What is the treatment for post-streptococcal glomerulonephritis (PSGN)?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: January 25, 2026 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

Treatment of Post-Streptococcal Glomerulonephritis

Treat all patients with post-streptococcal glomerulonephritis (PSGN) with penicillin (or erythromycin if penicillin-allergic) even when active infection has resolved, combined with supportive management of fluid overload and hypertension using diuretics and sodium restriction. 1, 2

Antibiotic Therapy

Administer antibiotics regardless of whether active infection is still present—the goal is to reduce streptococcal antigenic load, not to treat active infection. 1

  • First-line: Penicillin for all patients 1, 2
  • Penicillin allergy: Erythromycin 1, 2
  • Non-anaphylactic penicillin allergy or beta-lactamase producing organisms: First-generation cephalosporins (e.g., cephalexin) 1, 2
  • Severe infections or resistant organisms: Third-generation cephalosporins (e.g., ceftriaxone) 1, 2

During community outbreaks, systemic antimicrobials help eliminate nephritogenic strains of Streptococcus pyogenes from the population. 1

Critical pitfall to avoid: Do not withhold antibiotics simply because the pharyngitis or impetigo has clinically resolved—antigenic load reduction is therapeutic even after infection clearance. 1

Supportive Management of Nephritic Syndrome

Sodium and Fluid Management

  • Restrict dietary sodium to <2.0 g/day to control hypertension and fluid retention 1, 2
  • Monitor fluid status closely and adjust management based on clinical response 1, 2

Blood Pressure Control

  • Use diuretics as first-line agents for managing both fluid overload and hypertension 1, 2
  • Target blood pressure <130/80 mmHg (or <125/75 mmHg if proteinuria >1 g/day) 2
  • ACE inhibitors (captopril, enalapril) provide superior blood pressure control and improved echocardiographic changes compared to other antihypertensives 3
  • Nifedipine is effective for acute hypertensive episodes 3

Monitor closely for diuretic-related complications: hyponatremia, hypokalemia, GFR reduction, and volume depletion. 1, 2

Additional Supportive Measures

  • Treat metabolic acidosis if serum bicarbonate <22 mmol/L 1, 2
  • Consider treating dyslipidemia in patients with nephrotic syndrome, particularly those with other cardiovascular risk factors 1

Dialysis Indications

Provide dialysis for severe acute kidney injury with: 1, 2

  • Uremia
  • Refractory fluid overload
  • Life-threatening hyperkalemia

Immunosuppressive Therapy

Reserve corticosteroids ONLY for severe crescentic PSGN with rapidly progressive glomerulonephritis—evidence is anecdotal at best. 1, 2

  • Do NOT use immunosuppression for typical PSGN as the disease is self-limited with excellent prognosis 1
  • For most patients with immune complex glomerulonephritis presenting with eGFR <30 ml/min per 1.73 m², supportive care alone is recommended 1
  • Combined immunosuppressants for crescentic post-streptococcal glomerulonephritis showed no advantages over supportive therapy alone 3

Critical pitfall: Avoid routine immunosuppression—most cases resolve spontaneously and the evidence for immunosuppression is weak. 1

Monitoring and Follow-Up

Complement Monitoring

  • C3 complement levels should normalize within 8-12 weeks in uncomplicated cases 1, 2
  • If C3 remains low beyond 12 weeks, perform kidney biopsy to exclude complement C3 glomerulonephritis (C3GN) 1, 2

Regular Assessment

Monitor throughout disease course: 1, 2

  • Kidney function (serum creatinine, eGFR)
  • Blood pressure
  • Urinalysis with microscopy for proteinuria and hematuria
  • Urine protein-to-creatinine ratio

Kidney Biopsy Indications

Perform kidney biopsy when: 1

  • Diagnosis is uncertain
  • Atypical presentation
  • Persistently low C3 beyond 12 weeks
  • Rapidly progressive glomerulonephritis

Prognosis Considerations

The majority of children with epidemic PSGN have excellent prognosis, contrasting with poorer long-term outcomes in sporadic adult cases. 3 Hypertension during acute phase occurs in approximately 95% of patients but typically resolves within 3-5 days with normalization of glomerular filtration rate and plasma volume. 4 Persistent hypertension beyond the acute phase is a poor prognostic sign and contributes to glomerulosclerosis development. 4

References

1
Guideline

Management of Post-Streptococcal Glomerulonephritis (PSGN)

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

2
Guideline

Treatment of Post-Infectious Glomerulonephritis

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

3
Research

Evidence-based treatment limitations prevent any therapeutic recommendation for acute poststreptococcal glomerulonephritis in children.

Medical science monitor : international medical journal of experimental and clinical research, 2010

Related Questions

What is the management of post-streptococcal glomerulonephritis (PSGN)?
What is the initial management of Post-Streptococcal Glomerulonephritis (PSGN)?
What is the management of post-streptococcal (post-streptococcal infection) glomerulonephritis (inflammation of the glomeruli in the kidneys)?
What is the management of post-streptococcal glomerulonephritis (PSGN)?
What is the treatment for post-streptococcal glomerulonephritis (Post strep GN)?
What are the guidelines for preoperative, intraoperative, and postoperative management of a patient undergoing total pancreatectomy and double bypass surgery with a history of hypertension, diabetes, and coronary artery disease?
What are the next steps for a 56-year-old male with a 1-month history of intermittent, throbbing headaches, exacerbated by head movement, with recent alcohol intake and attempted relief with aspirin and paracetamol (acetaminophen) without improvement, and a sensation of feeling cold, possibly developing an upper respiratory illness, with no known chronic medical conditions and taking berberine supplements?
Is it acceptable to treat recurrent pneumonia in the same patient with the same antibiotic, considering their past medical history and potential for antibiotic resistance?
Can low magnesium levels contribute to the development of atrial fibrillation, particularly in older patients or those with pre-existing heart conditions?
What is the preferred IV fluid choice for a patient with moderate anemia (low red blood cell count)?
What are the benefits and risks of liposuction for a generally healthy adult patient with a history of medical conditions such as heart disease, diabetes, or previous surgeries?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question