Acute Glomerulonephritis Treatment & Management
- Author: Malvinder S Parmar, MB, MS, FRCP(C), FACP; Chief Editor: Vecihi Batuman, MD, FACP, FASN more...
Approach Considerations
Treatment of acute poststreptococcal glomerulonephritis (PSGN) is mainly supportive, because there is no specific therapy for renal disease. When acute glomerulonephritis (GN) is associated with chronic infections, the underlying infections must be treated.
The expertise available in the ICU may be needed for management of patients with hypertensive encephalopathy or pulmonary edema. Consultation with a nephrologist may be indicated. On an outpatient basis, renal function, blood pressure, edema, serum albumin, and urine protein excretion rate should be monitored.
In a retrospective study from New Zealand, Wong et al examined the characteristics and treatment of acute PSGN in 27 pediatric patients and determined that the need for acute dialysis was most common among the 11 children in the study with crescentic GN. They also determined that urinary sediment abnormalities persisted in the patients with crescentic GN even after a mean follow-up period of 3.2 years and that the benefits of immunosuppressive therapy were unclear in these patients.[6]
Go to Emergent Management of Acute Glomerulonephritis and Acute Poststreptococcal Glomerulonephritis for complete information on these topics.
Pharmacologic Therapy
Antibiotics
Antibiotics (eg, penicillin) are used to control local symptoms and to prevent spread of infection to close contacts. Antimicrobial therapy does not appear to prevent the development of GN, except if given within the first 36 hours. Antibiotic treatment of close contacts of the index case may help prevent development of PSGN.
Other agents
Loop diuretics may be required in patients who are edematous and hypertensive in order to remove excess fluid and to correct hypertension.
Vasodilator drugs (eg, nitroprusside, nifedipine, hydralazine, diazoxide) may be used if severe hypertension or encephalopathy is present.
Glucocorticoids and cytotoxic agents are of no value, except in severe cases of PSGN.
Diet and Activity
Sodium and fluid restriction should be advised for treatment of signs and symptoms of fluid retention (eg, edema, pulmonary edema). Protein restriction for patients with azotemia should be advised if there is no evidence of malnutrition.
Bed rest is recommended until signs of glomerular inflammation and circulatory congestion subside. Prolonged inactivity is of no benefit in the patient recovery process.
Long-Term Monitoring
Long-term studies on children with PSGN have revealed few chronic sequelae. Results of such studies are controversial because homogenous populations suitable for proper epidemiologic analysis have not been assembled.
Long-term studies show higher mortality rates in elderly patients, particularly those on dialysis. Patients may be predisposed to crescent formation.
Wen YK, Chen ML. The significance of atypical morphology in the changes of spectrum of postinfectious glomerulonephritis. Clin Nephrol. Mar 2010;73(3):173-9. [Medline].
Nasr SH, Markowitz GS, Stokes MB, et al. Acute postinfectious glomerulonephritis in the modern era: experience with 86 adults and review of the literature. Medicine (Baltimore). Jan 2008;87(1):21-32. [Medline].
Safadi R, Almog Y, Dranitzki-Elhalel M, Rosenmann E, Tur-Kaspa R. Glomerulonephritis associated with acute hepatitis B. Am J Gastroenterol. Jan 1996;91(1):138-9. [Medline].
Aggarwal A, Kumar D, Kumar R. Acute glomerulonephritis in hepatitis A virus infection: a rare presentation. Trop Doct. Jul 2009;39(3):186-7. [Medline].
Anochie I, Eke F, Okpere A. Childhood acute glomerulonephritis in Port Harcourt, Rivers State, Nigeria. Niger J Med. Apr-Jun 2009;18(2):162-7. [Medline].
Wong W, Morris MC, Zwi J. Outcome of severe acute post-streptococcal glomerulonephritis in New Zealand children. Pediatr Nephrol. May 2009;24(5):1021-6. [Medline].
Becquet O, Pasche J, Gatti H, et al. Acute post-streptococcal glomerulonephritis in children of French Polynesia: a 3-year retrospective study. Pediatr Nephrol. Feb 2010;25(2):275-80. [Medline].
Nebuloni M, Barbiano di Belgiojoso G, Genderini A, et al. Glomerular lesions in HIV-positive patients: a 20-year biopsy experience from Northern Italy. Clin Nephrol. Jul 2009;72(1):38-45. [Medline].
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