OFF TOPIC - Kidney function & meds questions

[kteague]

This week I was reading up on all my meds because my edema in my legs and feet is relentless even with recent doubling of my water pills. Edema has been long term and considered idiopathic since possible causes have been checked out (thyroid, heart, kidneys). A recent UA and renal panel showed no abnormalities to indicate kidney trouble.

The data on one of my meds says that clearance thru the urine can be decreased if patient has impaired renal function or takes other meds that clear thru the urine. (I take one other on the warning list + others that say they clear thru the urine. They were not flagged by pharmacy's computer system.)

So here's my questions - What happen's to the meds that do not clear? Is it something that accumulates in the kidneys? What does decreased clearance mean to one's health? Can a person have a normal renal panel and UA but still have something wrong with their kidneys?

Any one knowledgeable about this subject?

P.S. I found lots of material explaining clearance but not about the results of decreased clearance.

[Country4ever]

Hi kteague,
I think if a med doesn't clear fast enough, it can have a stronger effect on your body, plus it may develop into something else as it breaks down in your system.....which might not be good.
Some meds don't get broken down by the kidneys, but the liver. Each drug is different. So if something says "doesn't get cleared by the kidneys", I believe it means it gets broken down by the liver instead.
Also, its my understanding that if all your kidney tests are normal, and your creatinine clearance and BUN (blood urea nitrogen) are normal, then you should be able to take that drug.
Just because you retain water doesn't mean your kidneys aren't excreting things like they should.
I hope I haven't given you any incorrect info.

[tomjax]

What are your medical conditions?
Diabetes?
OSA?
HTN?

What meds are you taking?

Dosages are usually reduced if there is compromised clearance and some meds cannot be taken..

If you have creatinine cearance problems, you cannot take some meds such as metformin and ALeve.

You need someone really up to speed on meds in your conodition.

[Guest]

The internet is not the place to go for answers to such serious questions - your MD is the one to ask, and he may even need to talk to a specialist. There are many factors which could be involved that we're unaware of and you'd really be better off to talk to a pro.

[kteague]

Thank you for your responses.

If the creatinine clearance test is the 24 hour urine collection, I have never had that test. My BUN was normal. I will be talking with my doctor later in the week as I am supposed to report to him if the increased Furosemide has helped (it has not). He will indeed have to pursue this further because something is obviously wrong. I may have to push him a bit, but I have no problem being pushy. Just kidding - he's been very attentive to my myriad of health issues.

It may have nothing at all to do with the clearance of my meds, but when I read that I'm taking meds not recommmended to take together for that reason, I couldn't help but wonder in general what happens when you do.

Tomjax, my meds are:
Mirapex
Avapro
Diltiazem
Metformin
Furosemide
Tramadol
Pulmicort (Been off Prednisone 1 month)
Glaucoma eyedrops (Avant & Travast - sp?)
Tylenol

My pharmacy's computer program is supposed to flag incompatible meds. Maybe mine are fine, but I will ask the pharmacist to review my meds to be sure.

Thanks again.

Kathy

[tomjax]

Pharmacy computers can detect problems with meds taken together.
They usually do not flag drugs contraindicated in medical conditions.

If you have impaired renal function, then metformin may not be used.

Also, do not rely on your doc knowing this.
Many do not.

Mine did not(PCP)!!!
Also, do not count on YOUR pharmacist being aware.
In spite of the suggestion to ask your pharmacist, MOST of them have no clue on conditions and the med problems when taken improperly.

I could write a book on dumb prescribing by docs and the errors missed by pharmacists.
I have seen it happen far too many times.

[tomjax]

Also, SOMEONE shoulod be able to determin the cause of your edema.

A nephrologist is probably the person best prepared.

You did not mention if you had CHF?

[kteague]

I was hospitalized about a year ago when I was so backed up with fluid I was short of breath, and the admitting diagnosis was CHF. However, by the time I was discharged they didn't use that term. The paperwork said Uncontrolled HTN and fluid retention. At that time I was switched from Indapamide to Furosemide. When I left the hosptal after all the meds they gave me and flushing me out, I could not believe how my legs looked - hadn't seen my ankle bones in years. The more sleep I've gotten at night, the better my legs are in the morning, but within the hour they are swelled back up. Long story to say that my list of diagnoses at my doc does not include CHF but does say cardiomegaly, but only because one wall is slightly thickened.

I'm calling my doc today and will update as things change.

[Alisha]

Tomjax said "I could write a book on dumb prescribing by docs and the errors missed by pharmacists." As a patient affected by some of these errors, I could contribute to his book. So, Julie, it is important for patients to learn as much as they can from the internet and books, and also listen to friends or others regarding their experience with symptoms and drugs. Just be sure to keep in mind that everyone does not have the same experience or effects as others.

Kathy, I've also had a long term problem with edema. I did not go to hospital, but it has been so bad it affected my breathing and I had to sleep sitting in a chair. The doctors made all the tests you've had plus the 24 hour urine test and some kind of test on the legs. They gave up on finding a cause for the edema. Increasing the Furosemide helped a little but did not totally remove the painful swelling.

I had tests made for food toxicities. Since the test, I have avoided the foods that are toxic to my system and stay on a 4-day rotation diet to try to prevent new toxicities.

My sister and a friend both told me they had discovered on their own that when they took Tylenol for a few days they developed edema. I learned from my research that all NSAID's as well as Tylenol can cause edema. AND I also learned that Furosemide itself (even though it can help reduce swelling initially) can cause edema. I believe this is true of all meds for water-retention. My sister-in-law had edema from chemo and told me the only thing that helped hers was a walking exercise every day (and discontinuing the Furosemide).

Staying on the diet; avoiding Tylenol, NSAID's, and Furosemide; and walking 30 minutes most days keeps my edema at bay. If I stray from any one of these, the swelling increases and becomes painful again. A little swelling always remains, and I wish the doctors could have diagnosed the cause of the edema.

None of the things which have helped me may be useful for your edema, but you might want to consider them.

Also, Furosemide is a sulfa drug and you might want to be sure you are not allergic to sulfa. When your doc increased the Furosemide, did he prescribe a potassium supplement or mention the need for potassium-rich foods with Furosemide? Did he tell you to keep the sodium content of your diet low?

I am not a doctor or pharmacist and cannot and would not attempt to give medical advice. I am a patient who is very sensitive to drugs and have been prescribed a number of drugs that have caused more harm than good. IMHO be very careful and continue researching symptoms and drugs.

I will be praying for you.

Regards,

Alisha

[tomjax]

Cardiomegaly can be primary, but in most cases, ,I THINK, it can be preceeded by CHF and both can happen at the same time.
In any case, I bet you still have chf.

Your condition does not sound good and I think it is time for a full workup including a nephrologist and a cardioligist.

You need to nail the condition down because other things could be at work here.

The fact that the edema is not being resolved or at least helped by furosemide and other diuretics is not a good sign.

No lymphedema involved?
Please keep us posted

[kteague]

Sorry to take so long to get back - computer issues.

Doc ordered some more blood tests. My potassium was normal 2 weeks ago, but may not be now, so that will be repeated also. Will go forward after results are in. My legs are a little better in the mornings, but still quite uncomfortable the rest of the day. I don't know what weeping edema looks like, but I've had two small spots that just seem to ooze clear liquid. If any results of concern come back over the weekend I can be seen by by urgent care in the same organization.

If these tests don't reveal anything I'll ask them to dig deeper for answers. Normal in one area just means to look in another... and another if necessary.

Will post an update when more info is available. Oh, to my knowledge I don't have lymphedema. Thanks for your replies.

Kathy

[GumbyCT]

If these tests don't reveal anything I'll ask them to dig deeper for answers. Normal in one area just means to look in another... and another if necessary.

fwiw- yesterday I saw my PCP who said that using anti-inflamatory NSAID's, as in Aleve & Ibuprofen, will cause fluid retention. He said I could use Tramadol & Tylenol.

You didn't say if you are taking any of these but I just thought I'd mention it as it was news to me.

GumbyCT

[kteague]

Gumby,
I guess I'm doing something right. I haven't been able to take NSAIDS due to them causing stomach pain. I take Tylenol and have Tramadol but try not to take it regularly. The Tylenol hasn't been strong enough to work for me. Now I have one more reason to be careful what I do try for pain. Thanks for that info.

My blood tests (CBC, Comprehensive Metabolic Panel, Amylase & Lipase) came back normal with the exception of my calcium being low, so I have to boost that. The swelling is still bad. I have not yet talked to my doctor about where to go from here. Plan to do that tomorrow.

Kathy

[sootired2]

Hi Kathy,
Edema does not always stem from cardiac or kidney issues. Venous insufficiency is a very common cause of edema, especially if it gets better overnight and worse the more you are on your feet. It just means that the veins in your legs do not drain as well as they should. Sometimes the skin can be a little shiny looking and you might have less hair growth. It can lead to weeping and sometimes what is called venous stasis ulcers which are difficult to heal. Sometimes the skin can turn a little brownish color.

The best thing for this, after asking your physician, is elevating your legs above your heart, and wearing compression stockings. They can be ordered by prescription. You can also buy some OTC but they are not supposed to be as good.

If your BUN and creatinine are normal, that is good, and mean the problem is not likely renal.

Hope this helps.
Margaret

[Guest]

Medications for restless leg are often causes of edema. I was on Mirapex, like you, and developed cankles. They switched me to Requip. Same thing. I found it makes a difference if I don't take it every night, only on nights that the legs are driving me nuts. Another things that helps me is limiting my salt intake.