NEPHROTIC SYNDROME AND CHRONIC NEPHRITIS

NEPHROTIC SYNDROME AND CHRONIC NEPHRITIS

NEPHROTIC SYNDROME AND CHRONIC NEPHRITIS

NEPHROTIC SYNDROME AND CHRONIC NEPHRITIS

Introduction:

Nephrotic syndrome is no single disease entity, rather it is a conglomeration of symptoms and sign having more than one cause. The syndrome is of such potency that large quantities of protein is lost in urine resulting in loss of plasma albumin and fall in plasma osmotic pressure sufficient to cause oedema

Causes of Nephrotic Syndrome

The Condition is usually associated with the following

  • allergic reactions e.g. in insect bite
  • acute glomerulonephritis
  • infections like herpes zoster
  • systemic disease like diabetes mellitus and sickle cell
  • circulatory problems such as severe C.C.F and chronic constructive pericarditis

N/B: Glomerular disease is the main invent in adult while it might be cryptogenic or idiopathic

Pathophysiology of Nephrotic Syndrome

The kidney will produce Renin which combines with globulin to give angiotensin. Then angiotensin act on supra renal gland to release Aldesterone. The aldesteron will make the kidney to reabsorb water. Sodium is also absorbed with water which causes more retention of water. Causing Anasaka Oedema.

N/B: Nephritis can go from Acute to Chronic to Syndrome

"Nephrotic Syndrome and Chronic Nephritis"

Initial change in this condition is derangement of cells in the glomerular basement membrane. There is porosity in the membrane with loss of large quantity of protein in urine, while proteinuria increases, serum albumin decreases resulting in decrease osmotic pressure. The tissue capillaries have increased osmotic pressure than other cappillaries thus a pull is exerted and oedema occurs. Because of the loss into the tissue of fluids, plasma volume of fluid decreases. This leads to stimulation of production of aldesterone thus there is retention of electrolyte especially sodium and water, thereby increasing the oedema.

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Clinical manifestation

  • severe generaalized oedema
  • large (pronounced) proteinuria
  • hypo albunaemia
  • hyper lipidaemia (fat)

 

"Nephrotic Syndrome and Chronic Nephritis"

 

Diagnostic tests

  • clinical manifestations
  • lab findings
  • renal biopsy

Nursing care

  • Rest- same as in acute nephritis
  • Diet- high protein, high calorie and reduced salt
  • Observation- same as in acute nephritis. Steroid chart
  • Skin integrity- because he is oedematous, treat pressure areas
  • Hygiene- same
  • Emotional support as usual as in chronic nephritis
  • Medication- steroids, diuretics, antibiotics maintain steroid chart

Complication

The same as in acute nephritis. Protein malnutrition, high coagulability and blood (venous thrombosis)

 

"Nephrotic Syndrome and Chronic Nephritis"

 

CHRONIC NEPHRITIS

Chronic nephritis a condition that describes prolonged case of nephritis. It follows acute nephritis. However most clients may not present any evidence of predisposing history but that of infection can be found. The course is varied in some cases there is minimal impaired function and patient feels well showing little progression of disease with others there is high progression which usually ends in renal failure while in others it can be rapid

Etiology

  • Acute nephritis
  • Infection

Pathophysiology

There is slow but progressive damage of the glomeruli. The glomeruli shows hyper cellularity and becoming hardened. There is decreased kidney size, tubular atrophy, chronic interstitial inflammation and artreosclerosis. The gradual loss if renal function lastly occurs.

"Nephrotic Syndrome and Chronic Nephritis"

Clinical manifestations

Slow onset of recurrent dependent oedema, mild headache, dypsnea especially on exertion. Difficulty in steeping on lying flat, blurred vision, nocteuria, urinalysis usually shows albumin, cast and blood

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Management

  • no specific therapy exist occur
  • ensure rest through the patient may live a normal life
  • modify diet
  • taking care in administration of sodium
  • ensure balance diet with large quantities of protein
  • attempt steroid as certain forms may respond to the use of steroid
  • meticulous skin care
  • care of oedema especially in scrotum
  • monitor oral and parential fluid
  • watch for loss of appetite

Complication and prognosis

May be good or bad. May be renal failure, Uraemia

 

"Nephrotic Syndrome and Chronic Nephritis"

 

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