Nephrotic vs. Nephritic Syndrome

foreign engineers in this video today we're going to be talking about nephrotic versus nephritic syndrome so if you do like this video make sure to give it a thumbs up comment down below and don't forget to subscribe here's an engineered nursing and then go over and check out engineer.org that's where all of the notes and illustrations for these lectures that we put up here on YouTube are available for you guys to utilize and let's get started here talking first about nephrotic so as we go through our renal series we're we've been going over what type of structures and what all the functions are and then we started going into different disease Pathways and what we want to talk about here is the difference between a nephrotic syndrome versus a nephritic so we talked a little bit about nephritic when we talked about acute glomerulonephritis but I want to hit on just this quick video on the review of our filtration membrane and then our barrier and then how we have nephrotic and nephritic and what's the difference between them so if you're getting ready for a test or the NCLEX and you're like I need a quick refresher then this is the video for you so real quick we have here are glomerulus with our afferent arterial our efferent arterial and then we have our structure in here by our glomerulus and then we have our renal corpuscle with our Bowman's capsule our Bowman's facing here and then we want to quickly run through what are the different areas here of our glomera filtration barrier right what we're looking at here is we have three different steps if you forget you can check out the glomera filtration rate video but we have our capillary bed that has fenestrations right so we have these fenestrated capillaries within our glomerulus then we have our glomerular basement membrane which is this blue structure here which is negatively charged and then we have our podocytes right and what we're looking at here is how things funnel through from our blood into our nephron here so they become filtrate and becomes urine and this is the area where we can decipher whether we have nephrotic or nephritic syndrome so with nephrotic we're basically talking about the barrier here but in real if you're going minutely into the pathophysiology we're mostly concerned about the podocytes so what happens here is we have some sort of damage to the podocytes and because of our glomerular filtration membrane what it does is trying to keep red blood cells and proteins up into the body right and allowing for our electrolytes our nutrients toxins and wastes and anything that we don't need to get filtered out into our urine when there's a disruption there we're going to have some issues so we have damage we have inflammation and essentially along the way in our nephrotic we get a podocyte injury or protocyte damage and then once we have that issue these can open up okay and we start to get a large loss of proteins when we do get that enormous loss of proteins that's where we start to look at then what is going on in nephrotic syndrome we have a patient that comes in we think they have nephrotic syndrome one of the big things they're going to say is they're tired or fatigued and then they're going to have very very low proteins right because they're going to be losing a lot of proteins through their urine so when we do check their urine or their blood work they're either going to have a lot of protein in their urine or they're going to have a lot of protein missing in their blood and when we see this as a patient we're going to be seeing what we call a loss of a specific protein what's the one that's synthesized in the liver that's albumin right and what is albumin used for it's very important for us for transporting water for being able to form clots being able to do a lot of different things in the body getting nutrients to areas it needs to and hormones and areas it needs to so when we have low protein especially low albumin we call that hypoalbuminemia so if they have low albumin in the blood right they have hypoalbum anemia they're going to have high amounts of protein in the urine we call that proteinuria specifically with nephrotic syndrome it's going to be so high that it's actually going to be greater than 3.5 grams per day and then we're also going to have some blood work done more than likely increased bun creatinine and then that kind of creates the picture here of what nephrotic is but one of the biggest things or the biggest keywords you're going to be looking for on the NCLEX when you are taking this exam is the urine and the urine will always be described as foamy urine so let's recap really quickly we have a patient who has nephrotic syndrome they're going to have an increase in proteinuria right over 3.5 grams per day and then because of that they're going to have low albumin anemia meaning they're going to be at risk for things like edema clot hyperglycemia so what we're looking at for this patient just specifically on this is giving back the albumin right so we may administer the malbumin and then we're also going to be looking at getting that edema by giving them diuretics and then there's a lot of other things that we can do to treat this patient but this is just an overarching of what's going on with nephrotic now when we move over to nephritic what we want to do is we want to think about what's going on with this patient within nephritic syndrome we have inflammation specifically again we have some areas of issues within the filtration barrier but more so problems with the glomerular basement membrane and if you've seen the acute glomeronephritis video you'll know there's all about the antibody antigens that get stuck in here but most importantly it's inflammation within that glomerular basement membrane also known as our GBM so because we have that inflammation we're gonna at this patient they're going to have some of the similar complaints right they're going to be having maybe fatigue or headache but then as we start to look into their urine and what's going on with their urine analysis we can start to see some differences as well so with this patient we're going to see things like they're going to come in and say I'm having trouble going to the bathroom or I'm not not peeing as much as often so we call those things Algeria and urea they may be complaining of blood within their urine so we call that hematuria this patient will also have protein urea as well but not as high as someone with nephrotic syndrome so it won't be as high as 3.5 or greater but it still be slightly elevated and then this patient's also going to have this dark murky looking type of urine which we call that Coca-Cola Coca-Cola colored urine so now when we look at all this overarching issue with nephritic syndrome it is an overall of a decrease in the filtration rate with that coca-color colored urine in that protein area in the hematuria so if you want to remember anything within these two to be able to delineate between nephrotic or nephritic just think if it has blood in the urine is going to be more than likely a nephritic and not a nephrotic because we didn't talk about that over on the other side then we're going to look at our blood work right increased bun creatinine and then we're going to look at some of the other issues this patient might also have some issues with hypertension if they do not have a history of hypertension then they're all of a sudden a new onset of blood pressure issues could indicate there is something wrong with the kidney or if they already do have a problem they could be exacerbated by having this nephritic syndrome so we want to think about what's going on with this patient is there could be some type of infection that had occurred specifically in sort of a Peds patient where they had any type of streptococcus infection that was when untreated and then two weeks later they start having issues with uh going to the bathroom and dark urine they could have edema in areas facial edema up around the periorbital right or the lips later could be progressing to the feet into the hands and then if this is an adult patient not only having that peripheral but also having then a pleural effusion or a pericardial fusion and ascites as well so a lot of Edema can be occurring and with that we're looking to fix this patient's underlying cause with nephritic it's more so identifying what that underlying cause was that that pre-exacerbated this type of kidney injury so we could be looking at things like an infection so we're going to be giving them antibiotics that wasn't treated if they're having issues with hypertension we're going to give them anti-hypertensives and then we're going to be looking at trying to give them some type of fluid replacement or any other underlying issues that they have so then if we take a step back and we start to look at what's going on with both of these patients we can start to think that all right once we treat the issue on both sides whether it's giving somebody antibiotics for their nephritic issue or giving albumin for the nephrotic the care for both these patients essentially becomes the same right it's making sure we have adherence to medication making sure we are monitoring their eyes and O's if it's a adult patient making sure that their output is around 30 milliliters per hour if it's a pediatric patient it's one milliliter per kilogram per hour and then we also just want to make sure that these patients are getting better it's frequently checks with the vital signs checking those electrolytes through blood work checking the kidney function through blood work and making sure that this patient's Problem whatever it is along either syndrome is getting better and not worse and then any other modifications that we need to give them with diet we want to make sure we are following along with them as well whether it's replacing something taking out sodium adding in protein or anything else that we need to do in order for this patient to get better so remember as we go from nephrographic syndrome identifying what the issue is essentially the nursing care starts to look very similar at bedside once we identify that there's something going on with the kidney and the glomerulus so hope this video made sense I hope it cleared up for you any issues you had with understanding nephrotic versus nephritic and as always until next time foreign [Music]

Channel: Ninja Nerd Nursing

Views: 4,327

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Id: f4LqKDHppFM

Length: 10min 38sec (638 seconds)

Published: Wed May 24 2023