How are edema and hypertension managed in acute poststreptococcal glomerulonephritis (APSGN)?

Updated: Dec 05, 2018
  • Author: Rajendra Bhimma, MBChB, MD, PhD, DCH (SA), FCP(Paeds)(SA), MMed(Natal); Chief Editor: Craig B Langman, MD  more...
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Answer

Initial management of edema and hypertension include some degree of fluid and salt restriction along with enhanced diuresis. Thiazides are the diuretics of choice as they lead not only to diuresis but also effective control of hypertension. However, they are not effective if the glomerular filtration rate drops to less than 30mls/min/1.73 sq. meters. When more significant edema is present or pulmonary edema, loop diuretics need to be used in high intravenous doses. 

For more effective control of hypertension, use of B Blockers or calcium ion antagonist may be considered. The former can lead to hyperkalemia and the latter to fluid retention and should be closely monitored. Angiotensin converting enzyme antagonists and receptor blockers may be used but need to be closely monitored, especially in patients with declining kidney function as these agents may worsen glomerular filtration and lead to hyperkalemia.


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