From the Guidelines
The management of post-streptococcal glomerulonephritis (PSGN) should focus on supportive care, including treatment with penicillin or erythromycin to decrease the antigenic load, diuretics, antihypertensives, and dialysis if necessary, as well as corticosteroids for severe crescentic GN.
Key Components of Management
- Treatment with penicillin (or erythromycin, if penicillin-allergic) to decrease the antigenic load, even in the absence of persistent infection, as suggested by the 2013 American Journal of Kidney Diseases commentary 1
- Management of the nephritic syndrome with diuretics, antihypertensives, supportive care, and dialysis if necessary
- Use of corticosteroids for severe crescentic GN, based on anecdotal evidence
Additional Considerations
- Monitoring of blood pressure, renal function, urinalysis, and electrolytes is essential during the acute phase
- Follow-up should continue for 1-2 years to ensure complete resolution
- Most patients, especially children, recover completely within weeks to months without specific immunosuppressive therapy, as the condition typically resolves on its own 1
Treatment of Symptoms and Complications
- Hypertension can be managed with ACE inhibitors or calcium channel blockers
- Fluid overload and edema should be managed with fluid restriction and diuretics
- Acute kidney injury may require temporary dialysis in severe cases
From the Research
Management of Post-Streptococcal Glomerulonephritis (PSGN)
The management of PSGN is primarily symptomatic, focusing on supporting the patient's recovery and preventing complications. Key aspects of management include:
- Supportive treatment, such as monitoring and managing blood pressure, fluid balance, and electrolyte levels 2, 3
- Antibiotic therapy to treat the underlying streptococcal infection, although this does not directly affect the course of PSGN 4
- Control of hypertension, which can be achieved with antihypertensive medications such as ACE inhibitors or nifedipine 4
- Monitoring for and managing potential complications, such as acute kidney injury, nephrotic syndrome, and chronic kidney disease 5, 2, 3
Treatment Approaches
Different treatment approaches have been studied, including:
- The use of antimicrobials, such as cefuroxim and ceftibuten, although these have not been shown to have advantages over penicillin V 4
- The use of immunosuppressants, such as corticosteroids, in cases of crescentic PSGN, although the evidence for their effectiveness is limited 4, 6
- The use of rasburicase to manage hyperuricemia, although this is not a standard treatment for PSGN 2
Prevention
Prevention of PSGN is primarily focused on treating group A streptococcal infections promptly and effectively to prevent the development of complications 3. This can be achieved through:
- Early diagnosis and treatment of streptococcal infections, such as pharyngitis or impetigo
- Use of antibiotic therapy to treat streptococcal infections
- Public health measures to prevent the spread of streptococcal infections