Kidney function with PMR, prednisone, actemra?
Hi.
Has anyone had changes in blood levels regarding kidney function?
My CKD-EPI levels have never been a problem. But, now that I'm having fortnightly blood tests to check on inflammation levels, it's clear that the levels are decreasing. My CRP level is perfect no, incidentally after an initial level of 178.
My latest result showed CKD-EPI as 69 mL/min/1,73m2. Reference levels state that it should be more than 90 mL/min/1,73m2. It's been dropping slowly since March of this year and in the last two tests gone down from 82 to 69. So, what now? Am I now on the road to kidney problems after having zero problems for the past 73 years?
I was wondering if this has something to do with prednisone which I've been taking for about 6 months but, when I do a search, it seems that prednisone is often given to support kidney function so, in theory, ought not to make it worse.
I've been on actemra for about 6 weeks so I'm wondering if that might be affecting kidney function or at least the serum levels.
I really don't want to start having problems with my kidneys, especially as I feel deathly ill at the moment anyway.
Thanks for any replies.
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It just so happens that I had blood tests a couple of weeks ago for my primary care doctor, and the tests included eGFR. I just checked with Google, and it says CKD-EPI is the equation that produces eGFR. So I think we are talking about the same thing. I have been taking prednisone for a year, and Actemra for more than 10 months (weekly injections). My eGFR was 92 in the tests 2 weeks ago. It has consistently ranged from 89 to 100 over the past year, and that included several months where I was at high doses of prednisone - 40 - 60 mg per day. Google says the normal range for a 73 year old man is 60 - 90, so you are still well within the normal range. Google also says the best ways to take care of your kidneys are to make sure your blood pressure is ok, your blood sugar is controlled, you eat a healthy diet, exercise, stay hydrated, etc.
Actemra side effects list kidney and liver problems. Best to ask your doctor about it.
Edit: I didn't see Jeff's comment before posting. What he says makes sense. I'd still ask the doc though.
I should also mention, Google said the average value for a 73 year old man is 75.
My eGFR is consistently in the 60-70 range so listed as Stage 2 Chronic Kidney Disease. It was something new when PMR was diagnosed but that was 15 years ago and long before I started Actemra. My eGFR is regularly checked. As long as it stays in the 60-70 range my doctor isn't too worried. In Stage 2 CKD, the damage to your kidneys is still mild.
https://www.kidneyfund.org/all-about-kidneys/stages-kidney-disease/stage-2-chronic-kidney-disease-ckd-causes-symptoms-and-treatment
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Since starting Actemra my labs are monitored more regularly. My PMR symptoms are well controlled and my inflammation markers remain low. All across the board my lab values are improving. Liver function, HbA1C and lipid panel are markedly better. I have also lost weight and my blood pressure is good. My treatment with three blood pressure medications was stopped 2 years ago along with atorvastatin.
I had mild neutropenia on Actemra but not enough to warrant stopping Actemra. My LFT's are slightly elevated but that is attributed to non-alcoholic fatty liver disease (NALFD). My remaining lab abnormalities are attributed to Prednisone induced metabolic syndrome.
https://pmc.ncbi.nlm.nih.gov/articles/PMC9772659/
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When I was able to taper off Prednisone ... so many things improved. Part of the improvement might also be that my chronic systemic inflammation is controlled better. My inflammation markers increase again whenever Actemra is stopped or when the time between my monthly infusions is too long. I can't say I have ever suddenly had a PMR flare since being treated with Actemra. I have tolerable aches and pains but they are attributed to arthritis and other things.
I just Googled "is EGFR in the 60 - 70 range an indicator of kidney disease", and got this result:
"An eGFR (estimated glomerular filtration rate) in the range of 60-70 may indicate early-stage kidney disease, but it's not a definitive diagnosis on its own.
Here's why:
eGFR measures how well your kidneys are filtering waste from your blood. A normal eGFR is typically above 90. An eGFR between 60 and 89 is classified as Stage 2 Chronic Kidney Disease (CKD). However, a diagnosis of CKD Stage 2 requires evidence of kidney damage IN ADDITION to the eGFR value. This damage can include things like protein or blood in your urine, or abnormalities found through imaging tests.
eGFR naturally decreases with age. So, an eGFR of 65 in an older adult might be considered normal, whereas the same value in a younger person could warrant further investigation.
If your eGFR is 60 or higher and there are no other signs of kidney damage, you do not have CKD.
In summary:
An eGFR between 60 and 89 without kidney damage is generally considered a normal finding.
An eGFR below 60 that persists for three months or more is a strong indicator of kidney disease.
If your eGFR is between 60 and 89 and you have signs of kidney damage (like protein in your urine), it could indicate early-stage kidney disease (CKD Stage 2).
Important: It's crucial to discuss your eGFR results and any related concerns with your doctor. They can interpret the results in the context of your overall health and determine if further testing or treatment is needed. "
My PCP called it stage 2 a long time ago but it didn't get any worse. My eGFR dropped into the low 50's at times but other medications might have been the culprit. I think 49 was the lowest eGRR that was documented. So many medications have been stopped such that my eGFR is improving and it is back into the 60s again.
My uric acid level is being treated with allopurinol because of multiple small kidney stones in both kidneys. I painfully passed a larger kidney stone that was mostly composed of uric acid crystals. Now I do annual visits to a urologist. My urologist was very concerned about microscopic blood in my urine but no blood is detected in my urinalysis anymore, Warfarin was stopped along with other medications so everything combined with shrinking kidney stones seems to help with the blood in my urine and my eGFR. I still have some protein in my urine but that is also improving.
The eGFR blood test results here (Australia) are not given an exact number, with the "e" in front of GFR meaning estimated. In the last two years of blood tests for PMR, my eGFR result has always been >90 (per 1.73sqm), with the reference range being >60. To protect kidneys I drink extra water and avoid vitamin C supplements and high oxalate foods, both of which can cause kidney stones.
"e" in front of GFR meaning estimated.
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Same here. So many factors need to be considered with all lab values. Lab values are ever changing based on factors at the time on the blood draw. That is why they are monitored for trends rather than one lab value.