NS

1. MR. MOUNESH. D. BADIGER , MSc (N)
SENIOR TUTOR
MEDICAL SURGICAL DEPARTMENT
KAHER INSTITUTE OF NURSING SCIENCES,
BELAGAVI.
12/18/2020 5:18:53 AM 1MOUNESH

2. INTRODUCTION
The term Nephrotic Syndrome is coined from two
Greek words:
Nephros meaning kidney
Syndrome denoting a group of symptoms.
Nephrotic Syndrome is a set of symptoms related to
kidney dysfunction.
Incidence rate is 2 -7 per1000.12/18/2020 5:18:53 AM 2MOUNESH

3. It is defined as the non- neoplastic disease of the
kidney.
 It can affect all age groups. In children, it is most
common form the age of 2 to 6 years.
 Male slightly more likely to be affected than
females.
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4. DEFINITION
The Nephrotic syndrome is a primary glomerular disease
characterized by
1.High levels of protein (albumin) in the urine (proteinuria).
2.Low levels of proteins in the blood (hypoalbuminemia).
3.Increased levels of lipid (hyperlipidemia).
4.Swelling of body parts (edema).
Sometimes it is called as nephrotic syndrome or
nephropathy, nephrosis has numerous possible causes.
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5. CLASSIFICATION
Congenital nephrotic syndrome
Idiopathic or primary nephrotic
syndrome
Secondary nephrotic syndrome
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6. CONGENITAL NEPHROTIC
SYNDROME
It is rare but serious and fatal problem
usually associated with other congenital
abnormalities of kidney. (Polycystic kidney,
horse shoe shaped)
It is inherited as autosomal recessive disease.
Severe renal insufficiency and urinary
infections along with this condition result is
poor prognosis.12/18/2020 5:18:53 AM 6MOUNESH

7. IDIOPATHIC OR PRIMARY
NEPHROTIC SYNDROME
 It is the most common type(about 90%) and
regarded as autoimmune phenomenon as it
responds to immunosuppressive therapy.
 Subgroup of this type
Minimal change nephrotic syndrome(85%)
Proliferative nephrotic syndrome(5%)
Focal sclerosis nephrotic syndrome(10%)
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8. SECONDARY NEPHROTIC
SYNDROME
 It occur in children about 10% of all cases.
 This condition may occur due to some form of
 chronic glomerular nephritis
 Diabetes mellitus
 Systemic lupus erythematosis (SLE)
 Malaria
 Malignant hypertension
 Hepatitis ‘B’
 Infective endocarditis
 Drug toxicity, lymphomas
 Syphilis12/18/2020 5:18:53 AM 8MOUNESH

9. Nephrotic syndrome is usually caused by damage to the
clusters of tiny blood vessels (glomeruli) of your kidneys.
Focal segmental glomerulosclerosis. Characterized by
scattered scarring of some of the glomeruli, this condition may
result from another disease or a genetic defect or occur for no
known reason
CAUSES AND RISK FACTORS
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10. Minimal change disease. This is the most common
cause of nephrotic syndrome in children. Minimal
change disease results in abnormal kidney function,
but when the kidney tissue is examined under a
microscope, it appears normal or nearly normal.
12/18/2020 5:18:53 AM 10MOUNESH

11. Membranous nephropathy. This kidney disorder is the
result of thickening membranes within the glomeruli.
The exact cause of the thickening isn't known, but it's
sometimes associated with other medical conditions,
such as hepatitis B, malaria, lupus and cancer.
Systemic lupus erythematosus. This chronic
inflammatory disease can lead to serious kidney
damage.
12/18/2020 5:18:53 AM 11MOUNESH

12. Amyloidosis. This disorder occurs when substances
called amyloid proteins accumulate in organs.
Amyloid buildup often affects the kidneys, damaging
their filtering system.
Blood clot in a kidney vein. Renal vein thrombosis,
which occurs when a blood clot blocks a vein
connected to the kidney, can cause nephrotic
syndrome.
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13. RISK FACTORS
Medical conditions that can damage kidneys.
Certain diseases and conditions increase risk of developing
nephrotic syndrome, such as diabetes, lupus, amyloidosis and
other kidney diseases.
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14. Certain medications. Examples of medications
that can cause nephrotic syndrome include non
steroidal anti- inflammatory drugs and drugs used
to fight infections.
Certain infections. Examples of infections that
increase the risk of nephrotic syndrome include
HIV, hepatitis B, hepatitis C and malaria (parasitic
infection).12/18/2020 5:18:53 AM 14MOUNESH

15. Damaged glomerular capillary membrane
Loss of plasma protein (albumin)
Stimulates synthesis of lipoproteins Hypoalbuminemia
Hyperlipidemia
Decreased oncotic pressure
Generalized edema
(fluid moves from vascular space to extracellular fluid)
Activation of renin–angiotensin system (to
maintain BP & Electrolytes' balance by kidney)
Sodium retention (ADH by hypothalamus
posterior pituitary gland)
Edema
PATHOPHYSIOLOGY
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18. CLINICAL MANIFESTATION
Proteinuria
Hypoalbuminemia
Hyperlipidemia
Per orbital edema
Ascites
Respiratory difficulty
Anorexia
Anasarca
12/18/2020 5:18:53 AM 18MOUNESH

19. Pallor and shiny skin with
prominent vein
Change in the quality of hair due
to protein deficiency
Weight gain
Fatigue , and lethargic
Hypertension or hypotension
Pitting edema
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20. DIAGNOSTIC STUDIES
 History collection
Physical examination
Urine analysis ( massive
proteinuria more than 3.5
gm /day,
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21.  Elevated serum cholesterol
level high than 450 to 1500mg/dl.
Blood investigations : Reduced
serum protein concentration i.e.
albumin level less than 2gm/dl,
and elevated plasma lipid level
in the blood.
 CBC , ( serum electrolytes
level, calcium, BUN )
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22.  Renal biopsy
 Imaging
studies.
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23. MANAGEMENT12/18/2020 5:18:53 AM 23MOUNESH

24. Blood pressure medications.
Drugs called angiotensin-
converting enzyme (ACE)
inhibitors reduce blood pressure
and also reduce the amount of
protein released in urine.
Medications in this category
include benazepril (Lotensin),
captopril and enalapril (Vasotec).
MEDICAL MANAGEMENT
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25. Water pills. Water pills
(diuretics) help control
swelling by increasing your
kidneys' fluid output.
Diuretic medications
typically include furosemide
(Lasix). Others may include
spironolactone (Aldactone)
and thiazides, such as
hydrochlorothiazide.
12/18/2020 5:18:53 AM 25MOUNESH

26. Cholesterol-reducing
medications. Medications
called statins can help
lower cholesterol levels.
Statins include
atorvastatin (Lipitor),
fluvastatin (Lescol),
lovastatin (Altoprev),
pravastatin (Pravachol),
rosuvastatin (Crestor) and
simvastatin (Zocor).
12/18/2020 5:18:53 AM 26MOUNESH

27. Blood thinners. Medications called
anticoagulants help decrease
blood's ability to clot and may be
prescribed if patient had a blood
clot to reduce risk of future blood
clots.
Anticoagulants include heparin,
warfarin (Coumadin, Jantoven),
dabigatran (Pradaxa), apixaban
(Eliquis) and rivaroxaban (Xarelto).
12/18/2020 5:18:53 AM 27MOUNESH

28. Immune system-suppressing
medications.
Medications to control the
immune system, such as
corticosteroids, may decrease
the inflammation that
accompanies underlying
conditions, such as minimal
change disease, lupus and
amyloidosis
12/18/2020 5:18:53 AM 28MOUNESH

29. • Nutritional management
include salt free diet.
• Plasma expanders and Salt
poor human albumin may be
given in severe edematous
cases.
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30. Abdominal Paracentesis is done in case
of severe breathlessness due to Ascites.
12/18/2020 5:18:53 AM 30MOUNESH

31. COMPLICATIONS
 Atherosclerosis and related heart diseases
 Renal vein thrombosis
 Acute kidney failure
 Chronic kidney disease
 Infections, including pneumococcal pneumonia
 Malnutrition
 Fluid overload, congestive heart failure, pulmonary edema
12/18/2020 5:18:53 AM 31MOUNESH

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33.  Assessment
• Oedma around eyes, feet and genitalia
• Urine out put in 24 hrs – 200ml
• Body weight 18kg
• Fluid intake 250ml in 24 hrs
 Nursing diagnosis
• Fluid volume excess related to accumulation in tissue
 Planning
• To reduce excess amount of fluid accumulated in tissue
 Implementation
• Providing rest, comfortable position and frequent change of position
• Allowing diet with law salt and high protein(egg,fish,pulse)
• Administering prescribed medications.
• Offering potassium containing food(orange juice,banana)
• Restricting fluid intake
• Maintaining intake-output and body weight chart
• Urine testing for albumin12/18/2020 5:18:53 AM 33MOUNESH

34.  Assessment
• Oedmatous skin
• Protein loss in urine(++)
 Nursing diagnosis
• Risk for infection due to loss of protein in urine
 Planning
• To protect the child from infection
 Implementation
• Examining the child for any signs of infections and recording temperature,
pulse and respiratory rate
• Monitoring blood count
• Providing skin care, keep the skin dry and body power for soothing
• Keeping the nails short
• Preventing any injury of edematous skin
• Teaching the mother about skin care and signs of infections and involving
the mother during care of the child
12/18/2020 5:18:53 AM 34MOUNESH

35.  Assessment
• Loss of appetite
• Proteinuria
• Lethargy
 Nursing diagnosis
• Altered nutrition less than body requirement related to
disease condition
 Planning
• To improve nutritional status
 Implementation
• Providing small frequent feeding with protein and carbohydrate,
considering dietary restriction and child’s like and dislikes
• Providing nutritional supplementation as needed
• Encourage child to take food
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36.  Assessment
• Anxiety of the parents
• Fear of the child
 Nursing diagnosis
• Altered family process support due to hospitalization
 Planning
• Toprovide emotional child care
 Implementation
• Allowing parental involvement in
• Allowing play and self care as tolerated by the child
• Encouraging interaction with other child having chronic illness
• Answering the questions asked by the parents and allowing to
express frustration
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37.  Assessment
• Inability to take care of the child by the parents
 Nursing diagnosis
• Knowledge deficit about caring the child and medical
management
 Planning
• To improve knowledge about child care by health teaching
 Implementation
• Discussing about the care after discharge from hospital, regarding
rest, diet, hygiene, continuation of medications, need for medical
help an follow up
• Teaching about features of infections, signs of relapse and
precautions to prevent complications
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