane
Altered glomerular protein permeability
Massive proteinuria

12. Decreased oncotic pressure
Decreased vascular volume
Decreased renal blood flow
Activation of renin -angiotensin –aldosterone system & release of ADH
Tubular Na and water reabsorption
EDEMA

13. CLINICAL MANIFESTATION
• Periorbital puffiness
• Pitting edema over legs
• Generalised edema
• Ascites
• Hypertension
• Loss of appetite
• Weight gain

14. • Pleural effusion
• hydrothorax
• Hydrocele
• Hematuria
• Weakness
• Fever
• Joint pain

15. DIAGNOSIS
• Palpation
• Urine analysis-Dipstick test for proteinuria
(>3.5g/lt/day)
• Blood test-
Blood total serum albumin- reduced
serum albumin-reduced (2.5 g/dl)
Serum globulin-normal or increased
Cholesterol-increased
Serum creatinine-normal or elevated
Serum complement level-normal or low
• Needle biopsy of kidney

16. • Renal ultrasound
• ECG
• KUB-X ray
• Renal scan
• Intravenous urogram

17. MEDICAL MANAGEMENT
• Steroid therapy-
Prednisolone(drug of choice)
Daily dose 2mg/kg/day in 2-3 divided doses for
atleast 4-6 weeks
• Antibiotic therapy-
Penicillin antibiotics
• Diuretics-
Furosemide (1-44 mg/kg/day in 2 divided doses)

18. • Albumin infusion-
1 g/kg/day
• Immunosuppressive drugs-
Cyclophosphamide(2mg/kg daily for 12 weeks)
SURGICAL MANAGEMENT
Renal transplantation

19. • Dietary management-
High protein
High carbohydrate
Sodium restricted
Water restricted occasionally.

20. COMPLICATION
• Acute renal failure
• Renal vein thrombosis
• Atherosclerosis
• Chronic kidney disease
• Fluid overload
• Congestive heart failure
• Pulmonary edema
• infections

21. NURSING MANAGEMENT
• Excess fluid volume related to decreased kidney
function as evidenced by pitting edema or
periorbital puffiness.
• Imbalanced nutrition less than body requirement
related to damaged metabolism as evidenced by
anorexia,loss of protein,rejection of low salt diet.
• Fatigue related to discomfort as evidenced by
lethargy, extreme edema.
• Risk for infection related to immunosuppressive
drugs

22. PROGNOSIS
• Early diagnosis and appropriate treatment
80% children recover
• 10-15% becomes complicated with chronic
renal failure
• 2-4% cases may have fatal outcome

23. THANK YOU