Case presentation

on Nephrotic
Syndrome
DRISHA PAL
B.SC. NURSING , 3RD YEAR
NEOTIA ACADEMY OF NURSING
Introduction
• Nephrotic syndrome result when the glomerulus is excessively
permeable to plasma protein causing proteinuria that leads to
low plasma albumin and tissue edema.
Definition
• Nephrotic syndrome is a clinical disorder characterized by
marked increase of protein in urine(proteinuria), decrease
albumin in blood (hypoalbuminemia) , edema and excess lipid
in the blood (hyperlipidemia). This occurs as a consequences of
excessive leakage in plasma proteins into the urine because of
increased permeability of glomerular capillary membrane.
 Related
anatomy
and
physiology
ETIOLOGY
Pathophysiology of
Nephrotic Syndrome
Pathophysiology of
Nephrotic Syndrome
 Clinical
Manifestation
Clinical Manifestation
• Pitting dependent edema
Pitting edema occurs when excess
fluid builds up in the body,
causing swelling; when pressure is
applied to the swollen area, a "pit" will
remain. Although it can affect
any part of the body, pitting edema
usually occurs in legs, feet, and
ankles.
Investigation

History taking Physical examination

Laboratory investigation
Present in book Present in patient
• Urine analysis – Slows gross • Proteinuria – 1.5g/day
proteinuria(2.20g/day) presence of
slight hematuria, increase specific Specific gravity of urine is changed
gravity.

• Blood examination • Protin albumin0.5g/day

Cholesterol – 300mg/day
• Needle biopsy of kidney- for
histological examination of renal • -
tissue to conform diagnosis.
Investigation
Present in book Present in patient

• X Ray • -
• CT Scan •-
• MRI • -
 Medical management

Non pharmacological management

Management
Surgical management

Nursing management
 1. Medical Management
▪ Steroid therapy - oral prednisolone
▪ Antibiotic therapy –Antibiotic therapy is indicated in the presence of any
infection.
▪ Diuretics therapy – Frusemide/loop diuretics, thiazide
▪ Immunosuppressive drug therapy – levamisole,
cyclosporine, cyclophosphamide.
▪ Albumin infusion (1g/kg/day)may be given in case of massive edema and
ascites. It help to shift the fluid from intestinal space into vascular system.
Plasma or blood transfusion may be given in some cases to treat
hypoalbuminemia.
2. Non pharmacological Management

❑ Bed rest and high protein diet with restriction of fluid intake
are important aspect of management.
❑ general management of edema-
I. sodium and fluid retention
II. dietary protein supplement
III. low diet in saturated fat
 2. Non pharmacological Management

❑ Patient education-
I. Teach patient signs of nephrotic syndrome also review causes, purpose of prescribed treatments and
importance of long term therapy to prevent
Click to add textESRD
II. Instructor the patient in adverse effect of prescribed medications and methods of preventing infection if
taking immune suppressive agents
III. Carefully review with patient and family dietary aspect and fluid aspect. Consult for assistance in meal
planning.
IV. Serve / provide frequent meals in a pleasant setting as they are potential to become malnourished.
V. Discuss the importance of maintaining exercises decreasing cholesterol and fat intake and changing
other risk factors such as smoking, obesity and stress to reduce of severe thromboembolic complication.
3. Surgical management
• Renal transplantation
Complication
Present in book Present in patient
• Hypovolemia. • -
• Thromboembolic complication • -
• Altered drug metabolism due to • -
decrease in plasma protein
• progression to ESRD • -
• Generalized edema • ✓
• growth retention in children • -
• calcium and vitamin D deficiency.
• -
• protein energy malnutrition
• -
Thank you