Treatment

Most cases of PSGN are self-limiting and complications of volume overload are managed with supportive treatment.

Supportive care

Management of edema and volume overload

• Low-sodium diet: < 2 g/day

• Fluid restriction (e.g., < 2 L per day)

• Loop diuretics

Antihypertensives

• Indicated for hypertension refractory to management of edema and volume overload

• Preferred agents include:

  • Calcium channel blockers (e.g., nifedipine)

  • ACE inhibitors or ARBs

    • Uncertain benefit, given the self-limited nature of PSGN [2][6]

    • Avoid in patients with rapidly progressive renal dysfunction.

Avoid ACE inhibitors and ARBs in patients with rapidly worsening renal function and/or sudden onset of nephrotic range proteinuria, as these medications can exacerbate AKI and hyperkalemia.

Antibiotics do not affect the course of PSGN but should be administered in individuals with active GAS infection to prevent complications (e.g., abscess, rheumatic fever) and community outbreak of nephritogenic strains of S. pyogenes. [16]

• Indication: evidence of active infection (e.g., positive cultures for GAS) to prevent [1]

• Regimens: should be based on the site of infection

  • GAS tonsillopharyngitis: Initiate recommended antibiotic regimens for acute GAS pharyngitis.

  • Skin and soft tissue infections (e.g., impetigo): Begin empiric antibiotic therapy for skin and soft tissue infections.

Complications are more common in adults:

• Acute renal failure

• Rapidly progressive glomerulonephritis

• Nephrotic syndrome later in the course of the disease

• Recovery usually occurs within 6–8 weeks.

  • In children: restitution of kidney function in > 90% of cases

  • In some cases, urinalysis may remain abnormal for extended periods.

• In adults, about 50% of patients suffer from persistently reduced renal function.