Medications used for SLE with developing CKD

Currently on;


this is a lot of Meds just for one person, let alone 3! Thought I would give othersAn idea of what kind of MED regimen that Lupus patients must face in their struggle.
I was though, interested on how Dr. Angar thought of ALL these MED’s, His Medical OPINION on maybe some of these Medications
's are messing with my mood and maybe some of them aren’t helping at all. All advice given` is considered ADVICE only. I have a pretty firm grasp of this situation of what’s going on with my body, But from a Medical stand point, it’s left up to the professionals to advise a Patient of some sort.

DR, Have you ever come another case like mine, Sle Lupus Pt., who is on this kind of list of Medications comparable to mine. I seen no reply, this is why I felt like sharing this Personal information with you.
Comparability and unheard of Meds is my question to you Dr.?

Karen, Dr. Agar is out of town on holiday for a few more days. So, it may take him a little while to respond. It’s best to post your question at the same time as the other information you share, because without one, it’s hard to know why you posted, say, the drug list. :slight_smile:

That IS a lot of drugs! How do you keep track of them all?

[QUOTE=Dori Schatell;18890]Karen, Dr. Agar is out of town on holiday for a few more days. So, it may take him a little while to respond. It’s best to post your question at the same time as the other information you share, because without one, it’s hard to know why you posted, say, the drug list. :slight_smile:

That IS a lot of drugs! How do you keep track of them all?[/QUOTE]

Sorry, i’ll try to stay more attentive to posting questions and attachments, thanx :slight_smile:

I’ve been on these meds for quite some time , how do I remember? ITS MY “LIFE”.

Dear Karen

To deal with your ‘pill list’ first … and though many of the drug trade names you have used are NOT the same as the trade names used in countries other than the US, the agents (actual drugs) themselves are all very well known to me.

Unfortunately, your medication list is not, by any stretch of reality, an unusual one for patients with chronic kidney disease (CKD) – of any cause. It is not just those with lupus nephritis and developing CKD that have a medication lists like yours.

Typically, others – and especially but not only diabetic patients or patients with other immunological renal disease (eg: many of the other causes of glomerulonephritis) – have similar and sometimes overwhelming medication requirements.

As do many (if not most) CKD patients, you clearly have difficulties with blood pressure control. High blood pressure is so commonplace in kidney disease as to be an issue for most patients – regardless of the cause of their disease. And, to make matters worse, the blood pressure of kidney disease is rarely ‘easy, one-pill, blood pressure’. It is often difficult to treat and requires several ‘agents’ acting together. I see you are only on 2 BP pills, metoprolol and amiloride, so you have gotten away ‘lightly’ compared to many others.

Your underlying disease his being managed with prednisolone and plaquenil, both of these are commonly used drugs in lupus. Some lupus patients are on even more agents, like mycophenolate or other more ‘ooomphy’ immunosuppressants … there are a number of others … so, again, maybe you have escaped lightly there, too.

Cholesterol and triglyceride problems (abnormalities in the blood lipids – or fats) are so common in CKD patients that it is almost a surprise to see a patient who is NOT on something to lower the blood cholesterol … and you are, I see, on pravastatin for this.

Now, the majority of patients with advancing CKD are on an erythropoietin stimulation agent (ESA) … and you are on Procrit weekly. This is no surprise either. And, as an ESA tends to use up the iron stores of the body, an iron supplement is commonly needed – either orally (as in your case with a ferrous sulphate iron supplement daily) or, as is my own practice, an IV iron infusion given once a year of two as determined by need on the results of blood tests.

As with many CKD patients, it seems you have some trouble from accelerated vascular disease (= a fancy way of saying a faster rate of damage to small blood vessels than is normal … though all of us undergo some deterioration in our blood vessels as we age) and, if you have been or still are a smoker, this will make matters even worse. This has brought on problems with angina – you are on a nitrate patch – but, again, this is common for many CKD patients. To help with this, you are also on low dose aspirin … drugs like ecotrin help to prevent tiny clots from developing in small arteries and leading to heart attacks and the like.

Some types of kidney disease … like Gitelman’s Syndrome … a condition characterized by low magnesium and low potassium blood levels due to a leakage of magnesium and potassium into the urine by the tubules of the kidneys, need replacement of magnesium and potassium to sustain good and normal blood levels. I note you are on potassium (Klor-con) and magnesium (Slow Magnesium) supplementation though many CKD patients have problems with higher rather than lower potassium levels.

You have clearly had, or have been judged at risk from, gout as you are taking Allopurinol. So, too have many CKD patients where the kidneys can no longer excrete sufficient uric acid and a build up of uric acid crystals occurs in joints, causing painful gout. This is an issue for a huge number of CKD patients.

You are calcium x 2 a day … and here, you are lucky and many CKD patients have, in the past, had to take far more than 2 a day. Though there has been a slow move away from the use of calcium-based salts to control the high phosphate levels that occur with CKD, you are also on steroids (prednisolone) for your lupus nephritis and I suspect the calcium supplement is being used to reduce the risk of steroid-related bone weakening (osteoporosis) … indeed, perhaps it is being used for both phosphate control and bone maintenance.

Common to many patients with CKD – indeed the vast majority – is reflux oesophagitis. In addition, you are on both aspirin and prednisolone, each or both of which can cause ulceration or erosion of the lining of the tummy … so it is common practice (indeed sensible) to protect your tummy and your oesophagus with a proton pump inhibitor (PPI) … and I see that you are taking Protonix (pantoprazole) and Prilosec (omeprazole) for this – though it does surprise me a little that you are on both agents, as they both work in a very similar way. Though majority of CKD patients will be on one of these (or a similar agent), perhaps this is the only ‘negotiable’ pair on your list.

You are on a number of pain medications … and chronic pain, whether joint-related from arthritis, related to the kidney disease and its cause or to a range of other causes, is a fairly constant issue for many (if not most) CKD patients – regardless of the cause of their kidney disease. Pain is a private and personal battle – and its control a private and personal battle to wage with the help of your doctor(s). But, believe me; it isn’t at all uncommon for several pain drugs to be used by patients with all kinds of kidney complaints. Again, I am sad to say, you are in the majority here, not the minority!

Constipation often accompanies many medications – like blood pressure pills, calcium supplements and, simply, kidney disease where fluid levels can fall or fluctuate in the body and thereby interfere with the normal processes of wetting and softening of the content of the bowel. Softeners are often required.

Women – with and without kidney disease – all pass through the menopause, as, it seems, are you. That is a time-of-life medication choice you are making with your doctor. I have no other comment to make here.

Finally, CKD commonly may cause … or some of the necessary agents you take may cause … nausea. Some symptom-relief is often needed to relieve this distressing problem … and you take Compazine (prochloperazine) for this.

So, Karen, no … you are not unusual. Indeed, you are very usual and mirror the list of many a CKD patient – regardless of the cause. Replace your steroids and plaquenil with insulin and/or oral hypoglycaemic agents in diabetic kidney disease, or add a whole raft of anti-anginal agents if your angina were worse (which luckily it seems not to be) … and your list is common, not uncommon. I think other patients who read this might attest to this statement.

As for other agents to treat lupus nephritis … there are many – and these are used (or not) depending on the activity and aggressiveness of the SLE. Each patient, here, is different. To be only on steroids and plaquenil suggests you are being lightly, not aggressively controlled … as often is the case as a patient with SLE closes in on CKD5 (as I am surmising you are).

I hope this has helped … but, no, Karen, you are not unusual nor is your list surprising … just, that all kidney disease is awful. And, I so feel for all those who must pass through the progression to CKD5 and beyond to dialysis or transplantation where a whole new ball-park of medications rear their heads!

John Agar

Thank you so much for that informative answer. I am suprised also that they were treating the kidney’s Lightly with some meds. Some of the meds that I take also states in the side effect’s that it can also contribute to CKD. But I would assume the Doctor’s knows this when he perscribed it.
Best wishes,

interesting to read
Diet is also important and patients may need to limit [protein], [sodium] and [potassium] however, maintaining a well-balanced diet is very important. If any diet modifications are necessary, the physician will let the patient know and make a referral to a dietitian for individualized medical nutrition therapy.