Poststreptococcal Glomerulonephritis Treatment & Management

Updated: Nov 08, 2021
  • Author: Duvuru Geetha, MD, MRCP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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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. [19]

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.

Most patients do not require any medications after the acute phase, but antihypertensives may be needed in the chronic phase if the blood pressure remains high. For hypertension not controlled by diuretics, the usual second-line choices are calcium channel blockers, angiotensin-converting enzyme inhibitors (ACEIs), or angiotensin receptor blockers (ARBs), although ACEIs and ARBs carry the risk of hyperkalemia and temporarily impairing recovery of kidney function. [19] For malignant hypertension, intravenous nitroprusside or other parenteral agents are used.

In the acute phase, admit for observation and treatment of hypertension and congestive heart failure.  

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 kidney 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.

Admit for monitoring and to initiate dialysis (when indicated) if kidney function progressively worsens. Transfer may be necessary if kidney biopsy facilities are not available and the diagnosis is in doubt or if rapidly progressive renal failure develops. Transfer may also be necessary if azotemia worsens and dialysis facilities are not available on site.

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 or colonized. 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.




The following consultations may be beneficial:

  • Nutritionist or dietitian
  • Nephrologist

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.



Preventive measures are as follows:

  • 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).

Long-Term Monitoring

Patients who have had acute poststreptococcal glomerulonephritis should be monitored according to the following schedule:

  • 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.