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Forum Name: Rheumatology Topics

Question: RA meds vs. CKD


 hddana - Tue Nov 08, 2005 9:18 am

Diagnosed with RA 25 yr. ago, taking indomethacin 150mg. per day for last 25 yr. with minor exceptions to try Celebrex and one other nsaid that didn't help my symptoms. I am factor neg. and have shown less damage to joints than my SED rate and overall level of pain and stiffness would indicate.

I have seen a couple of rhematologists over the years, was diagnosed by a fairly renowned one, but in general have let either an internal med specialist or a family practictioner deal with my case. I also have high blood pressure for which I take lisinopril and in the past three years have taken Lipitor, recently switched to Tricor because I complained of muscle pain.

Blood work and 24-hr. collection show damage to kidneys, clearance about 60. Nephrologist suspects indomethacin involved in this problem. I am also taking my bp daily to report to her in Dec.

What are the options for someone with weakened kidney function as far as nsaids go? Any time I missed a dose of the indomethacin, I have felt really awful--can barely move, flu-like symptoms, terrible neck pain, etc. What do others with CKD do about nsaid use?
 Dr. Safaa Mahmoud - Thu Aug 10, 2006 8:09 pm

User avatar Hello,

Creatinine clearance normal range: 90–140 milliliters per minute (mL/min).

Low creatinine clearance indicate kidney damage. Kidney damage can reversible or chronic.
Chronic renal damage is diagnosed if the findings that support renal damage persists for more than 3 month after conservative measures.
Damage of the kidney is generally due to either reduced blood flow to the kidneys, or urinary tract blockage.

Indomethacin and NSAID are commonly used medications and can result in reversible renal damage in the majority of chronic users. Being hypertensive is another additional factor or by its own can cause renal damage.

Careful attention to renal function in patients receiving indomethacin and other NSAIDs should be taken, it is advisable to measure the serum creatinine in high-risk patients weekly for several weeks whenNSAID is started.

Measurement of creatinine clearance with 24-h urine collection is considered as an adequate estimate of GFR.

People with GFR above 60 cc/min are considered to have mild form or renal damage that warrants considering preventive measures that should be recommended by the nephrologist.

In general individuals with mild renal damaged are advise to keep their:
BP < 130/80
ACEI (lisinopril) or an ARB medications may be preferred agent for patients with HTN and kidney disease, as you are doing
LDL and HDL management to avoid cardiovascular problems
Vitamin D level > 50 (may use ergosterol)
Echocardiogram.

Serial estimation of GFR and creatinine clearance are very important to monitor the disease progression.

Disease-modifying antirheumatic drugs (DMARDs) may be considered in such situations to control the RA.

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