Nephrotic Syndrome in Child Health Nursing
Definition
Nephrotic syndrome is a kidney disorder characterized by excessive protein loss in the
urine (proteinuria), leading to low blood protein levels (hypoalbuminemia), swelling
(edema), and high cholesterol levels (hyperlipidemia). It results from damage to the
glomerular filtration barrier, allowing protein to leak into the urine.
Causes
1. Primary (Idiopathic) Nephrotic Syndrome (Most Common in Children)
• Minimal Change Disease (MCD) – Accounts for 80-90% of childhood
cases. The kidney tissue appears normal under a regular microscope but
shows changes under an electron microscope.
• Focal Segmental Glomerulosclerosis (FSGS) – Scarring of kidney
tissue.
• Membranous Nephropathy – Thickening of the glomerular membrane.
2. Secondary Nephrotic Syndrome (Caused by Underlying Conditions)
• Infections – Hepatitis B, hepatitis C, HIV, malaria.
• Systemic Diseases – Lupus nephritis (SLE), diabetes mellitus.
• Medications – Nonsteroidal anti-inflammatory drugs (NSAIDs),
certain antibiotics.
• Genetic Disorders – Congenital nephrotic syndrome.
Signs and Symptoms
1. Edema – Puffiness around the eyes (periorbital edema), swelling
in the legs, ankles, and abdomen (ascites).
2. Proteinuria – Frothy or foamy urine due to excessive protein loss.
3. Hypoalbuminemia – Low levels of albumin in the blood, causing
fluid leakage into tissues.
4. Hyperlipidemia – Increased cholesterol and triglycerides due to
liver overproduction.
5. Decreased Urine Output (Oliguria) – Due to fluid retention.
6. Pallor and Fatigue – Due to decreased protein and energy levels.
7. Increased Risk of Infections – Due to immune suppression.
8. Blood Pressure Changes – May be normal, low, or high depending
on disease severity.
Diagnostics
1. Laboratory Tests
• Urinalysis – Detects proteinuria (≥3.5 g/day).
• Serum Albumin Test – Measures hypoalbuminemia (<2.5 g/dL).
• Lipid Profile – Shows hyperlipidemia (high cholesterol and
triglycerides).
• Blood Urea Nitrogen (BUN) & Creatinine – Assesses kidney function.
• Electrolytes – Checks for imbalances.
• Complement Levels (C3, C4) – To differentiate primary vs. secondary
causes.
2. Additional Tests
• Renal Ultrasound – Assesses kidney structure and size.
• Kidney Biopsy – Done if the child does not respond to steroid therapy
or if secondary nephrotic syndrome is suspected.
Nursing Management in Child Health Nursing
1. Assessment
• Monitor for edema, weight gain, and fluid retention.
• Assess urine output and protein levels.
• Observe for infection symptoms (fever, malaise).
• Monitor blood pressure and signs of hypovolemia.
2. Nursing Interventions
• Fluid and Sodium Management: Restrict salt intake to reduce edema.
• Monitor and Record Daily Weight: Helps assess fluid retention or loss.
• Strict Intake and Output Monitoring: Tracks fluid balance.
• Prevent Infection: Encourage proper hygiene and vaccination.
• Skin Care: Prevent skin breakdown due to edema.
• Encourage Rest: Minimize physical activity during exacerbations.
• Educate Parents: Teach about medication adherence, diet, and signs
of relapse.
Treatment and Management
1. Medical Management
• Corticosteroids (Prednisone) – First-line treatment to reduce
proteinuria.
• Initial dose: 2 mg/kg/day for 4–6 weeks, followed by
tapering.
• Diuretics (Furosemide) – Helps reduce edema (used cautiously to
prevent hypovolemia).
• Albumin Infusion (in severe cases) – Replenishes lost protein.
• ACE Inhibitors (e.g., Enalapril, Lisinopril) – Reduces proteinuria and
blood pressure.
• Statins – Used in persistent hyperlipidemia.
• Immunosuppressants (for steroid-resistant cases):
• Cyclophosphamide
• Cyclosporine
• Tacrolimus
2. Dietary Management
• Low-sodium diet – Helps control edema.
• High-protein diet (in some cases) – To compensate for protein loss.
• Fluid restriction – If severe edema is present.
Surgical Management
• Kidney Transplantation:
• Considered for children with end-stage renal disease
(ESRD) due to progressive nephrotic syndrome.
• Peritoneal or Hemodialysis:
• Used if kidney function worsens significantly before
transplantation.
Conclusion
Nephrotic syndrome in children is a chronic kidney disorder requiring early diagnosis
and appropriate management. Corticosteroids remain the first-line treatment, but
supportive nursing care—including fluid balance monitoring, infection prevention, and
parental education—is essential. In severe or treatment-resistant cases,
immunosuppressive therapy or kidney transplantation may be necessary.
