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Nephrotic Syndrome

. A primary glomerular disease it appears in any condition that seriously damages the glomerular capillary membrane and results in increased glomerular permeabilityCharacterized by : -Marked increase in protein in the urine (proteinuria)Decrease in albumin in the blood (hypoalbuminemia)Oedema

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Nephrotic Syndrome

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    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

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