1. Written By: Sarah Gobbell
Nephrotic Syndrome
Written By: Sarah Gobbell

2. Etiology/ Pathophysiology
Syndrome- a complex of signs and symptoms resulting from a common cause.
Damaged glomeruli as a result of certain diseases cause proteins to perfuse into the urine
Characterized by marked proteinuria (protein in urine), hypoalbuminemia (loss of serum protein), edema (caused by decreased osmotic pressure).

4. Clinical Manifestations
General edema, mainly located around the eyes and extremities; especially around the feet and ankles.
Swollen abdomen/ facial swelling
Foamy appearance of urine
Unintentional weight gain
Poor appetite
High blood pressure
Decreased urine output

5. Labs/ Diagnostics
Blood chemistry shows hypoalbuminemia and hyperlipidemia- Urinalysis reveals urine protein
Renal biopsy identifies type and extent of tissue change
Other Tests to Rule Out Cause
Glucose tolerance test -- Complement levels
Antinuclear antibody Hepatitis B/C antibodies
Rheumatoid factor VDRL serology
Cryoglobulins -- Serum protein electrophoresis

6. Glucose Tolerance Test
Renal Biopsy
Glucose Tolerance Test
Blood Chemistry Test
Urinalysis
Cryoglobulins
VDRL Serology

7. Medical Management Treatment may be required for life
Corticosteroids, immunosuppressive, antihypertensive, and diuretic medications
Antibiotics are used to control infection
Angiotensin converting enzyme (ACE) inhibitors may reduce degree of protein loss in the urine
Medications to reduce cholesterol and triglycerides may be recommended

8. Nursing Interventions
Monitor I& O, weight, measure abdominal girth, BP
Bed rest if pt has extreme edema
Assess for electrolyte imbalance
Skin care/ gradual increase of
activity as edema resolves
Diet- protein replacement with foods that provide high biologic value ( meat, fish, poultry, cheese, eggs)
Sodium restriction

9. Patient Teaching
Medication regimen- type, dosage, side effects, the need to take meds as prescribed
Nutrition- high protein, low sodium
Self-assessment of fluid status- monitor weight, presence of edema
Signs/ symptoms indicating need for medical attention (edema, fatigue, headache, infection)
Need for follow-up care

10. Prognosis
25% of children and 50%-75% of adults will progress to renal failure within 5 years
May be remission or nephrotic syndrome will exist in chronic form
Besides treating the underlying problem, little can be done to prevent recurrence of nephrotic syndrome (permanent!)

11. The End