How is interstitial nephritis treated?

The polyethological nature of tubulointerstitial nephritis suggests a differentiated approach to its therapy in each specific case. Nevertheless, it is possible to single out the general principles of therapy of tubulointerstitial nephritis, which should include:

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

In addition, the treatment of tubulointerstitial nephritis should include prolonged etiotropic, pathogenetic and symptomatic therapy.

Termination of the effect of the etiological factor in a significant steppe contributes to the remission of the disease, and with acute tubulointerstitial nephritis can lead to complete recovery.

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

In the metabolic version of tubulointerstitial nephritis, it is necessary to observe the appropriate diet and drinking regimen.

With tubulointerstitial nephritis, developed against a background of circulatory and urodynamic disorders, it is necessary to observe the regime of "frequent" urination, with increased mobility of the kidney - therapeutic exercise.

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

As an immunocorrective therapy, lysozyme (2 mg / kg IM / kg twice daily for 10 days), levamisole (1-1.5 mg / kg for 3 days with a break of 4 days with mandatory control of the number of leukocytes, lymphocytes and platelets in peripheral blood - 2-3 courses).

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

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

As anti-sclerotic drugs are used: plakvenil, delagil in a dose of 5-10 mg / kg / day. For 3-6 months, cinnarizine - 12.5-25 mg twice a day for 3-6 months. In addition, agarpurine, euphyllin, curantyl, solcoseryl, etc. Are used to improve renal hemodynamics and prevent sclerosing.

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 this case, the intracellular hypertension in most cases initially is not manifested by a systemic increase in blood pressure. The most effective in this regard is the appointment of an ACE inhibitor (enalapril), which not only improves the intrarenal hemodynamics, but also reduces the level of proteinuria. Enalapril is administered at an initial dose of 0.1 mg / kg / day in the absence of hypertension. With the development of arterial hypertension in patients with tubulointerstitial nephritis, the dose of podbird is individually 0.2-0.6 mg / kg / day in 2 divided doses, while the goal of the doctor is to achieve a stable uterotonia.

Antioxidant and membrane stabilizing therapy is of great importance. For this purpose, retinol (1-1.5 mg / day), tocopherol acetate (1-1.5 mg / kg / day), vetorone (1 drop / year of life, but not more than 9 drops / day) is used for 3-4 weeks. Monthly 2-week courses: vitamin B6 (2-3 mg / kg / day the first half of the day), vitamin A (1000 U / year life in 1 intake), vitamin F (1 mg / kg per 1 intake), magnesium oxide 50-100 mg / day in 2-3 divided doses). Also 2% xydiphon solution (3 mg / kg / day 30 minutes before meals) or dimephosphon (30-50 mg / kg / day) - 3-4 weeks is prescribed. It is possible to appoint Essentiale for 1 capsule / day. Course in 14 days every 3 months.

Phytotherapy contributes to improvement of uro-and lymphodynamics, activation of regenerative processes in tubules, decrease in excretion of oxalates and urates.

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

Dispensary observation of children with tubulointerstitial nephritis.

Multiplicity of examination of specialists:

Pediatrician:

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

Nephrologist - 2 times a year;

ENT-doctor - once a year;

The dentist - 2 times a year.

In the case of a decrease in renal function and chronic renal failure:

• Pediatrician - 1 time per month;
• Nephrologist - 1 time in 2-3 months.

Particular attention is paid to:

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

Additional research methods:

• Analysis of urine;
• Activity II-I degree - 1 time per 10-14 days,
• remission - once a month;
• Nechiporenko test (Amburge) with remission once every 3-5 months;
• Urine culture once a year;
• sample Zimnitsky 2 times a year;
• daily excretion of oxalates, urates with urine 1-3 times a year;
• clinical blood test: after acute renal failure - once a year, with chronic kidney failure - once a year;
• biochemical blood test, urea, creatinine - once a year;
• sowing urine in the VC (Koch bacillus) with chronic tubulointerstitial nephritis - once a year;
• control examination for renal dysfunction (glomerular filtration, electrolyte excretion, acido-ammoniogenesis, ultrasound, radioisotope renography, etc.) in a nephrological hospital of one day - 1-2 times a year.

The main ways of recovery:

• mode;
• diet;
• stage method of treatment (membrane stabilizing therapy, pyridoxine, retinol, vitamin E, magnesium oxide, Essentiale), phytotherapy, physiotherapy, drinking mineral water;
• with intercurrent diseases: bed rest, copious drink, antihistamines, membrane stabilizing therapy, caution in prescribing antibiotics (!), control of urinalysis in the debut and recovery;
• treatment at a local sanatorium or resort.

Criteria for the effectiveness of clinical examination:

Deregistration after tubulointerstitial nephritis (toxic and allergic variant) 2 years after the examination in a nephrological hospital or one-day hospital in the absence of complaints, persistent clinical and laboratory remission, and preserved kidney functions. Patients with latent and undulating course of tubulointerstitial nephritis and with reduction of partial renal functions after acute tubulointerstitial nephritis are not taken off the register and after 15 (18) years are passed on for observation to the adult network.

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