Nephrotic syndrome causes your kidneys to release too much protein in your urine. Causes include kidney diseases that affect the tiny filters inside your kidneys. Symptoms include swelling, high amounts of protein in your urine and low amounts of protein in your blood. Treatment includes medications that address its underlying causes.

1. PRESENTED BY
REKHANJALI GUPTA
NURSING TUTOR
NEPHROTIC SYNDROME

2. TERMINOLOGY
• Proteinuria is a high level of protein in your urine.
• Hypoalbuminemia is a medical sign in which the level of albumin in the
blood is low.
• Hyperlipidemia abnormally elevated levels of lipids or lipoproteins in the
blood.
• Lipiduria presence of lipids in the urine.
• Hypercoagulation is a condition in which your blood clots too easily.
• Edema is swelling caused by too much fluid trapped in the body's tissues.

3. Introduction
• Nephrotic syndrome isn't a disease but is a condition
caused by marked proteinuria, hypoalbuminemia,
hyperlipidemia, lipiduria, increased coagulation, & edema.
• It results from a glomerular defect that affects the vessels'
permeability & indicates renal damage.
• Some forms of nephrotic syndrome may eventually progress
to end-stage renal failure.

4. Nephrotic Syndrome
Nephrotic Syndrome
• Chronic renal disorder
in which the basement
membrane surfaces of
the glomeruli are
affected, cause loss of
protein in the urine.

5. Causes
• Glomerulonephritis
• Metabolic diseases: diabetes mellitus
• Circulatory diseases: heart failure, sickle cell anemia,
and renal vein thrombosis.
• Infections: tuberculosis, enteritis; allergic reactions;
pregnancy; hereditary nephritis
• Neoplastic: multiple myeloma

6. Types
1. Idiopathic nephritic syndrome
– The most common in children for about 90%
2. Congenital Nephrotic Syndrome
– Rare in children & congenital
– It is inherited by an autosomal recessive gene,
meaning that males & females are equally
affected

9. Signs & symptoms
1.Main manifestations:
Edema (varying degrees) is the common symptom
Local edema: edema in face , around eyes( Periorbital
swelling) , in lower extremities.
Generalized edema (anasarca), edema in penis and
scrotum.

10. The symptoms of nephrotic syndrome
• Fatigue & malaise .
• Decreased appetite
• Weight gain from excess fluid
• Dull hair
• Foamy urine, decrease in frequency of urination .
• Food intolerances or allergies
• Proteinuria, high levels
• Low levels of proteinemia due to its loss in the urine
• High cholesterol levels in the blood

12. Diagnosis
• Urine tests (to check for protein) >40mg/m2/hr
• Blood tests for levels of cholesterol & albumin
• Renal ultrasound.
• Renal biopsy

13. Blood specimen
• Serum protein: decrease >5.5gm/dL , Albumin levels are low
( ＜ 2.5gm/dL).
• Serum cholesterol & triglycerides:
Cholesterol ＞ 5.7mmol/L (220mg/dl).
• ESR↑ ＞ 100mm/hr during activity phase
• Renal function

14. Medications
• Corticosteroids
• Immunosuppressive drug therapy
• Diuretics (to reduce the edema)
• Restriction to fluids intake
• IV albumin
• Special diet that restricts salt intake

15. NURSING MANAGEMENT
1. Assess and Document the location and character of the
patient's edema.
2. Vital signs: BP, Pulse
3. Monitor & record intake and output & weigh the patient
accurately each morning after s/he voids & before S/he eats.
Make sure S/he's wearing the same amount of clothing each
time you weigh him/her.
4. Careful monitoring of IV fluids
5. Plan a low-sodium diet with moderate amounts of protein.
6. Frequently check urine for protein.

16. 8. Provide meticulous skin care
9. Use a reduced-pressure mattress or padding to help prevent
pressure ulcers.
10. To prevent the occurrence of thrombophlebitis, encourage
activity & exercise
11. Psychological care - Give the patient & family reassurance &
support
12. Provide appropriate provisions corticosteroids
13. Give diuretic if prescribed

17. Complications
1. Infections: Infections is a major complication in children with NS.
It frequently trigger relapses. Common infections: URI, peritonitis,
cellulitis &UTI
2. Hypercoagulability (Thrombosis)
3. Cardiovascular disease :-Hyperlipidemia, may be a risk factor
for cardiovascular disease.
4. Hypovolemic shock
5. Others: growth retardation, malnutrition, adrenal cortical
insufficiency