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01 April 2010

Evidence-based treatment limitations prevent any therapeutic recommendation for acute poststreptococcal glomerulonephritis in children

Marco Zaffanello, Luigi Cataldi, Massimo Franchini, Vassilios Fanos

Med Sci Monit 2010; 16(4): RA79-84 :: ID: 878491

Abstract

The majority of children with the epidemic form of acute post-streptococcal glomerulonephritis (APSGN) have an excellent prognosis, which contrasts with the poor long-term outcome of sporadic cases. Therapy is largely supportive. Rarely, the disease shows long-term complications, worsening to chronic kidney disease requiring long-term interventional measures. To compare the effectiveness of different therapeutic strategies for the prevention and treatment of APSGN in childhood, the authors reviewed randomized controlled trials on the prevention and treatment of APSGN in children. Nine studies fit the inclusion criteria. Primary outcomes were the development of APSGN, the effectiveness of medication for controlling hypertension, and the development of chronic renal failure in patients with crescentic glomerulonephritis. No advantages of antimicrobials (cefuroxim, ceftibuten, and others) given for 5 days were found over penicillin V given for 10 days (4 trials). Nifedipine showed advantages in controlled acute hypertension (1 trial). ACE inhibitors (captopril and enalapril) had better control of blood pressure and echocardiographic changes than other antihypertensive drugs/diuretics (2 trials). The use of combined immunosuppressants for crescentic poststreptococcal glomerulonephritis showed no advantages over supportive therapy alone (1 study). The studies were of small number and with limitations that seriously weaken the results.

Keywords: Outcome Assessment (Health Care), Kidney Failure, Chronic - drug therapy, Infant, Newborn, Immunosuppressive Agents - pharmacology, Guidelines as Topic, Glomerulonephritis - therapy, Evidence-Based Medicine, Echocardiography - methods, Child, Preschool, Child, Blood Pressure, Anti-Infective Agents - pharmacology, Adolescent, Streptococcal Infections - complications

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