hope this slide is adequate for the nursing students.. if you want any further information do like to mail me. thanku

1. NEPHROTIC
SYNDROME
MANITA UPADHYAY
LECTURER

3. INTRODUCTION
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

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

5. INCIDENCE
• nephrotic syndrome is quite rare but has an
important role to play in the development of
kidney disease.
• in adults, the incidence of the condition is
approximately 3 cases per 100,000 per year.
the incidence of minimal change disease in
caucasian children is reported to be 2 per
100,000

6. TYPES
category it is regarded as a sort of
autoimmune phenomenon, especially since
it responds well to immunosuppressive
therapy.
1. Idiopathic NS:
In childhood, the vast majority belongs to

7. 2. Secondary NS:
•It occurs in children (about 10%) of all
cases.
•This condition may occur due to some form
of chronic glomerulonephritis, or due to
diabetes mellitus, SLE, malaria,
hypertension,
endocarditic,
hepatitis
HIV/AIDS,
malignant
B, infective
drug toxicity,
lymphomas syphilis etc.

8. 3. CongenitalNS:
•It is rare but a serious and fetal problem
usually associated with other congenital
anomalies of kidney.
•It is inherited as autosomal recessive disease.
•Severe renal insufficiency & urinary infections
along with this condition result is poor
prognosis.

9. 4. InfantileNS:
•The term is applied to NS occurring in infants
between 4 – 12months of age. Its major
causes are:
A. NPHS2
B. Diffuse mesengial sclerosis (DMS)

10. ETIOLOGY
1. Primary renal cause:
 Minimal-change nephropathy(70-
90% children and 10- 15%inadult)
 Glomerulosclerosis
 Acute post streptococcal
glomerulonephritis
 Immune complex glomerulonephritis.

11. 2. Systemic cause
• Infections
• Toxins – mercury, bismuth, gold
• Allergic – bee sting, inhaled pollen, food
allergy
• Cardiovascular – sickle cell disease, renal
vein thrombosis, congestive heart failure
• Malignancies – leukemia
• Others – systemic lupus erythematous,
anaphylactic purpura

12. PATHOPHYSIOLOGY
Decrease plasma oncotic
pressure
Compensatory synthesis of protein
including lipoprotein by liver
Due to E/F
Increase renal catabolism albumin
Hypoalbuminemia (less then 3.4 mg/DL)

13. Hyperlipidemia
Fluid escape into
the tissue
Decrease plasma
volume
Edema Decrease GFR
Generalized edema
(Anasarca or dropsy)
DECREASE LIPID
CATABOLISM DUE TO
LOW LEVEL OF
PROTEIN

14. CLINICAL MANIFESTATION
Four main symptoms of nephritic symptoms:-
• Protein urea
• Hypoalbuminemia
• Hyperlipidemia
• Edema- Periorbital edema, pitting edema, ankle
edema, Ascites, pleural effusion, Weight gain,
hypertension

15. • fatigue, headache, malaise and irritability
• foamy appearance of urine (decrease surface tension by
severe proteinuria)
• hematuria
• thrombophilia (clot formation)
• lipiduria
• dyspnoea
• anemia
• fever, rash, joint pain
• Weakness
• Anorexia
• flank pain

16. DIAGNOSTIC EVALUATION
palpation: due to edema and ascites kidney cannot be palpable.
urine analysis
hematuria
24 hour urinary total protein estimation – urine
sample shows proteinuria (>3.5 g per liter per 24
hours)
blood test
BUN
S.creatinine
S.protein
lipid profile

17. • Comprehensive metabolic panel(CMP)
shows hypoalbuminemia, albumin level is
<2.5g/dl
 Needle biopsy of kidney
 ECG
 KUB – X.ray
 Renal ultrasound
 Renal scan
 Intravenous urogram (IVU).

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

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

20. COMPLICATION
• infection
• thromboembolic complication
• pulmonary edema
• hypovolemia
• growth retardation
• altered drug metabolism
• ESRD

21. 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 glomerural
damage.
•Knowledge deficit related to disease process.