RA and kidney function

My wife, 51 years old, was diagnosed with Rheumatoid Arthritis about 2 years ago. Before that she had joint pain and was taking NSAIDs to relieve the pain. After seeing the rheumatologist, he referred her to a nephrologist because her GFR was at 50. After stopping NSAIDs and starting an a medication for rheumatoid arthritis her GFR has gone up to around 60. The nephrologist originally classified her as stage 3a kidney disease because of her original GFR, but after follow up appointments he said her kidney function was very good and took her out of the stage 3a kidney disease. Her GFR is still around 60 and she has been upset and nervous about her future because she wants to live a long healthy life and she is always worried about her kidney function. Can her kidneys regain most of their function back over time and is it possible for there to be little to no complications? She is worried and I have told her I will try and find her some answers.

Dr. Agar has retired. I’m a social worker, not a physician. I have worked with patients with kidney disease and kidney failure since 1978. I coordinated classes for people with chronic kidney disease. I hope the links that I’ve provided below. Feel free to discuss what I’ve provided with her nephrologist.

The calculator that estimates GFR can be off somewhat and is less precise when the GFR is 60 or higher. I would suggest that your wife to continue to see the nephrologist and track her kidney function labs. Here’s a fact sheet on tests and diagnosis of kidney disease.

She might ask her nephrologist if s/he had performed a urine albumin-creatinine test (uACR). When there is minimal albumin in the urine, the likelihood of progression is lower than when there is more albumin in the urine. This fact sheet shows a color-coded chart with GFR and uACR. This chart indicates the stage of CKD with the risk of progression.

The two most common reasons for kidney failure are diabetes or high blood pressure. If she has one or both of those diagnoses, controlling blood sugar and blood pressure can go a long way to protect kidney function. It’s really good that your wife stopped taking the NSAID for her arthritis as that class of drugs is known to adversely affect kidney function. I’d suggest she ask her nephrologist if other drugs she’s taking might contribute to kidney damage and she should ask the nephrologist before taking any new medication that another doctor prescribes. Here are things she can do to protect her kidney function.