Treatment Options for Acute Glomerulonephritis: Understanding Symptoms, Management, and Recovery

What Is Acute Glomerulonephritis?

Acute glomerulonephritis is a kidney condition that primarily affects children and adolescents. It typically develops following a recent infection, most commonly a streptococcal upper respiratory tract infection such as strep throat or impetigo. There is usually a latent period of about 1 to 2 weeks between the initial infection and the onset of kidney-related symptoms. This delay occurs because the disease is not caused directly by the bacteria, but rather by the immune system's response to it, leading to inflammation in the glomeruli—the tiny filtering units within the kidneys.

Recognizing the Clinical Symptoms

Common signs of acute glomerulonephritis include hematuria (blood in the urine), proteinuria (excess protein in the urine), facial and peripheral edema, and elevated blood pressure. The urine may appear dark, cola-colored, or cloudy due to red blood cell leakage. Swelling is often most noticeable around the eyes in the morning and may extend to the legs and hands as fluid retention worsens. In more severe cases, patients can develop complications such as acute kidney injury, which may require immediate medical attention. Rarely, fluid overload can lead to congestive heart failure, especially if hypertension and edema are left untreated.

Diagnostic Markers and Laboratory Findings

Diagnosis is supported by laboratory tests showing evidence of prior streptococcal infection. A positive antistreptolysin O (ASO) titer indicates recent exposure to group A beta-hemolytic streptococcus. Additionally, serum complement levels—particularly C3—are often significantly reduced during the active phase of the disease, helping differentiate it from other forms of glomerulonephritis. Urinalysis typically reveals red blood cell casts, a hallmark of glomerular damage. Blood tests may also show elevated creatinine and blood urea nitrogen (BUN), reflecting temporary impairment in kidney function.

Primary Treatment Strategies

The good news is that acute glomerulonephritis is often self-limiting, with most patients recovering fully within 6 to 8 weeks without long-term damage. However, early intervention is crucial to manage symptoms and prevent complications. The cornerstone of treatment includes bed rest during the acute phase, especially when there is significant edema or hypertension. Patients are encouraged to consume a balanced, low-sodium diet rich in vitamins and calories to support recovery while avoiding excessive fluid intake if swelling is present.

Antibiotic Therapy and Infection Control

Although the kidney inflammation itself is immune-mediated, treating the underlying infection remains essential. Penicillin or an alternative antibiotic (such as erythromycin in penicillin-allergic patients) is typically prescribed for 10 days to eradicate any residual streptococcal bacteria and prevent further immune activation. This step also helps reduce the risk of spreading the infection to others, particularly in school or household settings.

Managing Complications: Hypertension, Edema, and Renal Failure

For patients presenting with high blood pressure and fluid retention, antihypertensive medications and diuretics are commonly used. Thiazide or loop diuretics help eliminate excess fluid, thereby reducing edema and lowering blood pressure. Close monitoring of electrolytes and renal function is necessary during this phase. In rare instances where acute kidney injury progresses to oliguric renal failure, temporary dialysis—often hemodialysis—may be required to maintain fluid balance, remove toxins, and stabilize electrolyte levels until kidney function recovers.

Prognosis and Long-Term Follow-Up

While the majority of individuals make a complete recovery, approximately 15–16% may experience persistent urinary abnormalities, such as microscopic hematuria or mild proteinuria, potentially evolving into chronic glomerulonephritis. Therefore, ongoing follow-up with periodic urinalysis, blood pressure checks, and renal function tests is strongly recommended for at least 6 to 12 months post-recovery. Early detection of lingering issues allows for timely management and reduces the risk of future kidney disease.

Prevention and Patient Education

Preventing acute glomerulonephritis starts with prompt diagnosis and treatment of streptococcal infections. Educating parents, caregivers, and school nurses about the importance of completing antibiotic courses and recognizing early warning signs—like sore throat followed by dark urine or swelling—can significantly reduce incidence rates. Public health initiatives promoting hygiene and access to healthcare also play a vital role in minimizing outbreaks, especially in densely populated or underserved communities.