Kidney function/NSAIDs

Hi, I am sitting here panicking and worrying. Along with 20mg injection weekly of MTX, 10mg daily pred, 4 types of BP meds, omeprazole, 6 days of folic acid, co-codomal I also take 90mg daily of arcoxia (enterocoxib or something to give it its proper name!). My eGfR (kidney function) is down to 32 and should be over 100. I know the GP will take me off arcoxia (my anti-inflamm) as it is causing the kidney problem. Anybody else have this situation? If I try without an anti-inflam I increase swelling, stiffness and pain. Also feel generally rubbish. I have another blood test/urine test tomorrow to double check readings, but I know they are correct as they have been steadily decreasing weekly and I have already been taken off arcoxia once. Is there an alternative to NSAIDs that others use? I have to be very careful as the BP med ramipril very kindly gave me angio-oedema which means my drug usage is quite restricted anyway. Winter is coming and cold weather really does not agree with my fingers, especially, so am dreading being without a daily anti-inflamm. Thank you very much.

[Beth58]

Hi

I have the same problem with my Kidneys however, it's believed it's high BP over a long period of time that has caused the problem, it could be your BP causing your problems to look it up. I now also have heart failure to go with the kidney disease and still take anti inflams and DMARD's and a host of other meds for kidneys/bladder, heart and BP.

I asked about the arthritis meds pushing my BP up and both the Rheumy and Cardiologist say the arthritis drugs don't make that much of a difference and not to worry about taking them.

Beth x

[Hidden]

Thank you, Beth. I have had high BP for 11 years - hence all the meds. Due to swollen ankles etc since beginning of the year, my GP has been trying various different drugs and I am now off the ones that are supposed to cause ankle swelling .... but it is still with me. I suppose that the kidney problems are drug induced as opposed to real kidney deficiencies but the problem is if the kidneys don't recover after the drug induced problems. I know it is not the RA drugs themselves, it appears to be the anti-inflam, arcoxia. (which in a way, is good I guess?). GP has mentioned a renal referral which I desperately don't want as I feel I need to continue to get a grip on RA because this is the thing that hurts! Do you know what your eGFR is. You seem to have a proper kidney problem as opposed to my drug induced thingy - but you say you are still on anti-inflam - which ones, if you don't mind me asking. X You also appear extremely knowledgeable, so forgive me for wanting to pick your brain! X

[Beth58]

Sorry I'm not sure about eGFR, initially I was in a state of shock and as long as I felt all right I never probed for test values. I've never been one to get to hung up over test results until the diagnosis of Heart failure.

Don't worry about a renal referral, though if I'm honest the tests they did were pretty uncomfortable/embarrassing but the staff were great, that helped put me at ease. I was passing blood and with the frequency (every 15 mins) they thought it may have been cancer in the kidneys or bladder. Luckily it wasn't, I still pass blood but I'm fine with it and try not to worry, my doctor worries for me! lol Bless him. he does keep a close eye on me.

I still take Naproxen and Leflunomide with Lansoprazole to protect my stomach and pain killers mainly Tramadol now with Amytriptyline to help relax at bedtime, 3 BP meds and a beta blocker to reduce heart rate and bring BP down, which, so far is working although when I stand or stretch up I get dizzy and disorientated. Swings and roundabouts, cure one ailment and get something else to worry about.

Sorry for going on, hope this makes sense. xx

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Hello Beth, I agree that we can't purely go on 'readings' themselves, but as these are what the GP is basing her findings on .... what can I do? I also take amytriptyiline and co-codomal at night (thank goodnesss!). I have no symptoms - other than tiredness, which I think is RA - and don't want to accept the results but I don't think I have any power over them ... which is why the problem I have has arisen. Personally, I would be really happy to carry on with my current meds but I think that this ' control' is shortly being to be taken away from me. That is my worry. I don't want to start hurting again. X

[earthwitch]

I think your GP is right that you shouldn't be taking any kind of NSAID if your kidney function is that low and your blood pressure not properly controlled.

There is an alternative to NSAIDs, and its anti-tnf drugs. Your GP needs to really push your rheumatologist to consider them (as well as you asking), and I think its quite shocking that you haven't been offered them before now and they have continued prescribing the NSAID when your kidneys are so bad.

I would say that if you are on 4 BP meds and they still aren't controlling things properly, and its causing kidney failure, then you should urgently be seeing a cardiologist as well. This is NOT something that a GP alone should be dealing with, though your case is fairly typical in the NHS where they don't seem to aggressively investigate kidney failure until you get below 35 (by which time you can't often do a lot about getting rid of the cause of it). The NSAID will definitely be doing damage though, so the sooner it you stop the better.