Nephrotic syndrome ppt

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1. NEPHROTIC
SYNDROME
Mr. Abhijit Bhoyar
Lecturer

2. DEFINITION
Nephrotic syndrome is characterized
by massive protinuria
hypoalbuminemia, edema &
hyperlipidemia.

3. GENETIC DISORDER
•Nephrotic syndrome typical
•Finnish type congenital nephrotic syndrome.
•Focal segmental glomeurlo sclerosis.
•Diffuse mesangial sclerosis.
•Denys –drash syndrome.
•Schimke immuno ossesous dysplasia.
Etiology & Risk Factors

4. •Multisystem syndromes with or without nephritic
syndrome.
•Metabolic disorders with OR without nephritic syndrome.
•Idiopathic nephritic syndrome.
•Minimal change disease.
•Membranous nephropathy
•May also be consequence of inflammatory glomerular
disorder & features of nephritis.

5. SECONDARY CAUSES
Infection
Hepatitis B.C. HIV-1, malaria syphylis & toxoplasmosis.
Drug
Pencillamine gold non steroiodal anti-Inflammatory
drugs. Predominant infection, mercury heroin lithium.
Immunological and allergic disorders

6. Ct---SECONDARY CAUSES
•Malignant disease
•Lymphoma
•leukemia

7. TYPES( based on etiological factors)
Itisclassifiedbyprimary/idiopathic,secondaryandcongenital.
1.PrimaryNephroticSyndrome:Whenthesyndromeisassociated
with
•primaryglomerulardiseases.Itisthemostcommontype.Itisagainin
three
•formsieminimalchangenephriticsyndrome,mesangialproliferative
•nephroticsyndromeandfocalsclerosisnephroticsyndrome.

8. 2.SecondaryNephroticSyndrome:
•Whenthesyndromeoccursasapartofanysystemicdiseaseslike
DM,SLE,HTN,malignantmalaria,HIV/AIDS,drugtoxicityetc
3.CongenitalNephroticSyndrome:
•itiscausedbyarecessivegeneonanautosome.itisassociatedwith
othercongenitalanomaliesofkidney.
•Severerenalinsufficiencyandurinaryinfectionsalongwiththis
conditionresultsinpoorprognosis.

9. PATHOPHISIOLOGY
Due to etiological factors such as
idiopathic, Secondary & genetic
Glomerulardamage
Increased glomerular
permeability
Protenuria
&
Hypoalbumenemi

10. Decreased oncotic
pressure
Extravasations of fluid into the interstitial
space
Hypovolemia
Increased secretion of the RENNIN by the
kidney (RAAS stimulated)
Increased retention of sodium & water in
distal tubule caused edema

11. •Onset is insidious”thought to be caused by immune system
disturbances because it commonly occurs after a mild URI.
•Edemais typically the presenting symptom.
–Edema may be minimal or massive.
–Edema is usually first apparent around the eyes.
–Dependent edema occurs in areas of the body, such as the hands,
ankles, feet, and genitalia.
–Fluid that accumulates in the body spaces may give rise to ascites
and pleural effusions.
–Striae may appear on the skin from overstretching.
CLINICAL MANIFESTATION

13. •Profound weight gaincaused by edema; the child may
actually double normal weight.
•Decreased urine outputduring the edematous phase ”urine
appears concentrated and frothy.
•Pallor,
•Irritability,
•Lethargy,
•Fatigue.

14. •GI disturbances, including vomiting, diarrhea, and
anorexia caused by edema of intestinal mucosa.
•Hematuria and Oliguria
•Ascites
•Pleural effusion and respiratory distress
•Hepatomegaly
•Anaemia and infections

15. DIAGNOSTIC EVALUATION
•.Historyandphysicalexamination
•Urineexamination:itshowsgrossproteinuria(2-20g/day),
presenceofcast,slighthematuria,andincreasedspecificgravity.
•Bloodexamination:-itshowsreducedserumprotein
concentrations,albuminlessthan2.5g/dlandcholesterolmorethan
200mg/dl.LipoproteinsandBUNareincreased.Thereislessserum
sodiumandMgconcentrations.

16. •Renalbiopsy-itprovidesinformationregardingthe
glomerularstatusandthetypeofnephroticsyndrome,the
responsetodrugsandtheprobablecourseofdisease.Itis
indicatedincaseofpoorresponsetosteroidtherapy.
•Others:itincludeslowASOtitreandIgM,raisedIgGand
IgE

17. MANAGEMENT
•Medicalmanagement:
•GeneralMeasures:-Itisprincipallysupportive.Duringthe
edemaphasethechildisplacedonbedrest,buractivityis
notrestrictedduringremission.
•Diet:Itshouldincludehighprotein,saltrestricteddietand
fluidisalsorestricted.Dietshouldbeadjustedtothechild’s
appetiteandshouldnotinterferewithnutrientintake.

18. •Steroidtherapy:-Itshouldbeginassoonasthediagnosishasbeen
determined.Oralprednisoneisthedrugofchoicewhichisgiven2
mg/kg/dayin2-3divideddoseforatleast4-6wks.Antacidsarealso
givenalongwithprednisonetopreventgastriccomplications.
•Antibiotictherapy:-Itisindicatedinthepresenceofanyinfection.
•Diuretics:-Itisprescribedinthepresenceofmassiveedemaand
ascites.Loopdiuretics,frusemide(1-3mg/kg/dayin2doses)in
combinationwithmetolazoneisgiven.Pottasiumsupplementationto
begivenalongwithdiuretics.

19. ALBUMIN INFUSION
•Maybegivenincaseofmassive
edemaandascites.Ithelptoshiftthe
fluidfrominterstitialspaceintothe
vascularsystem.diuretictherapy
system.Diuretictherapyisgivenin
combinationofalbumininfusion
plasmaorbloodtransfusionmaybe
givenissomecasestotreat
hypoalbuminemia.

20. IMMUNOSUPPRESSIVE DRUGS
•May be administered along with Predinosolone in
case of frequent relapses and in steroid dependent
cases

21. SURGICAL MANAGEMENT
•Renal transplantation is indicated in end stage
renal failure due to steroid resistant glomerolo
sclerosis (focal and segmental)

22. 1. Fluid volume excess related to fluid accumulation in
tissue.
2. Difficulty in breathing related disease condition.
3. Risk for infection related to urinary loss of protein
and chronic steroid use.
NURSING MANAGEMENT
Assessment
Nursing diagnosis

23. Nursing diagnosis
4. Altered nutrition less than body requirement related
to loss of proteins through urine and anorexia.
5. Anxiety related to disease condition.

24. COMPLICATIONS
•Coagulation disorders
•Thrombosis
•Recurrent infections of various system
•Renal failure
•Growth retardation
•PEM
•Calcium and Vit D deficiency