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
