NEPHROTIC SYNDROME

Ndayambaje Israel

Introduction
Nephrotic syndrome isn't a disease but is
a condition Cxtxd 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.

Anatomy

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

Nephrotic criteria
1. Massive proteinuria:
Qualitative proteinuria:
3+ or 4+,
Quantitative proteinuria : more than
40 mg/m2/hr in children (selective).
2. Hypo-proteinemia : total plasma
proteins < 5.5g/dl & serum albumin :
< 2.5g/dl.
3. Hyperlipidemia: Serum cholesterol :
> 5.7mmol/L
4. Edema: pitting edema in different
degree

Causes
Glomerulonephritis
Metabolic diseases: diabetes mellitus
Collagen-vascular disorders: systemic
lupus erythematosus,periarteritis nodosa.
Circulatory diseases: heart failure, sickle
cell anemia, and renal vein thrombosis.
Nephrotoxins: mercury, gold, and
bismuth.
Infections: tuberculosis, enteritis; allergic
reactions; pregnancy; hereditary nephritis
Neoplastic: multiple myeloma

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

Pathophysiology
I. Proteinuria :Increase glomerular
permeability for proteins due to loss of
negative charged glycoprotein
Degree of protineuria: Mild: less than 0.5g/m2/day
Moderate: 0.5 2g/m2/day
Severe: more than 2g/m2/day
Type of proteinuria:A-Selective proteinuria: where proteins of
low molecular weight, such as albumin, are
excreted more readily than protein of HMW
B-Non selective : LMW+HMW are lost in
urine

Pathophysiology /2
II. Hypoalbinaemia
Due to hyperproteinuria----- Loss of
plasma protein in urine mainly the
albumin.
Increased catabolism of protein during
acute phase.

Pathophysiology /3
III. Edema
Reduction plasma colloid osmotic
pressure secondary to
hypoalbuminemia Edema & hypovolemia
*Intravascular volume antidiuretic
hormone (ADH ) & aldosterone(ALD)
water & sodium retention Edema
*Intravascular volume glomerular
filtration rate
(GFR) water & sodium retention
Edema

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.

The symptoms of nephrotic

syndrome

Fatigue & malaise

. Decreased appetite
Weight gain from excess fluid
Dull hair
Foamy urine, decrease in frequency of
urination
Pale fingernail beds .
Ears cartilage may feel less firm
Food intolerances or allergies
Proteinuria, high levels
Low levels of proteinemia due to its loss
in the urine
High cholesterol levels in the blood

! Four most common characteristics:

1.Massive proteinuria
2.Hypoalbuminemia (K+ normal &
BP normal)
3.Edema usually starts in
periorbital area & dependent areas
of the body and progresses to
generalized, massive edema.
Pitting edema of 4+. Caused by
hypo albumin which causes shift of
fluids to extracellular space. There
is an insidious weight gain- shoes
don't fit, etc..

4.Hyperlipidemia
* NB: there is no hematuria or
hypertension

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

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
Serum complement: Vary with clinical
type.

Renal function

Medications

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

Nrsg care
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.

Nrsg care
7. Monitor plasma albumin & transferrin
concentrations to evaluate overall nutritional
status.
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

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