Glomerulonephritis Associated with Nonstreptococcal Infection Treatment & Management

Updated: Apr 28, 2015
  • Author: James W Lohr, MD; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Treatment

Medical Care

In most cases, the treatment of glomerulonephritis (GN) associated with infection is based on treating the underlying infection. In certain instances, immunosuppressive agents such as corticosteroids may be employed to reduce glomerular inflammation.

Viral

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  • Chronic hepatitis B: Treatment is indicated if associated liver dysfunction is present. The usual regimen is interferon alfa-2b at 5 million U/d for 4 months or 10 million U 3 times a week for 4 months. The efficacy of pegylated interferon in regard to hepatitis B related renal disease is unclear at this time. Entecavir and lamivudine have also been used in patients with hepatitis B and GN. [13]
  • Chronic hepatitis C: Treatment is with recombinant human interferon alfa at 3 million U 3 times a week for 24 weeks. The pegylated form is long acting and slightly more effective. Preferably, interferon is given along with ribavirin, but this cannot be given in the presence of renal insufficiency. Rituximab has been used to treat hepatitis C related glomerulopathy. [14]
  • HIV: Highly active antiretroviral therapy (HAART) is the standard of care for patients with HIV, with or without nephropathy. [15] Treatment is based on findings from viral titers, the history of previous therapy, and, preferably, on the advice of an infectious diseases specialist. There is evidence that HAART therapy may slow the progression of HIV associated nephropathy to end-stage renal disease. Patients should also be started on angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB), as this may slow the progression of disease.
  • Other viral agents: Cytomegalovirus, parvovirus, and polyomavirus associated nephropathy are observed in immunocompromised individuals and those who have undergone renal transplantation. Treatment is with specific antiviral agents (ie, ganciclovir for cytomegalovirus and cidofovir for polyomavirus [JC and BK virus]) and temporary withdrawal of immunosuppression therapy.
  • Syphilis: Nephropathy is usually observed in secondary syphilis because this phase is associated with high levels of immune complexes. If CNS or ocular involvement is not present, treatment is similar to primary syphilis (ie, single IM dose of benzathine penicillin 2.4 million U). If the patient is allergic to penicillin, use doxycycline (100 mg PO bid) or erythromycin (500 mg PO qid) for 2 weeks.
  • Endocarditis: Treatment of shunt infections and visceral abscesses is usually is based on culture sensitivity results.

Paracytic

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  • Malaria: Even though falciparum malaria can cause acute tubular necrosis due to acute hemolysis, hypotension chronic-progressive nephropathy is observed with Plasmodium malariae infection. In comparison with falciparum malaria, P malariae infection is a more indolent form of infection, which affects only 25% of erythrocytes and tends to cause chronic progressive immune complex–mediated nephropathy. Treatment with chloroquine is effective for P malariae infection because resistance is uncommon. However, treatment of the infection does not usually slow the progression of nephropathy, and most patients progress to end-stage renal disease in 3-5 years.
  • Schistosomiasis: Usually, treatment with praziquantel does not slow the progression of nephropathy. Sometimes, if schistosomiasis is associated with co-infection with Salmonella species, treatment of the Salmonella infection improves the nephropathy.
  • Others: Agents used in leishmaniasis treatment include antimony compounds (eg, sodium stibogluconate) and amphotericin B, pentamidine, and paromomycin. Diethylcarbamazepine and ivermectin are used for treating filariasis.

Fungal

For aspergillosis, treatment is based on the site of infection and usually includes amphotericin.

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Surgical Care

If bacterial endocarditis or a shunt infection does not respond to antibiotics, then surgical intervention is indicated.

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Consultations

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  • Consultation with a nephrologist is indicated in patients with GN associated with infection.
  • Consultation with an infectious diseases specialist may be appropriate if the infectious etiology is unclear.
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Diet

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  • Salt restriction for is indicated for patients with hypertension.
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Activity

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  • Activity can be performed as tolerated by the patient.
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