Nephrotic syndrome.pptx

8/10/2019 Nephrotic syndrome.pptx

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Made Indra Ayu A.



Nephrotic syndrome is the excretion of 3.5 g

or more of the protein in the urine per day

and is characteristic of glomerular injuryNephrotic syndrome is more common in

children than adults and the causes usually

unknown (idiopathic) and only the kidney

usually organ that involved, termed primarynephrotic syndrome.

If is is cause by a systemic disease or other

causes (drugs, toxins), it is a secondary

nephrotic syndrome A peak incidence of Primary nephrotic

syndrome is on 2 and 3 years of age.



Disturbances in the glomerular basementmembrane leads to increase permeability toprotein and loss of electrical negative charge.

(Huether & McCance, 2008)

When protein is lost from the plasma, thepressure that draws fluid from the spacesbetween cell (interstisial spaces) back into thecirculation is greatly reduced

As the concentration of protein decrease, thepressure for water to move to the higherconcentration of protein increase

This causes loss of fluid in the circulation andleads to decrease fluid volume (hypovolemia)and low blood pressure

The excess fluid in the tissues result in edema

(Gutierrez & Peterson, 2007)



When blood pressure decreases, the kidneys

release renin, which raises blood pressure

and causes release aldosterone.

Aldosterone increase the amount of sodium

and water retained by the kidneys.

This extra fluid also leaks out of the

capillaries, which further contributes todeveloping edema.

(Gutierrez & Peterson, 2007)



Hypoalbuminemia results from urinary loss of

albumin combined with a diminished

synthesis of replacement albumin by the

liver. Loss of albumin stimulates lipoprotein

synthesis by the liver and hyperlipidemia



Minimal change nephropathy (MCN)

- The glomeruli often appear normal, andthere are few other renal structuralabnormalities.

- A systemic immune mechanism is a likelycause of the disese, and an unidentified

circulating permeability factor, released by Tlymphocyte, has been proposed.

Focal segmental glomerulosclerosis

- There is segmental loss of glomerular

capillaries with proliferation of themesangial matrik and adhesion of thecapillaries to Bowman’s capsule.

(Huether & McCance, 2008)



Proteinuria

A decrease in the amount of proteinin the plasma

Foamy urine output

Edema (periorbital)

Ascites

Respiratory difficulty from pleural

efusion

Anorexia, malobsorbtion, diarrhea



Pallor, with the skinny skin and

prominent veins

Blood pressure normal or slighty

decrease

Irritability, fatigue, lethargy

Hyperlipidemia

Lipiduria

Vitamin D deficiency



Tretment includes mild dietary restrictions

of fats, sodium, and potassiumDaily intake of 1 to 1.5 g of high biological-

value protein per kilogram of body weight

Vitamin D and iron are important

Fluids should be restricted if the patient is

hyponatremic

Infection should be treated vigorously

Drug therapy includes angiotensinconverting enzyme (ACE) inhibitors to

reduce proteinuria and to control

hypertension, if present.



Next.....

Diuretic such a furosemide

Albumin to treat edema

Steroid may be particularly effective

for the initial treatment of

nephrotic syndrome in children(glucocorticosteroid: prednisone)

Immunocupresive agents (i.e.,

cyclophosphamide) may be given tochildren who have relapses, are

resistant to steroid therapy, or both



Teach the patient and family about the

underlying cause or causes the disorder, theimportance of dietary therapy, and theprevention of infection

Monitor vital signs for fluid deficit. Assess breathsound for pulmonary edema as fluid moves intointerstisial spaces in the lungs

Assess for signs and symptoms electrolyteimbalance and infection

Monitor intake, output and daily weights

Promoto adequate dietary intake by monitoring

the patient’s degree of anorexia, depression,and malaise and making intervention asappropiate

Assist the patient and family in developingadequate coping skills for a chronic illness.





1. A, 7 years old come to Hospital andcomplaint that decreases of urine output.

After some examination there areproteinuria and hematuria. Blood presure140/90 mmHg, RR: 25x/m, HR: 103x/ m, T:37,8ºC (group 1 and 3)

2. B, 6 years old come to the hospital andcomplaint that he feel dispneu. And the area edema in periorbital. He looks palle and

weak. After some examination there aresome protein in the urine until 3.5 g. Bloodpressure: 100/60 mmHg, RR: 30x/m, HR: 88x/m, T: 36,7ºC (group 2 and 4)



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Nephrotic syndrome.pptx