Treatment and prevention of acute poststreptococcal glomerulonephritis

Treatment of acute poststreptococcal glomerulonephritis is as follows:

• Effects on the etiologic factor - streptococcal infection (patients and their relatives).
• Normalization of blood pressure, reduction of edema.
• Maintaining the water-electrolyte balance.
• Treatment of complications (encephalopathy, hyperkalemia, pulmonary edema, acute renal failure).
• Immunodepressive therapy - with nephrotic syndrome and protracted flow.

Given the association of acute acute nephritis with streptococcal infection, the treatment of acute poststreptococcal glomerulonephritis requires an antibiotic from the penicillin group (for example, phenoxymethylpenicillin 125 mg every 6 hours for 7-10 days) in the early days of the disease, and with allergy to erythromycin (250 mg every 6 hours for 7-10 days). Such therapy is primarily indicated if the disease occurs after the transferred pharyngitis, tonsillitis, skin lesions, especially with positive results of crops from the skin, throat, as well as with high titres of anti-streptococcal antibodies in the blood. Prolonged antibacterial treatment of acute poststreptococcal glomerulonephritis is necessary in the development of acute nephritis within the framework of sepsis, including septic endocarditis.

Acute poststreptococcal glomerulonephritis - regimen and diet

In the first 3-4 weeks of illness with large edema, macrogemuria, high hypertension and heart failure, it is necessary to strictly adhere to bed rest.

In acute period of the disease, especially with pronounced signs of nephritis (turbulent beginning with edema, oliguria and hypertension), one should sharply limit the intake of sodium (up to 1-2 g / day) and water. In the first 24 hours it is recommended to completely stop the intake of fluid, which in itself can lead to a decrease in edema. In the future, the intake of liquid should not exceed its discharge. Limiting sodium and water reduces the volume of extracellular fluid, which contributes to the treatment of hypertension. With a significant decrease in CF, oliguria it is desirable to limit the intake of protein [up to 0.5 g / kghsut]].

[1], [2], [3], [4], [5], [6]

Treatment of effusions in acute poststreptococcal glomerulonephritis

Because of the primary fluid retention that promotes the development of edema in acute poststreptococcal epomerulonephritis, treatment of acute poststreptococcal glomerulonephritis is limited to sodium and water:

• hypothiazide 50-100 mg / day (ineffective with a significant decrease in CF);
• furosemide at 80-120 mg / day (effective and with reduced CF);
• spironolactones and triamterene are not used because of the threat of developing hyperkalemia.

Edema of the lungs, complicating the course of acute cold syndrome, is usually the result of hypervolemia caused by sodium and water retention, rather than heart failure. In this case, digitalis ineffective and can cause intoxication.

Treatment of acute poststreptococcal glomerulonephritis includes the restriction of sodium and water, strong loop diuretics, morphine and oxygen.

Treatment of arterial hypertension in acute poststreptococcal glomerulonephritis

• A diet with sodium and water restriction, bed rest and the use of diuretics (furosemide) usually monitor moderate arterial hypertension (diastolic blood pressure <100 mmHg). Diuretics as a component of antihypertensive therapy reduce the need for other antihypertensive drugs.
• Vasodilators - calcium channel blockers (nifedipine 10 mg repeatedly for a day) are preferred with more pronounced and persistent hypertension.
• ACE inhibitors are used cautiously because of the risk of hyperkalemia.
• Furosemide in high doses, hydralazine intravenously, sodium nitroprusside, diazoxide are required as urgent measures for hypertensive encephalopathy (non-curable headache, nausea, vomiting) due to cerebral edema.
• Diazepam (unlike other anticonvulsant drugs is metabolized in the liver and not excreted by the kidneys) parenterally, if necessary intubation - with the development of convulsive syndrome.

Acute renal failure and acute poststreptococcal glomerulonephritis

Prolonged oliguria with acute poststreptococcal gmomerulonephritis occurs in 5-10% of patients.

Treatment of acute poststreptococcal glomerulonephritis in these cases includes a sharp restriction of sodium and water, potassium and protein in the diet. With increasing azotemia and especially hyperkalemia, hemodialysis is indicated.

Moderate hyperkalemia in acute poststreptococcal gmomerulonephritis is often observed, with severe hyperkalemia it is necessary to carry out emergency measures:

• furosemide in large doses to stimulate potassium -urease;
• insulin intravenously, glucose, calcium and sodium bicarbonate;
• urgent hemodialysis in the development of life-threatening hyperkalemia.

[7], [8]

Immunosuppressive therapy and acute poststreptococcal glomerulonephritis

• Patients with joined and long-lasting nephrotic syndrome (more than 2 weeks), an increase in the level of creatinine, which has no tendency to further increase, but does not return to normal, if it is impossible to carry out a biopsy of the kidney, prednisolone is shown [1 mg / kghsut]].
• Patients with fast-progressive renal failure need a kidney biopsy. If a half moon is detected, a short course of pulse therapy with methylprednisolone (500-1000 mg intravenously daily for 3-5 days) is recommended.

Prevention of acute poststreptococcal glomerulonephritis

A special problem is the diagnosis of the streptococcal nature of pharyngitis in patients without nephritis who complain of sore throat. Since in adults only 10-15% of all infectious diseases of the pharynx are caused by streptococcus, and when streptococcus is isolated from the pharynx, 10% of false negative and 30-50% of false positive results (especially in streptococcal carriers) are obtained, then to decide on the appointment of antibiotics, the following clinical approach.

Fever, an increase in palatine tonsils and cervical lymph nodes are more common in streptococcal infections, and the absence of these three symptoms makes streptococcal infection unlikely. Because of the high frequency of false positive and false negative results of bacteriological isolation of streptococcal culture from the throat to all patients with clinical triad: fever, enlarged palatine tonsils and cervical lymph nodes - antibiotics should be prescribed. In the absence of all these symptoms, antibiotic therapy is not indicated, regardless of the results of the bacteriological study. If there are certain symptoms, antibiotics are prescribed if positive bacteriological results are obtained.

Since the relatives of patients with acute poststreptococcal gmomerulonephritis have evidence of streptococcal infection within 2-3 weeks in most cases and nephritis develops in more than one-third, epidemics warrant the preventive treatment of acute poststreptococcal glomerulonephritis with antibiotics of relatives and other people at risk of infection .