 Welcome to Nursing School Explained and this video on nephrodic syndrome. This syndrome is actually not well understood as to what exactly causes it. But what we do know about it is that it occurs in one-thirds of patients with chronic conditions such as diabetes and systemic lupus that as we know can affect the kidney when there are long-term issues with these diseases. And also in pediatrics it's actually fairly common, it's the most common complication after a simple viral infection such as an upper respiratory infection. And so we don't exactly understand how it's caused but the glomerulus of the kidney becomes excessively permeable. So remember that that filtration of that filtration membrane of the kidney is very tight. And so it becomes more permeable, it opens up and so large molecules such as proteins can slip through which then causes protein urea. The patient loses a lot of their albumin and when we don't have albumin in our system we lose the ability to keep the fluids in the intravascular space by on chronic pressure and therefore we end up with severe, severe edema which then leads us to the signs and symptoms. So all this loss of the protein, the fluid seeps out of the intravascular space which actually makes the patient have fluid volume excess but it's not in the intravascular space, it's sitting in the spaces in the third spaces where it doesn't belong. And so the intravascular there's actually fluid volume deficit where the fluid just seeps out into the places such as in the third spacing and then it can be seen in asides and even anisarca which is just generalized edema. So this is much more significant than just peripheral edema that you would see as in a patient with let's say heart failure. So there's generalized edema that you can see in the arms, in the extremities, in the belly not only the asides sometimes patients become have dependent edema on their periphery on their sacrum and it's just really, really significant. And so then this massive protein urea is what causes it that we can certainly also see in the urine sample and then it also leads to hypertension because the body is kind of trying to hold on to fluid but the fluid is just kind of seeping out as the of human continues to leak out through that permeability, that permeable glomerulus. And because of the law of human, the liver then tries to generally generate more lipoproteins and that then turn leads to hyperlipidemia. So now in addition to having low proteins we also have patients with high cholesterol levels. And in the urine it can be seen as foamy frothy urine because these fatty cast that the liver is now overproducing are being also expelled in the urine. And the urine cup I tried to draw it out here will basically be urine and then on top there will be a significant layer of foam. It's almost as if you're pouring a beer into a cup and there's just massive amount of foam on top although the foam won't be white as you would see in beer. It's more like a urine kind of a yellow kind of a color. But there is not a lot of blood that's being lost and that's in contrast to glomerulina fritis which is another syndrome that affects the kidney. And then because of this intravascular fluid depletion the patient might have orthostatic hypotension so we need to be sure that when we change positions that we encourage them to do that very slowly so they don't fall or injure themselves. And also the other thing these patients are at risk for thromboembolism and that mostly has to do with the liver that's generating more of these lipoproteins now. And it also contributes to the coagulation not functioning properly and then in addition to these fatty acids that are now free roaming in the blood the patient because of the path of physiology as well as in combination of the treatments with steroid which is what we're going to get to in a moment puts the patient at high risk for thromboembolism. And then also the patient will be anorexic because most often they don't feel well, they have all the swelling, there's a lot going on, they can be really really ill as if anybody that has complications with their kidneys. And so then for diagnostic tests we certainly want to look at their kidney function and we'll see an increase in BUNI creatinine levels. Their liver function will be elevated as well as their lipids. The abdomen will be significantly low because it's just spilling out in the urine. Their sodium level will be low because it's going to be diluted in the bloodstream and so they will have low sodium. And then PTI now we want to check that because we know that they are at risk for thromboembolism so the coagulation studies will be very important. And then their urine samples certainly they'll be positive for protein and like I already mentioned there will be microscopic hematuria so it won't be bright red to the naked eye but if we do a dipstick it will show some blood cells on there. And then arena ultrasound as well is indicated to just see if there are any underlying causes that could be determining or causing this syndrome of this massive protein area. And so for treatment and nursing care we want to manage the underlying cause so whatever the cause is whether it's diabetes or lupus or whatever the underlying infection we want to treat that otherwise we won't be able to get that under control. And then this massive edema that we're dealing with asides and anisarca we certainly want to keep a close eye on that with daily weights, strict, strict eyes and nose. We want to put them on low sodium and low fluid diets or fluid restriction as well on a moderate protein diet so they still need to get the proteins but as long as the kidney is very permeable they're just going to be spilling that protein so we kind of have to give them a moderate amount to replenish their losses. And then we want to keep a close eye on the vital signs because of this intravascular fluid volume deficit that they might be experiencing and the worth of statics and also fall precautions are super important here. And then the leading cause of mortality from nephrodic syndrome is actually infection. So secondary infection that the patient would be getting when they're hospitalized with this syndrome. So we need to be very meticulous in our infection prevention measures and do all the appropriate hand washing and be very meticulous about that oral care, dental care, the food that they consume and all that. And then for medications, actually NSAIDs are recommended as well as ACE inhibitors to keep their blood pressure under control, diuretics to kind of get rid of that excessive fluids that's causing the massive edema. And then steroids because it is an inflammatory condition and steroids are certainly of big help there and then statins to treat this hyperlipidemia that we saw over here in the Path of Physiology and Signed Symptoms section. So if the principles with fluid volume excess and deficit and the iconic pressure, if it's been a while that you've reviewed those, please go ahead and go back to my other videos where I explain that, how it all relates to keeping the fluid in the intravascular system and how it tends to leak out of there and then what the consequences are and then again what the treatments for that would be. And then also I have a video on chlomerular nephritis, which is similar but different from nephrodic syndrome, another condition that can affect children as well as adults. And as always, thanks for watching, thanks for giving me a thumbs up and for any feedback you are able to provide and I'll see you soon.