This document discusses nephrotic syndrome, which is characterized by proteinuria, hypoalbuminemia, edema, and hyperlipidemia due to damage to the glomerular capillary membrane. This allows excess plasma proteins to leak into the urine. Causes include glomerulonephritis, diabetes, lupus, amyloidosis, sarcoidosis, cancer, drugs, and infections. Symptoms include edema, fatigue, weight gain, and hyperlipidemia. Treatment focuses on controlling edema and symptoms, treating underlying causes, and preventing infection. Nursing care centers around monitoring fluid status and intake, preventing infection, and managing cognitive effects of uremia.

1. Mr Pawan Sujane
(MSc. Nursing) MSN

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. It is a clinical disorder that is characterized by proteinuria,
hypoalbuminemia, edema and hyper-lipidemia. This occurs due
to excessive leakage of plasma proteins in urine because of
increase capillary permeability of the glomerulus.

4. • Glomerulonephritis
• DM
• SLE (Systemic lupus erythematosus)
mistakenly attacks healthy tissue in many parts of the body
• Amyloidosis of kidney ( deposit of amyloid substances)
• Sarcoidosis (abnormal collection of inflammatory cells)
• Cancer
• Trauma
• Infection
• Drugs
• Renal thrombosis

5. Due to E/F
Glomerular damage
Increased permeability of glomerulus capsule (to protein)
Proteinuria (3.5 gm/24 hours)
Increase renal catabolism albumin
Hypoalbuminemia (less then 3.4 mg/DL)
Compensatory synthesis of protein
including lipoprotein by liver
Decrease plasma oncotic pressure

6. Fluid escape into the tissue
Edema
Decrease plasma
volume
Decrease lipid catabolism
due to low level of protein
Decrease GFR
Increase Aldosterone
Sodium and water Retention
Generalized edema
Hyperlipidemia

7. • 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)
• Hematuria
• Thrombophilia (clot formation)
• Lipiduria
• Dyspnoea
• Anaemia

8. • History
• Physical examination
• Urinalysis - 24 hours urine
• Serum chemistry
• KFT/ RFT
• Creatinine clearance test
• Needle biopsy of kidney

9. 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.
• Hyperlipidaemia – low saturated fat, high unsaturated
fat, if unresponsive to nutrition therapy then take
hypolipidemic drugs such as statin.

10. • Thrombophilia – Heparin
• Infection – Antibiotics
• ACE inhibitors – to control hypertension
• Achieve better blood glucose level
2. Kidney damage
• Corticosteroid – prednisone
• Immunosuppressant – Cyclophosphamide

11. • Infection
• Thromboembolic complication
• Pulmonary edema
• Hypovolemia
• Growth retardation
• Altered drug metabolism
• ESRD

12. 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

13. 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 - Limit 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.

14. 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 stabilise 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.