Nephrotic Syndrome

Question 1

Patho

Where is the inflammatory response

Answer 1

In glomerulus

Question 2

Patho

What happens in glomerulus?

Answer 2

Big holes from so protein starts to leak out in the urine (proteinuria)

Question 3

Patho

After protein leaks to urine (proteinuria), the client is?

Answer 3

HYPOalbuminemic (low albumin in the blood)

Question 4

Patho

Without albumin, you can’t hold fluid in the vascular space…so where does it all go?

Answer 4

Tissue —now client is edematous

Question 5

Patho

Since all blood is going to tissue what has happened to circulating BV?

Answer 5

Decrease

Question 6

Patho

Kidneys sense decrease BV and want to do what?

Answer 6

Help replace it (RAS kicks in)

Question 7

Patho

What happens when RAS kicks in?

Answer 7

Aldosterone produced (Na and H20 retained)

Question 8

Patho

Aldosterone produced (Na and H20 saved) but what about protein?

Answer 8

Still no protein (albumin–remember hypo albumin) so vascular space can’t hold it, so leaks to tissues and you are edematous

Question 9

Patho overall?

Answer 9

• Inflammatory response
• Big holes leak protein out of glomerulus
• No albumin= can’t hold fluid in vas. space
• Fluid leaks to tissues–Edematous
• Circulating BV= Decreased due to leaks
• Kidneys think they need to fix so activate RAS
• Aldosterone released (retain Na and H20)
• Aldosterone released but no protein still
• All the retained Na and H20 leaks back to tissues
• Total body edema= Amasarca

Question 10

Problems associated with protein loss? (2)

Answer 10

1. Blood clots

2. High cholesterol and triglycerides

Question 11

Why are blood clots associated with protein loss?

Answer 11

Losing proteins that normally prevent their blood from clotting

Without these proteins, blood can clot and put them at risk for thrombosis

Question 12

Why is high cholesterol and triglycerides associated with protein loss?

Answer 12

Liver compensates by making more albumin causing an increased release of cholesterol and triglycerides

Question 13

Causes?

Answer 13

Idiopathic, but has been r/t:

• Bacterial or viral infections
• NSAIDS
• Cancer, genetic predisposition
• Systemic disease (lupus, diabetes)
• Strep

Question 14

S/S? (4)

Answer 14

Proteinuria
HYPOalbuminemia
Anasarca
HYPERlipidemia

Question 15

Tx–Meds

Answer 15

Proteinuria/HYPOalbuminemoia: Prednisone (decrease inflammation and shrink holes so protein can’t get out)

Anasarca: Diuretics (get rid of fluid) & ACE (to block aldosterone)

HYPERlipidemia: Lipid lowering drugs

Question 16

Tx- Diet

Answer 16

Decrease Na

Increase protein

Question 17

What therapy?

Answer 17

Anticoagulation therapy for up to 6 months

Question 18

Dialysis?

Answer 18

Yea

Question 19

Limit protein with kidney problems except ___

Answer 19

Nephrotic Syndrome