1. Nephrotic Syndrome

2. A primary glomerular disease – it appears in any condition that seriously damages the glomerular capillary membrane and results in increased glomerular permeability
Characterized by : -
Marked increase in protein in the urine (proteinuria)
Decrease in albumin in the blood (hypoalbuminemia)
Oedema
High serum cholesterol and low density lipoproteins (hyperlipidemia)

3. Pathophysiology Generally seen in children Occurs in adults also
Causes :
Chronic glomerulonephritis,
Diabetes mellitus with intercapillary glomerulosclerosis
Amyloidosis of the kidney
Systemic lupus erythematosus
Multiple myeloma
Renal vein thrombosis
Loss of plasma protein, particularly albumin in the urine
Liver produces enough
But loss is excessive
Hypoalbuminemia results

4. Clinical Manifestations
Oedema : the major manifestation
Soft and pitting
Around the eye, in dependent areas(sacrum, ankles, and hands)
Ascites
Malaise
Head ache
Irritability
Fatigue

5. Assessment and diagnostic findings
Albuminuria of 3 to 3.5 gms / day
WBC casts
Granular casts
Epithelial casts
Protein electrophoresis
Immunoelectrophoresis
Renal biopsy
Serum markers – lupus nephritis – Anti-C1q antibodies

6. Complications Infection due to immune deficiency
Thromboembolism esp of the renal vein
Pulmonary emboli
Acute renal failure
Accelerated atherosclerosis due to hyperlipidemia

7. Medical management Diuresis with caution
Diuretics combined with ACE inhibitors  reduces the degree of proteinuria in 4 to 6 weeks
Cyclophosphamide (cytoxan)
Immunosuppressant medications (azathioprine)
Chlorambucil (Leukeran)
Cyclosporine
Corticosteroids
Low sodium, liberal potassium diet
Protein intake 0.8 gms / kg / day; dairy products, eggs, meats
Low saturated fats

8. Nursing management I / O chart – urine measurement
Fluid and electrolyte balance
Monitoring of blood values of protein, and electrolytes
Dietary management
Patient education : the importance of diet and follow up care
Teaching the symptoms and signs of renal failure or infection
Drug management
Inform about complications and side effects of drugs
Psychological support