Glomerulonephritis, Poststreptococcal Follow-up
- Author: Duvuru Geetha, MD, MRCP; Chief Editor: Vecihi Batuman, MD, FACP, FASN more...
Further Inpatient Care
- In the acute phase, admit for observation and treatment of hypertension and congestive heart failure.
- Admit for monitoring and to initiate dialysis (when indicated) if renal function progressively worsens.
Further Outpatient Care
- Monitor blood pressure every month for 6 months and then every 6 months thereafter.
- Monitor BUN and serum creatinine levels every 3 months after the acute phase for 1 year and then yearly after that.
- Check serum complement levels at 6-8 weeks to make sure they have returned to normal.
- Check urine for hematuria and proteinuria every 3-6 months.
Inpatient & Outpatient Medications
- Most patients do not require any medications after the acute phase.
- In the acute phase, diuretics may be needed to control edema and congestive heart failure.
- Antihypertensives may be needed in the chronic phase if the patient's blood pressure remains high.
Transfer
- Transfer may be necessary if renal biopsy facilities are not available and the diagnosis is in doubt or if rapidly progressive renal failure develops.
- Transfer may be necessary if azotemia worsens and dialysis facilities are not available on site.
Deterrence/Prevention
- The patient and any family member or close personal contact should have a throat culture.
- Treatment with penicillin G or erythromycin (if allergic to penicillin) helps prevent nephritis in carriers and helps prevent the spread of nephritogenic strains to others.
- Patients with skin infections must pay close attention to personal hygiene.
- Epidemics should prompt empirical prophylactic treatment for high-risk individuals (family and close personal contacts).
Complications
- Complications in the acute phase include the following:
- Congestive heart failure
- Azotemia
- Early death secondary to congestive heart failure and azotemia
- Complications in the chronic phase include the following:
- Nephrotic-range proteinuria
- Chronic renal insufficiency and end-stage renal disease
Prognosis
- In children, the immediate prognosis is excellent.[2]
- In elderly patients who have congestive heart failure or azotemia in the early phase, early mortality rates can be as high as 25%.
- The long-term prognosis is debatable.
- Fewer than 1% of children have elevated serum creatinine values after 10-15 years of follow-up.
- Adults who develop massive proteinuria often have the garlandlike pattern of immune deposits. Their prognosis is worse; approximately 25% progress to chronic renal failure.
Patient Education
- Patients with skin infections should know the importance of personal hygiene.
- In epidemics, all close personal contacts and family members should be told to seek medical attention for prophylactic treatment of streptococcal infections.
- For excellent patient education resources, visit eMedicine's Kidneys and Urinary System Center and Ear, Nose, and Throat Center. Also, see eMedicine's patient education articles Blood in the Urine and Strep Throat.
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