Treatment for poststreptococcal glomerulonephritis

Is there any treatment for poststreptococcal glomerulonephritis?

The treatment for poststreptococcal glomerulonephritis is primarily supportive because the infection is no longer present and the immune complex deposition in the kidney resolves spontaneously over time.

For supportive therapy, the major focus is on blood pressure and volume control. Importantly, the tubules are relatively unaffected by the glomerular disease, and there is a sodium-avid state that accompanies the glomerular inflammation.

The absorption of sodium and water leads to significant volume overload and salt-sensitive hypertension. Therefore in addition to the use of regular antihypertensive medications along with salt and water restriction, the early inclusion of loop diuretics is particularly efficacious in poststreptococcal glomerulonephritis.

The use of steroids or more aggressive forms of immunosuppression for poststreptococcal glomerulonephritishas not been shown to alter the natural history of the disease and exposes the patient to the potential short- and long-term risks of immunosuppression.

The only exception to this rule is the presence of severe crescentic glomerulonephritis.

This subset of poststreptococcal glomerulonephritis includes the standard features of diffuse proliferative glomerulonephritis coupled with the presence of crescents that arise from the parietal epithelium.

Often these patients have been treated with bolus steroids, and there are anecdotal reports of the use of cytotoxic therapy, but there are no well-designed studies supporting the benefit of these therapies.

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