Dhanya VJ, Assistant Professor, Child health nursing,SUM nursing college,Bhubanewsar

2. NEPHROTIC SYNDROME
DHANYA VJ
ASSISTANT PROFESSOR
SUM NURSING COLLEGE

4. DEFINITION
Nephrotic syndrome is a symptom complex
manifested by massive edema,
hypoalbuminemia, marked albuminuria and
hyper lipidemia (hypercholestremia).

5. INCIDENCE
• Common among 2-6 yrs.
• More common in males.
• Mean age is 2.5 yrs
• Incidence 2-7/1000 children

6. TYPES OF NEPHROTIC SYNDROME
• 1.Congenital nephrotic syndrome
• -rare but serious fatal problem
• Associated with other congenital anomalies
of kideney.
• Inherited autosomal recessive disease

7. 2.Primary or Idiopathic nephrotic
syndrome
• Most common type (90%)
• It is regarded as autoimmune phenomenon
as it responds to immuno suppressive
therapy
• It includes minimal change nephrotic
syndrome, mesanglialproliferative nephrotic
syndrome and focal sclerosis nephrotic
syndrome

8. 3.Secondary Nephrotic syndrome
• Occurs in 10 % of children.
• It may occur due to
 Chronic glomerulonephritis
 Diabetes mellitus
 SLE
 Malaria
 Hepatitis B
 Drug toxicity
 HIV

9. ETIOLOGY
Primary glomerular
disease
Membraneous
proliferative disease
Focal glomerulonephritis

10. Extrarenal cause
4
•Allergens: Inhaled pollens
5
• Drug-Pencillamine, NSAIDS, Captopril,
Heroin
6
•Toxins : Mercury, Bismuth
• Gold

11. PATHOPHYSIOLOGY
Alteration in glomerular membarane
Glomerular permeability to protein
Increased loss of protein in urine
Decreased osmotic pressure

12. Decreased vascular volume
Decreased renal blood flow
Increased secretion of aldosterone
Tubular sodium and water reabsorption
Edema

13. CLINICAL MANIFESTATIONS
Four main symptoms of nephritic symptoms:-
• Proteinuria
• Hypoalbuminemia
• Hyperlipidaemia
• Oedema

14. CLINICAL MANIFESTATIONS
• Onset is slow
• Edema around eyes ,legs and labia
• Anasarca

15. CLINICAL MANIFESTATIONS
• Ascites
• Decreased urine output (frothy, increased
specific gravity)
• Hematuria
• Edema-pitting edema,
Periorbital edema,
Peripheral edema

16. CLINICAL MANIFESTATIONS
• Loss of appetite but weight gain
• Shortness of breath
• Pallor
• Fever, rash, joint pain
• Irritability
• Flank pain
• Malaise

17. DIAGNOSTIC EVALUATION
• Gold standard test:-24 hrs urine protein
measurement.(proteinuria >3.5 g per litre per
24 hr)
• Albumin level is <2.5 g/dl (normal 3.5 – 5
g/dl)
• Elevated LDL ,VLDL
• Urea, creatinine
• Biopsy of kidney

18. DIAGNOSTIC EVALUATION
• Low ASO titer and IgM raised IgG,IgE, serum
complement is normal.
 ECG
 KUB – X-ray
 Renal ultrasound
 Renal scan
 Intravenous urogram (IVU).

19. MEDICAL MANGEMENT
• Steroid therapy :- Prednisolone 2 mg /kg/day
at least 4 to 6 weeks.
• Antacid to prevent gastric complication
• Antibiotic therapy

20. MEDICAL MANGEMENT
• Diuretics :-Frusemide 1-3 mg/kg/day or
Spirinolactone 2- 3mg/kg/day
• Potassium supplementation

21. MEDICAL MANGEMENT
• Albumin infusion (1gm/kg/day)incase of
massive edema.
• Incase of hypoalbuminemia ,blood
transfusion or plasma given
• Immunosuppressive drugs :-methotrexate,
cyclophosphamide

22. DIETARY MANGEMENT
• Children should take a well-balanced diet
rich in protein. Sodium is restricted when
marked edema is present.
• Provide high protein and high
carbohydrates diet to patient.
• If disease in advance stage then avoid
protein intake because it is affected to kidney.
• Water restriction may be indicated if
decreasing salt intake does not control edema.

24. NURSING MANAGEMENT
• Care during hospitalisation
• Administer medications
• Maintain fluid electrolyte balance
• Prevention of infection
• Promote rest
• Provide emotional support

25. 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 disease
condition.
•Knowledge deficit related to disease process.

26. COMPLICATIONS
• ACUTE RENAL FAILURE
• ATHEROSCLEROSIS
• CHRONIC KIDNEY DISEASE
• CHF
• PULOMONARY EDEMA
• INFECTION