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Suggest Treatment For NSAID-induced Nephropathy
Question: I was at the hospitals Er--was in severe pain- have taking diclofenac sodium 75 mlg and Prednosone-- I was running a fever and so much pain in my body-Doc did a urinalysis-16h and stopped the diclofenac-it was bad for my kidneys I have Adult onset stills disease diagnosed 3 yrs ago ---Er Doc said that it looks like I have Gout from the tests the Er did-I am weak-- can't stand--know I am taking Rylenol 3- and Prednosone-this is a long term problem --Don't have Insurance-please give some advice-I am 48 years old
Brief Answer:
You need steroids, DMARDS, and febuxostat but after rheumatologist consult
Detailed Answer:
Hi! Welcome to health care magic!
Your concerns are very mitaculous. Looks like you have suffered from NSAIDS induced nephropathy. This was deduced probably on you ER labs which might have shown protein leak in urine or deranged renal functions.
Now the problem is that, NSAIDS were part of treatment with stills disease. Now for nephropathy, you have to remove the offending agent but at the same time you have to look for other options for treating your primary disease. You are left with acetaminophen and steroids like prednisone for that. You can use DMARDS like anakinra after discussing with rheumatologist. Even methotrexate and Hydroxychloroquine may also be discussed with the rheumatologist.
For uric acid, if it is due to the kidney insult, you can wait with hydration and acute attack can be dealt with steroids as NSAIDS can't be given. After acute attack settles, you shift to drugs with reasonable renal safety profile like febuxostat.
All these options are so critical that, using drugs without proper workup and advise of rheumatologist will lead to more harm then benefit. Till then continue steroids like prednisone and for pain stick to acetaminophen only.
Hope this has answered your query, if you have any more questions, please close the discussion. You can also reach me directly through my profile in future, in case of any more questions, Regards.
You need steroids, DMARDS, and febuxostat but after rheumatologist consult
Detailed Answer:
Hi! Welcome to health care magic!
Your concerns are very mitaculous. Looks like you have suffered from NSAIDS induced nephropathy. This was deduced probably on you ER labs which might have shown protein leak in urine or deranged renal functions.
Now the problem is that, NSAIDS were part of treatment with stills disease. Now for nephropathy, you have to remove the offending agent but at the same time you have to look for other options for treating your primary disease. You are left with acetaminophen and steroids like prednisone for that. You can use DMARDS like anakinra after discussing with rheumatologist. Even methotrexate and Hydroxychloroquine may also be discussed with the rheumatologist.
For uric acid, if it is due to the kidney insult, you can wait with hydration and acute attack can be dealt with steroids as NSAIDS can't be given. After acute attack settles, you shift to drugs with reasonable renal safety profile like febuxostat.
All these options are so critical that, using drugs without proper workup and advise of rheumatologist will lead to more harm then benefit. Till then continue steroids like prednisone and for pain stick to acetaminophen only.
Hope this has answered your query, if you have any more questions, please close the discussion. You can also reach me directly through my profile in future, in case of any more questions, Regards.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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