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NEPHROTIC SYNDROME
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Definition
Kidney disorder characterized by markedproteinuria, hypoalbuminemia,
hyperlipidemia, and edemaResults from a defect in the permeability of glomerular vesselsSome forms my be eventually progress toend- stage renal failure
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Causes
Membranous glomerulonephritis Focal glomerulosclerosis Membranoproliferative glomerulonephritis Metabolic diseases such as diabetes mellitus Collagen-vascular disorders Circulatory diseases, such as heart failure,
sickle cell anemia, and renal vein thrombosis
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Causes
Nephrotoxins, such as mercury, gold, andbismuth
Infections, such as tuberculosis and enteritis Heridetary nephritis Neoplastic disease, such as multiple myeloma
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Pathophysiology
Alteration in the glomerulus Plasmaprotein lost into the urine throughdamaged glomerular basement membrane(Proteinuria) Intravascular fluidmigrates into the interstitial spaces(Hypovolemia) Increased reninproduction causes increased excretion of aldosterone and reabsorption of sodiumelevation of cholesterol and triglycerides
EDEMA
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Assessment findings (signs and
symptoms) Edema usually periorbtal independent areas ( sacrumankles and hands)
Malaise
Headache irritably fatigue swollen external genital
respiratory difficulty pallor diarrhea
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Diagnostic test findings
Protein electrophoreses andimmunoelectrophoreses- to determine type of proteinuria exceeding 3 to 3.5 g/day
Serum markers (Ant C1q)Microscopic hematuria urinary castsNeedle biopsy of the kidney- for histologicexamination to confirm diagnoses
Blood testing- reveals increased serumcholesterol. Phospholipids and triglyceride levelsand decreased serum albumin levels
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Medical Management
Bed rest for a few days to promote diuresisand reduce edema
Dietary restrictions of protein and cholesterolto lower lipidemia
Low sodium low saturated fat liberalpotassium
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Nursing interventions
Frequently check urine proteinMonitor and document the location and
degree of edemaMonitor intake and output and checkweight at the same time each morning
Provide good sin care
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Nursing interventions
Encourage activity and exercise to avoidthrombophlebitis and provideantiembolism stocking as orderedMonitor for and teach the patient aboutother steroid- related complicationsincluding masked infections increasedsusceptibility to infections ulcers steroid -induced diabetes