Can PMR cause kidney problems?

[Smokygirl]

Can PMR cause kidney disease? Blood tests are showing that my kidney function has been getting worse over the last two years. This started at the same time as my PMR. I am now at stage 3 kidney failure and am really worried about it. My GP says there is nothing that can be done. He also said that autoimmune diseases can cause this. Anyone else in this situation and have you found anything to stop it getting worse? Very grateful for any advice! Thankyou xxxx

[PMRpro Ambassador]

I haven't ever seen anything to suggest that PMR is linked with renal disease - but there are other forms of vasculitis that do so that should really be checked out by a specialist.

What is your eGFR now? I'm assuming the GP is basing his assessment n the automatic reporting of eGR which seems almost universal now - it was never intended as a diagnosis - it was to provide warning of renal deterioration long before it got severe. It sounds as if your GP is not using it properly - which is what specialists said would happen!

healthline.com/health/stage...

They think the GP should be doing something ... No it can't be cured. That isn't the same as saying there is nothing to be done.

[Smokygirl in reply to PMRpro]

Thanks so much as usual Pro! My eGFR is 54 so defo stage 3. Looking at my historical blood tests it started to reduce from 70 at the same time as my PMR began. My doc said that he has a patient with Lupus who also shows the same pattern.

He says that it all happens very slowly but as you yourself confirm, there is no way of curing it. It has worried me so very much.

I have tried to research it online but although they say eat less protein and less potassium—- and walk —— there doesn’t seem to be much advise.

Do you think I should see a renal specialist before it gets any worse?

It’s a conundrum. Anyway, thanks again for your help. We would be totally lost without you, that is for sure! Xxx

[PMRpro Ambassador in reply to Smokygirl]

Have you been under a rheumy? What would concern me is that the PMR diagnosis by the GP may be missing something because he is right, it is a feature in lupus and also in other forms of vasculitis where organs are involved (unlike PMR).

However,

kidney-international.org/ar...

says

"... K/DOQI guidelines do not take age in account when classifying patients. As GFR decreases with age, the number of persons with CKD stages 3–5 (diseased) increases with age, as shown by many investigators and as illustrated in Figure 3. However, our data indicate that the 60 ml/min/1.73 m2 cannot be used to define a diseased population. Our reference values illustrate that MDRD-GFR decreases with age. A GFR of 60 ml/min/1.73 m2 is within the normal reference range for men >60 years and women >50 years. Our data suggest that recommendations to define kidney disease must be changed. In a recent study, the use of a threshold value of 60 ml/min/1.73 m2 independent of age was also questioned.21. Using a database of the VA system in the US containing creatinine data of predominantly male persons, it was shown that a GFR of 50–59 ml/min/1.73 m2 was associated with an increased mortality risk only in younger persons (age 18–54 years). For older persons, GFR values below 50 ml/min/1.73 m2 (age 55–74) or 40 ml/min/1.73 m2 proved better thresholds. "

I don't think you are about to crumple in a heap and need dialysis! That was one of the criticisms originally about the eGFR being given to GPs and other non-specialists because there was a risk that patients would be told "you have stage 3 kidney disease" without any further explanation and get upset when actually it is perfectly normal for their age.

This

jasn.asnjournals.org/conten...

also emphasises the fact that eGFR decreases naturally as a part of aging and so a much lower threshold would be more suitable at your age of over 65 - they quote 45 so you aren't anywhere near that yet - and just a few months above 65 if I remember rightly

Your GP is right really - and the message is, don't worry about it.

[Smokygirl in reply to PMRpro]

Ohhhh—- You are wonderful Pro!!! You really have reassured me! I think it was seeing the decline in the last two years all of a sudden which looked rapid to me! Thank you a million—- You have made me smile and feel so much better! Huge hugs xxxxx

[DorsetLady PMRGCAuk volunteer]

In 2013 my kidney function test came back as stage 3 - GP not particularly perturbed, just gave me some info on it.....subsequent tests shown no issues....

Fast forward to 2021 - off Pred nearly five years and GCA in remission - stage 3 again identified...same response, different GP, different surgery... nothing to to be concerned about....

considered commensurate with age...no further action required.

But if you are concerned, then maybe follow it up.

[Smokygirl in reply to DorsetLady]

Oh that is very reassuring DL. The only thing is that when I look at the history of my bloods for the last two years, I can see it going down!!I am due a blood test next week ( my three monthly one) so I’ll see what those results are. My GP also said not to worry, it is a very slow decline—- but it looked fast to me!

[SheffieldJane]

It is a pity that your GP left you feeling anxious when there is a lot of reassurance to be had as DorsetLady has outlined. Personally , I like to have all the information and would want a referral to a Nephrologist in the pipeline. Probably just to be told that it is a very common condition that is associated with getting older. Best wishes x

[Smokygirl]

Thankyou so much Jane. I am due my three monthly blood test next week so shall see what the results are. I tend to forget that I will be 80 next Birthday as PMRpro gently reminded me!!! Trouble is that between my ears I am only 21!!! Sending hugs!

[Bridge31]

Gosh Estelle I’m so sorry you have this worry but having read everyone’s replies it sounds as though everything will be ok.We plod on 🤗🤗🤗

[Smokygirl in reply to Bridge31]

Huge hugs Doony! Xxx

[piglette]

I am stage 3 CKD too. It was thought to be caused by pred as the readings were perfectly OK before starting taking steroids. The GP said we need to watch it!! While stage 3 CKD isn't curable, an early diagnosis can mean a stop to further progression. It can also mean a decreased risk of complications, such as heart disease, anemia, and bone fractures.

[Smokygirl in reply to piglette]

Thanks so much Piglette! So, what have you done to halt the decline? Did you see a nephrologist?

[piglette in reply to Smokygirl]

No, I haven’t. My GP just said we need to keep an eye on it.

[Smokygirl in reply to piglette]

Good! It is all reassuring! Xxx

[piglette in reply to Smokygirl]

In fact the only reason I found out that I had CKD was because I got the on line facility to my medical records and saw it there. No one had told me. I talked to a GP about it and he said not to worry it happened as you got older and he had it too!!

[Smokygirl in reply to piglette]

🤣🤣🤣 That is so amusing—— and again, so reassuring! Thanks again! xxxx

[Pixix]

No idea about kidneys, but sending you a hug because your responses are so cheery and you are obviously trying to remain positive! S x PS I do like them grilled with bacon, not trying to belittle a very worrying condition but just to keep a smile on your face!

[Smokygirl in reply to Pixix]

You are lovely Pixix! You have loads of problems and yet you too are always cheerful. And yes, you did make me smile!! Xxx

[Pixix in reply to Smokygirl]

It worked! Good news!

[Charlotteab]

Reading the responses to your original email, Smokygirl, also has me feeling a lot better. I just found out my creatinine level is high (104) and my eGFR is low (50), and I was starting to panic. I am almost 63 and have been on prednisone for PMR since last August, although I am working at tapering it down, very slowly. My doctor never contacted me about my latest blood results (I only found out about them by accessing them online through the lab), so I assume he's not worried. It's reassuring to know that simply getting older can result in wonkier kidney numbers, and there's no need to go into panic mode. Thanks again to this amazing forum!

[Smokygirl in reply to Charlotteab]

Dont worry Charlotte!

I have also found in the last three years that some of my vitamins were causing incorrect lab results! Biotin for instance causes completely untrue Thyroid results! There were others too. Good tip ---- before you have any bloods taken , stop your vitamins for five days beforehand!

Every good wish! xxx

[Charlotteab in reply to Smokygirl]

I didn't know that - thanks for the suggestion!