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Chronic tubulointerstitial nephritis: treatment
Last reviewed: 23.04.2024
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When determining the tactics of managing a patient with analgesic nephropathy, one should take into account the presence of concomitant factors that can increase the severity of kidney damage:
- chronic heart failure;
- diabetes mellitus type 2;
- disturbances of uric acid metabolism.
In the elderly, a combination of several forms of kidney damage ("multimorbidity"), for example, analgesic and urate, diabetic nephropathy, as well as ischemic kidney disease and chronic pyelonephritis, is possible.
Treatment of chronic tubulointerstitial nephritis (analgesic variant) is based on complete refusal of admission of non-narcotic analgesics and NSAIDs. With the development of terminal renal failure, renal replacement therapy is beginning, but the survival of patients with analgesic nephropathy is slightly lower than in other chronic kidney diseases, which is partly due to old age and the presence of concomitant chronic diseases.
Prophylaxis of analgesic kidney damage is possible with strict medical control of taking appropriate medications by the patient, when they are prescribed strictly according to indications, if possible in the form of short courses and in low doses. Selective inhibitors of cyclooxygenase-2 also contribute to the development of kidney damage.
With long-term intake of aminosalicylic acid, regular monitoring of serum creatinine values (no less than 1 time per 3 months) is necessary, with the development of signs of kidney damage, it is expedient to cancel the drug.
Prevention of cyclosporine nephropathy consists in the use of small and medium doses of the drug, regular monitoring of its concentration in the blood and the use of calcium channel blockers (verapamil, diltiazem, long acting dihydropyridine - amlodipine, felodipine, lacidipine).
It is necessary to exclude consumption by the population of traditional medicine that has not undergone established licensing procedures.
Patients receiving lithium-containing drugs are recommended to determine the serum creatinine concentration before the start of treatment, in the future - monitoring at least once a year. With worsening kidney function, it is expedient to replace lithium preparations with carbamazepine or valproic acid. With the development of acute renal failure, a solution of sodium chloride is administered in large amounts (up to 6 liters), if necessary, hemodialysis is used.
Treatment of lead intoxication consists in the appointment of a chelate - sodium calcium edetate. Antihypertensive therapy and correction of uric acid metabolism disorders are shown.
The main approach to the treatment of radiation nephropathies is antihypertensive therapy and nephroprotection in general. As the drugs of choice, ACE inhibitors are considered.
In the treatment of chronic tubulointerstitial nephritis (sarcoid variant), glucocorticosteroids are effective. The initial dosage is 1-1.5 mg / kg, the duration of treatment is determined individually, based on the dynamics of disease activity markers. In the syndrome of hypercalciuria / hypercalcemia without signs of tubulointerstitial nephritis, prednisolone is prescribed in smaller doses (35 mg / day), and chloroquine is also used.
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