Pediatric Nephrotic Syndrome

Pediatric Nephrotic Syndrome

  • Nephrotic syndrome is characterized by heavy proteinuria, hypoalbuminemia, and edema.
  • Pediatric nephrotic syndrome are usually the primary type.
  • Approximately 85% to 95% of primary cases in preadolescents are minimal change nephrotic syndrome and are associated with minimal histologic changes in the glomeruli.
  • Nephrotic syndrome annually inflicts about 16 children per 100,000 younger than age 16 in the United States.
  • It is slightly more common in males than females in younger children, but this disappears in teenagers and adults.
  • Mean age of onset is 2 and a half years.

Pathophysiology:

  • Underlying defect is thought to be caused by the loss of charge selectivity of the glomerular basement membrane, which permits negatively charged proteins, primarily albumin, to pass easily through the capillary walls into the urine.
  • Excessive urinary loss of protein and catabolization by the kidney of circulating albumin leads to a decrease in serum protein.
  • The colloidal osmotic pressure that holds water in the vascular compartments is reduced because of the decrease in the amount of serum albumin. This allows fluid to flow from the capillaries into the interstitial spaces, thus producing edema.
  • The shift of fluid from the plasma to the interstitial spaces reduces the vascular fluid volume, which in turn stimulates the renin-angiotensin system and the secretion of the the antidiuretic hormone and aldosterone.
  • Tubular resorption of sodium and water is increased to increase intravascular volume.
  • The loss of proteins, particularly immunoglobulins, predisposes the child to infection.

Clinical Manifestations:

  • Edema
  1. Periorbital edema usually becomes apparent first
  2. Dependent edema in the hands, ankles, feet, genitalia
  3. Ascites and pleural effusions
  4. Striae due to overstretching
  • Profound weight gain
  • Decreased urine output
  • Pallor, irritability, lethargy, fatigue
  • GI disturbances such as vomiting, diarrhea and anorexia

Diagnostic Evaluation:

  • Urinalysis, usually with protein of 2+ or greater
  • 24-hour urine protein, frequently greater than 2 g/m2 per day
  • Total protein and albumin reduced
  • Cholesterol, greater than 200 mg/dL

Complications:

  • Peritonitis
  • Septicemia
  • Cellulitis
  • Thrombosis
  • Acute renal failure

Management:

  • Steroid therapy
  • Immunosuppressants:
  1. Cyclophosphamide
  2. Cyclosporin A
  3. Tacrolimus
  • IV Albumin 25%

Nursing Management:

  • Relieve excess fluid by administering steroids or alternative drugs as prescribed.
  • Offer foods high in potassium, low in sodium, fat and sugar.
  • Encourage activity as tolerated.
  • Restrict fluids as ordered. Strictly monitor intake and output.
  • Weigh patient daily.
  • Provide meticulous skin care to the edematous parts of the body.
  • Give emotional support to the child and his parents.
  • Help child adjust to body image changes by explaining changes ahead of time.

Photo credits: www.medicaldude.com

Daisy Jane Antipuesto RN MN

Currently a Nursing Local Board Examination Reviewer. Subjects handled are Pediatric, Obstetric and Psychiatric Nursing. Previous work experiences include: Clinical instructor/lecturer, clinical coordinator (Level II), caregiver instructor/lecturer, NC2 examination reviewer and staff/clinic nurse. Areas of specialization: Emergency room, Orthopedic Ward and Delivery Room. Also an IELTS passer.

What Do You Think?