lipoid nephrosis


nephrosis

 [nĕ-fro´sis] 1. nephropathy.2. any kidney disease, especially one marked by purely degenerative lesions of the tubules" >renal tubules. adj., adj nephrot´ic. Often the cause is not known. When a viral infection precedes the symptoms, it is probably a precipitating rather than a causative factor. There may be not one but several pathologic processes involved, all of which affect the glomerular membranes, increasing their permeability to protein.
The loss of proteins, especially albumin, by leakage from the capillaries into the urine, produces a shift of fluids from the intravascular fluid compartment into the interstitial spaces. The result is edema and hypovolemia, which stimulates tubular reabsorption of sodium and water to increase intravascular volume. These pathologic processes and others that are less well understood bring about the group of symptoms known as the nephrotic syndrome.
The first sign noted is usually swelling about the eyes on rising in the morning that subsides during the day. As edema worsens there is a gradual weight gain, which parents may mistake for healthy growth. The fluid shift progresses and eventually causes abdominal swelling from ascites, respiratory difficulty from pleural effusion, and generalized edema. anasarca (severe generalized swelling) sometimes occurs in association with an acute infection. Intestinal edema can cause diarrhea and anorexia. There is also a diminished output of urine, which is dark and frothy.Diagnosis and Treatment. Laboratory analyses of urine and blood reveal proteinuria, elevated specific gravity of the urine, decreased serum proteins, and elevated serum cholesterol levels. Renal biopsy and the appearance of renal tissue under microscopic examination can establish the diagnosis and identify the type of nephrotic syndrome present.
Treatment includes rest during the edema phase, management of fluid balance, and administration of corticosteroids such as prednisone. Corticosteroid therapy is gradually decreased until the urine is free of proteins and edema subsides. About 80 per cent of children with nephrosis have a favorable prognosis. Cases resistant to this therapy may be given an immunosuppressant such as cytoxan, which is alternated with prednisone every other day.Patient Care. The acutely ill child is hospitalized for diagnostic testing and placed on bed rest until there is remission of symptoms. In the presence of massive edema, sodium is restricted but water usually is not. While on bed rest the child will need diligent skin care to prevent breakdown of the skin over edematous tissues. Measures are taken to avoid respiratory infections to which these children are especially susceptible.
Monitoring includes measurement of vital signs, daily weight, fluid intake and output, and abdominal girth. The progress of edema is assessed daily or more often as indicated. Once the swelling subsides the child usually is less lethargic and should be ready and eager to resume usual activities.
In preparation for discharge the parents are taught how to test urine for albumin, the purpose and untoward side effects of prescribed medications, signs of relapse, and the techniques and importance of avoiding infection. Referral to a home health care nurse or visiting nurse may be appropriate if the parents have a need for continued support and guidance.amyloid nephrosis chronic nephrosis with amyloid degeneration of the median coat of the arteries and glomerular capillaries.lipid nephrosis (lipoid nephrosis) minimal change disease.lower nephron nephrosis renal insufficiency leading to uremia, due to necrosis of the lower nephron cells that blocks the tubular lumens of this region; seen after severe injuries, especially crushing injury to muscles. See also crush syndrome.

lip·oid ne·phro·sis

idiopathic nephrotic syndrome occurring most commonly in children, in which glomeruli show minimal changes with no thickening of the basement membranes, fat vacuoles in the tubular epithelium, and fusion of glomerular foot processes. Synonym(s): minimal-change disease, nil disease

lip·oid ne·phro·sis

(lip'oyd nĕ-frō'sis) Idiopathic nephrotic syndrome occurring most commonly in children, in which glomeruli show minimal changes with no thickening of the basement membranes, fat vacuoles in the tubular epithelium, and fusion of glomerular foot processes.