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NUR117: Nephrotic Syndrome Discussion
NUR117: Nephrotic Syndrome Discussion

8. A nurse is caring for a child who has nephrotic syndrome. Which of the following findings is associated with this diagnosis?

Nephrotic Syndrome Exhibition
Nephrotic Syndrome Exhibition

Some patients exhibit signs of acute renal failure (ie,
reduction in glomerular filtration rate and oliguria).
These signs usually are reversed when the intravascular
volume is expanded by infusion of salt-poor human
albumin and diuresis is induced by furosemide or other
diuretic drugs. Rarely, acute renal failure can be caused
by bilateral renal vein thrombosis. The diagnosis is made
by ultrasonography. Thromboembolic complications also
can affect the lungs, the brain, and the peripheral vessels.
The overall incidence of thromboembolic events is about
3%. Such events are caused by loss of antithrombin III
and protein S in the urine as well as an increase in
fibrinogen concentration, leading to a hypercoagulable
state.
The antiphospholipid syndrome also has been incriminated as a cause of thromboembolic complications in
some patients who have nephrotic syndrome. This disorder is characterized by persistently elevated concentrations of antibodies directed against membrane anionic
phospholipids (eg, anticardiolipin antibody, antiphosphatidylserine) or their associated plasma proteins, predominantly beta-2 glycoprotein I (apolipoprotein H).
A circulating anticoagulant also may be present. The
mechanism of thrombosis in this syndrome has not yet
been defined. Emerging evidence from murine models
suggests that antiphospholipid-mediated complement
activation may be the primary event. Irrespective of cause
or pathogenesis, the first line of treatment is lowmolecular weight heparin. If the thrombosis extends,
thrombolytic drugs, such as tissue plasminogen activator,
followed by warfarin should be considered. Warfarin
should be discontinued as soon as the nephrotic syndrome resolves.
Infections are frequent and serious complications of
nephrotic syndrome. Urine loss of factor B (which contributes to opsonization of bacteria), a decrease in IgG
synthesis, and impaired T-cell function contribute to the
susceptibility to infection. The most common infection is
peritonitis, which used to be due primarily to Streptococcus pneumoniae. Vaccination has reduced infections with
S pneumoniae substantially and increased the relative
frequency of gram-negative organisms. There also has
been an increase in penicillin-resistant S pneumoniae.

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