How is interstitial nephritis treated?

The polyetiological nature of tubulointerstitial nephritis requires a differentiated approach to its therapy in each specific case. However, it is possible to identify general principles of tubulointerstitial nephritis therapy, which should include:

• cessation of the influence of the etiological factor (chemical, physical, infectious, autoimmune, toxic-allergic, etc.) on the interstitium of the renal tissue;
• organization of general and motor regimes aimed at reducing the functional load on renal tissue;
• rational, gentle diet therapy, the purpose of which is to reduce the metabolic load on renal tissue;
• elimination of abacterial inflammation in renal tissue;
• elimination of metabolic disorders;
• prevention of interstitial sclerosis;
• restoration of kidney function.

In addition, treatment of tubulointerstitial nephritis should include long-term etiotropic, pathogenetic and symptomatic therapy.

Cessation of the influence of the etiologic factor significantly contributes to the remission of the disease, and in acute tubulointerstitial nephritis can lead to complete recovery.

For tubulointerstitial nephritis of postviral genesis, recombinant interferons are used, in particular Viferon (up to 7 years - Viferon 1, over 7 years - Viferon 2 - 1 suppository rectally 2 times a day for 10 days, then every other day for 1-3 months).

In the case of the metabolic variant of tubulointerstitial nephritis, it is necessary to follow an appropriate diet and drinking regimen.

In case of tubulointerstitial nephritis that developed against the background of circulatory and urodynamic disorders, it is necessary to follow a regime of "frequent" urination, and in case of increased mobility of the kidney - therapeutic exercise.

Pathogenetic treatment of tubulointerstitial nephritis should be aimed at reducing and eliminating abacterial inflammation, reducing renal tissue hypoxia, correcting microcirculation disorders, reducing the activity of lipid peroxidation processes and increasing antioxidant protection, stabilizing renal cytomembranes.

Lysozyme (2 mg/kg intramuscularly 2 times a day for 10 days) and levamisole (1-1.5 mg/kg for 3 days with a 4-day break with mandatory monitoring of the number of leukocytes, lymphocytes and platelets in the peripheral blood - 2-3 courses) are used as immunocorrective therapy.

In acute tubulointerstitial nephritis or in the acute period of chronic tubulointerstitial nephritis, prednisolone may be prescribed at a dose of 1-2 mg/kg per day in the morning for 3-10 days, sometimes up to 1 month. In tubulointerstitial nephritis with nephrotic syndrome or severe proteinuria, prednisolone must be prescribed at a dose of 2 mg/kg/day, but not more than 60-80 mg/day, with a transition to an alternating course after 4 weeks and a gradual reduction in the prednisolone dose if there is a good response to therapy. Cyclophosphamide may be prescribed instead of prednisolone at a dose of 2 mg/kg/day.

Parmidine is prescribed as an anti-inflammatory drug and antioxidant, which reduces the consumption of endogenous vitamin E, improves microcirculation due to its anticoagulant effect, and reduces the activity of the kallikrein-kinin system. Parmidine is prescribed when the inflammatory process subsides, 0.25 g 2-3 times a day for 4-6 months.

The following drugs are used as anti-sclerotic agents: plaquenil, delagil at a dose of 5-10 mg/kg/day for 3-6 months, cinnarizine - 12.5-25 mg 2 times a day for 3-6 months. In addition, agapurin, euphyllin, curantil, solcoseryl, etc. are used to improve renal hemodynamics and prevent sclerosis.

The most important direction in the treatment of tubulointerstitial nephritis is the fight against intrarenal hypertension, which contributes to the development of sclerosis and a progressive decrease in renal function. In most cases, intrarenal hypertension does not initially manifest itself as a systemic increase in blood pressure. The most effective in this regard is the administration of an ACE inhibitor (enalapril), which not only improves intrarenal hemodynamics, but also reduces the level of proteinuria. Enalapril is prescribed in an initial dose of 0.1 mg / kg / day in the absence of arterial hypertension. With the development of arterial hypertension in patients with tubulointerstitial nephritis, the dose of the drug is adjusted individually, 0.2-0.6 mg / kg / day in 2 doses, while the doctor's goal is to achieve stable normotension in the child.

Antioxidant and membrane-stabilizing therapy are of great importance. For this purpose, retinol (1-1.5 mg/day), tocopherol acetate (1-1.5 mg/kg/day), vetoron (1 drop/year of life, but no more than 9 drops/day) are used - for 3-4 weeks. Monthly 2-week courses: vitamin B6 (2-3 mg/kg/day in the first half of the day), vitamin A (1000 IU/year of life in 1 dose), vitamin F (1 mg/kg in 1 dose), magnesium oxide (50-100 mg/day in 2-3 doses). A 2% solution of xydiphone (3 mg/kg/day 30 minutes before meals) or dimephosphone (30-50 mg/kg/day) is also prescribed - 3-4 weeks. Essentiale can be prescribed at 1 capsule/day in a 14-day course once every 3 months.

Phytotherapy helps improve uro- and lymphodynamics, activate regenerative processes in the tubules, and reduce the excretion of oxalates and urates.

Symptomatic therapy of tubulointerstitial nephritis should include the treatment of foci of chronic infection, normalization of muscle tone, restoration of physical performance, and restoration of the functional state of the intestine.

Outpatient observation of children with tubulointerstitial nephritis.

Frequency of specialist examinations:

Pediatrician:

• II degree of activity - 2 times a month;
• I activity level - once a month;
• Remission - 1 time in 3-6 months

Nephrologist - 2 times a year;

ENT doctor - once a year;

Dentist - 2 times a year.

In case of decreased renal function and chronic renal failure:

• Pediatrician - once a month;
• Nephrologist - once every 2-3 months.

Particular attention is paid to:

• general condition;
• diuresis;
• blood pressure;
• relative density of urine;
• urinary sediment;
• crystalluria;
• clinical signs of renal failure.

Additional research methods:

• urine analysis;
• activity of II-I degree - 1 time in 10-14 days,
• remission - once a month;
• Nechiporenko (Amburge) test during remission once every 3-5 months;
• urine culture once a year;
• Zimnitsky test twice a year;
• daily excretion of oxalates and urates in urine 1-3 times a year;
• clinical blood test: after acute renal failure - once a year, in chronic renal failure - once a year;
• biochemical blood test, urea, creatinine - once a year;
• urine culture for VC (Koch's bacillus) in chronic tubulointerstitial nephritis - once a year;
• control examination for renal dysfunction (glomerular filtration, electrolyte excretion, acidoammoniogenesis, ultrasound, radioisotope renography, etc.) in a one-day nephrology hospital - 1-2 times a year.

The main ways of recovery:

• mode;
• diet;
• staged treatment method (membrane stabilizing therapy, pyridoxine, retinol, vitamin E, magnesium oxide, essentiale), herbal medicine, physiotherapy, drinking mineral waters;
• in intercurrent diseases: bed rest, plenty of fluids, antihistamines, membrane stabilizing therapy, caution when prescribing antibiotics (!), monitoring urine tests at onset and during recovery;
• treatment at a local sanatorium or resort.

Criteria for the effectiveness of medical examination:

Removal from the register after tubulointerstitial nephritis (toxic-allergic variant) 2 years after examination in a nephrology hospital or a one-day hospital in the absence of complaints, stable clinical and laboratory remission, and preserved renal functions. Patients with latent and undulating course of tubulointerstitial nephritis and with a decrease in partial renal functions after acute tubulointerstitial nephritis are not removed from the register and, upon reaching 15 (18) years of age, are transferred for observation to the adult network.

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