Nephrotic syndrome may be caused by primary (idiopathic) renal disease or by a variety of secondary causes. Patients present with marked edema, proteinuria, hypoalbuminemia, and often hyperlipidemia. Nephrotic syndrome is a primary glomerular disease characterized by the following: Marked increase in protein in the urine (proteinuria) Decrease in albumin in the blood (hypoalbuminemia) Edema (The swelling (edema), can be most noticeable on the face, around the eyes, around the feet and ankles, and in the belly area (or the abdomen). High serum cholesterol and low-density lipoproteins (hyperlipidemia) Nephrotic syndrome is a clinical disorder characterized by marked increase of protein in the urine ( proteinuria ), decrease in albumin in the blood (hypoalbuminemia ),edema, & excess lipids in the blood ( hyperlipidemia ) Pathophysiology Nephrotic syndrome can occur with almost any intrinsic renal disease or systemic disease that affects the glomerulus. Although generally considered a disorder of childhood, nephrotic syndrome does occur in adults, including the elderly. Causes include: Chronic glomerulonephritis Diabetes mellitus with intercapillary glomerulosclerosis Amyloidosis of the kidney Systemic lupus erythematosus Multiple myeloma and renal vein thrombosis. NSAIDs Pre eclampsia

1. NEPHORTIC SYNDROME

2. OVERVEIW
•Nephrotic syndrome may be caused by primary
(idiopathic) renal disease or by a variety of
secondary causes. Patients present with marked
edema, proteinuria, hypoalbuminemia, and often
hyperlipidemia.

3. NEPHORTIC SYNDROME
• Nephrotic syndrome is a primary glomerular disease
characterized by the following:
 Marked increase in protein in the urine (proteinuria)
 Decrease in albumin in the blood
(hypoalbuminemia)
 Edema (The swelling (edema), can be most noticeable on the
face, around the eyes, around the feet and ankles, and in the
belly area (or the abdomen).
 High serum cholesterol and low-density lipoproteins
(hyperlipidemia)

4. NEPHORTIC SYNDROME
• Nephrotic syndrome can happen
when tiny filtering units
(glomeruli) within the kidney are
damaged.
• This damage within the kidney
allows protein normally kept in
body to leak into the urine, which
lowers the amount of protein in
your blood.

5. Definition
• Nephrotic syndrome is a clinical disorder
characterized by marked increase of protein in the
urine ( proteinuria ), decrease in albumin in the blood
(hypoalbuminemia ),edema, & excess lipids in the
blood ( hyperlipidemia ) Or
• Nephrotic syndrome is characterized by the loss of
plasma protein, particularly albumin, in the urine.

6. PATHOPHYSIOLOGY
 Nephrotic syndrome can occur with almost any intrinsic renal disease or
systemic disease that affects the glomerulus.
 Although generally considered a disorder of childhood, nephrotic
syndrome does occur in adults, including the elderly. Causes include:
1. Chronic glomerulonephritis
2. Diabetes mellitus with intercapillary glomerulosclerosis
3. Amyloidosis of the kidney
4. Systemic lupus erythematosus
5. Multiple myeloma and renal vein thrombosis.
6. NSAIDs
7. Pre eclampsia

7. PATHOPHYSIOLOGY &SEQUENCE OF EVENTS IN NEPHROTIC
SYNDROME

8. Clinical Manifestations
•The major manifestation of nephrotic syndrome is
edema. It is usually soft and pitting and most
commonly occurs around the eyes (periorbital), in
dependent areas (sacrum, ankles, and hands), and in
the abdomen (ascites).
•Other symptoms, including malaise, headache,
irritability, and fatigue, are common

9. Periorbitaledema

11. Assessment and Diagnostic Findings
• There are no established guidelines on the diagnostic
workup or management of nephrotic syndrome. Imaging
studies are generally not needed, and blood tests should be
used selectively to diagnose specific disorders rather than
for a broad or unguided workup.

12. 1. Initial investigation should include history,
physical examination, and a serum chemistry panel.
• In client history including Identify medication or toxin
exposure; risk factors for HIV or viral hepatitis; and
symptoms suggesting other causes of edema Obtain
history of diabetes, systemic lupus erythematosus, or
other systemic illness
• Renal biopsy may be useful in some cases to confirm
an underlying disease or to identify idiopathic disease
that is more likely to respond to corticosteroids.

13. Laboratory investigations
1. Urine dipstick (Confirm proteinuria)
2. Random urine protein/ creatinine ratio Quantify degree of
proteinuria (ratio greater than 3 to 3.5)
3. Serum creatinine (Rule out acute renal failure, assess
glomerular filtration rate)
4. Serum albumin (Assess degree of hypoalbuminemia)
5. Lipid panel (Assess degree of hyperlipidemia)

14.  Proteinuria (predominately albumin) exceeding 3 to 3.5 g/day is
sufficient for the diagnosis of nephrotic syndrome.
 Protein electrophoresis and immunoelectrophoresis may be
performed on the urine to categorize the type of proteinuria. The
urine may also contain increased WBCs as well as granular and
epithelial casts.
 A needle biopsy of the kidney may be performed for histologic
examination of renal tissue to confirm the diagnosis.
 Recent studies have confirmed the usefulness of serum markers
as a means of assessing the disease process. Anti-C1q antibodies
are the most reliable markers for assessing disease activity in
lupus nephritis.

15. COMPLICATIONS
• Complications of Nephrotic syndrome include :
 Hypovolemia
 Infection (due to a deficient immune response)
Thromboembolism (especially of the renal vein)
 Pulmonary emboli, acute renal failure (due to
hypovolemia)
 Accelerated atherosclerosis (due to hyperlipidemia).
 Progression to end – stage renal failure

16. Medical Management
• The objective of management is to preserve renal
function.
•Treatment of most patients should include fluid and
sodium restriction, oral or intravenous diuretics, and
angiotensin-converting enzyme inhibitors. Some adults
with nephrotic syndrome may benefit from corticosteroid
treatment.

17. FLUID AND NUTRITION
 Creating a negative sodium balance will help reduce
edema, presumably as the underlying illness is treated
or as renal inflammation slowly resolves.
 Patients should limit their sodium intake to 3 g per
day, and may needto restrict fluid intake (to less than
approximately 1.5 L per day).

18. DIURETICS
•Diuretics are the mainstay of medical
management.
• Loop diuretics, such as furosemide (Lasix) or
bumetanide, are most commonly used.

19. ACE INHIBITORS
•Angiotensin-converting enzyme (ACE) inhibitors have
been shown to reduce proteinuria and reduce the risk of
progression to renal disease in persons with nephrotic
syndrome.

20. ALBUMIN
• Intravenous albumin has been proposed to aid diuresis,
because edema may be caused by hypoalbuminemia and
resulting oncotic pressures.
• Corticosteroids or immunosuppressive agents to decrease
proteinuria.

21. Nursing Assessment.
1. Obtain history of onset symptoms including changes in
characteristic of urine and onset of edema.
2. Perform physical examination looking for evidence of
edema and hypovolemia.
3. Assess vital signs, daily weights, intake and output,
and laboratory valves.

22. Nursing Diagnosis
1. Risk for Deficient Fluid volume related to disease
process.
2. Risk for infection related to treatment with
immunosuppressive agents.

23. Client Education and health Maintenance
 Teach client S/S of Nephrotic syndrome; also review causes,
purpose of prescribed treatments, and importance of long- term
therapy to prevent ESRD.
 Instruct to client in adverse effects of prescribed medications
and methods of preventing infection if taking
immunosuppressive agents.
 Carefully review with client and family dietary and fluid
restrctions.
 Discuss the importance of maintain exercise , decreasing
cholesterol intake and fat intake.