Post-streptococcal glomerulonephritis medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
The mainstay of treatment is pharmacotherapy, however dietary therapy is useful for controlling edema and hypertension. Dietary therapy includes low salt, protein intake, and water restriction. If the streptococcal infection is still present, it should be treated with antibiotics. To control severe hypertension, labetalol is usually used, mild to moderate hypertension, furosemide is used, for rapidly progressive crescentic acute post-streptococcal glomerulonephritis, | The mainstay of treatment is pharmacotherapy, however dietary therapy is useful for controlling [[edema]] and [[hypertension]]. Dietary therapy includes low [[salt]], [[protein]] intake, and water restriction. If the [[Streptococcal infections|streptococcal]] infection is still present, it should be treated with [[antibiotics]]. To control severe [[hypertension]], [[labetalol]] is usually used, mild to moderate hypertension, [[furosemide]] is used, for rapidly progressive crescentic acute post-streptococcal glomerulonephritis, [[methylprednisolone]] is preferred. | ||
==Medical therapy== | ==Medical therapy== | ||
The mainstay of treatment is pharmacotherapy, however dietary therapy is useful for controlling edema and hypertension | The mainstay of treatment is pharmacotherapy, however dietary therapy is useful for controlling [[edema]] and [[hypertension]] | ||
'''Dietary therapy''' | '''Dietary therapy''' | ||
*Low salt intake | *Low [[salt]] intake | ||
*Low protein intake | *Low [[protein]] intake | ||
*Water restrictions | *[[Water]] restrictions | ||
'''Pharmacotherapy''' | '''Pharmacotherapy''' | ||
*If the streptococcal infection is still present, it should be treated with antibiotics<ref name="pmid11344703">{{cite journal |vauthors=Zoch-Zwierz W, Wasilewska A, Biernacka A, Tomaszewska B, Winiecka W, Wierciński R, Porowski T |title=[The course of post-streptococcal glomerulonephritis depending on methods of treatment for the preceding respiratory tract infection] |language=Polish |journal=Wiad. Lek. |volume=54 |issue=1-2 |pages=56–63 |date=2001 |pmid=11344703 |doi= |url=}}</ref> | |||
According to 2012 KDIGO guidelines , the following pharmacologic therapy is currently indicated for specific patients with PSGN.<ref name="pmid22895519">{{cite journal| author=Radhakrishnan J, Cattran DC| title=The KDIGO practice guideline on glomerulonephritis: reading between the (guide)lines--application to the individual patient. | journal=Kidney Int | year= 2012 | volume= 82 | issue= 8 | pages= 840-56 | pmid=22895519 | doi=10.1038/ki.2012.280 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22895519 }} </ref> | |||
*Diuretics are indicated for adult patients with signs of azotemia or heart failure | |||
*ACE-I or ARBs are indicated for adult patients with persistent proteinuria for > 6 months, especially if > 1g/24hrs | |||
*If the [[streptococcal infection]] is still present, it should be treated with [[antibiotics]]<ref name="pmid11344703">{{cite journal |vauthors=Zoch-Zwierz W, Wasilewska A, Biernacka A, Tomaszewska B, Winiecka W, Wierciński R, Porowski T |title=[The course of post-streptococcal glomerulonephritis depending on methods of treatment for the preceding respiratory tract infection] |language=Polish |journal=Wiad. Lek. |volume=54 |issue=1-2 |pages=56–63 |date=2001 |pmid=11344703 |doi= |url=}}</ref> | |||
*To control severe hypertension, following drugs can be used: | *To control severe hypertension, following drugs can be used: | ||
**Preferred regimen: Labetalol 0.5-2 mg/kg/h IV | **Preferred regimen: [[Labetalol]] 0.5-2 mg/kg/h IV | ||
**If refractory to labetalol then, Preferred regimen: Diazoxide or Nitroprusside 0.5-2 mcg/kg/min IV | **If refractory to labetalol then, Preferred regimen: [[Diazoxide]] or [[Nitroprusside]] 0.5-2 mcg/kg/min IV | ||
*For mild to moderate hypertension: | *For mild to moderate hypertension: | ||
**Preferred regimen: Furosemide 1-3 mg/kg PO q24h | **Preferred regimen: [[Furosemide]] 1-3 mg/kg PO q24h | ||
*For treatment of rapidly progressive crescentic acute post-streptococcal glomerulonephritis, following regimen is used:<ref name="pmid20357732">{{cite journal |vauthors=Zaffanello M, Cataldi L, Franchini M, Fanos V |title=Evidence-based treatment limitations prevent any therapeutic recommendation for acute poststreptococcal glomerulonephritis in children |journal=Med. Sci. Monit. |volume=16 |issue=4 |pages=RA79–84 |date=April 2010 |pmid=20357732 |doi= |url=}}</ref> | *For treatment of rapidly progressive crescentic acute post-streptococcal glomerulonephritis, following regimen is used:<ref name="pmid20357732">{{cite journal |vauthors=Zaffanello M, Cataldi L, Franchini M, Fanos V |title=Evidence-based treatment limitations prevent any therapeutic recommendation for acute poststreptococcal glomerulonephritis in children |journal=Med. Sci. Monit. |volume=16 |issue=4 |pages=RA79–84 |date=April 2010 |pmid=20357732 |doi= |url=}}</ref> | ||
**Preferred regimen: Methylprednisolone | **Preferred regimen: [[Methylprednisolone]] | ||
==References== | ==References== | ||
Latest revision as of 16:33, 12 June 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]
Overview
The mainstay of treatment is pharmacotherapy, however dietary therapy is useful for controlling edema and hypertension. Dietary therapy includes low salt, protein intake, and water restriction. If the streptococcal infection is still present, it should be treated with antibiotics. To control severe hypertension, labetalol is usually used, mild to moderate hypertension, furosemide is used, for rapidly progressive crescentic acute post-streptococcal glomerulonephritis, methylprednisolone is preferred.
Medical therapy
The mainstay of treatment is pharmacotherapy, however dietary therapy is useful for controlling edema and hypertension
Dietary therapy
Pharmacotherapy
According to 2012 KDIGO guidelines , the following pharmacologic therapy is currently indicated for specific patients with PSGN.[1]
- Diuretics are indicated for adult patients with signs of azotemia or heart failure
- ACE-I or ARBs are indicated for adult patients with persistent proteinuria for > 6 months, especially if > 1g/24hrs
- If the streptococcal infection is still present, it should be treated with antibiotics[2]
- To control severe hypertension, following drugs can be used:
- Preferred regimen: Labetalol 0.5-2 mg/kg/h IV
- If refractory to labetalol then, Preferred regimen: Diazoxide or Nitroprusside 0.5-2 mcg/kg/min IV
- For mild to moderate hypertension:
- Preferred regimen: Furosemide 1-3 mg/kg PO q24h
- For treatment of rapidly progressive crescentic acute post-streptococcal glomerulonephritis, following regimen is used:[3]
- Preferred regimen: Methylprednisolone
References
- ↑ Radhakrishnan J, Cattran DC (2012). "The KDIGO practice guideline on glomerulonephritis: reading between the (guide)lines--application to the individual patient". Kidney Int. 82 (8): 840–56. doi:10.1038/ki.2012.280. PMID 22895519.
- ↑ Zoch-Zwierz W, Wasilewska A, Biernacka A, Tomaszewska B, Winiecka W, Wierciński R, Porowski T (2001). "[The course of post-streptococcal glomerulonephritis depending on methods of treatment for the preceding respiratory tract infection]". Wiad. Lek. (in Polish). 54 (1–2): 56–63. PMID 11344703.
- ↑ Zaffanello M, Cataldi L, Franchini M, Fanos V (April 2010). "Evidence-based treatment limitations prevent any therapeutic recommendation for acute poststreptococcal glomerulonephritis in children". Med. Sci. Monit. 16 (4): RA79–84. PMID 20357732.