NEPHROTIC SYNDROME- ENGLISH
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NEPHROTIC
SYNDROME-
Nephrotic syndrome isn’t a disease. It’s a
group of symptoms that can appear if kidneys aren’t working right. This
may be due to increased permeability of
glomerulus which results in passing of plasma proteins in urine.
Small blood vessels
in Nephrons function as a filter, clearing out waste and
extra water from blood. That waste and water collects in
bladder and leaves your body as urine. These vessels are called “glomeruli,” the filtering part
of kidney.
When
they’re damaged, too much protein slips through the filters into urine. The result is nephrotic syndrome.
Nephrotic
syndrome can affect both adults and children.
CAUSES
OF NEPHROTIC SYNDROME -
Any
condition that affects kidney can cause NEPHROTIC SYNDROME. Some of main causes
are-
Ø
Some
potential causes of the disease include infections from viruses, allergic reactions,
taking certain medications, and using non-steroidal anti-inflammatory drugs
(NSAIDs)
Ø
Focal segmental glomerulosclerosis, or FSGS, is a disease
that scars the glomeruli. It’s the most common primary cause of nephrotic
syndrome in adults. FSGS can be caused by a virus, such as HIV, or some medications.
Ø
Membranous nephropathy, in which the
membranes of the glomeruli thicken. Causes may
include cancer, malaria, hepatitis B, and lupus.
Ø
Diabetes, which is the most common secondary
cause of nephrotic syndrome in adults. It can cause kidney damage, known
as diabetic nephropathy.
Ø
Lupus(systemic lupus erythematosus), a chronic
disease of the immune system, can seriously damage the kidneys.
Ø
Amyloidosis, which happens when you have a buildup
of substances called amyloid proteins in your blood. This can damage
your kidneys.
SIGN
AND SYMPTOMS-
There
are four main signs or symptoms make up nephrotic syndrome. They are:
Ø
Too much protein in urine (Proteinuria).
Ø
High fat and cholesterol levels in the blood. “hyperlipidemia.”
Ø
Swelling of
legs, feet and ankles, and sometimes of your hands and
face. This is called edema.
Ø
Low levels of albumin in your blood. “hypoalbuminemia.”
Other
sign and symptoms of nephrotic syndrome are:
Ø
Weight
gain
Ø
Vomitting
Ø
anorexia
Ø
Feeling
very tired
Ø
Decreased
Urine output.
Ø
Pallor
skin
DIAGNOSTIC
INVESTIGATIONS-
q
Urine
examination for specific gravity and albuminuria.
q
Blood
Examination for Serum protein and A/G ratio
q
Serum
cholesterol level
q
ESR
q
Biopsy
of Kidney
TREATMENT-
Nephrotic
syndrome is managed medically and Medicines may include:
Ø
Blood-pressure
medications called Angiotensin converting enzyme inhibitors (ACE
inhibitors) and ARBs
(angiotensin-receptor blockers), which reduces the pressure in glomeruli and lower the amount of protein in
your urine
Ø
Diuretics,
or water pills, to reduce swelling
Ø
Cholesterol-lowering
drugs
Ø
Blood
thinners, or anticoagulants, to make blood reduce the chances of blood
clots .
Ø
Medications
that turn down the immune system, such as corticosteroids
Ø
The
patient may need to cut down on salt to reduce swelling.
Ø
The
patient may also be suggested to eat a diet low in saturated
fats and cholesterol.
NURSING MANAGEMENT-
Ø
The
child may be advised bed rest and
activity limitation which may be started again as condition improves.
Ø
Vital
signs are monitored such as heart rate , respiratory rate and temperature and
recorded.
Ø
The
balance diet is provided to maintain sufficient nutritional status.
Ø
Intake
output chart should be maintained. Daily recording of weight & edema is
important nursing management in nephrotic syndrome.
Ø
Child should be provided with low salt and low
cholesterol diet. Salty chips or wafers should be avoided.
Ø
Recreation
and play therapy in the bed is important to divert child’s attention from disease
process.
Ø
Observation
for early signs of infection is very important as patient is on
immunosuppressive therapy.
Ø
Parents
should be explained about the disorder and possible treatment to alleviate their anxiety.
Ø
Assessment of respiratory status and edema is done and
should be notified in case of deterioration.
Ø
Dyspnoea
may be relieved by sitting position and sometimes abdominal paracentesis is
required so prepare child for the procedure.
Ø
Parents
should be explained about need for proper follow-up visits as and when
required.
Ø
Other Nursing interventions – includes all nursing
care of hospitalized child that we have discussed in previous lecture under
heading Nursing care of hospitalized child in the lecture “Child Health
Nursing”.
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