amyloid nephrosis
nephrosis
[nĕ-fro´sis]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.
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.
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.