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What Do These Following Lab Reports Indicate?
Question: Hi there doctor my father is 96 yrs old with prostate cancer psa 5.0 no mits signs and is on hormone therapy lupron injections and casodex pills his urea was in average of 9-12 mmol/l and creatinine was average 120-130 mmol/l the past year,2 weeks ago he has arcoxia 90 daily one pill for one week and voltraine one pill for 4 days due to his arthritis pain,after that he had his regular tests urea climed from 9.0 to 19 mmol/l and creatinine raised from 116 to 140 mmol/l does he need further investigations or is it normal after the meds
Brief Answer:
it's not normal
Detailed Answer:
Hello,
arcoxia and other non-steroidal-anti-inflammatory drugs (NSAID) may reduce blood flow in the kidneys. In some cases this may lead to kidney injury, expressed as an increase in urea and creatinine and perhaps a low urine volume production. First of all he has to stop taking any NSAID. He can try paracetamol for pain relief. If paracetamol is not enough a low potency opioid can be added (according to your doctor's instructions of course).
What's more important right now is to make sure that your father produces an adequate volume of urine every day. Anything close or less than 500mL per day is not enough. He needs another measurement of urea and creatinine and electrolytes and clinical examination by his doctor to search for signs of renal failure. If no such signs exist then hydrating the patient may correct the renal indices sometimes. It needs to be done under close medical supervision though because the fluids and electrolytes in 96 years old men are sensitive issues!
I hope you find my comments helpful!
You can contact me again, if you'd like any clarification or further information.
Kind Regards!
it's not normal
Detailed Answer:
Hello,
arcoxia and other non-steroidal-anti-inflammatory drugs (NSAID) may reduce blood flow in the kidneys. In some cases this may lead to kidney injury, expressed as an increase in urea and creatinine and perhaps a low urine volume production. First of all he has to stop taking any NSAID. He can try paracetamol for pain relief. If paracetamol is not enough a low potency opioid can be added (according to your doctor's instructions of course).
What's more important right now is to make sure that your father produces an adequate volume of urine every day. Anything close or less than 500mL per day is not enough. He needs another measurement of urea and creatinine and electrolytes and clinical examination by his doctor to search for signs of renal failure. If no such signs exist then hydrating the patient may correct the renal indices sometimes. It needs to be done under close medical supervision though because the fluids and electrolytes in 96 years old men are sensitive issues!
I hope you find my comments helpful!
You can contact me again, if you'd like any clarification or further information.
Kind Regards!
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your answer he stopped taking nsaid 2 days before the test this is the first time he had this increase and his urine is fine he passes urine frequently,attached is his tests ans on the right side is his previous results
Brief Answer:
there seems to be a worsening in renal function
Detailed Answer:
You're welcome!
I've reviewed the tests and I have the same opinion as before. You can see the worsening yourself by checking the eGFR values. This stands for estimated glomerular filtration rate. A value of around 50mL/min is great for his age. The decline to 38mL/min seems that something went wrong in the meantime. Sometimes it's just a matter of hydration. But the urea/creatinine ratio are against this cause. It's probably the NSAID (arcoxia and voltaren). Repeat measurements would be needed. If the values remain high or if they get higher a consultation with a nephrologist would be appropriate. Be sure to check the urine volume and electrolyte values regularly until then.
Kind Regards!
there seems to be a worsening in renal function
Detailed Answer:
You're welcome!
I've reviewed the tests and I have the same opinion as before. You can see the worsening yourself by checking the eGFR values. This stands for estimated glomerular filtration rate. A value of around 50mL/min is great for his age. The decline to 38mL/min seems that something went wrong in the meantime. Sometimes it's just a matter of hydration. But the urea/creatinine ratio are against this cause. It's probably the NSAID (arcoxia and voltaren). Repeat measurements would be needed. If the values remain high or if they get higher a consultation with a nephrologist would be appropriate. Be sure to check the urine volume and electrolyte values regularly until then.
Kind Regards!
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you again,when should he repeat the test? And if it remains the same is this a critical issue will he be needing dialysy or he is far from this point?
Brief Answer:
it has to be done as soon as possible
Detailed Answer:
He has to do it as soon as possible. Since he's having no symptoms (apparently) he may have no serious long term issues (like dialysis). Dialysis is done when a patient cannot excrete the fluid, the electrolytes or the acids. There is no sign of such a situation right now but more tests are required.
Urine production and the evolution of creatinine and potassium measurements are very important in assessment and further management.
Kind Regards!
it has to be done as soon as possible
Detailed Answer:
He has to do it as soon as possible. Since he's having no symptoms (apparently) he may have no serious long term issues (like dialysis). Dialysis is done when a patient cannot excrete the fluid, the electrolytes or the acids. There is no sign of such a situation right now but more tests are required.
Urine production and the evolution of creatinine and potassium measurements are very important in assessment and further management.
Kind Regards!
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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