NEPHROTIC SYNDROME SYMPTOMS; CAUSES,DIAGNOSIS, DIET, TREATMENT
Nephrosis is a syndrome that may be an outcome of renal disorders (Nephrotic syndrome symptoms) especially glomerular nephritis in which there are proteinurea (presence of excess protein in the urine), hypoalbuminurea(low deposit of albumin in the urine), oedema(abnormal infiltration and excess accumulation of serious fluid in connective tissue) and hyper lipidemia(presence of excess fat or lipids in the blood). More so, Nephrotic syndrome symptoms is an abnormal condition that is marked by deficiency of albumin in the blood and its excretion in the urine due to altered permeability of the glomerular basement membranes
TYPES OF NEPHROTIC SYNDROME
There are three types of Nephrosis:
- Inherited or Congenital Nephrotic Syndrome: The Clients are small gestational age they do not respond to treatment and often die within 2 years
- Secondary Nephrotic Syndrome: Follows known glomerular disease such as glomerulo-nephritis, collagen diseases, toxicity to drugs, sickle cell disease or diabetes mellitus
- Idiopathic Nephrotic Syndrome: Over 80% of Nephrotic Syndrome in Children is idiopathic, occurring in young children 2 to 3 years of age.
PATHOPHYSIOLOGY OF NEPHROTIC SYNDROME
The major pathological changes in nephrosis occur at the basement membrane of the glomerulus. The cause is not known but it is speculated to be an antigen-antibody reaction of biochemical changes that causes increased basement membrane permeability. This allows protein albumin to pass through (5 to 15gms of protein in 24hrs).
Hypoalbuminaemia (nephrotic syndrome symptoms) decreases colloid osmotic pressure and draws fluid out of the vascular compartment into the interstitial spaces resulting in oedema. Hypo-volaemia(reduced volume of blood) decrease renal plasma flow and glomerular filteration rate, activating the renin-angiotensin mechanism as well as volume receptor in the left atrium of the heart. The increased adesterone and ADH responding to low volume cause salt and water retension compounding oedema.
NEPHROTIC SYNDROME SYMPTOMS
Nephrotic syndrome symptoms: The nurse maybe able to assess the young client brought about by fluid shift in the tissue. The child gains weight over a period of several week . There may be puffiness around the eyes (Periorbital oedema) and it is noticed in the morning and disappear during the day when the oedema in the abdomen and lower extremities is more evident plueral effusion and scrotal & labial oedema are late signs. In Nephrotic syndrome symptoms, Diarrhea from intestinal mucosa oedema maybe noted.
The skin maybe susceptible to break down and the patient appears pale, lethargic and irritable. He is malnourished but major indication are masked by oedema, subtle clues are loss of appetite and changes in luster of the hair. In Nephrotic syndrome symptoms, Urinary output is decreased and urine is dark and frothy.
A patient with nephrotic syndrome symptom may not know until routine blood are carried out. The results of these tests will show that there is presence of too much protein in the urine, and that there is not enough protein in the blood, or that there is possibly too much fat or cholesterol in the patient's blood.
Simply put nephrotic syndrome symptoms that a patient may notice includes:
- Oedema (swelling) in the legs, feets, ankles, and sometimes the hands and face
- gaining of weight
- increase fatigue (tiredness)
- Urine (foamy and bubble)
- loss of appetite
NEPHROTIC SYNDROME DIAGNOSIS
Diagnosis is confirmed by laboratory analysis of blood and urine Total serum proteins are reduced and serum cholesterol and plasma lipids are elevated. HB and Haematocrits are normal due to haemo-concentration. There is no serum sodium level, Proteinurea and presence of hyaline cast, Red Blood Cell and Fat bodies are characteristics of the urinalysis. Renal Biopsy may demonstrate glomerular sclerosis, nephritis and membranous nephropathy (nephrotic syndrome symptoms).
HOW TO REDUCE PROTEIN IN URINE (REDUCING URINARY PROTEIN EXCRETION)
HOW TO REDUCE PROTEIN IN URINE
Steroid is given to promote diuresis (an increased excretion of urine) and maintain protein free urine.
Prednisone 10 to 14mg is administered. Diuresis may take upto 4 weeks to be protein free Response to steroids often determine the course of the disease. Those who respond favourably 20 to 40% are termed "steroid sensitive" and usually do not have recurrences.
Some who respond but have recurrences 60 to 80% are termed "steroid dependent". About 5% to 10% of individuals with nephrotic syndrome are steroid resistance and alternatively have chronic renal failure.
Steroid are used over a period of time and so has to be monitored for its side effects by both the nurse and the parents of the patient. As the patient responds to therapy with decreased protein urea, the steroid are tappered gradually . Since the patient may have to be cared for at home, the patient's parents requires explicit instruction for the use of the drug.
Immunosuppressive drugs e.g. Cyclophosphamide (cytoxan) maybe used with steroid or as an alternative.
Side effects include leukopenia(a condition in which the number of white blood cells circulating in the blood is abnormally low), Aspermia(Absence of sperm in the seminal fluid), Lack of oogenesis (formation and maturation of egg). All the side effects must be monitored.
NEPHROTIC SYNDROME DIET
Attention must be directed towards restarting nutritional intake. A high protein, well balanced diet is encouraged unless the child has Azotemia (accumulation of Nitrogen in the blood) and renal failure and protein is contra indicated.
At the acute stage there is lack of appetite equals to anorexia so the nurse and the parents have to encourage the child as appropriate
Nephrotic syndrome symptoms
Because Gama globulin levels are low, the Patient is prone to infection. The nurse patient, family can plan to use asepsis to prevent spread of disease. Antibiotics can be used prophylactically
Patients on steroid or immunosuppressant therapy are also prone to infection and must be observed closely.
NEPHROTIC SYNDROME TREATMENTS
The following NEPHROTIC SYNDROME TREATMENTS plans should be implemented when Nephrotic syndrome symptoms appear
- Planning and Implementation (HOW TO REDUCE PROTEIN IN URINE)
The goal of medical therapy is to maintain a protein free urine, prevent infection and restore nutrition.
Nursing plans are developed with patient and family t restore urinary elimination, restore fluid balance, promote nutrition, prevent infection and provide a balance of sleep and activity.
In acute stage, the patient is hospitalized.
- Fluid Balance
Oedema of Nephrosis is resistance to diuretic therapy, but diuretics that reduce sodium retension e.g. Spironolactone may be used. Salt poor albumin maybe used for plasma expanding properties. Low sodium diet to prevent additional fluid retension during the acute stage. Fluids are restricted when there is massive oedema. Fluid loss can be evaluated by recording intake and output & daily weight.
- Sleep and Activity
In Nephrotic syndrome treatments, During the acute stage, the patient is weak and fatigue, and so is placed on bed rest. When the oedema subsides, the activity can be increased as tolerated. During the acute stage, the nurse and the parent of the patient can turn the client, positioning his oedematous body comfortably. Bone fracture are common in patients on steroid.
- Discharge Instructions
Because the cause of nephrosis may involve exacerbation and remission, in Nephrotic syndrome treatments the parents can be instructed to manage child at home. Specific information should include use of drugs, diet and activity restrictions. Maintenance of hygiene practice to prevent infection is also encouraged.
The course of nephrosis may include, exacerbation or remissions and evaluation of nursing care is appropriate at both stages. Nursing diagnosis of urinary elimination , fluid balance and nutrition are salient.
Particularly there is no cure for nephrotic syndrome but there are Nephrotic syndrome treatments that are helpful to manage the nephrosis symptoms and prevent more kidney damage. If the kidney of the patient stops working, then dialysis or kidney transplant is needed and pertinent to support life
Professional Healthcare advice from a medical personnel (Doctor) is necessary to treat the symptoms of nephrotic syndrome
- Drugs to checkmate Blood Pressure and Cholesterol level will help in the reduction of having disease of the heart
- Drugs to help the body to get rid of excess water can also help checkmate patient's blood pressure and can reduce oedema(swelling)(
- Drugs to against blood clots can assist in preventing heart attack and stroke
In considering HOW TO REDUCE PROTEIN IN URINE
Dietary change can also assist the patient to manage symptoms of nephrosis. Intake of fish or meat with low fats instead of higher fat content can help checkmate the cholesterol level. Reduction in salt (sodium) intake can prevent swelling and ensure the blood pressure kept under control at a healthy level.