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Will eGFR value drop in the next test and what are the chances of progressing into stage 4 kidney disease?

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Internal Medicine Specialist
Practicing since : 2003
Answered : 959 Questions
I have a question about a recent eGFR rating of 56 - The reason I got tested was because I had a job where I was working outside in about 100 degree heat for about 4-5 weeks. I apparently did not drink enough water as I got dehydrated, my urine wasn't too bad but it was close to root beer color but not quite. I even felt a pull in my back when I urinated. My lower back hurt and I felt pain in my right hip (not severe, just kinda dull) that radiated into my right testicle (I am a male - and I do have vericoceles so that pain is not uncommon.) The minor pain radiated also down mostly into my inner left thigh and a little to the knee. I started drinking tons of water and went immediately THAT DAY to my PCP so any test would show the problem at it's peak. He did a urinalysis and said everything was fine. He said, and I quote, "The only thing we found was a TINY, and I mean TINY amount of blood but nothing to be concerned about). My Dr. is well-respected and has been practicing for over 30 years and is passionate about BP and Kidneys. He's not a Neph. but pretty close. After that, we drew blood and when the results came back, my eGFR was 56. He's been my family Dr. since I was 15 and since I take Nucynta (300mg/day - for the last 3 years) and Temazepam to cope with chronic pain, we do blood work every 4-6 months so we have a baseline and everything was fine before.He wasn't extremely concerned (I just turned 38 yrs old) and said that I could probably come back from it. He said he sees people come back from the 50's all the time. He made no adjustments to my medication. I don't know any of the other metrics besides the eGFR. I won't hold you to it, just looking for a "what do you think" answer. Do you think this was due to dehydration and considered "acute" (even though I was probably dehydrated for about 5 weeks). Once I got fully hydrated, within two weeks, all my symptoms subsided. No pain anywhere and my urine is perfectly straw colored and has been consistenly. I go back in a few weeks for follow-up blood work. My main concern is, what are the chances of a massive drop? I would obviously like to get the GFR trending upward, but would be happy if it just stabilized. Based on what I told you, is it likely that my eGFR could significantly drop with this next test? All the sudden find myself in Stage 4? My Dr. said it doesn't work that way and I was not in any immediate danger. I don't know if this would be considered acute since it developed via dehydration over the course of 5 weeks, or chronic. And what are the chances of seeing a rapid progression into stage 4 on the next blood work?
Posted Sun, 16 Feb 2014 in General Health
Answered by Dr. Vaddadi Suresh 59 minutes later
Brief Answer: I can say that your's is acute kidney injury. Detailed Answer: Hi, Mr XXXX. Thanks for posting to us. I will try to clarify. eGFR is dependent on hydration of the body. If you are terribly dehydrated, your GFR falls, means your kidney is injured. Once you start hydration again, like you did, the residual damaged nephrons will take some time to recover and hence you may not immediately see normalization of GFR, while your symptoms abate or urine normalizes. Your chances of progression into stage 4 are NIL as you had no past history of kidney disease or diabetes. I can confidently say that your's is acute kidney injury. I can assure you that your third month reading will show your eGFR well near normal. Hope I have cleared your doubt, please feel free to post any further questions. I WISH YOU A SPEEDY RECOVERY. Regards.
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Follow-up: Will eGFR value drop in the next test and what are the chances of progressing into stage 4 kidney disease? 26 minutes later
You are awesome and thank you for being so thorough and putting it in terms I can understand. I have one other concern I forgot to mention. I started taking Nucynta about 3 years ago. No problems. About a year and a half ago, I noticed that if I take more than 300mg a day, that i get Paresthesia all over my body. Pins and needles and sometimes very itchy rashes and hives that would come and leave just as quickly. Prednisone took care of it. (Everyone chalked this up to the classic Opiate itch). But it still happens every time I exceed 300 mg on any day and the wierd thing is, if I take something else with it that would normally not cause me to itch, say Promethezine or tobacco (I used to dip -quit that a year ago) then it would make my itching worse. Always gone when i wake up the next morning or the paresthesia will just dissipate over time. The only concern is, if the itch is from the Opiate, why would other medications that (if taken on their own) would not cause me to itch would worsen and potentiate the itch when in conjunction with higher doses of Nucynta. And it IS dose related. Same result with Hydrocodone except more intense. Even a Kennalog shot made it worse. So that had me worried that maybe it wasn't the opiate at all, but a build up of urea/toxins in my system (thus straining my kidneys) aka they can't keep up. It just seemed wierd that certain other meds - that when taken on their own would not cause any issues, but in conjunction with larger amounts of the opoid - would intensify the itching and rash. When that happened, (this was way before my eGFR issue) we did bloodwork too and liver and Kidney's were fine. One other thing. I just rememberd, I do remember my doctor saying on about 4 months before the blood work that revealed my eGFR of 56 that my "Kidney's seemed a little stressed." But he left it at that. I'm guessing that was just probably dehydration too since I admittedly drink too much soda pop and not enough water. I was probably dehydrated at that time because I was pretty much living on Mountain Dew at the time. I really was drinking a lot of it and my throat would get hoarse at lot. After this scare, I have obviously upped my water intake. But anyway, does that change your thoughts on your first answer considering there might have been a slight trend from the previous blood work where he noticed my Kidney's a little stressed? Or just probably the same reason as the last lab - just needed to drink more water? I've been very bad about drinking water the last couple of years.
Answered by Dr. Vaddadi Suresh 12 hours later
Brief Answer: sorry for delayed reply Detailed Answer: Hi, sorry for delayed reply. Answering your first question, Trapentadol levels can be increased in the blood by various medications and alcohol, so that any normal dose you take may become overdose. now you have to say whether you consume alcohol or not. There is a long list of drugs that interact with Nucynta (Trapentodol) and many more to add as it is a relatively new drug. Answering your second question, now that you say your doc had given a clue regarding stressed kidneys, i guess you have to serially follow up with blood tests to confirm the chronicity. I still want to say there is nothing to fear about, as progression is known to take years. Feel free to post any further questions. All the best.
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Follow-up: Will eGFR value drop in the next test and what are the chances of progressing into stage 4 kidney disease? 5 hours later
Thank you! I do not drink alcohol. None of instances of itching involved alcohol at all. I think it is the dehydration that has stressed my Kidneys but we do routine blood work every 3-6 months depending on what my Dr. wants. So are you saying that if I have more than one test within 3 months where the eGFR is slightly below 60 then it is chronic and cannot be reversed? I tend to think that for that 6 month period I was chronically dehydrated which is what made brought the eGFR down. Now that I am well-hydrated we will still keep an eye on it. But let me make sure I am clear on what you said: Even if it is technically "chronic" or if the eGFR stays the same or goes up or down a point or two, that as long as I take care of myself and stay well-hydrated then it's nothing to worry about because it should not get worse or if it does, it will probably get worse only at a very, very slow rate. In other words, it probably will not be a factor for decades. Is this what you are telling me? My biggest fear is a dramatic drop but you still don't think that is likely? Sorry for all the questions. I can handle a slow decline over decades because we all slowly decline over decades anyway. I just am afraid of that dramatic drop where I go from eGFR of 56 to eGFR of 27 in three months.
Answered by Dr. Vaddadi Suresh 33 minutes later
Brief Answer: Eventually you can revert back to normality Detailed Answer: Hi, you are perfectly clear. Technical chronicity (GFR 3 months) may be reached by many patients; but eventually they can revert back to normality once the imposing factor (transient insult) is removed. For example, patients whose kidneys are damaged by contrast (used for angiography) may technically show low eGFR for 6 months or even more; but they eventually stabilize at some point for many years and may also become normal after years. I am stating this by experience after following patients for some years ( I happen to be the in-charge of dialysis wing in our hospital). At the least, i can say that, as you barely have any risk factors, worst case is you will very very slowly progress which may coincide with natural ageing. A caution note-dramatic drops can happen if you encounter any condition that stresses your kidney like severe dehydration, nephrotoxic drugs etc, but it is all in your hands. I believe i managed to clear your anxiety. So, be happy and lead a healthy life. bye.
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Follow-up: Will eGFR value drop in the next test and what are the chances of progressing into stage 4 kidney disease? 3 hours later
Thank you so much for your time. I have only one final question for you and I promise that will be it. Please just give me your opinion as it relates to the last thing you said: You said, "A caution note-dramatic drops can happen if you encounter any condition that stresses your kidney like severe dehydration, nephrotoxic drugs etc.." When I got my eGFR result of 56 my Dr. made the comment that he suspects it is the Nucynta or dehydration causing it or both. But he did not make an adjustment in my Nucynta at that time. I think he is waiting to see the next results which tells me he probably thinks that if it is the Nucynta, that we would have ample time to discontinue it before I am in severe danger. Final Question And I Will Leave You Alone: Since my Dr. did not change my dosage of Nucynta, if Nucynta DOES, in fact, turn out to be the cause of my low eGFR, my next test could show another significant drop in eGFR since I have continued the Nucynta as usual. So if my next blood work comes up with another significant drop in eGFR and it turns out to be the Nucynta causing it, would the damage be reversible assuming a dramatic reduction or discontinuation of the Nucynta? Would the kidneys have a good chance to reasonably recover if Nucynta is the cause and we remove it? If not, would dramatic reduction or discontinuation at least halt the progression assuming it is the underlying cause (stress)?
Answered by Dr. Vaddadi Suresh 34 minutes later
Brief Answer: Nucynta is not nephrotoxic. Detailed Answer: Hi Mrs XXXX, I take pleasure in answering. There is no data that Nucynta can damage kidneys. The fact is; it should be used with caution in patients with already damaged kidneys because its excretion will be reduced resulting in dose pooling in the blood. So, it is a good idea to reduce the dose to minimum to avoid side effects like sedation or itch but stopping that drug is not necessary as it is by no way going to damage your kidneys. Nephrotoxic drugs are pain killers like brufen, diclofenac, some antibiotics like streptomycin and neomycin etc. I still believe that your dehydration issue is the cause for your kidney problem, and now that it is settled, you can expect recovery or atleast stabilization of your GFR in your next tests. All the best.
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Follow-up: Will eGFR value drop in the next test and what are the chances of progressing into stage 4 kidney disease? 22 minutes later
One thing: Thank you! I know I said one more question but the other medicine I take is a benzodiazepine called Temazepam - some nights 90 mg. Is it nephrotoxic or of concern at all? Will close discussion immediately after this and give you a great review. Thank you! Thank you! Thank you! You are awesome. You have made a difference in my life and reduced my stress which should also help my Kidneys so thank you.
Answered by Dr. Vaddadi Suresh 6 minutes later
Brief Answer: Temazepam is not nephrotoxic. Detailed Answer: Hi, the answer is no, but the same thing applies to this also (just like for Nucynta). I would suggest you to half the dose for getting rid of possible side effects. Otherwise, it is not nephrotoxic. After next test,I hope to hear from you "EVERY THING IS NORMAL". All the best.
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