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NEPHROTIC SYNDROME

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Definition

Kidney disorder characterized by markedproteinuria, hypoalbuminemia,

hyperlipidemia, and edemaResults from a defect in the permeability of glomerular vesselsSome forms my be eventually progress toend- stage renal failure

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Causes

Membranous glomerulonephritis Focal glomerulosclerosis Membranoproliferative glomerulonephritis Metabolic diseases such as diabetes mellitus Collagen-vascular disorders Circulatory diseases, such as heart failure,

sickle cell anemia, and renal vein thrombosis

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Causes

Nephrotoxins, such as mercury, gold, andbismuth

Infections, such as tuberculosis and enteritis Heridetary nephritis Neoplastic disease, such as multiple myeloma

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Pathophysiology

Alteration in the glomerulus Plasmaprotein lost into the urine throughdamaged glomerular basement membrane(Proteinuria) Intravascular fluidmigrates into the interstitial spaces(Hypovolemia) Increased reninproduction causes increased excretion of aldosterone and reabsorption of sodiumelevation of cholesterol and triglycerides

EDEMA

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Assessment findings (signs and

symptoms) Edema usually periorbtal independent areas ( sacrumankles and hands)

Malaise

Headache irritably fatigue swollen external genital

respiratory difficulty pallor diarrhea

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Diagnostic test findings

Protein electrophoreses andimmunoelectrophoreses- to determine type of proteinuria exceeding 3 to 3.5 g/day

Serum markers (Ant C1q)Microscopic hematuria urinary castsNeedle biopsy of the kidney- for histologicexamination to confirm diagnoses

Blood testing- reveals increased serumcholesterol. Phospholipids and triglyceride levelsand decreased serum albumin levels

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Medical Management

Bed rest for a few days to promote diuresisand reduce edema

Dietary restrictions of protein and cholesterolto lower lipidemia

Low sodium low saturated fat liberalpotassium

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Nursing interventions

Frequently check urine proteinMonitor and document the location and

degree of edemaMonitor intake and output and checkweight at the same time each morning

Provide good sin care

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Nursing interventions

Encourage activity and exercise to avoidthrombophlebitis and provideantiembolism stocking as orderedMonitor for and teach the patient aboutother steroid- related complicationsincluding masked infections increasedsusceptibility to infections ulcers steroid -induced diabetes