How is mild-to-moderate 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

Mild-to-moderate hypertension does not warrant emergency management and is treated most effectively with bedrest, fluid restriction, and less-frequent doses of the medications mentioned above.

The use of loop diuretics, such as furosemide (1-3 mg/kg/d oral [PO], administered 1-2 times daily), may hasten resolution of the hypertension.

For patients resistant to treatment, either hydralazine or nifedipine is indicated.

Angiotensin-converting enzyme (ACE) inhibitors are effective, although these agents have the potential to produce hyperkalemia and usually are not first-line drugs in acute glomerulonephritis.

Edema and circulatory congestion are usually not sufficiently marked to produce more than minimal discomfort. Restriction of fluids to those amounts needed to replace insensible losses is the best treatment for edema and circulatory congestion.

Loop diuretics (furosemide) administered PO have been reported to reduce the length of hospitalization in children who are edematous. If congestion is marked, administer furosemide parenterally (2 mg/kg).

Phlebotomy, rotating tourniquets, dialysis, or digitalization is rarely necessary.


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