Nephrotic Nolan — Childhood Nephrotic Syndrome: Puffy Eyes, Frothy Urine & Protein Loss
His eyelids are swollen shut in the morning and his urine foams — protein is leaking straight out of him
Nolan's mother thought his eyes were puffy from crying. Four days later his belly is swollen, his urine foams, and he has gained six pounds.
Nolan has nephrotic syndrome: damaged glomeruli leak massive protein into the urine, dropping serum albumin so fluid shifts into the tissues. The result is periorbital edema worst in the morning, generalized swelling and ascites, frothy urine, weight gain, and a high cholesterol level. Blood pressure is usually normal and there is little or no blood in the urine — the classic contrast with glomerulonephritis. Care is corticosteroids, daily weight and abdominal girth, a low-sodium diet, protection of fragile edematous skin, and infection prevention, because lost immunoglobulins leave him vulnerable.
Read Nephrotic Nolan's full story →The story arc
The setup
Nolan's eyelids are puffy each morning and improve a little by afternoon, so the swelling is dismissed as allergies.
The turn
His abdomen distends, his urine foams in the toilet, and he gains six pounds in a week.
The crisis
Nolan spikes a fever, and the nurse knows an infection in this child is dangerous.
The save
Nolan starts corticosteroids, is weighed daily on the same scale with abdominal girth measured, eats a low-sodium diet, and his fragile swollen skin is protected and repositioned.
NCLEX study section — Childhood Nephrotic Syndrome: Puffy Eyes, Frothy Urine & Protein Loss
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Pediatrics
Take this chapter into practice questions on the same topic.