Nephrotic Syndrome Written By Sarah Gobbell Etiology Pathophysiology

Nephrotic Syndrome Written By: Sarah Gobbell

Etiology/ Pathophysiology • Syndrome- a complex of signs and symptoms resulting from a common cause. • Damaged glomeruli as a result of certain diseases cause proteins to perfuse into the urine • Characterized by marked proteinuria (protein in urine), hypoalbuminemia (loss of serum protein), edema (caused by decreased osmotic pressure).

Clinical Manifestations • General edema, mainly located around the eyes and extremities; especially around the feet and ankles. • Swollen abdomen/ facial swelling • Foamy appearance of urine • Unintentional weight gain • Poor appetite • High blood pressure • Decreased urine output

Labs/ Diagnostics • Blood chemistry shows hypoalbuminemia and hyperlipidemia- Urinalysis reveals urine protein • Renal biopsy identifies type and extent of tissue change • Other Tests to Rule Out Cause – Glucose tolerance test -- Complement levels – Antinuclear antibody -- Hepatitis B/C antibodies – Rheumatoid factor --VDRL serology

Renal Biopsy Urinalysis Glucose Tolerance Test Cryoglobulins Blood Chemistry Test VDRL Serology

Medical Management • Treatment may be required for life • Corticosteroids, immunosuppressive, antihypertensive, and diuretic medications • Antibiotics are used to control infection • Angiotensin converting enzyme (ACE) inhibitors may reduce degree of protein loss in the urine • Medications to reduce cholesterol and triglycerides may be recommended

Nursing Interventions • Monitor I& O, weight, measure abdominal girth, BP • Bed rest if pt has extreme edema • Assess for electrolyte imbalance • Skin care/ gradual increase of activity as edema resolves • Diet- protein replacement with foods that provide high biologic value ( meat, fish, poultry, cheese, eggs) • Sodium restriction

Patient Teaching • Medication regimen- type, dosage, side effects, the need to take meds as prescribed • Nutrition- high protein, low sodium • Self-assessment of fluid status- monitor weight, presence of edema • Signs/ symptoms indicating need for medical attention (edema, fatigue, headache, infection) • Need for follow-up care

Prognosis • 25% of children and 50%-75% of adults will progress to renal failure within 5 years • May be remission or nephrotic syndrome will exist in chronic form • Besides treating the underlying problem, little can be done to prevent recurrence of nephrotic syndrome (permanent!)

The End