What fluids are recommended for managing Poststreptococcal Glomerulonephritis (PSGN)?

Fluid Management in Post-Streptococcal Glomerulonephritis (PSGN)

Diuretics are the preferred agents for managing fluid overload in PSGN, along with dietary sodium restriction. 1

First-Line Management Approach

• Restrict dietary sodium intake to <2.0 g/d (<90 mmol/d) to reduce edema, control blood pressure, and manage proteinuria 1, 2
• Use diuretics as first-line therapy for volume overload and hypertension management 1, 2, 3
• If diuretic response is insufficient, add mechanistically different diuretics (combination therapy) 1
• Monitor closely for diuretic adverse effects including hyponatremia, hypokalemia, GFR reduction, and volume depletion 1, 2

Hypertension Management

• Target systolic blood pressure in adult patients should be <120 mmHg using standardized office BP measurement 1
• For children, target 24-hour mean arterial pressure at the 50th percentile for age, sex, and height by ambulatory blood pressure monitoring 1
• Use ACE inhibitors or ARBs at maximally tolerated doses for patients with both hypertension and proteinuria 1
• Counsel patients to hold RAS inhibitors and diuretics when at risk for volume depletion (e.g., during intercurrent illness) 1

Special Considerations

• Fluid management is primarily supportive as PSGN is typically self-limiting 3
• Hypervolemia in acute PSGN can lead to congestive heart failure, pulmonary edema, and hypertensive encephalopathy, requiring aggressive fluid management 3, 4
• Transient hypertension in the acute phase often resolves within 3-5 days with normalization of glomerular filtration rate and resolution of edema 4
• Renal replacement therapy (dialysis) may be necessary in severe cases with acute kidney injury 2, 3

Monitoring Parameters

• Regular assessment of kidney function, blood pressure, and fluid status 2
• Monitor serum electrolytes, particularly potassium and sodium levels when using diuretics 1, 2
• If using ACE inhibitors or ARBs, use potassium-wasting diuretics and/or potassium-binding agents to maintain normal serum potassium 1
• Treat metabolic acidosis if serum bicarbonate is <22 mmol/l 1

Common Pitfalls to Avoid

• Do not assume normal urinalysis rules out PSGN, as some patients may present with minimal urinary abnormalities 5
• Avoid excessive fluid restriction that may compromise renal perfusion 2
• Be vigilant for complications during the first 7-10 days of disease when hypertension, edema, and impaired renal function are most severe 6
• Do not delay treatment of hypertension, as persistent hypertension is associated with poorer long-term outcomes 4, 6