Nephrotic syndrome is a condition where there is a change in renal function, which is characterized by:
- decrease in urine output
The existence of the glomerular injury is usually followed by a:
- proteinuria increased
- increased glomerular permeability to protein loss
- Primary renal parenchymal disease
- Acute post-streptococcal glomerulonephritis
- Idiopathic Glomerular
- Systemic Diseases
- DM, renal abnormalities that are characteristic of diabetes is diabetic nephropathy
- Amyloidosis / associated with chronic diseases such as tuberculosis, chronic osteomiliti, lung abscess, ulcerative colitis and neoplasms.
- SLE is known as lupus nephritis. SN is a clinical manifestation of SLE
- Mechanical circulatory disorders
- Renal vein thrombosis
- The increase in renal venous pressure can lead to increasing the basal membrane permeability resulting in leakage of plasma
- Right heart syndrome
- Proteinurin to congestive heart disease.
- In nephrotic syndrome, type III hypersensitivity reaction occurs in which the immune complex precipitated in the tissue.
- Activation of the complement system also stimulates vaksoaktive amines (including histamine) and this substance causes retraction of endothelial cells thus increasing vascular permeability.
- Changes in membrane glomerolus, causing increased permeability, allowing the proteins (especially albumin) out through the urine (proteinurine).
- Decreased oncotic pressure causing albumin moves from intra vascular space into interstitiel.
- Transfer of proteins to the interstitial cavity causing lipoproteinemia.
- It stimulates the liver to compensate by increasing the production of lipoproteins and increased concentrations of blood fats (hyperlipidemia).
- When the liver is not able to compensate for damage in fat and protein metabolism.
- Transfer of protein exit the vascular system, causing fluid to move into the space plasma interstitisel resulting edema and hypovolemia.
- Decrease in vascular volume stimulates renin angiotensin system, which allows the secretion of aldosterone and antidiuretic hormone (ADH).
- Aldosterone stimulates increased reabsorsi distal tubules of the sodium and water, leading to increased edema.
- weight increased
- edema anasarca
- abdominal pain
- swelling of the face, especially around the eyes
- voleme urine decreased, sometimes colored thick and foamy
- pale skin
- the child becomes irritable, tiredness / lethargy
- celulitis, pneumonia, peritonitis or sepsis
- blood pressure is usually normal / up slightly
a. Focus Assessment
- Urinary System (oliguric, urine retention, proteinurin and urine discoloration).
- Fluid and electrolyte balance (excess fluid, edema, ascites, weight gain, dehydration)
- Circulation (increased blood pressure)
- Neurology (decreased level of consciousness due to dehydration)
- Breathing (shortness of breath, tachypnea)
- Mobility (redness, malaise)
b. Nursing Diagnosis
- Impaired Urinary Elimination related to Na and water retention.
- Excess Fluid Volume related to edema
- Imbalanced Nutrition Less Than Body Requirements related to damage protein metabolism
- Ineffective Breathing Pattern related to suppression of the diaphragm due to ascites