adrenal insufficiency and reduced renal function

[Koalajane]

hi, I am now on 3.5mg of prednisolone and suffering with some symptoms of adrenals struggling. I am experiencing fatigue and some tummy symptoms, occasional diarrhoea and quite often nausea.

I have regular blood tests (eGFR) for kidney function and my last one showed my kidney function to have dropped. I am having another blood test for this in 10 days and hope it is a bit better. It had been stable before.

Does anyone know if adrenals struggling could have an effect on kidney function.

Thank you

[DorsetLady PMRGCAuk volunteer]

This paragraph from suggests there is -

Aldosterone

This mineralocorticoid hormone produced by the zona glomerulosa plays a central role in regulating blood pressure and certain electrolytes (sodium and potassium). Aldosterone sends signals to the kidneys, resulting in the kidneys absorbing more sodium into the bloodstream and releasing potassium into the urine. This means that aldosterone also helps regulate the blood pH by controlling the levels of electrolytes in the blood.

Full link here -

hopkinsmedicine.org/health/...

Are you on any other medication that could also affect readings -I had some issues a couple of years ago with my BP meds [Candesartan - an ARB -angiotensin receptor blocker] when they raised potassium levels. Soon sorted by limiting too many potassium rich foods.

Do you know what Stage CKD your readings represent - as we age they are less effective...

[Koalajane in reply to DorsetLady]

Just been thinking and as my kidney function has dropped by 9 points and the only change in meds has been the Cosopt eye drops if it could be to do with that as well. I think I will stop them for a while

[Koalajane]

I am on lisonipril and amlodipine plus atorvastatin. Ohh amitriptyline as well

thank you for your help.

My creatinine is high so wonder if that is all the cheese and nuts I eat!!

[DorsetLady PMRGCAuk volunteer in reply to Koalajane]

It’s a job to know sometimes -you do what you think/hope is best -and then find it affects something else you haven’t even thought of!

[Koalajane in reply to DorsetLady]

Just had the result from todays eGFR blood test. My previous one had gone down from 51 to 43 and this one has gone up to 55, so I am a lot happier now. I made sure I was well hydrated before todays test and have cut my protein intake.

[DorsetLady PMRGCAuk volunteer in reply to Koalajane]

Good 😊

[Blearyeyed in reply to Koalajane]

The whole combo of medications you are on can affect your kidney function , which is why the usually should check your electrolytes every 3-6 months, so the adrenal Insufficiency may only be adding to the problem.Have you had electrolytes checks now?

The combo of medications can also effect your levels of Vitamin D , Vitamin B12 and Folate as well because of the effect on absorption and metabolism of nutrients.

If you've not had these tested ( B12/ Folate/ ferritin in the last 6 months Vitamin D last 12 months) I'd suggest you get them tested too. Insufficiency in these nutrients increasing symptoms in many health issues including affecting kidney and liver function, increasing adrenal Insufficiency symptoms , blood sugar and insulin sensitivity and affecting kidney function.

[Koalajane in reply to Blearyeyed]

I am on d3/calcium and k2 as well. The only thing changed since last test was the Cosopt eye drops.

I have not yet had a discussion with a doctor about this. If necessary I assume that will happen after the results of the blood test in just over a week. I am a type 2 diabetic but have been in remission for over 6 years.

[Blearyeyed in reply to Koalajane]

Trouble is there can still be low absorption even when taking regular supplements and have a good diet if you are taking certain combinations if medication which is why the GP is meant to do these regular nutrient tests but they don't.The effect as the ranges change of Vitamin B12, Folate and Vitamin D is very slow and not noticeable for a long time. Often it only begins to show symptoms once another tiny change in dose or the addition of a new medication comes in , and the drug is always held responsible when in reality it those more basic nutrient and absorption issues that are the underlying factor. Which is why minor changes in brands and drugs don't have much effect on your general health symptoms.

GPs just assume like patients do that if you are on a supplement then everything will be fine , but that commonly isn't the case, I've learned that from bitter experience. And GPs seldom suggest blood tests for Vitamin B12 or Folate and you generally have to request them even if you have obvious indicators in your symptoms and other blood tests.

I'd been on high doses of Vitamin D for over eighteen months and was still Deficienct, it did not improve beyond insufficiency until I'd pushed for B12 testing and finally got this treated. My electrolyte ranges and recurring Anaemia also improved.

All may be fine for you , but if you haven't had the tests already I'd still recommend that your request them just to be able to rule them out and see if the levels you have are on the low side and a few tweaks in supplements or diet could simply make a significant difference to your adrenal and blood glucose related symptoms.

[Koalajane in reply to Blearyeyed]

I don’t think I have blood glucose related symptoms

[Blearyeyed in reply to Koalajane]

But you do have adrenal and gastro ones , I just included blood sugar on the reply because it can also effect this generally.Stomach and kidney function sensitivity problems are common with the combination of medications you have, especially if you also have diabetes , or had it in the past and could potentially have low or borderline nutrient/ electrolyte levels.

You can have normal and subclinical changes in daily blood sugar test monitoring and nutrient blood tests but they can still cause acute gastrointestinal symptoms, adrenal symptoms and chronic fatigue.

[Missus835 in reply to Koalajane]

I've been on atorvastatin for a week and previously rosuvastatin for a week. Both mess up my digestive system, with terrible cramps, gas, rolling tummy and diarrhea. Rosuvastatin was the worst. My muscles are also sore but that could also be related to my current pred taper. I also seem to be a little salty or cranky which is not normal. Hopefully all will settle.

[PMRpro Ambassador]

Adrenal insufficiency can be a cause of acute kidney injury,

However - a single high creatine can be due to dinner last night (a load of steak or other animal protein such as cheese) or if you were dehydrated for any reason. That then affects the eGFR result. It is only a problem if you are ill or it lasts 3 months.

[Koalajane]

thank you. I didn’t eat red meat but probably did eat cheese and nuts. I may have been dehydrated a bit as my appointment was first thing in the morning and I did the 10 minute walk in 7 minutes! I will make sure I don’t have so much protein before the next test and drink plenty.

Do you know anything about the Cosopt eye drops as I am wondering if I should stop using them until I can speak to the eye clinic. They were given for the steroid implant Ozurdex but that has now dissolved and my eye pressure was fine the last couple of visits to the eye clinic.

I suppose it could be a mixture of all

[PMRpro Ambassador in reply to Koalajane]

There are a few things that can do it and they can all add up.

However - while theoretically the drops could have an effect, it is very very unusual and would be more likely in a patient with long standing renal problems.

[Koalajane in reply to PMRpro]

Not sure how long I have had my eGFR monitored, probably about 5 years now after having protein in my urine. I was sent to a nephrologist who did loads of blood tests and sent me for an ultrasound of my kidneys. He was happy and discharged me after asking for me to have 6 monthly blood tests for eGFR. Last year I was asked to have the test again, no surprise as I was definitely dehydrated rushing around on a very hot day. The test after was the first one I knew the result from the NHS app which showed 51 and the comment was stable. This last test it had gone down to 43 so a bit concerning now. We will see what the next test shows on the 7th August.

[Almostaweed]

You don't say whether or not you are taking Omeprazole to protect the stomach lining from the Pred. I believe Omeprazole may affect the kidneys, as I think does Gaviscon. However, not taking Omeprazole may be as risky as taking it. So after reducing it for a while I have decided to take the full 20mg again.

[Koalajane]

no I don’t take a PPI at all

[Karenjaninaz]

I was shocked once when my EGFR (kidney function) went to the 40's; normal for my age is around 70. My rheumy suggested I keep hydrated. Ever since drinking more water, it's been normal-and its summer when dehydration in more common.