Methotrexate blood test results

[Chickenkeeper2015]

Hi all - long time no speak. I’m guilty of disappearing while things were going ok for us.

I’m hoping you guys can shed some light though...

My partner has been taking MTX and benapali for about 2 years now, and most of the RA symptoms have been largely under control for that time, but since early spring this year he’s been really struggling with fatigue.

He had kidney stones in Feb which passed, then the next routine blood test in March showed higher than usual creatinine (112 - it’s usually under 90), and lower eGFR (66 - it’s usually >90) - both of which were highlighted in the monitoring record and the next blood test date says 1 month rather than the normal 3. They actually got him in in 2 weeks, but according to the results in the book, didn’t test him for creatinine or calculate eGFR!!! Since then his blood tests have been every 2 to 4 weeks but there are two sets of results missing altogether and no results in that time (a total of 4 tests) for creatinine or eGFR!! WBC result is low every time - around 3 (he’s normally around 4).

He’s going to ring rheumatology this week to try to find out what’s going on, but in the meantime does anyone know whether the low WBC and/or kidney function of eGFR 66 (assuming it’s still low which we don’t actually know) would cause the fatigue he’s currently struggling with (which is worse than he had with the untreated RA) or the nagging one-sided headaches?

Thanks and sorry for the long post.

[Chickenkeeper2015]

*the bullet points in the book were written by me

[helixhelix]

Oh fouey. I had written a long reply and it vanished. So my short answer is: Yes, this could all be related. Ring rheumatology, chase up those missing results, and tell them about headaches as well as fatigue.

[nomoreheels]

Could well be related. I'd do as you intend & contact his team for further advice.

Odd creatinine & eGFR not being repeated as the latter particularly isn't terribly useful on it's own, several repeated tests show a trend which is of more use to see how things are improving or not. Again, something to discuss with his Rheumy team.

Is he keeping well hydrated? Might be worth increasing his intake some if not.

I hope you have useful replies Jenny.

[medway-lady]

Sorry eGFR (but it is estimated based on weight , age etc) and creatine are vital as its kidney function and if a kidney problem is suspected but at 66 its near to normal and both readings do flucuate a lot and as we get older it goes down anyway. At 66 probably no real symptoms. Mine is 20% but even at 12% tiredness is bad as is confusion but it does'nt really hurt. If they were worried about kidneys I'd have thught they'd do a ct scan. But I'm not medically qualified. I'd say trust the professionals who look at the overall picture over time. I have mine tested every month and that is by the Renal Team. I do agree about drinking enough its like for me 3 pints a day at least of water plus tea, etc.

I think talking to Rhuemy is best as fatigue from kidney failure is no different from the fatigue of RA and the amount of times I've been asked about fatigue while in front of a doctor barely able to keep eyes open ....... BTW has the b12 been tested that makes a huge difference to me. Best of luck xx

[Chickenkeeper2015]

Thankyou all for your replies. They’re really helpful. He is going to ring rheumatology today so will speak to them tomorrow. In the mean time I’ll badger him to keep drinking. Thanks again. Jenny