Nephrotic syndrome in children

Dhanya VJ, Assistant Professor, Child health nursing,SUM nursing college,Bhubanewsar

2. NEPHROTIC SYNDROME
DHANYA VJ
ASSISTANT PROFESSOR
SUM NURSING COLLEGE

4. DEFINITION
Nephroticsyndromeisasymptomcomplex
manifestedby massive edema,
hypoalbuminemia,markedalbuminuriaand
hyperlipidemia(hypercholestremia).

5. INCIDENCE
•Common among 2-6 yrs.
•More common in males.
•Mean age is 2.5 yrs
•Incidence 2-7/1000 children

6. TYPES OF NEPHROTIC SYNDROME
•1.Congenital nephrotic syndrome
•-rare but serious fatal problem
•Associated with other congenital anomalies
of kideney.
•Inherited autosomalrecessive disease

7. 2.Primary or Idiopathic nephrotic
syndrome
•Most common type (90%)
•It is regarded as autoimmune phenomenon
as it responds to immuno suppressive
therapy
•It includes minimal change nephrotic
syndrome, mesanglialproliferative nephrotic
syndrome and focal sclerosis nephrotic
syndrome

8. 3.Secondary Nephrotic syndrome
•Occurs in 10 % of children.
•It may occur due to
Chronic glomerulonephritis
Diabetesmellitus
SLE
Malaria
HepatitisB
Drugtoxicity
HIV

9. ETIOLOGY
Primary glomerular
disease
Membraneous
proliferative disease
Focal glomerulonephritis

10. Extrarenal cause
4
•Allergens: Inhaled pollens
5
•Drug-Pencillamine, NSAIDS, Captopril,
Heroin
6
•Toxins : Mercury, Bismuth
•Gold

11. PATHOPHYSIOLOGY
Alteration in glomerularmembarane
Glomerular permeability to protein
Increased loss of protein in urine
Decreased osmotic pressure

12. Decreased vascular volume
Decreased renal blood flow
Increased secretion of aldosterone
Tubular sodium and water reabsorption
Edema

13. CLINICAL MANIFESTATIONS
Four main symptoms of nephritic symptoms:-
•Proteinuria
•Hypoalbuminemia
•Hyperlipidaemia
•Oedema

14. CLINICAL MANIFESTATIONS
•Onset is slow
•Edema around eyes ,legs and labia
•Anasarca

15. CLINICAL MANIFESTATIONS
•Ascites
•Decreased urine output (frothy, increased
specific gravity)
•Hematuria
•Edema-pitting edema,
Periorbital edema,
Peripheral edema

16. CLINICAL MANIFESTATIONS
•Loss of appetite but weight gain
•Shortness of breath
•Pallor
•Fever, rash, joint pain
•Irritability
•Flank pain
•Malaise

17. DIAGNOSTIC EVALUATION
•Gold standard test:-24 hrs urine protein
measurement.(proteinuria>3.5 g per litreper
24 hr)
•Albumin level is <2.5 g/dl (normal 3.5 –5
g/dl)
•Elevated LDL ,VLDL
•Urea, creatinine
•Biopsy of kidney

18. DIAGNOSTIC EVALUATION
•Low ASO titer and IgM raised IgG,IgE, serum
complement is normal.
ECG
KUB –X-ray
Renalultrasound
Renalscan
Intravenous urogram(IVU).

19. MEDICAL MANGEMENT
•Steroid therapy :-Prednisolone 2 mg /kg/day
at least 4 to 6 weeks.
•Antacid to prevent gastric complication
•Antibiotic therapy

20. MEDICAL MANGEMENT
•Diuretics :-Frusemide 1-3 mg/kg/day or
Spirinolactone 2-3mg/kg/day
•Potassium supplementation

21. MEDICAL MANGEMENT
•Albumin infusion (1gm/kg/day)incase of
massive edema.
•Incase of hypoalbuminemia ,blood
transfusion or plasma given
•Immunosuppressive drugs :-methotrexate,
cyclophosphamide

22. DIETARY MANGEMENT
•Childrenshouldtakeawell-balanceddiet
richinprotein.Sodiumisrestrictedwhen
markededemaispresent.
•Providehighproteinandhigh
carbohydratesdiettopatient.
•Ifdiseaseinadvancestagethenavoid
proteinintakebecauseitisaffectedtokidney.
•Waterrestrictionmaybeindicatedif
decreasingsaltintakedoesnotcontroledema.

24. NURSING MANAGEMENT
•Care during hospitalisation
•Administer medications
•Maintain fluid electrolyte balance
•Prevention of infection
•Promote rest
•Provide emotional support

25. NURSING MANAGEMENT
NURSING DIAGNOSIS:
•Riskforinfectionrelatedtoimmunosuppressive
drugs.
•Fluidandelectrolyteimbalancedrelatedto
edema.
•Impairedskinintegrityrelatedtodisease
process.
•AlterednutritionrelatedtoAnorexia.
•Alteredkidneyfunctionrelatedtodisease
condition.
•Knowledgedeficitrelatedtodiseaseprocess.

26. COMPLICATIONS
•ACUTE RENAL FAILURE
•ATHEROSCLEROSIS
•CHRONIC KIDNEY DISEASE
•CHF
•PULOMONARY EDEMA
•INFECTION