Nephrotic Syndrome
Definition
Nephrotic syndrome is a kidney disease characterized by:
- A marked increase in protein in the urine (proteinuria)
- A decrease of albumin the blood (hypoalbuminemia)
- Edema (swelling, especially around the eyes, feet, and hands)
- A high cholesterol and low density lipoproteins (hyperlipidemia)
This clinical disorder is seen in any condition that seriously damages the glomerular capillary membrane and results in increased glomerular permeability.
Causes
Primary causes of nephrotic syndrome include, in approximate order of frequency:
- Minimal-change nephropathy
- Focal glomerulosclerosis
- Membranous nephropathy
- Hereditary nephropathies
Nephrotic syndrome is caused by various disorders that cause damage to the kidneys, specifically the basement membrane of the glomerulus. This immediately causes abnormal excretion of protein in the urine. In children, the most common cause of nephritic syndrome is minimal change disease while inadults membranous glomerulonephritis is the most common cause.
Aside from the mentioned caiuses, this clinical disorder can also occur as a result of infection such as strep throat, hepatitis or monocnucleosis. Use of certain drugs, genetic disorders and immune disorders can also result to nephrotic syndrome.
Diseases that affect multiple body systems can also cause nephrotic syndrome. These are the secondary causes of nephrotic syndrome:
- Chronic glomerular nephritis
- Diabetes mellitus with intercapillary glomerulosclerosis
- Amyloidosis of the kidney
- Systemic lupus erythematosus
- Renal vein thrombosis
Frequency
- Nephrotic syndrome can affect all age groups.
- In children, it is most common from age 2 to 6.
- This disorder occurs slightly more often in males than females.
Clinical Manifestations
- The major manifestation of nephrotic syndrome is edema. It is usually soft and pitting, and is most commonly found around the eyes (periorbital), in dependent areas (sacrum, ankles and hands) and in the abdomen (ascites).
- Foamy appearance of the urine
- High blood pressure
- Weight gain from fluid retention
- Poor appetite
- Malaise
- Head ache
- Irritability
- Fatigue
Diagnostic Evaluation
- Urinalysis – shows microscopic hematuria, urinary casts, large amounts of protein and other abnormalities.
- Needle biopsy of the kidney – for histology examination of renal tissue to confirm the diagnosis
- Creatinine clearance, BUN, creatine blood test, albumin blood test (may be low)
Management
- Keep the patient on bed rest for a few days to promote diuresis, thereby, reducing edema.
- Low-sodium diet (for severe edema)
- Prednisone (adrenocorticosteroids) – to reduce proteinuria
- Diuretics – for severe edema
- ACE inhibitors or angiotensin receptor blockers (ARBs) – to control hypertension. ACE inhibitors may also help decrease the amount of protein loss in the urine.
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.
