Nephrosis (Nephrotic Syndrome)

  1. General information
    1. Autoimmune process leading to structural alteration of glomerular membrane that results in increased permeability to plasma proteins, particularly albumin
    2. Course of the disease consists of exacerbations and remissions over a period of months to years
    3. Commonly affects preschoolers, boys more often than girls
    4. Pathophysiology
      1. Plasma proteins enter the renal tubule and are excreted in the urine, causing proteinuria.
      2. Protein shift causes altered oncotic pressure and lowered plasma volume.
      3. Hypovolemia triggers release of renin and angiotensin, which stimulates increased secretion of aldosterone; aldosterone increases reabsorption of water and sodium in distal tubule.
      4. Lowered blood pressure also stimulates release of ADH, further increasing reabsorption of water; together with a general shift of plasma into interstitial spaces, results in edema.
    5. Prognosis is good unless edema does not respond to steroids.
  2. Medical management
    1. Drug therapy
      1. Corticosteroids to resolve edema
      2. Antibiotics for bacterial infections
      3. Thiazide diuretics in edematous stage
    2. Bed rest
    3. Diet modification: high protein, low sodium
  3. Assessment findings
    1. Proteinuria, hypoproteinemia, hyperlipidemia
    2. Dependent body edema
      1. Puffiness around eyes in morning
      2. Ascites
      3. Scrotal edema
      4. Ankle edema
    3. Anorexia, vomiting, and diarrhea, malnutrition
    4. Pallor, lethargy
    5. Hepatomegaly
  4. Nursing interventions
    1. Provide bed rest.
      1. Conserve energy.
      2. Find activities for quiet play.
    2. Provide high-protein, low-sodium diet during edema phase only.
    3. Maintain skin integrity.
      1. Do not use Band-Aids.
      2. Avoid IM injections (medication is not absorbed into edematous tissue).
      3. Turn frequently.
    4. Obtain morning urine for protein studies.
    5. Provide scrotal support.
    6. Monitor I&O, vital signs and weigh daily.
    7. Administer steroids to suppress autoimmune response as ordered.
    8. Protect from known sources of infection.

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