Treatment of Post-Streptococcal Glomerulonephritis
The treatment of post-streptococcal glomerulonephritis (PSGN) is primarily supportive, focusing on management of symptoms while the disease typically follows its self-limiting course. 1, 2
Antimicrobial Treatment
- Antibiotic therapy: Even though PSGN typically occurs 1-3 weeks after the initial streptococcal infection, patients should be treated with antibiotics to eliminate any remaining streptococcal organisms:
- First-line: Penicillin (or erythromycin if penicillin-allergic) 1
- Purpose: To decrease antigenic load even in the absence of persistent infection
- Duration: Standard 10-day course
Management of Kidney Manifestations
Fluid and Electrolyte Management
- Fluid restriction: Crucial in patients with volume overload 2
- Sodium restriction: Limit dietary sodium intake to help control edema and hypertension 1
Hypertension Management
First-line treatment: Diuretics (loop or thiazide) 1, 3
- Effectively controls hypertension and edema
- May also address hyperkalemia if present
- Monitor for adverse effects: hyponatremia, hypokalemia, GFR reduction, volume depletion
For severe or resistant hypertension:
Edema Management
- Diuretics: Primary treatment for edema 1
- If diuretic response is insufficient: Add mechanistically different diuretics 1
Severe Complications
- For severe crescentic PSGN: Corticosteroids may be considered based on anecdotal evidence only 1
- Renal replacement therapy: Dialysis if necessary for severe acute kidney injury 2
Monitoring and Follow-up
- Blood pressure monitoring: Especially important during the first 7-10 days when hypertension is most severe 3
- Renal function tests: Monitor creatinine, BUN, electrolytes
- Urinalysis: Follow for resolution of hematuria and proteinuria
- Complement levels: C3 levels typically normalize within 8-12 weeks
Prognosis
- Most children and adults with PSGN have an excellent prognosis 2, 5
- Epidemic form has better outcomes than sporadic cases 4
- Poor prognostic indicators:
- Crescent formations on renal biopsy
- Renal insufficiency at presentation
- Hypoalbuminemia
- Persistent hypertension beyond the acute phase 6
Important Caveats
- Avoid immunosuppressive therapy in typical PSGN as it is generally not beneficial 4
- IgA-dominant postinfectious GN (especially associated with staphylococcal infections) needs to be distinguished from PSGN as it should not be treated with corticosteroids 1
- Persistent hypertension beyond the acute phase (>3-5 days) may indicate a more complicated course and requires close follow-up 6
- While the disease is generally self-limiting, a small percentage of patients may develop persistent urinary abnormalities, hypertension, or chronic kidney disease 2
Remember that the most severe manifestations typically occur in the first 7-10 days of disease, requiring vigilant monitoring during this period. After this acute phase, most patients recover completely without long-term sequelae.