Nephrotic syndrome is a kidney condition that causes the person’s body to pass too much protein in the urine. This syndrome is usually caused by the damage that happens to the small blood vessels in the kidneys that filter waste and excess water from the person’s blood.
Nephrotic syndrome causes swelling of the feet and ankles which increases the risk of having other health problems. A nephrotic syndrome happens when the kidneys aren’t working right.
A nephrotic syndrome is a combination of nephrotic-range proteinuria with a decreased level of serum albumin and edema. Other indicators of nephrotic syndrome include increased cholesterol levels in the person’s blood, and sticky blood that can cause blood clots in the person’s legs and lungs.
Signs and Symptoms of Nephrotic Syndrome
- severe swelling or edema around the eyes, ankle, and feet
- foamy appearance of the urine as a result of excess protein in the urine
- increased weight due to retention of the fluids
- fatigue
- appetite loss
Causes of Nephrotic Syndrome
A nephrotic syndrome is caused by damage to the glomeruli of the kidneys. The glomeruli filter the person’s blood that passes through the kidneys and separates what the body needs and what the body does not need.
When the glomeruli are healthy it helps keep the blood protein that is needed to maintain the right amount of fluid in the body. When the glomeruli are damaged this will allow too much blood protein in the body which will lead to nephrotic syndrome.
The primary causes of nephrotic syndrome may include:
- Focal segmental glomerulosclerosis (FSGS). FSGS is a condition that happens when the glomeruli are affected by a disease, a genetic defect, or an unknown cause.
- Membranous nephropathy. Membranous nephropathy is a disease that happens when the person’s glomeruli become thick. This may happen along with lupus, hepatitis B, malaria, or cancer.
- Minimal change disease. When a person has minimal change disease the kidneys look normal on a microscope but because of an unknown reason, the kidneys do not filter personally.
- Renal vein thrombosis. Renal vein thrombosis is a disorder that happens when a blood clot blocks a vein that drains the person’s blood out of the kidneys.
Other diseases which cause a nephrotic syndrome that affect the person, which is called secondary causes of nephrotic syndrome, these diseases include:
- Diabetes. Uncontrolled blood sugar can affect the blood vessel all over the person’s body including the kidneys.
- Lupus. Lupus is an example of an autoimmune disease that causes inflammation in the joints, kidneys, and other organs of the body.
- Amyloidosis. Amyloidosis is a rare type of disease that is caused by the buildup of the protein amyloid in the person’s organs which can build up in the kidneys, which would possibly result in kidney damage.
Risk Factors to Nephrotic Syndrome
Factors that increase the risk of a person having nephrotic syndrome include:
- Medical conditions that can damage the kidneys. Some diseases and conditions increase the risk of nephrotic syndrome including diabetes, lupus, amyloidosis, reflux nephropathy, and other types of kidney disease.
- Certain medications. Nonsteroidal anti-inflammatory medications and drugs that are used to fight infection might cause nephrotic syndrome.
- Certain infections. Infections including HIV, hepatitis C, and malaria increase the risk of a person having the nephrotic syndrome.
It is important to remember that if a person has one of these risk factors does not mean that the person will develop nephrotic syndrome. However, it is important to advise the patient to monitor his or her health and consult a physician if he or she is experiencing symptoms that are consistent with nephrotic syndrome.
Complications of Nephrotic Syndrome
Possible complications of a person with nephrotic syndrome include:
- Blood clots. If the person’s glomeruli have difficulty filtering the blood properly this can lead to loss of blood protein that will increase the risk of developing blood clots in the person’s vein.
- High cholesterol and elevated blood triglycerides. If the level of the protein albumin in the person’s blood falls, the liver will produce more albumin. At the same time, the liver will release more cholesterol and triglycerides.
- Poor nutrition. Malnutrition may happen to a person with nephrotic syndrome because of too much protein in the blood. Too much protein in the blood may lead to weight loss which can be masked by edema. A person with nephrotic syndrome may also experience anemia, low protein levels, and low levels of vitamin D.
- High Blood Pressure. If the glomeruli are damaged this may result in an increase in body fluid which may increase the person’s blood pressure.
- Acute kidney injury. If a person’s kidneys lose their ability to filter blood because of the damage to the glomeruli, the waste products can build up in the person’s blood quickly. If this happens to the patient, emergency dialysis might be needed.
- Chronic kidney disease. The kidneys may lose their function over time because of nephrotic syndrome. If the function of the kidneys falls low enough the patient might need dialysis or a kidney transplant.
- Infections. Increased risk of infection such as pneumonia and meningitis may happen to patients with nephrotic syndrome.
- Underactive thyroid gland or hypothyroidism. The person’s thyroid may not be able to make enough thyroid hormone.
- Coronary artery disease. The patient may experience narrowing of the blood vessels which limits blood flow to the person’s heart.
Diagnosis of Nephrotic Syndrome
To help in diagnosing nephrotic syndrome, the physician will first take the patient’s medical history. The patient will be asked about his or her symptoms, and any medications that he or she is taking and with present underlying conditions.
The physician will perform a physical examination that includes blood pressure taking and auscultation of the heart.
The following are the several tests used to diagnose nephrotic syndrome:
- Urine tests. The patient will be asked to provide a sample of his or her urine and the urine will be sent to the laboratory to determine the levels of protein in the patient’s urine. In some cases, the nurse may be asked to collect a urine sample for 24 hours.
- Blood tests. A sample of blood will be taken from the patient’s vein in the arms to analyze the blood markers of the overall kidney function, blood albumin level, cholesterol, and triglyceride levels.
- Ultrasound. The ultrasound is used to create an image of the patient’s kidneys and the doctor uses the images to evaluate the structure of the kidneys. A kidney ultrasound is used to assess the size, location, shape, and related structure of the kidneys including the ureters and the bladder. A kidney ultrasound may also help in diagnosing and detecting cysts, tumors, obstructions, fluid collection, and infection within the kidneys.
- Biopsy. When doing a biopsy, a sample of kidney tissues is collected for further testing that will help in determining what may be causing such a condition. A thin biopsy needle is inserted through the patient’s skin and into the kidneys to get samples from the kidney tissues for analysis.
Treatment of Nephrotic Syndrome
Nephrotic syndrome treatment involves treating other medical conditions that may be a cause of the nephrotic syndrome. Nephrotic syndrome in some patients can go away completely after treatment and in others, it can be controlled with oral medications. The physician may also recommend medications and diet counseling to help the patient control the signs and symptoms and treat complications of nephrotic syndrome.
Medications for nephrotic syndrome include:
- Blood pressure medications. Ace inhibitors or angiotensin-converting enzymes will help reduce blood pressure and will help in reducing the protein release in the urine.
- Water pills(diuretics). These medications will help to control swelling by increasing the kidney’s fluid output. Diuretics help rid the body’s salt and water and help release sodium into the urine which will help in reducing blood pressure.
- Cholesterol-reducing medications. These medications will help in decreasing the person’s cholesterol levels. However, it is not confirmed if cholesterol-lowering medications can improve the condition of the patient with nephrotic syndrome.
- Blood thinners or anticoagulants. Blood thinners may be given to reduce the blood’s ability to clot. Anticoagulant medications will help in the prevention of recurrent thrombosis which includes deep vein thrombosis, pulmonary embolism, and ischemic stroke.
- Immune system-suppressing medications. To help decrease inflammation that accompanies some of the conditions that cause nephrotic syndrome the patient may be given immune system-suppressing medications such as corticosteroids.
Prevention of Nephrotic Syndrome
The patient may be instructed to reduce salt intake to decrease swelling and the patient may be instructed to eat foods low in saturated fats and cholesterol.
Some causes of nephrotic syndrome cannot be prevented but the nurse may instruct the patient to take action to prevent the damage to the glomeruli by:
- Managing high blood pressure and diabetes if the patient is currently diagnosed with the condition.
- Encourage the patient to have his or her vaccination for common infections, especially those people working around patients with hepatitis or other diseases.
- Encourage the patient to take medications as directed by the physician and finish his or her prescription even if he or she starts to feel better.
Nephrotic Syndrome Nursing Diagnosis
Nursing Care Plan for Nephrotic Syndrome 1
Nursing Diagnosis: Fatigue related to edema-related discomfort secondary to the nephrotic syndrome as evidenced by easy fatigability with any activity, extreme edema, and lethargy.
Desired Outcomes:
- The patient will be able to express understanding about the alternative ways and activities with rest periods.
- The patient will express decreased fatigue and will demonstrate participation in necessary activities.
| Nephrotic Syndrome Nursing Interventions | Rationale |
| 1. Evaluate and check the patient’s level of fatigue, weakness, and degree of edema and check if the patient is experiencing difficulty moving. | Assessing the level of fatigue will help in revealing information that causes fatigue and will also help in assessing the difficulty of moving when moving and changing his or her position. |
| 2. Create scheduled activities with consideration and observe the changes in behavior after the activity. | This will help enhance endurance and avoid fatigue, disease conditions, steroid therapy, and inactivity. |
| 3. Advise and instruct the patient to do bed rest, especially during the acute stage. And advise the patient to rest during times of exhaustion. | If the patient has severe edema, bed rest will help in decreasing fatigue and conserve energy. |
| 4. Instruct the patient about the ways to do progressive activities such as self-care and exercises as tolerated. | This will help the patient increase tolerance to physical activity. |
| 5. Collaborate with an occupational therapist as needed and teach the patient about energy conservation methods. | The patient should learn about the energy conservation methods and the patient should learn how to organize activities including activities of daily living that can help the patient conserve energy and reduce fatigue. The patient may be advised by the occupational therapist about the use of assistive devices that he or she may use. |
| 6. Encourage the patient to vent out his or her feelings about the impact of fatigue. | Expression of feeling will help the patient cope with fatigue because fatigue is both physically and emotionally challenging for the patient. |
Nursing Care Plan for Nephrotic Syndrome 2
Nursing Diagnosis: Deficient Knowledge related to the patient’s lack of exposure to information about the disease secondary to the nephrotic syndrome as evidenced by the patient’s verbalization about his or her need for information about the condition, drug administration, follow-up care, and procedures.
Desired Outcomes:
- The patient will be able to enumerate and explain the disease process.
- The patient will be able to participate and comply with the procedures.
| Nephrotic Syndrome Nursing Interventions | Rationale |
| 1. Assess and evaluate the patient’s knowledge about the disease, including the signs and symptoms, diet, and activity aspects of care. Medications procedure and side effects. | Evaluating the patient’s knowledge about the condition will provide information about the education needed for follow-up care. |
| 2. Educate the patient and the significant others about the condition including the cause and the expected treatment. Encourage the patient and the significant others to ask questions and give enough time for discussion. | The nurse may use teaching techniques and aids to help the patient and significant others understand the condition and management accurately. The nurse should address the questions of the patient and the significant others to evaluate their understanding of the teaching. |
| 3. Instruct the patient about the medication procedure and treatment that he or she may have. | The nurse should emphasize the importance of the proper medication and administration including the expectations from drug therapy. |
| 4. Allow the patient and the significant others to demonstrate the proper way of urine collection and testing to monitor edema, protein, and albumin level. | This will help the nurse to facilitate monitoring for possible relapse of the disease. |
| 5. Advise the patient and the significant others to monitor the weight, blood pressure, and urine output of the patient regularly and refer immediately to the physician if the weight and blood pressure increases. | The patient’s weight and blood pressure should be monitored to avoid complications and to |
Nursing Care Plan for Nephrotic Syndrome 3
Nursing Diagnosis: Risk for infection related to inadequate defenses of the body secondary to nephrotic syndrome.
Desired Outcomes:
- The patient’s body temperature will remain at its appropriate levels.
- The breath sounds of the patient will be auscultated clear bilaterally.
- The patient’s urine will appear clear and without a foul-smelling odor.
| Nephrotic Syndrome Nursing Interventions | Rationale |
| 1. Assess the patient’s body temperature, urinary changes, and skin changes, and assess for respiratory changes such as dyspnea, and productive cough. | Proper assessment should be done by the nurse to determine the presence of infection due to nephrotic syndrome. |
| 2. Maintain and advise the patient’s family to practice medical aseptic technique and handwashing before giving care to the patient. Advise the patient to avoid contact and exposure to people with existing infections. | Medical aseptic technique and handwashing will help in promoting preventive measures against infection. Patients with nephrotic syndrome are at risk of having an infection. |
| 3. Maintain and provide a warm and comfortable environment by regulating the room temperature and humidity. | This will avoid chills and susceptibility to possible upper respiratory tract infection. |
| 4. Explain the possible signs and symptoms of infection and advise to report as soon as possible if the sign and symptoms are present. | This intervention will help the nurse plan needed interventions to avoid relapse and complications. |
| 5. Provide and administer medication as needed and as prescribed by the physician and monitor the patient after medication administration. | Medications will help in preventing and treating infections and will help in preventing possible complications. |
| 6. Monitor and check the laboratory results of the patient including the white blood cell count regularly and accurately. | The laboratory result of the patient, especially the WBC levels should be checked because an increase in WBC count indicates the body’s effort to fight pathogens and a decrease in WBC count indicates severe risk of infection. |
Nursing Care Plan for Nephrotic Syndrome 4
Nursing Diagnosis: Excess fluid volume related to decreased kidney function and fluid accumulation secondary to the nephrotic syndrome as evidenced by pitting edema, decreased urine output, and edema of the mucous membrane.
Desired Outcomes:
- The patient will maintain an appropriate fluid balance and will be free from edema.
- The patient will maintain adequate body weight and will be free from excess fluids.
| Nephrotic Syndrome Nursing Interventions | Rationale |
| 1. Check the weight of the patient regularly and correctly using the same weighing scale every day. | The patient’s daily body weight is a good and accurate indicator of the patient’s hydration status. The nurse should remember that the 0.5 kg weight gain per day may indicate fluid retention. |
| 2. Monitor the patient’s intake and output strictly and regularly. | Proper measurement of the intake and output will help in identifying fluid balance and ensure that the patient has a proper intake of fluids and other needed nutrients. |
| 3. Determine and identify possible sources of excess fluids including food and medications used. | It is important to identify the possible sources of fluid excess to aid in the needed therapeutic regimen. |
| 4. Instruct the patient to limit his or her intake of fluids as ordered by the physician. | The fluid intake amount is determined based on the weight, urine output, and the patient’s response to treatment. Fluid restriction may be advised and indicated for patients with severe edema. |
| 5. Administer medications such as diuretics or immunosuppressants as prescribed by the physician and monitor the patient’s response after the medication. | Medications including diuretics and immunosuppressants may be used to reduce tissue edema. |
| 6. Monitor the patient’s serum BUN and creatinine levels to assess the patient’s renal function. | Changes in the serum BUN and creatinine levels and other electrolyte levels may indicate kidney dysfunction. Checking the BUN and creatinine levels will help in diagnosing acute or chronic kidney disease. |
Nursing Care Plan for Nephrotic Syndrome 5
Imbalanced Nutrition: Less Than Body Requirements
Nursing Diagnosis: Imbalanced Nutrition Less Than Body Requirements related to the inability to ingest and digest foods and nutrients secondary to the nephrotic syndrome as evidenced by anorexia and weight loss.
Desired Outcomes:
- The patient will express understanding about the proper nutrition that he or she needs.
- The patient will be able to consume and increase his or her intake of foods that would help him or her to regain balanced nutrition.
| Nephrotic Syndrome Nursing Interventions | Rationale |
| 1. Determine and check the patient’s exact body weight and do not estimate the patient’s body weight. | It is vital to check the patient’s weight accurately using a scale. Checking the weight is important because it is used as a basis for the patient’s caloric and nutritional requirements. When the weight of the patient decreases it indicates poor health and inability of the body to fight infection. |
| 2. Check and evaluate the patient’s nutritional daily patterns including the patient’s food preference, caloric intake, and diet history. | The patient’s dietary pattern and preference should be considered when planning meals. |
| 3. Instruct the patient about the need for and importance of the intake of foods high in potassium, low fat, and low sodium and include a moderate amount of proteins in the diet. | Foods that are high in potassium maintain the therapeutic serum potassium levels in the body. A low sodium diet helps in preventing and decreasing fluid retention. |
| 4. Provide and maintain a comfortable and delightful environment during meals. | A comfortable and delightful environment will increase the patient’s appetite. |
| 5. Refer the patient to a dietitian for a comprehensive nutrition assessment and methods that will give nutritional support. | Referral to a dietitian will help the nurse to determine the patient’s daily nutritional requirements that will help in promoting sufficient nutrition intake. |
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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