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NEPHROTIC SYNDROME

NEPHROTIC SYNDROME. A clinical disorder characterized by marked increase of protein in the urine .(Proteinuria) Decrease in albumin in the blood (Hypoalbuminemia), edema, and excess lipid in the blood.

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NEPHROTIC SYNDROME

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  1. NEPHROTIC SYNDROME • A clinical disorder characterized by marked increase of protein in the urine .(Proteinuria) • Decrease in albumin in the blood (Hypoalbuminemia), edema, and excess lipid in the blood. • These occurs as a consequence of excessive leakage of plasma proteins into the urine because of permeability of the glomerular capillary membrane.

  2. Pathophysiology & Etiology • Seen in any condition that seriously damages the glomerular capillary membrane. • Chronic glomerular nephritis • DM with intercapillary glomeruloscelerosis • Amyloidosis of kidney

  3. Systemic lupus erythematosus • Renal vein thrombosis • Secondary to malignancy (Older adults) 2) Hypoalbuminemia results in decreased oncotic pressure, causing generalized edema as fluid moves out of the vascular space. • Circulating volume then activates the renin – angiotensin system causing retention of sodium and further edema. • Mechanism for lipid is unknown.

  4. Clinical Manifestations • Insidious onset of pitting edema, periorbital edema and ascites, weight gain. • Fatigue, headache, malaise, irritability • Marked proteinuria – leading to depletion of body proteins. • Hyperlipidemia – leading to accelerated atherosclerosis.

  5. Nursing Interventions Increasing circulating volume & decreasing edema • Monitor daily weight, I&O and urine specific gravity • Monitor CVP (If indicated), vital signs, orthostatic blood pressure and Heart rate to detect hypovolemia. • Monitor serum BUN & Creatinine to assess renal function.

  6. Administer diuretics / immunosuppressants as prescribed and evaluate pt’s response. • Infuse IV albumin as ordered – • Encourage bed rest for a few days to help mobilize edema, however some ambulation is necessary to reduce to risk of thrombo – embolic complications. • Enforce mild to moderate Na and fluid restriction, if edema is severe, provide high protein diet -

  7. Preventing Infection • Monitor for signs& symptoms of infection. • Monitor temperature routinely, check laboratory values for nutropenia. • Use aseptic technique for all invasive procedures and strict hand washing by pt and all contacts. Prevent contactby pt with persons who may transmit infection.

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