Wilm’s Tumor&

Nephrotic SyndromeBy

M.Maheswari,3rdYear B.Sc(N),

GCON,RIMS,kADAPA

Age Race Gender Family history Certain genetic factors\Birth defects WAGR Syndrome Beck with-Weidman syndrome Denys-Drash Syndrome

Bloom syndrome Soto’s syndrome Perlman syndrome

Aniridia

Hemi hypertrophy

Cryptorchidism

Hypospadias

Tumors arise from renal parenchyma in either central or polar location

↓Tumor may be a rim of compressed normal tissue

↓ Expanding mass surrounded by pseudo capsule

of connective tissue↓

Appears to separate kidney tumor ↓

Tumor get encapsulated (thin& easily torn)↓

Growth rapid↓

Become↓

Vascular, soft, gelations&necrotic in the center

Fever Nausea Loss of appetite Short ness of breathing Constipation Without pain a mass in abdomen Swelling or a hard mass in the abdomen

Medical History and physical examination

Imaging test Ultrasound (sono gram) CTscan MRIscan Chest X-ray Bone scan Lab tests Kidney biopsy

This system describes wilm’s tumor stages using Roman numbers I to V

STAGE I:- The tumor within the kidney and was completely removed

by surgery.STAGE II:- The tumor has grown beyond the kidney. About 20% of all

wilms tumors are stage-2.STAGE III:- The tumor has spread to lympnodes in the abdomen or

pelvis. STAGE IV:- The cancer has spared through the blood to organs away

from the kidneys such has the LUNGS, LIVER, BRAIN or BONE, or to LUMPH NODES four away from the body.

STAGE V:- Tumors are found in both kidneys at stage V

There are 3 types1. Chemotherapy2. Surgery3. Radiation therapy

Under the chemo the drugs used for six monthsThe drugs are Actinomycin-D

Vincristine

Doxorubicin

Cyclophosphamide

Carboplatin

Dose:- 15mg /kg daily by intravenous route for 5days.

Action:- It is antibiotic obtained from species of Streptomyces.

It is very toxic and hence its use is limited

Inhibition of mitotic spindles, they are obtained from the periwinkleplant, rosea, vinca.

Uses:- Hodgkin’s disease and acute lymphatic leukemia.

The drugs affect rapidly growingcells and produce the bonemarrow depression leading to leucopnia, anemia and thrombocytopenia

Hair lossMouth soresLoss of appetiteNausea and VomitingDiarrhea

Remove the kidney

Radical nephrectomy

Partial nephrectomy

Surgical Exploration

Injuries to major Blood Reaction to Anesthesia

Internal Bleeding

Infections

Radiation Therapy uses high-energy rays, or particles to kill

cancer cells.Newer radiation techniques:- 3D-CRT

IMRT

Damage the ovaries

Hair loss

Skin reactions

Nausea

Reduced kidney functions

Heart or lung problems

Slowed or delayed growth and development

Increased risk of Second cancers later in life

NURSING MANAGEMENTNURSING DIAGNOSIS Altered thermoregulation of body

temperature r/t to infections as evidenced by checking vital signs.

GOAL To reduced temperatureINTERVENTION Provide comfortable position. Assess the fever characteristics. Provide cold compress of the body

In effective air way clearance related to broncho spasm as evidenced by breath

less ness.GOAL To improve breathing pattern.Intervention Assess the breathing pattern Provide the O2 inhalation or nebulization Provide broncho dilators

Altered nutrition less than body requirements related to anorexia as evidenced by weight loss.

GOAL To improve nutritional status.Intervention Assess the nutritional status of the client Monitor food intake not weight loss or

weight gain Maintain favorable eating fluids as ordered

There is the remarkable correlation a among the DNA content in the cells of wilm’s tumor, histologic sub type, and treatment out come. Stem lines of both the primary tumor and Meta stases are in the diploid and low aneploid (hyper diploid) range

Introduction:- Nephrotic syndrome is primary a

paediatric disorder and is 15 times more common in children than adults.

Nephrotic syndrome is one of the common cause of hospitalization among children.

Definition:- Nephrotic syndrome is a symptom

complex manifested by massive edema, hypoalbuminemia, marked albuminuria and hyper-lipidemia.

“Parul data”. Nephrotic syndrome refers to a kidney disorder characterized by protenuria, hypoalbuminemia, and edema.

“Jean weiler”.

The annual incidence of nephritic syndrome in the united states in children younger than 16years is 2 per 1,00,000 children (rother berg and heymann.1957; Schlesinger, 1968, sultz,1972) and cumulative prevalence is 16 per 1,00,000 children (Schlesinger,1968).

Congenital nephritic syndrome

primary or idiopathic nephritic syndrome

secondary nephritic syndrome

Genetic disorder:- Typical Nephrotic syndrome:- Finnish focal segmental glomerulo sclerosis Diffuse mesengial sclerosis Protinuria Multisystem Metabolic disorder

Minimal change disease

Membranous nephropathy

Infections;- Hepatitis B&C

HIV-1

Malaria

Syphillis

Penicillamine

Mercury

Lithium.

Immunologic or Allergic disorder:- Foodallerges Associated withmalignent disease:- Lymphoma Leukemia Glomerular Hyper filtration:- Morbid Obesity

Primary Cause:- Conginital or genetic cause Membranous nephropathy Secondary cause:- Infections Drug reactions Haemolytic uremic syndrome

Alteration in the glomerulus

Hypovolemia

Increased reninproduction Reabsorption of sodium

EDEMA

Ascites Pleural effusion Genital edema Anorexia Abdominal pain Diarrhea Vomiting Fatigue Lethergy Periorbital puffiness Profound weight gain Respiratory Distress Heamaturia Hepatomagaly

History of illness Physical Examination Laboratory investigations Urine Examination Blood examination Renal biopsy

Albumin infusion (1gm/kg/day) may be given in case of massive edema and ascites.

Immunosuppressive drugs (levamisole, methotrexate, Cyclophosphamide, Cyclosporine, Chlorambucil)

Prednisone at a dose of 2mg/kg/day Remission steroids Initiative therapy Cyclophosphamide or Chlorambucil Cyclosporine

Frusemide-1to3mg/kg/day in divided doses along with Spironolactone 2to mg/kg/day in two divided doses is given.

Oral Penicilline

Nursing Diagnosis:- Risk for impaired skin integrity r\t

to edema and decreased circulation Goal:- To improved circulation Interventions:- Ensure that the child changes position

every 2 hours Maintain good hygiene

Risk for infection r\t to urinary loss of gamma globulins and immune suppressive therapy

Goal:- To reduced infection Interventions:- Administered antibiotics as ordered Monitor child for fever, cough, and

sore throat

Excess fluid volume r\t to decreased excretion of sodium and fluid retention

Goal:- To decreased fluid volume Interventions:- Monitor intake and output each shift Monitor blood pressure at least once

each shift

Growth retardation, Renal Failure Thrombosis Recurrent infections Immune suppressive therapy Thrombosis Coagulation disorders Pleural effusion

Calcium and vitamin-D Deficiency

Protein Energy malnutrition

Relapse of Nephrotic Syndrome

The majority of children with steroid-responsive nephritic syndrome have repeated relapse. Which generally decreased in frequency as the child grows order. Although there is no proven way to predict an individual child’s course, those children who respond to steroids rapidly and those who have no relapse.

Over the past few decas, research in to wilm’s tumor has to great advances and much higher cure rates for this type of cancer. Still, not all children are cured, and even those who are cured might still have long-term side effects from treatment, so more research is needed.

Research is continuing to unravel how changes in certain genes cause wilm’s tumors and affect how aggressive tumors are likely to be.

Researches are also studying the gene changes that seem to cause wilm’s tumor cells to grow and spread. This may lead to treatments that specifically target these changes.

Research continues to study ways to improve treatment for children with wilm’s tumors.

As researches have learned more about the gene changes inwilms tumor cells. They have started to develop never drugs that specifically target these changes.