Nephrotic syndrome is a primary glomerular disease characterized by proteinuria, hypoalbuminemia, edema, and hyperlipidemia. It is seen in any condition that seriously damages the glomerular capillary membrane, causing increased glomerular permeability with loss of protein in the urine. Generally a disorder of childhood, it does occur in adults, including the elderly. Causes in clued chronic glomerulonephritis and diabetes mellitus, among other conditions.
CLINICAL MANIFESTATIONS
• Major manifestation is edema (usually periorbital, in dependent areas [sacrum, ankles, and hands], and ascites).
• Malaise, headache, irritability and fatigue
• Protein electrophoresis and immunoelectrophoresis to determine type of proteinuria
• Serum markers (Anti-C1q)
ASSESSMENT AND DIAGNOSTIC METHODS
• Proteinuria (exceeding 3 to 3.5 g/day_
• Microscopic hematuria, urinary casts
• Needle biopsy of the kidney for histology examination to confirm diagnosis
MEDICAL MANAGEMENT
Objective of management is to preserve renal function.
• Bed rest for a few days to promote diuresis and reduce edema
• Diet with high biologic protein (0.8 g/kg/day) to replenish urinary losses
• Low sodium, low saturated fat, liberal potassium
Pharmacologic Therapy
• Diuretics for severe edema, in combination with angiotensin-converting enzyme (ACE) inhibitors
• Adrenocorticosteroids to reduce proteinuria
• Antineoplastic agents Cytoxan) or immunosuppressive agents (Imuran, Leukeran, or cyclosporine)
NURSING MANAGEMENT
• In the early stages, nursing management is similar to that of acute glomerulonephritis.
• As the disease worsens, management is similar to that of chronic renal failure.
• Monitor intake and output; note sings of low plasma volume and impaired circulation with prerenal acute renal failure.
• Instruct patient receiving steroids or cyclosporine regarding medication and signs and symptoms that must be reported to physician.
• Instruct patient in selecting a high-protein diet while restricting cholesterol and fat intake.
