Transcript Nephrotic Syndrome File

presentation: nephrotic
syndrome
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Definition
Pathophysiology
Sign and symptom
Clinical manifestation
Assessment and diagnosis
Complication
Medical management
Nursing management
Physiology of the Upper and
Lower Urinary Tracts
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The healthy human body is composed of
approximately 60% water. Water balance is
regulated by the kidneys and results in the
formation of urine. Urine is formed in the
nephrons through a complex three-step
process :
three-step process :
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glomerular filtration
absorption into peritubular capillaries
reabsorption into tubule
Glomerular Filtration
about 20% of the blood passing through the glomeruli
is filtered . The filtrate normally consists of water,
electrolytes, and other small molecules, because
water and small molecules are allowed to pass,
whereas larger molecules stay in the bloodstream.
Efficient filtration depends on adequate blood flow
that maintains a consistent pressure through the
glomerulus. Many factors such hypotension can
alter this blood flow and pressure.
Tubular absorption and Tubular
reabsorption for excretion in urine
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capillaries into tubular filtrate, 99% is reabsorbed
into the bloodstream, resulting in the formation of
1000 to 1500 mL of urine each day. Although most
reabsorption occurs in the proximal tubule,
reabsorption occurs along the entire tubule.
Reabsorption and secretion in the tubule frequently
involve passive and active transport and may require
the use of energy. Filtrate becomes concentrated in
the distal tubule and collecting ducts under hormonal
influence and becomes urine, which then enters the
renal pelvis.
Nephrotic syndrome
 Definition
:
is a type of renal failure characterized
by increased glomercular permeability
Pathophysiology
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Nephrotic syndrome can occur with almost
any intrinsic renal disease or systemic
disease that affects the glomerulus. Although
generally considered a disorder of childhood,
nephrotic syndrome also occurs in adults,
including the elderly. Causes include chronic
glomerulonephritis, diabetes mellitus with
intercapillary glomerulosclerosis, and renal
vein thrombosis.
Sign and symptoms:
1.Marked increase in protein (particularly
albumin) in the urine (proteinuria)
2. Decrease in albumin in the blood
(hypoalbuminemia)
3. Edema
4. High serum cholesterol
Clinical Manifestations
The major manifestation of nephrotic
syndrome is
1- edema commonly occurs around the eyes
(periorbital), ankles, and hands, and in the
abdomen (ascites).
2- irritability
3- headache
4- malaise.
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Assessment and Diagnostic Findings
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Proteinuria (predominately albumin)
exceeding 3.5 g/day is the hallmark of the
diagnosis of nephrotic syndrome . The urine
may also contain increased white blood cells
(WBCs) as well as granular and epithelial
casts.
A needle biopsy of the kidney may be
performed for histologic examination of renal
tissue to confirm the diagnosis.
complication:
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Complications of nephrotic syndrome include:
infection (due to a deficient immune response)
Thromboembolism (especially of the renal vein)
pulmonary emboli
accelerated atherosclerosis (due to
hyperlipidemia).
Medical managements:
1- Diuretics may be prescribed for the patient with
severe edema.
2- The use of angiotensin-converting enzyme (ACE)
inhibitors in combination with loop diuretics often
reduces the degree of proteinuria
3- Other medications used in treating nephrotic
syndrome include antineoplastic agents
(cyclophosphamide ) or immunosuppressant
medications (azathioprine
Nursing Management:
1- In the early stages of nephrotic syndrome, nursing
management is similar to that of the patient with
acute glomerulonephritis, but as the condition
worsens, management is similar to that of the patient
with chronic renal failure
2- The patient who is receiving corticosteroids or
cyclosporine requires instructions about the
medications and signs and symptoms
3-. When indications of an acute infection, such as an
acute respiratory tract infection, are first apparent,
increased maintenance doses of corticosteroids
Regulation of Acid–Base Balance:
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The normal serum pH is about 7.35 to 7.45 and must
be maintained within this narrow range
The first is to reabsorb and return to the body's
circulation any bicarbonate from the urinary filtrate
the second is to excrete acid in the urine. Because
bicarbonate is a small ion, it is freely filtered at the
glomerulus. The renal tubules actively reabsorb most
of the bicarbonate in the urinary filtrate. To replace
any lost bicarbonate, new bicarbonate is generated
by the renal tubular cells through a variety of
chemical reactions. This newly generated
bicarbonate is then reabsorbed by the tubules and
returned to the body.