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Nephrotic syndrome.pptx
- 1. NEPHROTIC SYNDROME PREPARED BY: PRAJNASUBEDI B.SC.NSG 4TH YR 6TH BATCH
- 2. INTRODUCTION: Nephrotic syndrome isa group of symptoms which is seen in any condition that seriously damages the glomerular capillary membrane , causing increased glomerular permeability with loss of protein in urine.
- 3. DEFINITION: Nephrotic syndrome isa group of symptoms characterized by proteinuria ( > 3.5 grams per day), low blood protein levels , high cholesterol levels , and edema.
- 4. INCIDENCE: All agescan be affected. Most common during 2 to 6 years. Affects male more than female.
- 5. CAUSES: Autoimmune diseasessuch as systemic lupus erythematosus. Diabetes Mellitus Hypertension Drug toxicity : excessive use of NSAIDS Malaria , hepatitis infection etc.
- 6. Types: • 90% ofcases Primary / Idiopathic Nephrotic syndrome • 10% of cases Secondary Nephrotic Syndrome • Serious and rare Congenital Nephrotic syndrome
- 7. Primary / IdiopathicNephrotic syndrome: Most common in children. Exact cause is unknown but are mainly associated with autoimmune cause. It is also known as minimal change disease : This disorder results in abnormal kidney function , but when the kidney tissue is examined under a microscope , it appears normal , or nearly normal.
- 8. Secondary Nephrotic Syndrome: Causes may be various disorders that can damage the glomerulus of the kidneys. Diseases such as Diabetes Mellitus , Hypertension , Systemic Lupus Erythematosus and other infections might be the cause.
- 9. Congenital Nephrotic Syndrome: Itis serious and rare condition caused by autosomal recessive disorder. No therapies are effective usually. Infants die under 1 or 2 years of age.
- 10. PATHOPHISIOLOGY: The glomerular basementmembrane is negatively charged layer . Due to antibody attack or other causes , this property is lost which allows proteins especially albumin to pass through glomerular membrane.
- 11. CLINICAL FEATURES: Excessiveweight gain , edema – peri-orbital initially , then in extremities , increases in the morning. Ascites , scrotal/labial swelling may be present. Urine changes ; decreased volume Frothy and pallor Edema of intestinal mucosa may lesd to loss of appetite , poor intestinal absorption.
- 13. Contd.. Fatigue ,lethargic, irritability. Blood pressure may be normal or slightly decreased due to decreased intravascular volum Susceptibility to infection increases Dyspnea may be seen due to pleural effusion , ascites and other type of fluid.
- 14. DIAGNOSIS: • Family history •Birth history • Antenatal history HISTORY TAKING: • Edema can be seen PHYSICAL EXAMINATION: • Urinalysis • Serum tests • Hematology • Kidney biopsy • KUB X-ray • USG INVESTIGATIONS:
- 15. INVESTIGATION AND FINDINGS: Urinalysis: Shows marked proteinuria , cast ,few RBCs , increased urine specific gravity 24 hrs urinary protein excretion : >50 mg/kg/day Serum: Markedly decreased serum protein (albumin) High cholesterol (450-1500 mg/dl) Hyponatremia
- 16. CONTD: Hematology: Normalor increased hemoglobin level High platelet count Kidney biopsy Done if there is recurrent relapses , non responsive to treatment
- 17. COMPLICATIONS: Blood clots /venous thrombosis Poor nutrition High blood pressure Acute kidney failure Chronic kidney failure Infections
- 18. TREATMENT: Goals of management: Reduce urinary protein excretion. Reduce fluid retention. Prevent infections and complications.
- 19. Pharmacological treatment: Diuretics: Frusemide , spironolactone Corticosteroids : Prednisolone Albumin Infusion : Immune suppressant therapy : For child who continue to have proteinuria (+2 or more) after 8 weeks of steroid therapy are treated with immune suppresant therapy such as cyclophosphamide.
- 20. Nursing managements: Monitoredema urine characteristics , albumin , I/O , abdominal girth , daily weight , etc. Administer medications such as diuretics , antibiotics and corticosteroid as ordered. Improve nutritional status. • Low sodium diet • High calorie and high protein diet • Small and frequent feeding
- 21. Contd.. Encourage activitiesand exercise. Maintain skin integrity • Provide skin care. • Change position every 2 hrs. • Check for skin break down. Prevent and manage side effects of steroid therapy. Discharge plan and home care teaching.
- 22.
- 23. ASSIGNMENT: Develop a nursingcare plan of child with NEPHROTIC SYNDROME.