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Suggest Treatment For Gradual Decrease In GFR

Posted on Tue, 23 Jun 2015

Question: Hi. 35-yr-old female with no history of cardiac problems, high blood pressure or diabetes or kidney disease. Do have undifferentiated connective tissue disorder for which I take Plaquenil, 200mg 2x/day. Now worried it may be affecting my kidneys. eGFR has decreased from 80 in Nov of 2014 to 60 on May 5, 2015 and now down to 54.12 on 05/28/2015. BUN/CREAT ratio is 9.2, CREAT is 1.2 (up from 1.04 on May 5), and A/G ratio is .9. No UA has been done since September 2014 when I had a UTI. Have a history of frequent UTIs. Begged my rheumatologist to refer me to a nephrologist, which he did. Will she her 07/01/15. Family doctor, who did initial bloodwork and discovered the 20 point eGFR decrease, would not refer me. I am very concerned that my autoimmune disease is attacking my kidneys or that something else is wrong and I can't get any doctors to take me seriously. What could be causing this? What can I do? I have called all of my docs (PCP, rheumatologist, and future nephrologist), left messages, AND faxed them my lab results. I am scared and not getting any answers. One more piece of info--I have a history of iron deficiency anemia that lasted for 2 years but was resolved for 8 months with iron supplements. It has also now returned, with a HGB of 11.7. Lowest HGB was 9.8 in August 2012. Have had two EDGs and a colonoscopy, so pretty sure cause is not a GI bleed. Thanks!

Answered by Dr. Rakesh Madhyastha (4 hours later)

Brief Answer:
Need more info

Detailed Answer:
Hello

Thanks for the query

I understand your concern. However to answer your questions I need a few more details from you

1. What formula is being used to measure GFR?
2. Was anytime urine test done to look for proteinuria?
3. Please let me know all the medications you are currently on?
4. Also please let me know your height and weight

I will certainly help you, please get back to me. I am awaiting your reply

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (23 hours later)

Dear Dr. Madhyastha

Here are the answers to your questions:

1. What formula is being used to measure GFR?

The lab uses Orchard Harvest and the formula they use for eGFR can be found at nkedp.nih.gov

2. Was anytime urine test done to look for proteinuria?

The only urine test I had recently was in September 2014 when I had a verified UTI with moderate blood and proteinuria of 30.

3. Please let me know all the medications you are currently on?

I take the following:
Levothyroxine .112mcg once a day
200mg Plaquenil two times a day
2mg klonopin as needed, up to three times a day
300mg of gabapentin two times a day
Nexium 40mg twice daily
Bentyl 10mg twice daily
Zarah (birth control pills)
Brintellix 20mg once a day
Lithium carbonate 300mg once a day (stopping it as of today as a precaution for my kidneys)
Levoceterizine 5mg once daily
Zofran 8mg as needed every 8 hours
Benadryl 50mg every 6hrs as needed
Albuterol inhaler as needed
Veramyst, two sprays in each nostril once a day
Ibuprofen as needed (stopping as of today to protect kidneys)

4. Also please let me know your height and weight

I am 5'5" and weigh 178lbs.

Also, I forgot to mention that I have gastroparesis.

Thank you!

Sincerely,

XXXX

Answered by Dr. Rakesh Madhyastha (36 minutes later)

Brief Answer:
Reversible factors

Detailed Answer:
Hello

Thanks for the getting back with such details

Here is what I suggest you should do

1. eGFR is not a very accurate means of measuring renal function, they might have used the MDRD formula which is known to underestimate the GFR. Your serum creat is within normal limits and this implies normal renal function and most clinical decisions are taken using serum creat and known GFR
2. There are reversible factors, lithium and brufen is known to be nephrotoxic, so stopping these drugs will show some improvement. Brufen is an NSAID which is known to reduce GFR significantly
3. Further work up for chronic kidney disease must be done now that UTI is cured. Please get ultrasound done for kidney size and also 24 hour urine protein and creat.
4. If there is proteinuria then I strongly recommend you to be on ACE/ARB is enalapril or loasrtan to retard the decline in GFR.

I hope I was of help, if you have any further queries please get back to me

Regards

Note: For further queries related to kidney problems and comprehensive renal care, talk to a Nephrologist. Click here to Book a Consultation.

Above answer was peer-reviewed by : Dr. Yogesh D