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Nephrotic Syndrome- The mulas-1.ppt

  1. Nephrotic Syndrome By Mwila B. C. (2009)
  2. Definition  Nephrotic syndrome is a renal disorder due to damage to the renal glomeruli resulting in heavy protein urea, low plasma protein, hyper lipidemia and generalized oedema(Anasarca).  It is a renal disease characterized by increased permeability of the glomeruli to protein (Protein urea), low plasma protein, hyperlipidemia and generalized oedema
  3. Causes  Nephrotic syndrome has been associated with allergic reactions such as;  Insect bites  Pollen  Acute glomerulonephritis especially the minimal change type  Post-streptococcal glomerulonephritis  Infections  Herpes zoster, HIV, hepatitis B, hepatitis C, syphilis, malaria, tuberculosis.
  4. Causes cont  Systemic diseases  Diabetes mellitus  Systemic Lupus erythematosus (a chronic inflammatory disease)  Amyloidosis (A disease in which a wax, starch like , glycoprotein (or amyloid) accumulates in the tissue and organs)  Sickle cell disease 4. Circulatory problems  Severe congestive heart failure  Constrictive pericarditis
  5. Causes cont  Cancers  Hodgkin’s  Lung  Colon  Breast  Renal transplantation  Chronic kidney failure  Pregnancy (Pre eclampsia)  Chronic kidney failure  The cause of nephrotic syndrome in children is usually idiopathic
  6. Causes cont  Medicines, such as nonsteroidal anti-inflammatory drugs, penicillamine, gold therapy, or captopril.
  7. Incidence  Males are more commonly affected than females.
  8. Pathophysiology  The initial physiologic change is damage to the cells in the glomerular basement membrane from immune complex deposition, nephrotoxic antibodies or any other cause already mentioned.  The damage results in increased glomerular basement membrane porosity and permeability to protein resulting in proteinuria
  9. Pathophysiology cont  This results in reduced plasma protein such as albumin.  The reduced plasma protein leads to reduced oncotic or osmotic pressure.  This will lead to increase movement of fluids from the intra vascular spaces into the extra vascular as well as reduced ability to pull back fluids into the capillaries
  10. Pathophysiology cont  This will lead to edema  Fluid loss from the vascular system to the extra vascular will lead to reduced circulatory volume (Hypovolaemia)  This will lead to reduced cardiac out put which will culminate in reduced renal blood flow  This will cause Reduced glomerular filtration rate (GFR), causing renal ischaemia.
  11. Pathophysiology cont  This will lead to the release of rennin  Rennin will cause the activation of angiotensinogen to angiotensin I  Angiotensin I will later be converted to angiotensin II with the help of angiotensin converting enzyme.  Angiotensin will cause vasoconstriction in order to increase renal blood flow.
  12. Pathophysiology cont  It will also lead to increased secretion of aldosterone to retain more sodium and water  This will worsen the oedema causing it to be generalized (Anasarca)  Proteinuria: Occurs due to the structural damage to the glomerular basement membrane  An increase in size and number of pores allows passage of more and large protein molecules
  13. Pathophysiology cont  Negatively charged fixed components in the capillary walls of the glomerular repel negatively charged protein molecules  Reduction of these fixed charged components results in the genesis of heavy proteinuria
  14. Pathophysiology cont  Hyperlipidaemia: Diminished plasma oncotic pressure stimulate hepatic lipoprotein synthesis  Low-density lipoproteins and cholesterol are elevated most frequently causing the Hyperlipidaemia.
  15. Signs and symptoms  Severe generalized oedema due to low albumin level and retention of water and sodium  Pronounced proteinuria due to damage to the glomerular basement membrane  Hypoalbuminemia due to albiminuria  Hyperlipidemia due to increased hepatic synthesis of lipids  Urine volume and renal function may be either normal or greatly reduced to damage to the kidney.
  16. Signs and symptoms cont  Dyspnea due to pulmonary oedema or congestion.  Peri orbital edema due to low plasma protein  Fatigue is common as renal function reduces dramatically.  Anorexia is common due to GIT involvement, ascitis with impaired absorption.
  17. Diagnosis  Blood for serum albumin will be low  Blood for serum cholesterol will be increased  Blood for Urea and electrolytes will show electrolyte imbalance such as low potassium levels.  Renal biopsy will help to confirm the diagnosis or reveal the extent of renal damage  Urinalysis will show proteinuria
  18. Diagnosis cont  Creatinine and creatinine clearance. Results of these tests give information on how well your kidneys are working.  History may reveal predisposing factors like gold poisoning, diabetes, etc  Clinical feature will show generalized oedema  Kidney ultrasound to look at the kidneys. This exam can rule out other cause.  A 24-hour urine collection, which measures the total amount of protein in the urine collected over 24 hours> it will show that protein loss is high.
  19. Treatment  Treatment of nephrotic syndrome depends on the cause of the disease and may include:  Diuretics, such as or furosemide (Lasix), to reduce oedema dose 0.5-1.5mg/kg body weight.  Medications, such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs), to reduce the amount of protein lost in the urine, lower blood pressure, and slow the progress of the disease.  In rare cases, salt-free albumin given through a vein (IV). Albumin helps remove extra fluid from the tissues.
  20. Treatment cont  Corticosteroids may be useful in controlling the illness,e.g. hydrocortisone 25-100mg. Or predinisolone5-25mg daily.  Bed rest in patients with severe oedema or those with infections  Antibiotics if infection suspected or for prophylaxis e.g. Amoxyl 62.5-250mg tds for 5/7  Dietary protein is prescribed at 1g/kg body weight.
  21. Nursing care Refer to Glomerulonephritis
  22. Nursing management NURSING MANAGEMENT  Monitor patient’s intake and output  Weigh patient daily to monitor oedema  Assess skin condition for any skin breakdown  Observe for signs and symptoms of infection and pulmonary oedema
  23. Nursing management cont  Promote adequate nutrition  Offer oral hygiene regulary to help reduce metallic taste  Prevent infection because urinary protein losses impair body defences  When infection is suspected address the problem immidiately
  24. Nursing management cont  Protect patient against sources of infection  Invasive procedures must be avoided or performed under strict aseptic technique  Edematous tissue is susceptible to skin breakdown and infection
  25. Nursing management cont...  Careful positioning and frequent change of position increase comfort and prevent infection  Air or water matresses may increase comfort and relieve skin pressure
  26. Nursing management cont  Educate patient on medication regimen  Educate patient on dietary adjustments and methods to meet nutritional needs  Educate patient to assess self for fluid status
  27. Nursing management cont  Promote good habits to prevent infection  Emphasize need for follow- up care to monitor renal function
  28. Nursing management cont  Kidney failure  CCF due to fluid overload  Pulmonary edema
  29. End of the lecture Thank your for your attention And may our good lord bless and protect you all (Mwila b. c. 2009)