Glomerulonephritis, Poststreptococcal Treatment & Management

  • Author: Duvuru Geetha, MD, MRCP; Chief Editor: Vecihi Batuman, MD, FACP, FASN   more...
 
Updated: Apr 13, 2010
 

Medical Care

Symptomatic therapy is recommended for patients with acute poststreptococcal glomerulonephritis (APSGN), and it should be based on the clinical severity of the illness. The major goal is to control edema and blood pressure.

  • During the acute phase of the disease, restrict salt and water.
    • If significant edema or hypertension develops, administer diuretics.
    • Loop diuretics increase urinary output and consequently improve cardiovascular congestion and hypertension.
  • For hypertension not controlled by diuretics, usually calcium channel blockers or angiotensin-converting enzyme inhibitors are useful. For malignant hypertension, intravenous nitroprusside or other parenteral agents are used.
  • Indications for dialysis include life-threatening hyperkalemia and clinical manifestations of uremia.
  • Restricting physical activity is appropriate in the first few days of the illness but is unnecessary once the patient feels well.
  • Steroids, immunosuppressive agents, and plasmapheresis are not generally indicated.
  • A renal biopsy is indicated for patients with rapidly progressive renal failure. If the biopsy findings show evidence of crescentic glomerulonephritis with more than 30% of the glomeruli involved, a short course of intravenous pulse steroid therapy is recommended (500 mg to 1 g/1.73 m2 of methylprednisone qd for 3-5 d). However, no controlled clinical trials have evaluated such therapy.
  • Long-term treatment with steroids or immunosuppressives is not recommended.
  • Specific therapy for streptococcal infection is an important part of the therapeutic regimen.
    • Treat patients, family members, and any close personal contacts who are infected.
    • Throat cultures should be performed on all these individuals. Treat with oral penicillin G (250 mg qid for 7-10 d) or with erythromycin (250 mg qid for 7-10 d) for patients allergic to penicillin.
    • This helps prevent nephritis in carriers and helps prevent the spread of nephritogenic strains to others.
  • Patients with skin infections must practice good personal hygiene. This is essential.
  • During epidemics, recommend that high-risk individuals, including close contacts and family members, receive empirical prophylactic treatment.
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Surgical Care

Surgical care is not indicated.

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Consultations

  • Nutritionist or dietitian
  • Nephrologist
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Diet

  • Low-salt diet - Two grams of sodium per day
  • Fluid restriction - One liter per day
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Activity

  • Restricting physical activity is appropriate in the first few days of the illness but is not necessary once the patient feels well.
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Contributor Information and Disclosures
Author

Duvuru Geetha, MD, MRCP  Assistant Professor of Medicine, Department of Renal Medicine, Bayview Medical Center, Johns Hopkins University

Duvuru Geetha, MD, MRCP is a member of the following medical societies: American Society of Nephrology and International Society of Nephrology

Disclosure: Nothing to disclose.

Specialty Editor Board

Chike Magnus Nzerue, MD  Associate Dean for Clinical Affairs, Vice-Chairman of Internal Medicine, Meharry Medical College

Chike Magnus Nzerue, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Society of Nephrology, and National Kidney Foundation

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Ajay K Singh, MB, MRCP, MBA  Associate Professor of Medicine, Harvard Medical School; Clinical Chief, Renal Division, Director of Dialysis, Brigham and Women's Hospital; Consulting Staff, Faulkner Hospital

Disclosure: Nothing to disclose.

Rebecca J Schmidt, DO, FACP, FASN  Professor of Medicine, Section Chief, Department of Medicine, Section of Nephrology, West Virginia University School of Medicine

Rebecca J Schmidt, DO, FACP, FASN is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Nephrology, International Society of Nephrology, National Kidney Foundation, Renal Physicians Association, and West Virginia State Medical Association

Disclosure: Abbott Grant/research funds Speaking and teaching; AMAG Honoraria Speaking and teaching; Amgen Honoraria Speaking and teaching; Ortho Biotech Honoraria Speaking and teaching; Renal Ventures Ownership interest Other

Chief Editor

Vecihi Batuman, MD, FACP, FASN  Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Medicine Service, Southeast Louisiana Veterans Health Care System

Vecihi Batuman, MD, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, and International Society of Nephrology

Disclosure: Nothing to disclose.

References

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Diagram of a nephron.
 
 
 
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