Nephrotic Syndrome
Short Note
Definition
Primary glomerular disease
Characterized by the following :
Marked Proteinuria
Hypoalbuminemia
Eodema
Hyperlipidemia
It is a syndrome i.e. a collection of symptoms
Pathophysiology
Damage of the glomerular capillary membrane - increased permeability - loss of plasma protein, particularly albumin - Osmolarity of the plasma decreased → oedema; Activation of the renin angiotensin system → sodium retention → Oedema
Loss of proteins → increased production of lipoproteins → Hyperlipidemia (increased cholesterol level)
Causes
Any intrinsic renal disease or systemic disease that affects the glomerulus :
chronic glomerulonephritis
diabetes mellitus with intercapillary glomerulosclerosis
Amyloidosis
Systemic lupus erythematosus
Multiple myeloma
Renal vein thrombosis
Clinical Features
Periorbital oedema
Edema over sacrum, ankles and hands
ascites
Malaise
Headache
Irritability
Fatigue
Complications
Infection (due to a deficient immune response)
Thromboembbolism (esp. renal vein)
Pulmonary emboli
acute renal failure
Accelerated atherosclerosis
Medical Management
Severe Oedema - Diuretics ACE inhibitors
Cyclophosphamide (Cytoxan)
Azathioprine
Chlorambucil (Lukeran)
Cyclosporin
Corticosteroids
Liberal Carbohydrates to reduce breakdown of proteins
Diet
Low Sodium, Liberal Potassium
Low saturated fat
High proetin
Nursing
I/O Chart
Education - self care - diet restriction to control Hypertension, oedema, - instructions both by words and written
Monitor BP, BUN, Creatinine,
Revision of doses of medicine
Report infections
Investigations
Proteinuria > 3 gm/day
WBC, granular and epithelial casts in urine
Blood Urea & Serum creatinine
