eGFR During Induction

[Atimlin_1]

Hello I started induction treatment about a month ago with very limited eGFR change and was wondering for those who have gone a full 6 months whether it usually takes more time to see any meaningful changes in eGFR numbers? My nephrologist says its a full 6-month phase so numbers may not change much during initial period. If anyone has experience they can share would be appreciated. Mainly helps with managing the uncertainty. Thank you!

[Suzi70 Administrator Vasculitis UK]

what induction treatment are you having, if you don’t mind me asking?

[Atimlin_1 in reply to Suzi70]

hello I am having Rituximab 1g IV at 2 week intervals plus reduced-dose steriod (Pexivas regimen). Plan is for 6 months Induction. Thank you!

[Suzi70 Administrator Vasculitis UK in reply to Atimlin_1]

When you say you have renal limited vasculitis , were you told which type of vasculitis? Because you have mentioned PEXIVAS I presume you have a diagnosis of ANCA Associated vasculitis ?

What is your kidney function if you don’t mind me asking?

[Atimlin_1 in reply to Suzi70]

Yes correct ANCA.

[Suzi70 Administrator Vasculitis UK in reply to Atimlin_1]

Do you know your kidney function? I am only asking because cyclophosphamide is often the treatment used initially for kidney involvement because it works faster.

[Atimlin_1 in reply to Suzi70]

Yes on 1st treatment eGFR was around 24. Two weeks later 31 then two weeks later 28. Doc said best I can hope for is 40-50 given scarring. Unfortunately.

[Suzi70 Administrator Vasculitis UK in reply to Atimlin_1]

Were you told why they are using Rituximab instead of cyclophosphamide?

[Atimlin_1 in reply to Suzi70]

Yes they said fewer side effects. Actually I feel nothing except a bit of insomnia. A couple days ago he talked about introducing Farxiga but when I researched that is says "not for people who recently received immmunosuppressive therapy to treat kidney disease". So confused on that one.

[Suzi70 Administrator Vasculitis UK in reply to Atimlin_1]

My concern is that it takes a while for Rituximab to kick in so you have the potential to lose kidney function before it does kick in where as cyclophosphamide has more an immediate effect.

Both Rituximab and cyclophosphamide come with their own side effects. It’s a case of weighing up risks and benefits.

Perhaps have another chat with your consultant and also about Farxiga, as I understand this drug is to treat type 2 diabetes?

[Atimlin_1 in reply to Suzi70]

Thanks very much for your feedback here. I actually met a new specialist yesterday. She said the same thing. Seems my profile calls for Rituximab with careful monitoring of kidney function and better diet, especially protein management where I have been taking too much. Instead of Farxiga she is recommending a nominal increase in Losartan with daily blood pressure monitoring. I will probably accelerate my next appointment to two weeks instead of 4 to see where eGFR is to ensure it is not falling. What a lifestyle change, this is really complex but trying to remain optimistic about all the benefits coming from better diet, exercise and no more alcohol use. I really appreciate your taking the time.....thank you.