How is poststreptococcal glomerulonephritis treatment?

Updated: Dec 16, 2020
  • Author: Duvuru Geetha, MD, MRCP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

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. [18]

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 renal function. [18] 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.

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