Treatment of Post-Infectious Glomerulonephritis

Introduction to Treatment

The American Journal of Kidney Diseases recommends the treatment of post-infectious glomerulonephritis centers on antibiotic therapy to reduce antigenic load combined with supportive management of the nephritic syndrome, with immunosuppression reserved only for severe crescentic disease 1, 2

The American Journal of Kidney Diseases suggests administering penicillin (or erythromycin if penicillin-allergic) even when active infection is no longer present to decrease the streptococcal antigenic load, applicable to classic post-streptococcal glomerulonephritis occurring 1-3 weeks after pharyngitis or impetigo 1, 3, 4
First-generation cephalosporins (e.g., cephalexin) are appropriate alternatives for non-anaphylactic penicillin allergies or when beta-lactamase producing organisms are suspected 4
Third-generation cephalosporins (e.g., ceftriaxone) should be used for severe infections or in areas with high prevalence of resistant organisms 4

The American Journal of Kidney Diseases recommends managing the clinical manifestations of acute glomerulonephritis as the cornerstone of treatment 1
Restrict dietary sodium to <2.0 g/day to control hypertension and fluid retention 4
Use diuretics as first-line agents for managing fluid overload and hypertension 1, 4
Target blood pressure <130/80 mmHg (or <125/75 mmHg if proteinuria >1 g/day) 5
Monitor closely for diuretic-related complications including hyponatremia, hypokalemia, GFR reduction, and volume depletion 4

The American Journal of Kidney Diseases recommends corticosteroids should be considered ONLY for severe crescentic glomerulonephritis with rapidly progressive renal failure, based on anecdotal evidence with weak evidence quality 1, 2, 3
Do NOT use corticosteroids for IgA-dominant post-infectious glomerulonephritis, which typically occurs with staphylococcal infections (including MRSA), particularly in elderly and diabetic patients 1, 3

Assess C3 complement levels at diagnosis and follow serially—C3 should normalize within 8-12 weeks in uncomplicated cases 4
If C3 remains low beyond 12 weeks, perform kidney biopsy to exclude complement C3 glomerulonephritis (C3GN) 4
Monitor kidney function, blood pressure, proteinuria, and hematuria regularly throughout the disease course 4
Treat metabolic acidosis if serum bicarbonate <22 mmol/L 4

For endocarditis-related glomerulonephritis (increasingly caused by staphylococcal species), antibiotic treatment must continue for 4-6 weeks, though hematuria, proteinuria, and azotemia may persist for months after infection eradication 1, 3