3. INTRODUCTION
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
4. DEFINITION
It is a clinical disorder that is characterized by
proteinuria, hypoalbuminemia, edema and
hyperlipidemia.
This occurs due to excessive leakage of
plasma proteins in urine because of increase
capillary permeability of the glomerulus.
5. INCIDENCE
• 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
6. TYPES
category it is regarded as a sort of
autoimmune phenomenon, especially since
it responds well to immunosuppressive
therapy.
1. Idiopathic NS:
In childhood, the vast majority belongs to
7. 2. Secondary NS:
•It occurs in children (about 10%) of all
cases.
•This condition may occur due to some form
of chronic glomerulonephritis, or due to
diabetes mellitus, SLE, malaria,
hypertension,
endocarditic,
hepatitis
HIV/AIDS,
malignant
B, infective
drug toxicity,
lymphomas syphilis etc.
8. 3. CongenitalNS:
•It is rare but a serious and fetal problem
usually associated with other congenital
anomalies of kidney.
•It is inherited as autosomal recessive disease.
•Severe renal insufficiency & urinary infections
along with this condition result is poor
prognosis.
9. 4. InfantileNS:
•The term is applied to NS occurring in infants
between 4 – 12months of age. Its major
causes are:
A. NPHS2
B. Diffuse mesengial sclerosis (DMS)
10. ETIOLOGY
1. Primary renal cause:
Minimal-change nephropathy(70-
90% children and 10- 15%inadult)
Glomerulosclerosis
Acute post streptococcal
glomerulonephritis
Immune complex glomerulonephritis.
13. Hyperlipidemia
Fluid escape into
the tissue
Decrease plasma
volume
Edema Decrease GFR
Generalized edema
(Anasarca or dropsy)
DECREASE LIPID
CATABOLISM DUE TO
LOW LEVEL OF
PROTEIN
14. CLINICAL MANIFESTATION
Four main symptoms of nephritic symptoms:-
• Protein urea
• Hypoalbuminemia
• Hyperlipidemia
• Edema- Periorbital edema, pitting edema, ankle
edema, Ascites, pleural effusion, Weight gain,
hypertension
16. DIAGNOSTIC EVALUATION
palpation: due to edema and ascites kidney cannot be palpable.
urine analysis
hematuria
24 hour urinary total protein estimation – urine
sample shows proteinuria (>3.5 g per liter per 24
hours)
blood test
BUN
S.creatinine
S.protein
lipid profile
18. MANAGEMENT
1. Symptomatic treatment
• Edema –
Rest – not for prolong time
Nutrition – 1 gm protein/kg/day, not more that, sodium
restriction, water not greater then the level of diuresis.
Medication – Loop diuretics (furosemide)
• Hypoalbuminemia – moderate intake of protein, rich
in animal protein.
• Hyperlipidemia – low saturated fat, high unsaturated
fat, if unresponsive to nutrition therapy then take
hypolipidemic drugs such as statin.
21. NURSING MANAGEMENT
NURSING DIAGNOSIS:
•Risk for infection related to immunosuppressive drugs.
•Fluid and electrolyte imbalanced related to edema.
•Impaired skin integrity related to disease process.
•Altered nutrition related to Anorexia.
•Altered kidney function related to glomerural
damage.
•Knowledge deficit related to disease process.
Editor's Notes
minimal change ns – this predominant type, seen 86% of the cases.
significant change ns – this is infrequent. mesangial proliferation is seen in 5% cases and focal sclerosis in 10% of cases.
Renal insufficiency is poor function of the kidneys that may be due to a reduction in blood-flow to the kidneys caused by renal artery disease. Normally, the kidneys regulate body fluid and blood pressure, as well as regulate blood chemistry and remove organic waste.
Diffuse mesangial sclerosis (DMS) is a histopathologic finding in some children with congenital (CNS) or infantile nephrotic syndrome (INS). In DMS, there is an increase in mesangial matrix without mesangial cellular proliferation, leading to obliteration of glomerular capillaries and eventual glomerulosclerosis
Anaphylactoid purpura: A form of blood vessel inflammation that affects small capillaries in the skin and the kidneys. It results in skin rash associated with joint inflammation (arthritis) and cramping pain in the abdomen