Poststreptococcal Glomerulonephritis Treatment & Management

Updated: Aug 07, 2016
  • Author: Duvuru Geetha, MD, MRCP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Treatment

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. Those sequelae are most likely to arise in the first 7 to 10 days of APSGN. [11]

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, angiotensin-converting enzyme inhibitors (ACEIs), or angiotensin receptor blockers (ARBs) are useful, although ACEIs and ARBs carry the risk of hyperkalemia and temporarily impairing recovery of renal function. [11] For malignant hypertension, intravenous nitroprusside or other parenteral agents are used.

Other features of therapy are as follows:

  • 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. Throat cultures should be performed on patients, family members, and close personal contacts, and treatment should be provided for all patients found to be infected. 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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Consultations

See the list below:

  • Nutritionist or dietitian
  • Nephrologist
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Diet and Activity

Dietary measures are as follows:

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

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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