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Neonatal tetanus
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Neonatal tetanus
Asthma
Diarrhea

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NEPHROTIC SYNDROME DEFINITIONS

✍️ Nephrotic Syndrome, group of symptoms caused by the excretion of large amounts of protein in the urine due to kidney impairment or where the 'filters' in the kidney become 'leaky' and large amounts of protein leak from the blood into the urine

✍️It is a renal disease characterized by variety of symptoms that accompany any condition that seriously impairs the glomerular capillary membrane resulting in increased permeability to protein (proteinuria), low plasma protein (hypoalbuminemia), hyperlipidemia(high fat levels) and generalized oedema (anasarca) especially around the eyes, feet, and hands.

✍️ It is a renal disorder due to damage to the renal glomeruli resulting in heavy protein urea, low plasma protein, hyper lipidemia and generalized oedema(Anasarca).

✍️ It is a renal disease characterized by increased permeability of the glomeruli to protein (Protein urea), low plasma protein, hyperlipidemia and generalized oedema

🤔CAUSES Are divided into primary and secondary

✍️PRIMARY – also called idiopathic, is associated with diseases intrinsic to the kidney such as;
✔️  Diseases affecting the glomerular.
✔️ Minimal change disease

✔️Minimal change- there is virtually no change detectable in the glomeruli if a sample of kidney is looked at under the microscope. The glomeruli look normal under the microscope, but may have some minor change that allows leakage of protein. The cause of minimal change disease is not clear. Something to do with a slight change in the immune system, or a reaction of parts of the immune system to some unidentified factor causes about 9 in 10 cases of nephrotic syndrome in children under the age of five years. about 1 in 5 cases of nephrotic syndrome in adults.

✔️  Membranous nephropathy; There is some thickening of the membrane in the glomeruli (the 'filter' of the glomeruli) which makes the glomeruli 'leaky' to protein. The thickening may be caused by abnormal reaction of the immune system to some infections or drugs can cause this disease. It‘s very common in adults unlike children
✔️ Lipoid nephrosis commonly in children, glomeruli show degenerative changes with no thickening of the basement membranes.
✔️  Focal segmental glomerulosclerosis (FSGS): condition where small scars (sclerosis) develop on some glomeruli as a reaction of the immune system to kidney transplantation, or he**in injection. Accounts for up to 1 in 10 cases of nephrotic syndrome in children but a higher percentage of cases in adults
✔️  Allergic reaction Insect bites, Pollen, Snake venom.

🤔SECONDARY– refers to the causes outside the kidney such as
✔️  Systemic diseases ✔️Systemic lupus erythematosus(a chronic inflammatory disease).
✔️ Amyloidosis -accumulation of a protein-based substance amyloid (waxy protein resembling starch) in the glomeruli tissues.
✔️ Diabetic nephropathy (diseased kidney/nephrone because of diabetes) there is thickening of glomerular basement membrane and mesangial expansion affecting the glomerular filtration rate.

✔️Sickle cell disease
✔️ Neoplasm: Hodgkin‘s disease, carcinoma ( renal cell, lung, neuroblastoma, breast, and etc)
✔️ Infection: HBV/Hepatitis C, HIV, syphilis, Schistosomiasis,, malaria, tuberculosis Herpes zoster, these conditions cause thickening of membranes within the glomeruli.
✔️ Drug/Toxins: Mercury, vaccine, pellicillamine, He**in, gold therapy, or captopril, Non-steroid anti-inflammatory drugs.
✔️ Circulatory problems: Such as constrictive pericarditis and severe congestive heart failure.
✔️ Chronic kidney failure and kidney transplantation. ✔️Genetic abnormalities- infantile NS presenting before the age of 3 months and congenital NS presenting at the age of 4- 12 months. This is due to abnormal formation of gene called nephrin.

🤔SIGNS AND SYMPTOMS

✍️Severe generalized oedema due to low albumin level and retention of water and sodium
✍️ Pronounced proteinuria due to damage to the glomerular basement membrane
✍️ Hypoalbuminemia due to albiminuria
✍️ Hyperlipidemia due to increased hepatic synthesis of lipids
✍️ Urine volume and renal function may be either normal or greatly reduced to damage to the kidney.
✍️ Dyspnea due to pulmonary oedema or congestion.
✍️ Peri orbital edema due to low plasma protein .

✍️MEDICAL MANAGEMENT

AIMS
✔️To relieve signs and symptoms
✔️ To prevent complications

✍️INVESTIGATIONS

✔️History Taking I will do history taking which will reveal history of schistosomiasis . I will do history taking which will reveal history of gold poisoning

✍️Physical Examination I will do physical examination which will reveal dyspnea on inspection . I will do physical examination which will reveal generalized oedema

✍️ Special Tests .
✔️ Renal biopsy: will help to confirm the diagnosis or reveal the extent of renal damage
✔️ I will do urinalysis which will show proteinuria ✔️Blood for Urea and electrolytes which will show electrolyte imbalance such as low potassium levels.

🤔TREATMENT

✔️Diuretics, such as or furosemide (Lasix), to reduce oedema Dose: 0.5-1.5mg per kg body weight.

✍️Corticosteroids e.g. hydrocortisone 25-100mg. or prednisolone 5-25mg daily.

✍️Bed rest in patients with severe oedema or those with infections
✍️Antibiotics if infection suspected or for prophylaxis e.g. Amoxyl 62.5-250mg tds for 5/7

✍️Dietary protein is prescribed at 1g peer kg body weight.

✍️COMPLICATIONS

✔️A high cholesterol level: If this persists long-term it is a risk factor for developing heart disease.
✔️ Pulmonary edema due to fluid leak, sometimes it leaks into lungs causing hypoxia and dyspnoea
✔️ CCF: due to fluid overload
✔️ Kidney failure: due to hypovolaemia
✔️ Infection: An increased risk of developing infections due to loss/ leakage of immunoglobulin (antibodies) in the urine

✔️ Vitamin D deficiency: can occur. Vitamin D binding protein is lost.

NURSING PROBLEMS IDENTIFIED

✍️Altered nutrition
✍️ Fluid volume deficit
✍️ Body image disturbance
✍️Risk of injury and infection
✍️Altered tissue perfusion

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