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Chronic tubulointerstitial nephritis - Treatment
Last reviewed: 04.07.2025
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When determining the tactics of managing a patient with analgesic nephropathy, it is necessary to take into account the presence of concomitant factors that can increase the severity of kidney damage:
- chronic heart failure;
- diabetes mellitus type 2;
- uric acid metabolism disorders.
In the elderly, a combination of several forms of kidney damage (“multimorbidity”) is possible, for example, analgesic and urate, diabetic nephropathy, as well as ischemic kidney disease and chronic pyelonephritis.
Treatment of chronic tubulointerstitial nephritis (analgesic variant) is based on complete refusal to take non-narcotic analgesics and NSAIDs. In the development of terminal renal failure, renal replacement therapy is started, however, the survival rate of patients with analgesic nephropathy is somewhat lower than with other chronic kidney diseases, which is partly explained by old age and the presence of concomitant chronic diseases.
Prevention of analgesic renal damage is possible with strict medical control of the patient's intake of the corresponding drugs, with their prescription strictly according to indications, if possible in the form of short courses and in low doses. Selective cyclooxygenase-2 inhibitors also contribute to the development of renal damage.
With long-term use of aminosalicylic acid, regular monitoring of serum creatinine levels is necessary (at least once every 3 months); if signs of kidney damage develop, it is advisable to discontinue the drug.
Prevention of cyclosporine nephropathy involves 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 dihydropyridines - amlodipine, felodipine, lacidipine).
It is necessary to exclude the consumption by the population of traditional medicines that have not undergone established licensing procedures.
Patients receiving lithium-containing drugs are recommended to determine the serum creatinine concentration before the start of treatment, and then monitor it at least once a year. If renal function deteriorates, it is advisable to replace lithium preparations with carbamazepine or valproic acid. If acute renal failure develops, sodium chloride solution is administered in large quantities (up to 6 l), and hemodialysis is used if necessary.
Treatment of lead intoxication consists of prescribing a chelate - sodium calcium edetate. Antihypertensive therapy and correction of uric acid metabolism disorders are indicated.
The main approach to the treatment of radiation nephropathy is antihypertensive therapy and nephroprotection in general. ACE inhibitors are considered as drugs of choice.
Glucocorticosteroids are effective in the treatment of chronic tubulointerstitial nephritis (sarcoid variant). 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 hypercalciuria/hypercalcemia syndrome without signs of tubulointerstitial nephritis, prednisolone is prescribed in smaller doses (35 mg/day), and chloroquine is also used.
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