Case study nephrotic

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Nephrotic syndrome (Nephrosis)

DEFINITION: • Nephrotic syndrome is a group of symptoms including protein in the urine (more than 3.5

grams per day), low blood protein levels, high cholesterol levels, high triglyceride levels, andsw elling.

• Autoimmune process leading to structural alteration of glomerular membrane that results in increased

permeability to plasma proteins, particulary albumin.

• Nephrotic syndrome is a disorder of the glomeruli (clusters of microscopic blood vessels in the kidneys

that have small pores through which blood is filtered) in which excessive amounts of protein are

excreted in the urine. This typically leads to accumulation of fluid in the body (edema) and low levels of

the protein albumin and high levels of fats in the blood.

• Nephrotic syndrome is not a specific glomerular disease but a cluster of clinical findings,

including:Marked increase in protein (particularly albumin) in the urine (proteinuria), Decrease in

albumin in the blood (hypoalbuminemia), Edema, High serum cholesterol and low-density lipoproteins

(hyperlipidemia).

ANATOMY AND PHYSIOLOGY:

The organs, tubes, muscles, and nerves that work together to create, store, and carry urine are the

urinary system. The urinary system includes two kidneys, two ureters, the bladder, two sphincter

muscles, and the urethra. Your body takes nutrients from food and uses them to maintain all bodily

functions including energy and self-repair. After your body has taken what it needs from the food, waste

products are left behind in the blood and in the bowel. The urinary system works with the lungs, skin,

and intestines—all of which also excrete wastes—to keep the chemicals and water in your body

balanced. Adults eliminate about a quart and a half of urine each day. The amount depends on many

factors, especially the amounts of fluid and food a person consumes and how much fluid is lost through

sweat and breathing. Certain types of medications can also affect the amount of urine eliminated. The

urinary system removes a type of waste called urea from your blood. Urea is produced when foods

containing protein, such as meat, poultry, and certain vegetables, are broken down in the body. Urea is

carried in the bloodstream to the kidneys. The kidneys are bean-shaped organs about the size of your

fists. They are near the middle of the back, just below the rib cage. The kidneys remove urea from the

blood through tiny filtering units called nephrons. Each nephron consists of a ball formed of small blood

capillaries, called a glomerulus, and a small tube called a renal tubule. Urea, together with water and

other waste substances, forms the urine as it passes through the nephrons and down the renal tubules

of the kidney

From the kidneys, urine travels down two thin tubes called ureters to the bladder. The ureters are about

8 to 10 inches long. Muscles in the ureter walls constantly tighten and relax to force urine downward

away from the kidneys. If urine is allowed to stand still, or back up, a kidney infection can develop. Small

amounts of urine are emptied into the bladder from the ureters about every 10 to 15 seconds. The

bladder is a hollow muscular organ shaped like a balloon. It sits in your pelvis and is held in place by

ligaments attached to other organs and the pelvic bones. The bladder stores urine until you are ready to

go to the bathroom to empty it. It swells into a round shape when it is full and gets smaller when empty.

If the urinary system is healthy, the bladder can hold up to 16 ounces (2 cups) of urine comfortably for 2

to 5 hours. Circular muscles called sphincters help keep urine from leaking. The sphincter muscles close

tightly like a rubber band around the opening of the bladder into the urethra, the tube that allows urine

to pass outside the body. Nerves in the bladder tell you when it is time to urinate, or empty your

bladder. As the bladder first fills with urine, you may notice a feeling that you need to urinate. The

sensation to urinate becomes stronger as the bladder continues to fill and reaches its limit. At that

point, nerves from the bladder send a message to the brain that the bladder is full, and your urge to

empty your bladder intensifies. When you urinate, the brain signals the bladder muscles to tighten,

squeezing urine out of the bladder. At the same time, the brain signals the sphincter muscles to relax. As

these muscles relax, urine exits the bladder through the urethra. When all the signals occur in the

correct order, normal urination occurs. Problems in the urinary system can be caused by aging, illness,

or injury. As you get older, changes in the kidneys’ structure cause them to lose some of their ability to

remove wastes from the blood. Also, the muscles in your ureters, bladder, and urethra tend to lose

some of their strength. You may have more urinary infections because the bladder muscles do not

tighten enough to empty your bladder completely. A decrease in strength of muscles of the sphincters

and the pelvis can also cause incontinence, the unwanted leakage of urine. Illness or injury can also

prevent the kidneys from filtering the blood completely or block the passage of urine

PREDISPOSING

FACTOR

RATIONALE

Age Children

ages 11⁄2 and 4 yr are predisposed in having nephrotic syndrome

Sex Males

are more predisposed than males in acquiring nephrotic syndrome

Genetics

People with family history of nephrotic syndrome increases likelihood of

developing nephrotic syndrome

Focal segmental

glomerulosclerosis

> HIV/AIDS

> Nephrectomy

Most common cause of idiopathic NS among adults. May be secondary to

HIV/AIDS infection or loss of nephrons.

Membranous

nephropathy

>Hepatitis B infection

> SLE

> Cancer

Deposition of immune complexes on the glomerular basement membrane

causing it to thicken. It can be secondary to certain cancers, Hepatitis B

infections and autoimmune disorders such as SLE.

Minimal change

disease Causes 80 to 90% of childhood nephrotic syndrome in children 4 to 8

years of age idiopathic in nature.

Diabetes Mellitus

Prolonged elevated blood glucose levels alters glomerular base membranes

thereby causing impaired renal function

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Nephrotic syndrome (Nephrosis) DEFINITION: • Nephrotic syndrome is a group of symptoms including protein in the urine (more than 3.5 grams per day), low blood protein levels, high cholesterol levels, high triglyceride levels, andsw elling. • Autoimmune process leading to structural alteration of glomerular membrane that results in increased permeability to plasma proteins, particulary albumin. • Nephrotic syndrome is a disorder of the glomeruli (clusters of microscopic blood vessels in the kidneys that have small pores through which blood is filtered) in which excessive amounts of protein are excreted in the urine. This typically leads to accumulation of fluid in the body (edema) and low levels of the protein albumin and high levels of fats in the blood. • Nephrotic syndrome is not a specific glomerular disease but a cluster of clinical findings, including:Marked increase in protein (particularly albumin) in the urine (proteinuria), Decrease in albumin in the blood (hypoalbuminemia), Edema, High serum cholesterol and low-density lipoproteins (hyperlipidemia). ANATOMY AND PHYSIOLOGY: The organs, tubes, muscles, and nerves that work together to create, store, and carry urine are the urinary system. The urinary system includes two kidneys, two ureters, the bladder, two sphincter muscles, and the urethra. Your body takes nutrients from food and uses them to maintain all bodily functions including energy and self-repair. After your body has taken what it needs fro ...
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