From the Research
The treatment of interstitial lung disease (ILD) associated with mixed connective tissue disorder (MCTD) in patients with chronic kidney disease (CKD) should prioritize corticosteroids as the first-line treatment, with careful dosage adjustment and monitoring of renal function, as supported by the most recent study 1.
Key Considerations
- The treatment approach should be individualized based on disease severity, kidney function, and patient-specific factors.
- Corticosteroids, such as prednisone, are typically started at 0.5-1 mg/kg/day (typically 30-60 mg daily) for 4-6 weeks, followed by a gradual taper based on clinical response.
- In CKD patients, mycophenolate mofetil is often preferred as a steroid-sparing agent at 1-1.5 g twice daily, with dose reduction to 500 mg twice daily for GFR <25 ml/min.
- Cyclophosphamide can be used for severe cases at 1-2 mg/kg/day orally with dose reduction of 25-50% for GFR <30 ml/min, while monitoring for myelosuppression.
- Alternative options include azathioprine (1-2 mg/kg/day with 50% dose reduction in CKD) and rituximab (1000 mg IV on days 1 and 15, repeated every 6 months).
Supportive Care
- Oxygen therapy as needed
- Pulmonary rehabilitation
- Vaccination against pneumococcal disease and influenza
Monitoring
- Regular monitoring of renal function, drug levels, and pulmonary function tests is essential, as these medications can cause nephrotoxicity, and CKD affects drug clearance.
- The most recent study 1 highlights the importance of individualized treatment and careful monitoring in patients with CTD-ILD and CKD.