Nephrotic syndrome is a symptom of glomerular inflammation. Nephrotic syndrome is a protein-wasting disorder. Nephrotic syndrome damages the glomerular capillary permeability.

Definition of Nephrotic syndrome

Nephrotic syndrome is a primary glomerular disease characterized by proteinuria, edema, and hypoalbuminemia.

Types of Nephrotic syndrome

1. Primary Nephrotic syndrome (85%)

• Minimal change Nephrotic syndrome.
• Most common Nephrotic syndrome.
• Focal segmental glomerulosclerosis.
• Membranous nephropathy.

2. Secondary Nephrotic syndrome (10%)

• Occur in children of all cases.
• Occur due to chronic glomerulonephritis.

3. Congenital Nephrotic syndrome

• Rare disorder.
• Occur due to serious and fatal problems associated with kidney disorder.

Cause of Nephrotic syndrome

• Glomerulonephritis
• Diabetes mellitus
• Autoimmune reaction due to antigen
• Renal disorder
• Antibody reaction
• Nephrotic substance
• Trauma and infection
• Renal thrombosis
• Systemic lupus erythematosus  (SLE)
• Viral infection

Pathophysiology of Nephrotic syndrome

Cause

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Damage glomerular

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Effect glomerular basement membrane

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Proteinuria

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Decrease serum albumin level (hypoalbuminemia)

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Oncotic pressure also decrease

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Fluid-filled up in extracellular space

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Edema.

Signs & Symptoms of Nephrotic syndrome

• Tried symptoms of Nephrotic syndrome –
  • • Proteinuria
    • Hypoalbuminemia
    • Edema.

• Hyperlipidemia
• Anorexia, weakness and fatigue
• Hypertension
• Shortness of breath ( SOB )
• Anaemia ( due to RBC loss )
• Irritability and restlessness
• Weight gain
• Ascites
• Puffiness around the eyes
• Abdominal pain and diarrhoea
• Pleural effusion and pulmonary edema.

Diagnosis of Nephrotic syndrome

• History collection and physical examination.
• Urine analysis ( 24 hrs. urine )

• Haematuria
• Proteinuria

• Blood test ( CBC )

• Serum protein decrease
• Serum cholesterol increase
• Blood urea nitrogen ( BUN )
• Serum creatinine (increase).

• Renal function test.
• Renal biopsy.
• Renal USG.
• X-ray
• Intravenous urogram ( IVU )
• Renal scan

Treatment of Nephrotic syndrome

• Drug of choice is prednisolone.
• Diuretic drug for edema.
• Corticosteroids and immunosuppressive drugs.
• Antilipidemic.
• Antihypertensive drugs.
• Antibiotics for infection.
• Anticoagulant therapy.
• ACE inhibitors.

Dite’s in Nephrotic syndrome

• A high protein diet, treat proteinuria condition.
• High carbohydrate diet.
• Sodium restriction diet.
• Fluid restriction.

Complications in Nephrotic syndrome

• Infection
• Hypovolemia
• Pulmonary edema
• Growth retardation
• Thromboembolic complication.

Nursing Management of Nephrotic syndrome

• Nurses monitor vital signs and patient daily urine output.
• Monitor daily weight of patients.
• Observe edema condition and restrict fluid intake.
• Diagnostic urinalysis and assess proteinuria.
• Provide a high carbohydrate and high protein diet to patients.
• Provide sodium restriction diet.
• Provide corticosteroid, diuretic and immunosuppressant therapy.
• Provide cell prescribe medication.
• Encouragement for oral hygiene.
• Maintain patient input and output charts.
• Nurses use proper aseptic techniques.

A nurse prepares the patient for hemodialysis.

• Provide physiological and emotional support.
• Nurses focus on a high-protein diet.

Key Points

1. Protein wasting renal disorder – Nephrotic syndrome. 
2. Tried symptoms of Nephrotic syndrome – Proteinuria, edema, hypoalbuminemia.
3. Common type of Nephrotic syndrome – Primary Nephrotic syndrome.
4. Drug of choice of Nephrotic syndrome – Prednisolone.
5. Common nursing action, when patient on diuretic therapy – Daily weight measure.
6. Common diet in aprotic syndrome – High protein diet.