Nephrotic syndrome is a collection of symptoms that indicates kidney damage. These symptoms include albuminuria, hyperlipidemia, hypoalbuminemia and dependent edema. Damaged glomeruli allow proteins, most commonly albumin, to leak into the urine. As albumin leaks into the urine, the blood can no longer absorb the fluid which results in edema and leads to ascites.
Primary nephrotic syndrome is caused by certain diseases that specifically affect the kidneys and include minimal change nephropathy, focal segmental glomerulosclerosis, which is the formation of scar tissue within the glomeruli and membranous nephropathy, which occurs when immune molecules form deposits on the glomeruli.
Secondary nephrotic syndrome occurs secondary to other systemic diseases such as diabetes (most common), lupus, amyloidosis, and renal vein thrombosis. The overuse of NSAIDS and some antibiotics is also attributed with damage to the glomeruli. Infections such as HIV, hepatitis B, hepatitis C and malaria may increase the risk of developing kidney disease.
Maintain adequate fluid balance and nutrition
Temperature- monitor for signs of infection, especially with immunosuppressant therapy
Blood pressure- hypotension may indicate hypovolemia
Heart rate- tachycardia may be a sign of infection or hypovolemia
Monitor fluid balance
Insert indwelling catheter unless contraindicated for infection
Indwelling catheter will provide more accurate measurement of urine output
Monitor diagnostic studies
Assess for skin integrity
Lack of protein in the blood reduces the integrity of skin and increases the risk of breakdown and ulceration.
Assess dependent and periorbital edema
Evaluate and report degree of edema (+1 – +4)
There may be a gain of up to 10lbs of fluid before pitting is noticed
Administer medications and evaluate response
Monitor for volume depletion with use of diuretics
Diuretics help to flush out fluid from the tissues to decrease edema. Excess urination may result in volume depletion and lead to dehydration or hypovolemia
Monitor for corticosteroid toxicity for ongoing use
Long term use of corticosteroids can have severe side effects. Monitor for:
Assist with Rest / Ambulation
Initially, bed rest is encouraged to help mobilize edema.
After the first few days of treatment, encourage ambulation and elevation for venous return and prevent thromboses
Provide nutrition education
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