6. Nephrotic Syndrome

what causes protein loss in nephrotic syndrome?

increased glomerular basement membrane permeability allows protein (albumin) to leak into the urine

• glomeruli become really leaky

what’s the most common form of nephrotic syndrome in children?

idiopathic, also called minimal change nephrotic disease (MCD); other forms are congenital and secondary

what are the four hallmark features of nephrotic syndrome?

1. massive proteinuria (foamy urine)

2. hypoalbuminemia

3. generalized edema

4. hyperlipidemia

what urine findings occur with nephrotic syndrome?

frothy or foamy urine with 3+ to 4+ protein

why does nephrotic syndrome cause edema?

albumin loss lowers oncotic pressure, allowing fluid to shift from blood vessels into interstitial tissues

how does edema typically progress in children with nephrotic syndrome?

• periorbital edema in the morning progresses to generalized edema

• may include severe labial or scrotal swelling and ascites

• ascites can make breathing uncomfortable

why does hyperlipidemia occur with nephrotic syndrome?

the liver increases protein production to compensate for albumin loss and also produces more lipids

• serum triglycerides and cholesterol skyrocket

what medication treats most pediatric cases of nephrotic syndrome?

corticosteroids, such as prednisone

• suppress the immune response and reduce glomerular permeability

• promote diuresis

what’s the top safety concern with corticosteroid therapy for nephrotic syndrome? *

immunosuppression and increased infection risk

• spontaneous bacterial peritonitis is a major concern

how should infection risk be managed during corticosteroid therapy?

• monitor for fever

• avoid sick contacts

• administer prophylactic antibiotics if ordered

• delay live vaccines during immunosuppressive corticosteroid therapy

what other corticosteroid effects should families be taught to expect?

• fluid retention and hypertension

• mood swings

• increased appetite

• moon face

corticosteroids make kids hold on to _____

fluids

how should fluid balance be monitored in nephrotic syndrome? *

strict intake and output and daily weights

• same time, same scale, same clothing

• weight changes reflect fluid shifts

how should ascites be monitored in nephrotic syndrome? *

measure abdominal girth at the umbilicus daily

how should fragile edematous skin be protected in nephrotic syndrome? *

• elevate swollen extremities

• reposition frequently

• avoid adhesive tape

what nutritional goal is important for children with nephrotic syndrome?

adequate nutrition to support growth

what family support is needed for nephrotic syndrome?

education about treatment and monitoring, along with emotional support