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Nephrotic Syndrome
- group of s&s of any condition that impairs glomrerular capillary membrane, leading to inc permeability to protein
- four classic syndrome: proteinuria, hypoalbuminemia, edema, hyperlidemia/htn
- - increase risk of infection
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Nephrotic Syndrome causes
- DM
- sickle cell anemia
- SLE
- drug reaction- nsaid, heroin
- allergic reaction- pollen, insect bites
- infections
- 2/3 pt systemic disease
- 1/2 pt will progress to CRF
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Nephrotic Syndrome Dx test
- dec albumin, total protein
- inc trig & chol
- inc bun & crt
- proteinuria, lipiduria (cast- fats platlets, inc amt)
- inc BUN- dehydration
- norm crt
- Crt- breakdown of muscle- excreted through kidney
- both elevated- renal failure
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Nephrotic Syndrome Management
- ID & resolve cause, relieve edema
- diet- inc protein (if lg loss in urine), inc cal, low NA (to tx edema)
- diuretics- thiazide or loop
- steriods- inc flamm
- fluids restriction- only if renal failure
- skin care- r/t edema
- statin- inc HLD
- reduce risk for infection
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acute glomerulonephritis aka acute nephritic syndrome
- inflammation of the glomeruli of both kidneys caused by an immune reaction
- thought to be autoimmune disease
- classified as infectious or postinfectious
- 2nd leading cause of renal failure
- follows respiratory or skin infection
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etiology nephritic syndrome
- acute postinfectious- usually follows upper respiratory or skin infection with strep (2-3 weeks after)
- adults and children (3-10) most often affected
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Patho nephritic syndrome
- immune system responds to infection by forming antigen-antibody complexes
- complexes get trapped in glomerular capillary membranes, causing inflammation and damage
- basement membrane gets damaged
- damaged glomeruli dont filter correctly
- - RBC, protein leak into urine
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patho 2 nephritic syndrome
- scar tissue forms, obstructing blood flow & increasing capillary permeability
- protein loss in urine dec plasma- albumin inc osmostic pressure
- dec plasma protein dec oncotic pressure
- edema, oliguria and HTN result
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nephritic syndrome manifestations
- insidious or sudden
- ** inc urine SG (norm 1.003-1.030) b/c low urine output
- ** inc BUN & Crt
- ** HTN- mod to severe
- ** reduced GFR- vol overload, oliguria/anuria
- GFR-
- - is from perfusion b/c no blood to this area. no perfusion - cant get fluid out
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nephritic syndrome manifestations 2
- edema- peripheral, perioribital
- smoky urine (brown), hematuria, proteinuria
- dec Crt clearance- 24 hour urine test- we are holding on to crt
- fatigue, s/s of FO
- - edema, htn, wt gain, s3, crackles
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nephritic syndrome management medical
- symptomatic- prevent complications of vol overload, eliminate antigens, prevent further damage
- Na and fluid restriction- edema
- diuretics & antihypertensives- Ace
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nephrictic syndrome- nursing interventions
- inc CHO (inc cal), mod pro, low Na, low K diet
- good skin care (edema), daily wt, BR, then gradual inc activity
- assist with coping mechanisms of pt and family
- teach to avoid infections
- - antibiotics (penicillian)
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chronic glomerulonephritis
- category of diseases with varying causes
- may be an outcome of the acute form (can get fibrous and scar tissue)
- middle aged pt may have no previous hx of renal disease or infection
- course is gradual
- ** severe HTN develops, hasten renal damage- hx htn, develops this will make renal damage worst
- renal cortex thins, renal arteries, get thick and atherosclerotic
- kidney atrophies and function ceases
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chronic glomerulonephritis manifestations
- similar to acute, not as severe until kidney damage is extensive
- ** hallmarks- elev BP, fixed SG 1.010- kidney is not concentrated urine anymore
- SOB, edema
- nocturia & polyuria
- - bc kidney can no longer concentrate
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chronic glomerulonephritis management
- control edema and HTN (supportive)
- dialysis
- kidney transplant
- chronic end up with failure
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