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British Liver Trust
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Spironolactone - Acute Kidney Damage.

Hi everyone, first post here.

I was recently diagnosed with Cirrhosis after being admitted to hospital with Alcholic Hepatitis. Further tests showed several grade 1 oesophogal varices, enlarged spleen and a gunked up gallbladder.

The hospital were great. I was in for 2 weeks while they sorted me out and detoxed me too (3 months off drink now and never going back to it!)

Shortly after being discharged I developed moderate ascites, which I just tolerated till it became unbearable. Saw the consultant and was prescribed Spironolactone and asked for a blood test 5 days later.

I want sure what he wanted to test me for but I googled it and one of tests requested was AKI Score which I found out was a kidney function test for Acute Kidney Injury.

Anyway last week I had a call from my GP about some test results (Which turned out to be the test I took 5 days after starting on Spironolactone.) GP was concerned about kidney function and advised I drank plenty of water. I made sure to get a print out of the test and it showed kidney function had dropped from my usual 90 something percent to just 49 percent, and my AKI had a warning saying stage 3 (it only goes up to 3).

Then found out that Spironolactone can cause Acute Kidney Injury!

I'm unsure what to do now. I missed yesterday's dose as my anxiety about it was through the roof.

Should I stop taking them until I can speak to the consultants secretary on Monday or just i keep taking them and hope for the best?!

Sorry if this was a bit long winded, I'm very concerned an anxious about it.

Already got a knackered liver, last thing I need is knackered kidneys too.

Thank you.

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Spirolactone can work well in clearing the fluid from ascites. However I have been taken off it because of kidney readings. It also causes my potassium to rise to dangerous levels which could cause seizure. I have been admitted and treated for this 3 times.

To sum up it works well for most people but not everybody. Spirolactone and fuerisamide is all I’ve been offered. I’m still on fuerisamide

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Thank you. The Spiro is working well (100mg a day) as far as reducing the ascites. I look more like my normal self and the discomfort and pain has gone. This just after a month on it.

Potassium levels are fine thankfully. I've been surprised how well they've worked as I seem to have a high tolerance to drugs - probably what helped me on my way to becoming a functioning alcoholic!

How is your ascites now, are your current diuretics working?

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Hi Garyvh

Fuerisamide is all I’m on and this keeps my legs clear of fluid.

Regular drains of abdomen and chest is all they can do to keep me mobile and comfortable. I recently had 17L drained which is nearly 3 stone in weight!

Keep a 2 weekly check on your bloods and learn what the figures mean so you stay on top of it. You may be asked to restrict your fluid intake and increase your protein intake to help keep the fluid in your blood.

We are all different so listen to your liver doctor.

Well done on quiting drinking. It gets easier every day so stick with it.

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Hi garyvh.sorry to hear your issues. I hace been living with cirrhosis 10 yrs this year. I have had ascites 4 times.. 3 times i was drained and 4th time was using soirinalactone. Back in 2008, i was on 200mg per day of soirinalactone and 100mg of fruesomide. Never worked. Hence the parenthesis.

I do know it can affrct kidney function thars why i was constantly tested every 2 weeks via blood test to check potassium levels and kidney function, most important is you have a low sodium diet. They did work for me the 4th time round and touch wood i have not had any ascites since 2014. We are all different when it comes to meds .. hope all goes ok 😊

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Hi Garyvh

Yes its not uncommon for Diuretics like spironalactone to affect kidney function. Your AKI of 3 basically reflects the change from your normal values. Its a pretty significant change and its something your doctor will review. At 49 though your kidneys are still working pretty well. I wouldn't imaging they would want that to persist or reduce much further though.

I had a similar problem with the spironalactone. I was on Furosemide initially but that was becoming ineffective so started on the Spiro. It too affected my kidney function so they played around with the dose and used it on and off to limit the potential damage. I must admit it wasn't that effective at the dose i was getting anyway, and to increase the dose would have created a bigger problem so couldn't be done.

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Hi Garyvh,

I don't think you should go off any prescribed meds without your doctor's okay first. My husband has been on a few different meds for fluids since his liver failure and was on then taken off spironolactone due to its effect on his breasts not his kidneys.

I'm not sure where you live and that may impact the medications one gets. Perhaps you can call your pharmacy to see if there are any significant problems with staying on your current meds for the time until you can contact your doctor's office.

Best wishes,

Mary

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Hi Mary. I take 50mg/ day Spironolactone as a maintenance dose. I've only been off it once when I was in hospital for something else and the doctor stopped it. Next morning, a nurse asked me to look at my feet.They were massive and it was starting to swell my legs, just like the good, old days, lol, so I was put straight back on the Spiro. I have gynaecomastia, but it's infinitely better than swollen legs and feet and then ascites. My lower legs are a little swollen still but I can live with that 😁.

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You didn'tmention dosages. .but I'd think it unlikely that not taking it for a few days would hurt you (I've gone without for weeks at a time ) but EVERYONE is different. What you have said however, I'd be hoping it is the drug spironolactone. .as this can be adjusted

I had quite a ordeal with astitis and I'll only be telling you about myself ( self serving) but TRY and I know it's easier said than done a fortnight with zero salt. ...it worked wonders for me and I'd even advise it for those with out any liver issues ..amazing everything seems to have salt in it

B

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Phone nhs 24 for advise number is 111

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Hi Garyvh...I was taking 75mg a day Spironlactone...for just over a year....i started getting acute pains under my nipples...i'm a guy by the way !!!!...and swelling around them...also erectile dysfunction...and other nasty feelings and sometimes pains in my back....I stopped taking it....I have been told that this medicine is also prescribed to people who wish to change gender !! I have Compensated Cirrhosis and have stopped drinking and smoking for more than a year now....and will never take that medicine again.....But i suppose that if you are suffering from ascites you should get opinions on alternatives to Spironlactone from your Doctor.... Well done for giving up the bottle !! stay strong and Good luck to you

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Hello Barry here, I've just read your comments regards spironolactone I've certainly had the painful nippes and share the erection issues you mentioned and if it did behave I'd not have anything to. ..well how can I put it I'd feel like I'd ejeculated but nothing came out so to speak! You think that it may be the spironolactone? It makes sense. .I've not read the gender change concerns and I'd put it all down to stresses of the cancer. .which has now gone away ..An 18 cm tumour on the right lobe (nearly all of the lobe) is now undetectable on scans ...anyone with liver cancer out there please ask about a procedure called SERts . It involves radioactive micro beads being via the femoral artery placed into the tumour which then destroys the tumour from within . I was given 10 months to live from 9/11/2016 ..I went to Australia

" to die" , in May I had the procedure

Please everyone with liver cancer ask about this procedure, it isn't free but surely with enough people demanding something has got to be done ..so only the well off are offered?

Oh I was given a charity grant thank God

Cheers all

Barry

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Hi Garyvh - I have cirrhosis through alcohol and at the time my liver failed I also had AKI. I've been on Spironolactone for about 6 months (100mg) and I was on Furosemide on top but they stopped that one. The explanation I was given was that it was assisting kidney function but was being monitored so that it didn't take over the function of the kidneys. I'm now just on Sprio as a maintenance drug. My kidney function is fully returned though I do drink a lot of fluids. I do get sensitive nipples (I'm male) and a build up of breast tissue but that is something I plan to address later on. I'd rather that than Ascites and Oedema again. In terms of kidneys mine recovered fully while on Spiro but I am drinking a lot of water and doing my best to go low sodium (though that bit is harder for me than alcohol). Best of luck with finding what works for you and do talk about it to your doctors - they can't help if they don't know. Best of luck

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I can't advise what you should do. I can say that I've been on it for blood pressure and water retention for over a year and a half and my kidney function has been fine. I have a host of other problems but they started before the Spiro and the Spiro seems to have helped some of my problems. There are other diuretics your Dr can prescribe that may work better for you.

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Yes kidney function must be monitored whilst taking diuretics. Your consultant /GP should be arranging this. Douro did not work for me and I was admitted to hosp 6 days ago for iv forced diuretic along with . I have lost well over a stone.

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Hi, The advice you have been given is right everyone is different.I took spiro for ascites and just soldiered on when I wasn't feeling too great as I didn't like the ascites when I went to see my liver nurse I was taken in as my blood pressure was 70 over 30 and I had AKI .Came off it and drained 14 litres every 10 days or so. One factor is how good your liver function is .I am now post transplant and have to drink plenty of fluids to keep my kidneys happy. But the best advise is talk to your consultant as that is the person who knows exactly what your situation is.I think we all tend to panic a little. Just avoid Dr Google.Good luck on your journey to full health.

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Thank you everyone for taking time to reply, really do appreciate it.

I got to speak to the gastro's secerataryand she passed my concerns on to the doctor.

The upshot was that yes my kidney function was normal before I started on the spira, but now it isn't. The doctor wants me to have another blood test and if it's still the same or has worsened, I need to stop taking them. What happens after that I dont know yet.

Thanks again

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