Nursing management of child with Nephrotic syndrome. The Nephrotic syndrome is a clinical state characterized by proteinuria, hypoalbuminemia, hyperlipidemia and edema, sometimes accompanied by hematuria, hypertension and reduced glomerular filtration rate.

1. NEPHROTIC
SYNDROME
Rajalakshmi.S
Lecturer
Josco College of Nursing
Edappon, Mavelikkara

2. INTRODUCTION
The Nephrotic syndrome is a clinical state
characterized by proteinuria, hypoalbuminemia,
hyperlipidemia and edema, sometimes accompanied
by hematuria, hypertension and reduced glomerular
filtration rate.

3. DEFINITION
 Nephrotic syndrome is clinical manifestation of a
large number of glomerular disorders. It is
characterized by massive proteinuria,
hypoalbuminemia, hyperlipidemia and edema
which generalized and also known as anasarca or
dropsy.

4. Anatomy of kidney

5. INCIDENCE
 It is common among children in the age group of
2-6 years.
 It is more common in males than females.

6. ETIOLOGY
1.Primary renal cause
 Minimal change nephropathy
 Glomerulosclerosis
 Accute post stretococal glomerulonephritis
 Immune complex glomerulonephritis

7. 2.Systemic causes
 Infection
 Toxins
 Allergies
 Cardiovascular –sickle cell diseases
 Malignancies –Leukemia
 Others –Amyloidosis, systemic lupus
 Erythematous etc.

8. CLASSIFICATION
 Primary nephrotic syndrome/ minimal change
nephrotic syndrome(MCNS)/ idiopathic nephrosis /
childhood nephrosis : result from the disorder within
the glomerulus
 Secondary disorder- result from secondary to
systemic disease such as hepatitis, systemic lupus
erythematosus. Heavy metal poisoning, or cancer
 Congenital form inherited as an autosomal
recessive disorder

9. PATHOPHYSIOLOGY
.
Due to metabolic, pathologic, biochemical, physiochemical, or
immune mediated disturbances
Alteration in glomerular basement membrane
Increasingly permeable to protein
Decreased colloidal pressure
Increase secretion
of aldosterone
Edema
Tubular Na+ and
H2O
reabsorption
Decreased
vascular vollume
Decreased renal
blood flow

10. CLINICAL FEATURES
 Edema around eyes,
legs and labia
 Anasarca
 Ascites
 Hydrothorax and
hydrocele
 Decreased urine output
frothy urine, increased
specific gravity

11.  Hematuria
 Fever , rash, joint pain
 Pallor
 Irritability
 Loss of appetite but
weight gain
 Susceptibility to
infections

12. DIAGNOSTIC EVALUATION
 24 urine protein measurement
 Blood test – lipid profile, electrolytes, urea,
creatinine
 Imaging of kidney
 Auto immune markers and Ultrasound of whole
abdomen

13. MEDICAL MANAGEMENT
 The goal of medical management is reduction of protein
excretion
 PREDNISOLONE – 2mg/kg/day – orally- divided doses
for 6 weeks , thereafter 1.5 mg/ kg as single dose on
alternate days for 6 weeks , after discontinued
 Protenuria disappears within the first week of therapy and
negative dipstick test for 2 consecutive days shows
positive response to treatment.

14.  Frequent relapses are treated by alkylating agent
such as CYCLOPHOSPHAMIDE ( 2mg/kg daily
for 12 weeks ), NITROGEN MUSTARD,
CYLOSPORINE OR LEVAMISOLE
 Diuretic and salt poor albumin may be indicated in
presence of severe edema. FURESEMIDE ( 1-4
mg/kg/ day in 2 divided doses) along with
aldosterone antagonist spironolactone ( 2-3 mg/kg/
day in 2 divided doses ) may be prescribed

15.  Well balanced diet rich in protein.
 Restrict sodium when marked edema is present
 Water restriction – if decreasing salt intake does
not control edema.

16. NURSING DIAGNOSIS
 Risk for impaired skin integrity related to edema and
decreased circulation
 Risk for infection related to urinary loss of gamma
globulins and immunosuppressive therapy
 Risk for deficient fluid volume( intra vascular)
related to protenuria, edema, effects of diuretics
 Excess fluid volume related decreased excretion of
sodium and fluid retension

17.  Anxiety (parental ) related to hospitalization of
child and caring for a child with a chronic disease
 Deficient knowledge about home management
related to anxiety or incomplete understanding

18. Nursing management
 Care during hospitalization
 Administer the prescribed medications
 Maintain fluid and electrolyte balance
 Prevention of infection
 Promote rest
 Provide emotional support
 Discharge planning and home care teaching

19. Care during hospitalization
 Educate importance of hospitalization
 Involve the parents for caring the child during
hospitalization
 Regularly monitor the vital signs
 Monitor the signs of infection
 Detailed charting of intake output
 Daily urine examination for albumin

20. Administer the prescribed
medications
 Child is receiving steroids, so the nurse must be
aware about the side effects of theses drugs
 Patients should be observed for gastrointestinal
bleeding, gastrointestinal ulcers, hyperglycemia
and cataract

21. Maintain fluid and electrolyte
balance
 Monitor serum sodium level of the child
 Fluid intake either oral/ IV should be strictly
monitored
 Assess for venous stasis, ascites and pulmonary
edema
 Accurately document the daily weight

22. Prevention of infection
 Use strict aseptic technique during invasive
procedure
 Monitor vital signs to detect early signs of
infection
 Isolate the child as he is immunosuppressive
therapy

23. Promote rest
 Provide passive play to the child as tolerated
 Allow a period of rest after activities
 Limit visitors during acute phase of illness

24. Provide emotional support
 Explain parents about disease and its treatment
 Allow the parents and child to express their
feelings, due to sudden weight gain and disturbed
body image

25. Discharge planning and home care
teaching
 Explain to the parents about treatment program,
follow-up and risk of relapse
 Encourage the parents to measure child’s weight
weekly
 Tell them to contact doctor if any unusual
symptoms appear
 Explain about the medications to be continued at
home.

27.  Dietary modification
 Advise them to reduce sodium intake 1-2gm daily
 Food should be avoided
• salt used in cooking and at table
•Seasoning blends ( garlic salt, season salt )
•Canned soups
•Canned vegetable containing salt
•Prepared food

28. •Fast foods
•Soya sauce
•Ketchup
•Salad dressing etc .
 Child can eat moderate amount of high protein animal
food( lean cuts of meat, fish, poultry)
Ask them to avoid saturated fats ( Butter, Cheese, Fried
foods, Fatty cuts of red meat and egg yolk )
Ask to increase unsaturated fat intake ( olive oil, canola oil,
peanut butter and nuts)
The child can eat low fat desserts.

29.  Increase intake of fruits and vegetables
 No potassium or phosphorus restriction is
necessary
 Monitor fluid intake includes all fluids and foods
that are liquid at room temperature.

30. COMPLICATIONS
 Acute renal failure, renal vein thrombosis
 Atherosclerosis and related heart disease
 Chronic kidney disease
 Fluid overload, congestive heart failure,
pulmonary edema
 Infections, including pneumococcal pneumonia

31. REFERENCE
 Hockenberry Marilyn J Hockenberry, Wilson David,
Rodgers Cheryl C. Wong’s essentials of peadiatric
nursing; 10th ed, Elsevier publications, New delhi; 2017
 James Rowen Susan; Nursing care of children:
Principles and practice; 2nd ed;elsevier publishers,
London; 2002

32.  Sharma Rimple; Essentials of peadiatric nursing,
2nd ed;2017, Jaypee brothers medical
publishers(p) Ltd, New delhi