Made Indra Ayu A.

Nephrotic

syndrome is the excretion of 3.5 g

or more of the protein in the urine per day
and is characteristic of glomerular injury
Nephrotic syndrome is more common in
children than adults and the causes usually
unknown (idiopathic) and only the kidney
usually organ that involved, termed primary
nephrotic syndrome.
If is is cause by a systemic disease or other
causes (drugs, toxins), it is a secondary
nephrotic syndrome
A peak incidence of Primary nephrotic
syndrome is on 2 and 3 years of age.

Disturbances in the glomerular basement

membrane leads to increase permeability to
protein and loss of electrical negative charge.
(Huether & McCance, 2008)
When protein is lost from the plasma, the
pressure that draws fluid from the spaces
between cell (interstisial spaces) back into the
circulation is greatly reduced
As the concentration of protein decrease, the
pressure for water to move to the higher
concentration of protein increase
This causes loss of fluid in the circulation and
leads to decrease fluid volume (hypovolemia)
and low blood pressure
The excess fluid in the tissues result in edema
(Gutierrez & Peterson, 2007)

 When

blood pressure decreases, the kidneys

release renin, which raises blood pressure
and causes release aldosterone.
Aldosterone increase the amount of sodium
and water retained by the kidneys.
This extra fluid also leaks out of the
capillaries, which further contributes to
developing edema.
(Gutierrez & Peterson, 2007)

 Hypoalbuminemia

results from urinary loss of

albumin combined with a diminished
synthesis of replacement albumin by the
liver.
Loss of albumin stimulates lipoprotein
synthesis by the liver and hyperlipidemia

 Minimal

change nephropathy (MCN)

- The glomeruli often appear normal, and
there are few other renal structural
abnormalities.
- A systemic immune mechanism is a likely
cause of the disese, and an unidentified
circulating permeability factor, released by T
lymphocyte, has been proposed.
Focal segmental glomerulosclerosis
- There is segmental loss of glomerular
capillaries with proliferation of the
mesangial matrik and adhesion of the
capillaries to Bowmans capsule.
(Huether & McCance, 2008)

 Proteinuria

decrease in the amount of protein

in the plasma
Foamy urine output
Edema (periorbital)
Ascites
Respiratory difficulty from pleural
efusion
Anorexia, malobsorbtion, diarrhea

 Pallor,

with the skinny skin and

prominent veins
Blood pressure normal or slighty
decrease
Irritability, fatigue, lethargy
Hyperlipidemia
Lipiduria
Vitamin D deficiency

 Tretment

includes mild dietary restrictions

of fats, sodium, and potassium
Daily intake of 1 to 1.5 g of high biologicalvalue protein per kilogram of body weight
Vitamin D and iron are important
Fluids should be restricted if the patient is
hyponatremic
Infection should be treated vigorously
Drug therapy includes angiotensin
converting enzyme (ACE) inhibitors to
reduce proteinuria and to control
hypertension, if present.

Next.....
Diuretic such a furosemide
Albumin to treat edema
Steroid may be particularly effective
for the initial treatment of
nephrotic syndrome in children
(glucocorticosteroid: prednisone)
Immunocupresive agents (i.e.,
cyclophosphamide) may be given to
children who have relapses, are
resistant to steroid therapy, or both

Teach the patient and family about the

underlying cause or causes the disorder, the
importance of dietary therapy, and the
prevention of infection
Monitor vital signs for fluid deficit. Assess breath
sound for pulmonary edema as fluid moves into
interstisial spaces in the lungs
Assess for signs and symptoms electrolyte
imbalance and infection
Monitor intake, output and daily weights
Promoto adequate dietary intake by monitoring
the patients degree of anorexia, depression,
and malaise and making intervention as
appropiate
Assist the patient and family in developing
adequate coping skills for a chronic illness.

1. A, 7 years old come to Hospital and

complaint that decreases of urine output.
After some examination there are
proteinuria and hematuria. Blood presure
140/90 mmHg, RR: 25x/m, HR: 103x/ m, T:
37,8C (group 1 and 3)

2. B, 6 years old come to the hospital and

complaint that he feel dispneu. And the are
a edema in periorbital. He looks palle and
weak. After some examination there are
some protein in the urine until 3.5 g. Blood
pressure: 100/60 mmHg, RR: 30x/m, HR: 88
x/m, T: 36,7C (group 2 and 4)

DISCUSS ABOUT THAT PROBLEM AND............

Make

a focus data!
Arrange the nursing diagnose!
Arrange the goals and nursing outcome
criteria!
Arrange the nursing intervention!