Nephrotic Syndrome: Nursing Care and Management

Jul 17, 2024

Nephrotic Syndrome: Nursing Care and Management

Overview

  • Nephrotic Syndrome: Condition characterized by significant increase in urine protein, low blood albumin (hypoalbuminemia), swelling (edema), and elevated blood lipids.
  • Pathophysiology: Increased permeability of glomerular capillary membrane leads to excessive plasma protein leakage into urine.

Key Symptoms

  • Proteinuria: ~3 grams/day
  • Hypoalbuminemia: Decreased serum albumin levels
  • Hyperlipidemia: Elevated LDL and triglycerides
  • Edema: Generalized, significant swelling
  • Increased risk of infections and thrombosis

Causes and Contributing Factors

  1. Diabetes Mellitus: Leading cause, can develop diabetic nephropathy
  2. Amyloidosis: Abnormal protein deposits in organs and tissues
  3. Systemic Lupus Erythematosus (SLE): Autoimmune disease attacking kidneys
  4. Viral Infections: Hepatitis B & C, HIV
  5. Medications: NSAIDs causing direct kidney toxicity
  6. Autoimmune Diseases: Chronic infections leading to immune complex deposition in glomeruli
  7. Immune Complexes: Proteins triggering inflammation and damage leading to nephrotic syndrome

Pathophysiological Effects

  • Damage to glomerular basement membrane (GBM), increased permeability, proteins leak into urine
  • Loss of natural anticoagulants (antithrombin, protein C, protein S) leads to increased risk of thrombosis
  • Decreased oncotic pressure, generalized edema, activation of RAS, sodium retention
  • Increased risk of infections due to loss of immunoglobulins (IgG, IgA)

Diagnostics

  1. Urinalysis: Presence of proteinuria, blood, and urinary casts, foamy urine appearance
  2. 24-Hour Urine Collection: Measuring protein loss and creatinine clearance
  3. Urine Protein Electrophoresis: Identifies specific proteins in urine
  4. Kidney Biopsy: Histological exam to confirm diagnosis and assess damage
  5. Blood Tests: Low total protein and albumin, elevated creatinine, triglycerides, and cholesterol levels

Potential Complications

  • Hypovolemia
  • Thromboembolic events (DVT, PE, stroke, renal vein thrombosis)
  • Medication toxicity due to hypoalbuminemia
  • Increased risk of infections (gram-negative, gram-positive bacteria, viruses)

Management and Nursing Care

  1. Pharmacological Treatment
    • Diuretics (Furosemide): Reduce fluid retention and edema
    • ACE Inhibitors: Lower BP and reduce protein leakage
    • Corticosteroids: Reduce inflammation
    • Anticoagulants (Heparin, Warfarin): Prevent thrombotic events
  2. Edema Management
    • Compression stockings, leg elevation, sodium and fluid restriction
    • Albumin infusion to maintain oncotic pressure and reduce edema
  3. Dietary Adjustments
    • Protein supplements, vitamins (C, D), minerals (zinc)
    • Reduced intake of saturated fats
    • Statins (Atorvastatin): Manage hyperlipidemia
    • Omega-3 fatty acids: Reduce triglyceride levels
  4. Lifestyle Modifications
    • Regular exercise, quit smoking, manage stress
  5. Infection Prevention
    • Monitor for signs of infection, strict aseptic technique during procedures
    • Educate on avoiding crowded places, hand hygiene, wearing masks
  6. Patient and Family Education
    • Symptom awareness, medication side effects
    • Importance of attending medical appointments and complying with treatment
    • Dietary and fluid management instructions

Q&A Discussion

  • Review of assessment questions emphasizing the clinical knowledge of nephrotic syndrome, diagnostic methods, and management strategies.

Next Session: Renal Calculi and related Q&A.