Rising creatinine with zoledronic acid infusions...

[Vsahay]

My dad has been receiveing zoledronic acid for past 2 months after a rise in his psa.(on abiraterone for past 1 year and psa started rising this june.doc has advised to continue taking abiraterone and has prescribed zoledronic infusions).

After starting zoledronic his ALP has seen a mild reduction and is within normal limits but creatinine has risen drom .79 to 1.05.Also eGFR has decreased from 94 to 74 after 2 infusions.

Should he continue with monthly zoledronic injections?

He is taking medicines for diabetes(alsp insulin), high blood pressure and thyroid problems.

[LearnAll]

There is a FDA warning about possible kidney damage with Zaledronic acid in some patients.

A serum creatinine of 1.05 is not clear indication of kidney damage as it is still within normal range. Upper limit of normal creatinine is 1.17

eGFR is considered OK as long as it stays above 60. Minor kidney related parameter changes are not uncommon. A close eye on creatinine and BUN should be kept.

Review his other medicines and see if there is any other med he is taking which can cause kidney injury. Discuss with his doctor. This is not a medical advice.

[Vsahay in reply to LearnAll]

So as long as creatinine is within normal limits,should my dad take monthly infusions of zometa?

[LearnAll in reply to Vsahay]

Two most important indicators of kidney function are (1) Blood Urea Nitrogen and (2) creatinine. If both of these are in normal limits, it means kidneys are doing fine.

When kidney damage starts happening, these two numbers start going up above the stated normal range..

[LearnAll in reply to Vsahay]

I will first check my bone density by DEXA scan and if my T score comes normal , I will not agree to zoledronic acid or denosumab. I keep checking my bone mineral density every 3 months and chart it to see any significant decline in T values. I am not on any bone meds and plan to stay this way until my T score goes below -2.0 (presently it is -1.0)

[Grandpa4 in reply to Vsahay]

Don’t pay too much attention to the normal limits. Serum creatinine level is the result of production from muscle and excretion from the kidney. Muscular people typically have higher creatinines. Assuming the amount of muscle stays constant the serum creatinine should reflect kidney function and a 10% increase in creatinine as your Dad had is just that. I would follow it and see it returns to his baseline over a couple of months. At this point he has plenty of kidney function but if it happens every infusion it could be a problem.

[Tall_Allen]

Ask his doctor. Was Zometa beased on the observation of bone mineral density loss on a DEXA scan?

Also discuss adding Celebrex to his Zometa therapy. The combination can increase survival by 22% in men with metastases.

[Vsahay in reply to Tall_Allen]

No he has not undergone any scans yet.Doc has asked for a bone scan in feb 2020.

[Tall_Allen in reply to Vsahay]

Not a bone scan - a DEXA scan. IMHO, he should not be taking Zometa unless he has low bone mineral density.

[LearnAll in reply to Tall_Allen]

Totally agree with TA on this. Why someone need to be on zoledronic acid if his Bone Density Scan (called as DEXA) shows normal bone density ? There is no reason for bone medication...if his T score on Bone Density Scans are showing normal values. In such a case, some dietary calcium in form of home made yogurt and vit D 800 mg a day, green leafy vegetables , with regular walking 3 to 5 miles a day and Yoga stretching poses will be more than sufficient to preserve bones.

[Schwah in reply to Tall_Allen]

Isn’t the 22% reduction in deaths in and of itself sufficient reason to be in zometa with Celebrex if you have stage four PC?

Schwah

[Tall_Allen in reply to Schwah]

With any drug, one has to look at the therapeutic ratio (benefits vs harms). You are right that the STAMPEDE trial, where this salubrious combination was discovered, mainly looked at newly diagnosed men with metastases. But with men living longer, and the risks of side effects of bone strengthening agents increasing with time taking the drugs, I think there is a balance to be considered.

[Radars in reply to Tall_Allen]

can you help please, I have just had my bone profile, egfr and the result is 101mL/min/1.73 m*2; I have a trace of protein in my urine sample, I have had 2 zoledronic acid infusions.

[Tall_Allen in reply to Radars]

90 or higher is normal. What's the problem?

[Radars in reply to Tall_Allen]

thanks, it's with protein in my urine sample.

[Tall_Allen in reply to Radars]

Maybe retest in 3 months.

[Radars in reply to Tall_Allen]

thankyou, I will do another urine sample.

[Radars in reply to Tall_Allen]

serum creatinine level (xe2q5)below range 49umol/L[59.0-104.0] below reference limit, that's not good is it.

[Radars in reply to Tall_Allen]

when I put my egfr creatinine results it said not good 101 mL/min/ 1.73m*2 ,is it to high or what. that was Google

[Hidden]

Here's the prescribing information for Zometa which includes dose reduction for creatinine. It looks like it would need to be out of range in order to require dose reduction. You can find a table for creatine level vs. dose in the prescribing information linked below:

pharma.us.novartis.com/site...

[tango65]

If creatinine is increasing with zoledronic acid, discuss to change to denosumab.

[Vsahay]

Thankyou for the advices.I shall discuss about DEXA scan with doc at next appointment.

[Ghssan]

Use natural remedies to improve creatinine to acceptable std.

Cranbury and bicarbonate sodium are antioxidants and do the job

Take One small spoon of sodium bi mixed with water and lemon every morning .

[Vsahay in reply to Ghssan]

Does this have any side effects?

[Ghssan]

No

Those are normal herby or natural

They are anti oxidants

[Ghssan]

Pls read NHS article on bicarbonate and how to use it and its benefits