Low GFR on Anticoagulant
Posted , 4 users are following.
My doctor has referred me to a nephrologist and now I'm worried I have kidney problems due to the medicine I'm taking. I'm 66 and in January 2018, I had a pulmonary embolism (blood clot in lung) and was put on the anticoagulant, Xarelto. I had terrible side effects and was just switched to Eliquis at a lower dosage. Before the clot, I was healthy, taking only Vitamin D, non-smoker, normal BP. All my vitals normal & normal blood tests. On the day I had the clot, my creatine was 0.9 and GFR 66.6. Since then (5 months), I've had many blood tests and my GFR has bounced around dropping to 59, then 48, and up to 54. My creatine has been between 1.0 and 1.08. Dealing with the blood clot has been life changing and now this. My hematologist just switched me to a lower dose med, which is kinder to the kidneys, but my primary doc is referring me to a nephrologist. I thought he'd at least wait to see how I do on Eliquis. His nurse left a voice message and said "kidney function is gradually deteriorating, but still to a very mild degree."Am I in trouble here with these numbers? I can't take any other meds, so I don't know what the kidney doc would do. Diet changes? Any words of advice are appreciated.
0 likes, 15 replies
louise5027 graceCO
Posted
Hi Grace, I don't really know the effect your meds might be having but your Egfr result would put you around the stage 3 mark for kidney disease. This might be from the meds but can also just as easily be from the natural aging process.
The nephrologist will be able to advise you on this.
The treatment, if any necessary will vary from others as it will be dependant on the reason, you may well not need to take anything at all.
I have ckd3 and have been at this stage since diagnosis around 18 years ago. Mine is caused by a scarred kidney that then caused high blood pressure, I take one tablet a day and lead a perfectly normal life.
I would expect the doctor to tell you to refrain from taking any anti inflammatory tablets as this can affect kidney function.
graceCO
Posted
Thanks, Louise. I'm assuming it is the anticoagulant, because my GFR # dropped from 66.6 to 59 within two weeks of starting on the drug. I've had every test in the book to find the underlying cause of my clot and there is none, except that I was immobilized with the flu for 5 days prior. I'm hoping my hematologist will take me off the med after 6 months, which is just a few weeks away. Hope to see him before I see the nephrologist.
My primary doc ran a renal panel on me and I also had an ultrasound of my kidneys, which were normal. With the blood thinner I'm on, I cannot take any NSAID's anyway, so all I'm on is Eliquis and Vitamin D. I did have 2 CT scans (for the clot) with contrast dye and that's not great for the kidneys, either. I looked back on my GFR levels since 2013 and they were consistently 65 or over, until I went on this dreadful black box medicine. I'm hoping I'm not put on any more medicine. In the meantime, I'm doing what I can do to improve my kidney function with daily exercise, eating healthy and staying hydrated.
I'm so tired of all the testing I've been through & ER visits for the clot. What will the nephrologist likely do on the first appointment? Order any tests?
marj01201 graceCO
Posted
Grace, the nephrologist will likely order more tests. Mine typically runs renal panels (blood workups) and urine samples to check for protein in my urine. I've also had a biopsy so my nephrologist could get a better idea of what has caused the decline in my renal function. Of course I've also had CT scans like you've already had.
So, in short, yes, you'll likely have more tests. But hopefully you'll then know what's going on with your kidneys.
Let us know what you hear. And, I'm thinking nothing but good thoughts for you!
Marj
graceCO marj01201
Posted
Hi Marj, and thank you for replying. Appreciate the support! Last night, I spoke with a nephrologist (friend's husband) who told me he wasn't concerned at all with my numbers--my BUN & Creatinine are normal--and I should feel hopeful this will stabilize. As for the cause, it could be age, blood clot or med-related. He mapped out what would happen next--follow-up blood tests over time, and if they're stable, it's a closed matter. If they continue to deteriorate, he said they'd do a 24-hour creatinine test and, as you said, a biopsy to see what's going on. He feels that too many primary docs are prematurely referring patients to specialists when they all they need is monitoring at Stage 3.
I just had the renal panel 2 weeks ago, plus an ultrasound of my kidneys. Everything came back normal, except my GFR was 59. I just switched medicines 10 days ago, so I think I'll wait out another blood test. On Tuesday, I'll see my hematologist, a wonderful doc, who will likely run a panel on me. I'm hoping he'll be open to taking me off this blood thinner or at least have some guidance on the interaction of the med with renal function.
Crossing fingers these numbers stabilize. If not, I'm now seeing it's good to figure this out early to stem any further issues. Trying to look at the silver lining here. I'm assuming once they figure it out, we move on with our lives?
louise5027 graceCO
Posted
Hi, the nephrologist might order some tests, depending on what he thinks, he may well change your meds or just monitor you. I had a couple of tests about 15 years ago, one was a Renal Nuclear Scan, it's a simple injection of a dye then a scan to see where and how fast the dye goes and a Macturating Cystogram, this one is a simple x-ray after having a catheter fitted and you urinate while they x-ray you. But I must point out that these were to help find out function and cause so you may not have these.
I don't see either a nephrologist or urologist at all and only have an annual check-up with my Gp, but again everyone is different so try not to worry if you can.
graceCO louise5027
Posted
Oh, Louise, I do hope those tests are not in my future! I'm so burned out on testing and my primary doc unfortunately is "test-crazy" for every little thing. Whenever I've called his office with a new pain after my blood clot, he would send me to the ER. I've been there 5 times in 5 months, and only truly needed to go one time! I once had a wonderful doctor who didn't overreact and knew me so well as a patient that whenever I had an issue, he was typically "wait-and-see" and things always resolved in time. That reassurance and trust was such a gift and I remained healthy in his care. My current primary doc, who is nearing retirement, makes me very anxious--he is not reassuring at all and makes "mountains out of molehills" oftentimes. My inclination is to seek out another opinion. I think it's time.
I appreciate your kind words. I will try not to worry and hope I can get a resolution without too much fuss.
marj01201 graceCO
Posted
Marj
graceCO marj01201
Posted
Marj, I agree and I've decided to switch primary docs. I don't feel I'm in good hands with him and he's done nothing for me during these rough months post-clot. I have a few recommendations, so I'll get that handled. With Medicare & the supplemental insurance, it's a little complicated, but well worth the effort. At this stage of life, we especially need a smart, caring doctor when issues pop up.
marj01201 graceCO
Posted
graceCO marj01201
Posted
I have an update...I saw my hematologist and he thought the diagnosis of CKD3 was "a little extreme" based on my test results. But, he gave me a recommendation for a hematologist & I'm scheduled to see him on August 10.
I also changed my primary doctor. I went back to my former doctor, who is smart, caring & attentive and knows me well. (Had to switch docs, due to insurance changes a few years ago.) He looked over my recent blood work & CT scan and said he wouldn't tell me not to see a hematologist, but he doesn't think it's necessary right now. His feeling is that the kidney function has been impacted by the contrast dye & anticoagulant and he also thought the blood clot may have caused a little bleeding in the kidney, which is why I had the flank pain. So, he wants to get my records & look over my lipid panel & thyroid test results and see me in the fall. More of a "wait and see" approach and bet on the eGFR & creatine to stabilize or improve.
So, I'm thinking I'll delay the nephrologist appointment, until after I see my primary doctor again. He'll do blood tests then and I'll know where I stand.
Until then, I'm exercising daily and eating a kidney-friendly diet. No dairy, no alcohol, no red meat, no soda, low sodium...I actually feel really good with a lot of energy. Getting off that awful medication made a huge difference. Hoping my kidneys recover and I can move on and enjoy my life.
marj01201 graceCO
Posted
Grace, this is good news! I'm keeping my fingers crossed for you and your kidneys hoping they will inprove🐶
Marj
graceCO marj01201
Posted
Hi Marj,
I want to ask your opinion. Looks like my numbers are starting to improve, since I've been off the Xarelto and now taking Eliquis since 6/10. My GFR went from 50 on 7/2 to 57 on 7/31. Creatinine is now 1.03 down from 1.14. I won't see my primary doc until September, but I have an appointment with a nephrologist on 8/10, based on my former PCP's recommendation that I see one.
My new PCP (former doc who knows me well) didn't think I needed to see a nephrologist, because he thought my numbers would stabilize now that I was off Xarelto. (My nephrologist friend thought the same thing.) I decided to go to a private lab this week to get my blood work done (cost $27, a deal!) so I could see if my numbers were declining or not. If they were declining further, I planned to keep the nephrologist appointment. But, now I'm thinking I don't need to see the nephrologist right now. Thought I'd cancel and reschedule after I see my PCP in September (and more blood work), if he changes his mind and thinks I need to see him.
If you were in my shoes, what would you do? Many thanks, in advance.
marj01201 graceCO
Posted
Grace, that's a tough call. It takes so long to get an appointment with a nephrologist where I live I'd probably keep the appointment to get a baseline read from a nephrologist. Then if needed I'd be able to get back in more quickly for a follow-up appointment. Plus my PCP would have a nephrologist at the ready for a consult if needed. It might be an unnecessary appointment, but I tend to error on the side of caution with stuff like this.
it sounds like your kidneys are improving which is wonderful!
Marj
louise5027 graceCO
Posted
Grace, I presume your in the USA as you said ER, I'm in the UK where our treatments are different?
graceCO louise5027
Posted
Louis, yes, I'm in the USA. That your treatments would be different is surprising to me. How so?