What is the role of medications in the treatment of poststreptococcal glomerulonephritis?

Updated: Dec 16, 2020
  • Author: Duvuru Geetha, MD, MRCP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Therapy for patients with acute poststreptococcal glomerulonephritis is symptomatic in nature and depends on the clinical severity of the illness. The major aims are to control the edema and blood pressure.

During the acute phase of the disease, salt and water should be restricted. If significant edema or hypertension develops, diuretics should be administered. Loop diuretics increase urinary output and consequently improve cardiovascular congestion and hypertension.

For hypertension not controlled by diuretics, calcium channel blockers or angiotensin-converting enzyme inhibitors are generally useful. For malignant hypertension, intravenous nitroprusside or other parenteral agents are used.

The indications for dialysis include life-threatening hyperkalemia and clinical manifestations of uremia. Steroids, immunosuppressive agents, and plasmapheresis are not generally indicated. In patients with rapidly progressive renal failure, a renal biopsy is indicated. 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.

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