DEFINITION, CLASSIFICATION NEPHROTIC SYNDROME pathophysiology MANAGEMENT

2. NEPHROTIC
SYNDROME
PRESENTEDBY-
NEHA BHARTI
NURSINGTUTOR
M.Sc (N) MEDICAL SURGICAL NURSING

3. DEFINITION
 The term is coined from two words: Nephrons (in Greek) meaning kidney
and syndrome denoting a group of symptoms.
 It is a collection of symptoms that result when damage to the glomeruli
causes a loss of protein from the blood into the urine (more than 3.5 grams
per day).
 This loss of plasma proteins into the urine can cause massive edema (fluid
retention).

5.  It is 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 (called edema).
Sometimes called nephrotic syndrome or nephropathy, nephrosis has
numerous possible causes.

6.  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.

8. CLASSIFICATION
NEPHROTIC SYNDROME
Classification Nephrotic syndrome can be
Primary:- being a disease specific to the kidneys.
Secondary:- being a renal manifestation of a
systemic general illness

9. CAUSES AND RISK FACTORS
 Nephrotic syndrome is usually caused by damage to the clusters of tiny blood
vessels (glomeruli) of your kidneys.
 The glomeruli filter blood as it passes through kidneys, separating things body
needs from those it doesn't. Healthy glomeruli keep blood protein (mainly
albumin) — which is needed to maintain the right amount of fluid in your body
— from seeping into your urine. When damaged, glomeruli allow too much blood
protein to leave your body, leading to nephrotic syndrome.

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.
 The cause of the abnormalfunction typically can't be determined.

11.  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.
 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.  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.

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.

14.  Certain medications. Examples of medications that can
cause nephrotic syndrome include non steroidal anti-
inflammatorydrugs 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).

16. CLINICAL
MANIFESTATIONS
 Severe swelling (edema)
 Foamy urine, which may be caused by excess protein in your urine
 Weight gain due to excess fluid retention
 Fatigue
 Loss of appetite

17. DIAGNOSTIC
EVALUATION
 Urine tests. A urinalysis can reveal abnormalities in urine,
such as large amounts of protein, if patient’s have nephrotic
syndrome.
 Patient may be asked to collect urine samples over 24 hours
for an accurate measure of the protein in urine.

18. Blood tests. If patient have nephrotic syndrome, a blood test may
show low levels of the protein albumin (hypoalbuminemia) specifically
and often decreased levels of blood protein overall.
 Serum creatinine and blood urea also may be measured to assess
your overall kidney function.

19. Removing a sample of kidney tissue for testing. doctor may
recommend a procedure called a kidney biopsy to remove a small
sample of kidney tissue for testing.
 During a kidney biopsy, a special needle is inserted through skin
and into kidney. Kidney tissue is collected and sent to a lab for
testing

20. MANAGEMENT
 Treatment for nephrotic syndrome involves treating any underlying
medical condition that may be causing nephrotic syndrome. Doctor
may also recommend medications that may help control signs and
symptoms or treat complications of nephrotic syndrome.
 Medications may include:

21.  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).

22.  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.

23.  Cholesterol-reducing medications. Medications called statins
can help lower cholesterol levels. However, it's currently unclear
whether or not cholesterol-lowering medications can specifically
improve the outcomes of people with nephrotic syndrome, such as
avoiding heart attacks or decreasing the risk of early death. Statins
include atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin
(Altoprev), pravastatin (Pravachol), rosuvastatin (Crestor) and
simvastatin (Zocor).

24. 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).

25. 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

26. LIFESTYLE AND HOME
REMEDIES
 Reduce the amount of fat and cholesterol in diet to help control
blood cholesterol levels
 Eat a low-salt diet to help control the swelling (edema) patient
experience
 Limit foods that increase blood sugar levels when taking
medications that can lead to weight gain, such as steroids

27. NURSING MANAGEMENT
Excess Fluid Volume related to decreased kidney function or
fluid accumulation as evidenced by Pitting edema or periorbital
and facial puffiness in morning
GOAL:- To maintain the fluid volume in to patient body or to reduce
the chances of edema.

28.  Strictly monitor and record intake and output.
 Determine potential sources of excess fluid (e.g., food, medications
used).
 Advised to limit fluid intake as ordered.
 Administer corticosteroid (e.g., prednisone) as prescribed
 Teach parents on how to do dipstick urine testing and urine collection
and instruct to keep a record of results.
 Teach parents regarding kidney function and disease condition

29.  Imbalanced Nutrition: Less Than Body Requirements May
be related to inability to ingest and digest foods and absorb
nutrients as evidenced by Anorexia or Loss of protein
GOAL:- to maintain the nutritional status of the patient

30.  Monitor client’s weight daily
 Assess nutritional daily patterns including food preference, caloric intake, and
diet history.
 Encourage high potassium, low-fat, low sodium diet with moderate amounts
of protein.
 Provide comfortable and delightful environment during meal times.
 Consider six small nutrient-dense meals instead of three larger meals daily to
reduce the feeling of fullness.
 Schedule medications in such a way that they are not administered
immediately prior meals.

31.  Fatigue (An overwhelming, sustained sense of exhaustion
and decreased capacity for physical and mental work at usual
level) may be related to discomfort as evidenced by easily
fatigued with any activity or extreme edema.
GOAL:- to reduce the discomfort of the patient

32.  Assess extent of fatigue, weakness, degree of edema and difficult
movement or activity in bed
 Plan activities with consideration and observe for changes in
behavior following an activity.
 Provide chosen play activities as tolerated and modify the
schedule to allow for rest periods and after activity.

33.  Risk for Infection related to Inadequate secondary defenses.
GOAL:- To reduce the risk of infection

34.  Assess for an increase in temperature, respiratory changes
(dyspnea, productive cough with yellow sputum), urinary changes
(cloudy, foul-smelling urine), skin changes (tenderness, redness,
swelling).
 Maintain and teach medical aseptic techniques and hand
washing when providing care.
 Provide private room or share room with person who are free
from infections.
 Administer antibiotic therapy as ordered.