Med-Surg - Renal System, part 5: Nephrotic Syndrome, Urolithiasis
by Cathy Parkes December 17, 2021 Updated: January 17, 2022 4 min read
Hi. I'm Cathy, with Level Up RN. In this video, we're going to talk about nephrotic syndrome as well as urolithiasis. At the end of the video, I'm going to give you guys a little quiz to test your knowledge of some of the key points I'll be covering in this video. So definitely, stay tuned for that. And as always, if you have our Level Up RN medical-surgical nursing flashcards, be sure to pull those out, so you can follow on with me. First up, we have nephrotic syndrome, which is a kidney disorder characterized by the massive loss of protein in the urine. So with this disorder, we have damage to the basement membrane of the glomerulus such that the glomerulus becomes more permeable and allows for protein to pass into the urine. This can be caused by an infection, a systemic disease such as diabetes, or an autoimmune disorder such as lupus. There are a variety of causes. So a key protein that is being lost in the urine is albumin, and albumin is essential in the bloodstream because it helps to keep fluid into the bloodstream. If we are losing albumin in the urine, then that fluid is going to leave the bloodstream into the surrounding tissue. So key symptoms of nephrotic syndrome include edema. So this includes periorbital edema, so swelling around the eyes, as well as ascites, so that's fluid accumulation in the abdomen, and peripheral edema. In addition, the patient will have frothy urine because of that high protein content of the urine. So our little cool chicken hint here on the card is, when you think of nephrotic syndrome, think nephropathy, and that will help you to remember that with nephrotic syndrome, we have frothy urine.
Abnormal labs present with nephrotic syndrome include hypoalbuminemia, so decreased albumin in the bloodstream because we're losing it all in the urine, as well as hyperlipidemia. In terms of your analysis, we're going to have massive proteinuria, so over two plus. Diagnosis of nephrotic syndrome can be done using an ultrasound, as well as a renal biopsy. Treatment includes the use of corticosteroids to decrease inflammation in the kidneys, as well as diuretics to get rid of excess fluid. We can also administer 25% albumin to try to keep fluid in the bloodstream and out of the surrounding tissues. That can help decrease edema, and then, statins can be given to decrease cholesterol numbers. In terms of nursing care, we're going to want to monitor the patient's eyes and nose, their daily weight, and measure their abdominal girth daily. We're going to implement fluid and sodium restrictions as ordered. Usually, a moderate protein intake is appropriate for nephrotic syndrome. And you may think to yourself, well, they're losing all this protein. Don't they need extra protein? Well, the problem is when protein breaks down, it creates these waste products and acids that the kidneys have to deal with, and it's more work for the kidneys. And the kidneys are already struggling with this nephrotic syndrome, so we don't want to add that extra burden on the kidneys. And then, finally, we want to prevent skin breakdown. So any time a patient has severe edema like they do with this condition, it makes their skin so fragile, like tissue paper, so you definitely want to handle your patient with care. And then, you want to monitor your patient for infection due to the use of corticosteroids.
Next, we have urolithiasis, which is the presence of a stone, or calculi, in the urinary tract. When we have a kidney stone, that is nephrolithiasis. So stones are typically composed of calcium phosphate, calcium oxalate, or uric acid. So when we have super saturation of the urine due to slow urine flow, that can lead to crystallization and formation of a stone. Risk factors associated with this disorder include male gender damage to the urinary tract lining, high acidity or high alkalinity of the urine, as well as urinary retention and dehydration. Signs and symptoms include severe pain. This pain can occur on the flanks, the back, or the lower abdomen. The patient will also have dysuria, so difficulty with urination. They may also have fever diaphoresis, nausea and vomiting, tachycardia, tachypnea, as well as oliguria, and hematuria. So oliguria means we have a small amount of urine, and hematuria means that we might have blood in the urine. Diagnosis of urolithiasis can be done with a CT scan or ultrasound. Medications include analgesics, which could be NSAIDs for mild pain. It also can include opioid analgesics for severe pain, which is often present. We can also give antiemetics for nausea and vomiting. In terms of procedures, we can use a lithotripsy, which utilizes laser or shockwave energy to break up the stones, so hematuria and bruising at the lithotripsy site is expected after this procedure.
Also, after this procedure, you want to make sure you are straining the patient's urine for stone fragments that may be passed. In terms of nursing care, we're going to want to monitor the patient's eyes and nose, strain all their urine, because when they pass a stone, that stone can be sent to the lab for analysis. And that, in turn, can inform diet modifications that the patient can make to help prevent the formation of these stones in the future. Also, we want to provide some patient teaching. We need to advise them to increase their fluid intake to like three liters per day. Dehydration is a key risk factor with the formation of urolithiasis or kidney stones, so increasing fluid intake is essential. In addition, the patient should modify their diet to limit foods according to the type of calculi they have, so whether that's a calcium oxalate or uric acid stone? All right. It's quiz time. I have three questions for you. First question, a urinalysis of a patient with nephrotic syndrome will reveal what key abnormality? The answer is massive proteinuria. Question number two, why should the urine be strained for a patient with urolithiasis? The answer is, so we can catch the stone and send it to the lab for analysis. Question number three, frothy urine is a key symptom with what kidney disorder? The answer is nephrotic syndrome. Okay. That's it for this video. Thank you, so much, for watching, and good luck with studying.
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