Glomerular Disease and Nephritic Syndrome
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019 Edition
N04.9/N05.9
DESCRIPTION
Acute glomerulonephritis presents with one or more of the following: haematuria, proteinuria, an acute decrease in eGFR, fluid retention, or hypertension.
GENERAL MEASURES
- Give oxygen, and place patient in semi-Fowlers position if patient has respiratory distress.
- Early consultation with a specialist.
- Regulate fluid and electrolyte balance. Monitor weight closely.
- Dietary modification if severe kidney dysfunction, e.g. restrict salt, protein, potassium and phosphate intake.
- Avoid potential nephrotoxins: e.g. NSAIDs, aminoglycosides.
MEDICINE TREATMENT
Fluid overload
- Furosemide, as a slow IV bolus, 80 mg.
- Avoid unnecessary intravenous fluids.
If hypertension present: I12.0/I12.9
Diastolic BP >100 mmHg or systolic BP >150 mmHg:
- Amlodipine, oral, 5 mg as a single dose.
AND
- Furosemide, oral, 40–80 mg (if eGFR <30 mL/min/1.73m2).
OR
- Hydrochlorothiazide, oral, 25 mg (if eGFR ≥30 mL/min/1.73m2).
Check all medicines for possible dose adjustments. https://www.globalrph.com/index_renal.htm
CONSULTATION/REFERRAL
The management of glomerular disease is individualised and management of all patients should be discussed with a specialist.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Adult Hospital Level, 2020-2024_Version 1.0_17 October 2024
Chapter 7 Nephrology/Urological Disorders_7.1 Nephrology Disorders_7.1.2 Glomerular Disease and Nephritic Syndrome