Nursing the child with nephrotic syndrome or glomerulonephritis: weight, oedema, urine and blood pressure
- Safe practice
Daily weight, urine checks, blood pressure and watching the oedema tell the nurse whether a child's kidney disease is improving or worsening.
What it is
Nephrotic syndrome (most often minimal change disease, in children aged 2 to 6) causes heavy protein loss in the urine and oedema. Post-streptococcal glomerulonephritis follows a throat or skin infection by weeks and causes dark urine, swelling and high blood pressure. Haemolytic uraemic syndrome follows bloody diarrhoea and causes kidney failure. In all of them the nurse measures what changes first: weight, urine output and appearance, protein in the urine, blood pressure and oedema, and teaches the family the warning signs.
What it requires
- Accurate intake and output, and urine appearance at each void.
- Blood pressure with the right cuff size at every round, per protocol.
- Urine dipstick for protein as ordered; results can be affected by dehydration, contrast dye, exercise and infection.
- Low-salt diet and other measures prescribed by the team.
How it is applied (and why)
- Weigh the child each morning before breakfast on the same scale — daily change shows fluid gain or loss.
- Measure and record all intake and output; note urine colour and foam — falling output or dark urine needs reporting.
- Test urine with a dipstick as ordered and record the result — protein guides relapse and response to treatment.
- Take blood pressure with the right cuff — high pressure is common in glomerulonephritis and needs treatment.
- Check oedema of eyelids, legs, scrotum or labia and abdomen; record where and how much — swelling shows fluid retention.
- Support the prescribed low-salt diet with the family — salt drives fluid retention.
- Watch for infection (fever, abdominal pain, cough) and for signs of a clot — both are complications of nephrotic syndrome.
- Teach the family home weight, dipstick testing and warning signs before discharge — the family continues the monitoring at home.
In nursing practice
- Complications of nephrotic syndrome include infections, blood clots, fluid overload and kidney failure.
- Post-streptococcal glomerulonephritis usually resolves in weeks to months; rarely it leads to chronic disease.
- High potassium and heart failure can complicate acute glomerulonephritis: report abnormal results and breathlessness.
- Haemolytic uraemic syndrome is a leading cause of acute kidney failure in children; prevention includes cooked meat, safe water and hand washing.
Common mistakes
- Weighing at different times or on different scales, so the trend is meaningless.
- Not testing the urine at the times ordered, so a relapse is missed.
- Missing a fall in urine output because output is not recorded.
- Not teaching the family to report swelling, less urine, fever, severe headache or a seizure.
Test yourself
Think of the answer, then tap the question to see it.
Why is a child with nephrotic syndrome weighed every day?
Weight change reflects fluid retention or loss, so it shows whether the oedema is worsening or improving.
Which signs suggest post-streptococcal glomerulonephritis?
Rust-coloured or bloody urine, less urine, facial or leg swelling and high blood pressure weeks after a strep throat or skin infection.
Which signs after bloody diarrhoea suggest haemolytic uraemic syndrome?
Pallor, bruising or small red spots, and little or no urine; it is an emergency.
Which complications of nephrotic syndrome does the nurse watch for?
Infections (such as pneumonia) and blood clots; also fluid overload and kidney failure.
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Nephrotic syndrome (MedlinePlus, U.S. National Library of Medicine, 2024); Poststreptococcal glomerulonephritis (GN) (MedlinePlus, U.S. National Library of Medicine, 2024); Hemolytic-uremic syndrome (MedlinePlus, U.S. National Library of Medicine, 2024); Protein urine test (MedlinePlus, U.S. National Library of Medicine, 2024).
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Representative model, for educational purposes only.