Glomerulonephritis Associated with Nonstreptococcal Infection Guidelines

Updated: Mar 19, 2018
  • Author: James W Lohr, MD; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Guidelines

Guidelines Summary

In its clinical practice guidelines for glomerulonephritis (GN), Kidney Disease: Improving Global Outcomes (KDIGO) recommends treatment of the infectious disease and standard approaches to management of the kidney manifestations for poststreptococcal GN, infective endocarditis–related GN, and shunt nephritis. [3]

For hepatitis C virus (HCV)–associated GN, the guidelines make the following recommendations [3] :

  • Chronic kidney disease (CKD) stages 1 and 2: Combined antiviral treatment using pegylated interferon and ribavirin; dosage of ribavirin should be titrated according to the patient's tolerance and level of renal function.   
  • CKD Stages 3, 4, or 5 and not yet on dialysis: Monotherapy with pegylated interferon adjusted to the level of kidney function

For patients with mixed cryoglobulinemia (IgG/IgM) and nephrotic proteinuria or evidence of progressive kidney disease or an acute flare of cryoglobulinemia, treatment with plasmapheresis, rituximab, or cyclophosphamide, in conjunction with IV methylprednisolone, and concomitant antiviral therapy are recommended. [3]

For hepatitis B virus (HBV)–associated GN the guidelines recommend standard treatment with interferon-alpha or with nucleoside analogues, with the dosage adjusted to the degree of kidney function. For patients with biopsy-confirmed HIV-associated nephropathy, antiretroviral therapy should be initiated regardless of CD4 count. [20]

For patients with GN and concomitant malarial, schistosomal, or filarial infection, treatment is recommended with an appropriate antiparasitic agent to eradicate the organism. Corticosteroids or immunosuppressive agents should not be used for treatment of schistosomal-associated GN. A blood culture for Salmonella should be considered in patients with hepatosplenic schistosomiasis who show urinary abnormalities and/or reduced GFR. A positive blood culture for Salmonella necessitates anti-Salmonella therapy. [3]