Care in Illness

We've now discussed what MCD is, how you get it and who gets it, how to diagnose it, what the disease looks and acts like and how to treat the specific issue causing the disease.  Now let's talk about getting the whole body system back in good working condition.

In order to successfully treat MCD, the symptoms must be managed and overall health of the patient must be stabilized.  Below are some of the symptoms of nephrotic syndrome in MCD and the way in which they are treated:

Symptom	Nursing Intervention	Rationale
Swelling (Edema) (especially around the eyes, feet, ankles, abdomen)	Administer water pills (Diuretics) as ordered	This will allow the patient's body to release excess water and salt that the body is holding on to due to the excretion of protein.
Foamy Urine (excess protein in the urine)	Administer ACE inhibitors (angiotensin converting enzyme inhibitors), ARBs (angiotensin II receptor blockers) as ordered	These two medications both interfere with the renin-angiotensin-aldosterone cycle.  This cycle is the communication between the liver, the lungs, and the kidneys to help regulate blood pressure.  It tells the kidneys when to get rid of certain minerals and when to maintain them.
Poor appetite	Assist patient with diet regulation	The patient must remain nourished and healthy while the underlying problem is treated.
Weight gain	Administer water pills (Diuretics) as ordered	Weight gain is often due to excess fluid.
High blood pressure	Administer ACE inhibitors and ARBs as ordered	See above description for drugs
High cholesterol	Assist patient with diet regulation	The patient must remain nourished and healthy while the underlying problem is treated.

As we've discussed previously, the major problem in MCD is the malformation of the foot processes of the podocytes.  The treatment for this issue is summarized below:

Problem	Nursing Intervention	Rationale
Malformed foot processes of podocytes	Administer oral steroids (often Prednisone) as ordered	Corticosteroids give a great prognosis in both children and adults.  90% of patients will respond positively.  Minimal change disease will often completely remit in children within a few weeks.  About 50% of adult patients will relapse but steroids can be utilized again.

References:

http://kidney.niddk.nih.gov/KUDiseases/pubs/childkidneydiseases/nephrotic_syndrom/#sec10

      This website provides clear detail surrounding symptoms and treatment of primary childhood nephrotic syndrome...the illness that is caused by minimal change disease.  It is very thorough and easy to understand.

 http://umm.edu/health/medical/ency/articles/minimal-change-disease

http://umm.edu/health/medical/ency/articles/nephrotic-syndrome

http://www.unckidneycenter.org/kidneyhealthlibrary/minimalchange.html