Nephrotic Syndrome

The nurse managing nephrotic syndrome must understand the complex interplay of proteinuria, hypoalbuminemia, edema physiology, and the hypercoagulable state. Edema in nephrotic syndrome follows the underfill vs overflow hypothesis: the traditional underfill model proposes that albumin loss reduces plasma oncotic pressure, fluid shifts to interstitium, plasma volume decreases, triggering RAAS activation and sodium retention. The overflow model suggests that primary renal sodium retention (from tubular dysfunction) causes plasma volume expansion and edema. In reality, both mechanisms contribute depending on the underlying glomerular disease. The hypercoagulable state results from urinary loss of anticoagulant proteins (antithrombin III, protein C, protein S), increased hepatic synthesis of procoagulant factors (fibrinogen, factors V, VII, VIII), platelet hyperaggregability, and hyperviscosity from hyperlipidemia. Renal vein thrombosis occurs in 5-60% of patients (highest in membranous nephropathy). Infection risk is elevated due to urinary loss of immunoglobulins (especially IgG) and complement factors (especially factor B), creating susceptibility to encapsulated organisms (Streptococcus pneumoniae). Spontaneous bacterial peritonitis (SBP) can develop in patients with nephrotic ascites. The nurse manages diuretic therapy, monitors for thrombotic and infectious complications, implements fluid balance strategies, and...