Nephrotic Syndrome in Adults

Running head: Ivan Wiest Ivan Wiest Nephrotic Syndrome in Adults Nephrotic syndrome (NS) can occur in children or adults. For this presentation, adult onset NS will be discussed. Nephrotic syndrome is an uncommon disorder that affects 34/100,000 adults. It is equally common in men and women, and occurs more frequently in Black, Native American, and Hispanic people groups (Schub & Jaffe, 2011). Pathophysiology Nephrotic syndrome in adults is a disease of the kidney that involves dysfunctional glomerular capillaries which allow large amounts of plasma protein to leak into the urine, resulting in proteinuria, edema, hypoalbuminemia, elevated lipid levels in the blood, and a hypercoagulable state (Schub & Jaffe, 2011). An extremely large amount of protein loss also causes renal tubulointerstitial inflammation that results in sodium retention (Kodner, 2009). Proteinuria causes a decrease in the circulating plasma proteins, and unless the liver is able to compensate for this loss of protein by increasing albumin synthesis, edema will form (Hull & Goldsmith, 2008b).

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Most NS cases are caused by primary glomerular disease. In white patients, membranous nephropathy causes 33% of nephrotic syndrome, while focal segmental glomerulosclerosis is responsible for 50-57% of NS in the black population. Secondary causes of NS include diabetes mellitus, medications, systemic lupus erythematosus (SLE), cancer, infections, amyloidosis (Hull & Goldsmith, 2008b), and minimal change nephropathy (Mok, Cheung, & Lo, 2010). Risk factors associated with NS include family history of NS, intravenous drug use, Hepatitis B or C infection, HIV, immunosuppression, having taken nephrotoxic medications, chronic analgesia use, pregnancy, and allergic reaction (Schub & Jaffe, 2011).

2 Clinical Manifestations The most common presentation of nephrotic syndrome is new onset peripheral edema. Initially periorbital edema is noticed, as well as genital and lower extremity edema, and ascites. Some... [continues]

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