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Discussion Starter #1
For the past few months I've been following with nephrology with what they believe is early nephritis. I have had a few urine samples with blood and protein. I have mild (+1) pitting edema in my lower legs/eyelids in the morning. And over the past few doctors visits have noticed my blood pressure has been over 140/90. I am not due to see my nephrologist until April. Right now, we are holding off on a biopsy because they think I'm in Stage I or II nephritis which they don't treat. I will be seeing my rheumatologist who follows me in Milwaukee in January. Any advice? I'm getting worried about the blood pressure. Usually, they take it with the automated device first (which we were taught in my medical school classes is not accurate) and I will come up pretty high, but when taken manually has been normally. Now even my manual blood pressure is high. And I know this would have to be related to nephritis for me because I'm young (25), and of normal weight for my height, one parent has hypertension the other has normal blood pressure. Any advice? Anyone experience hypertension with early nephritis? My last GFR was 67 and creatinine was 1.0 .
 

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Hi Allerian,

I'm sorry you've got this added worry too:hug:

April is a long time away still. Is there a possibility of moving the appointment forward? Alternatively you should call your rheumtologist for advice.

My feeling is it is certainly possible that your hypertension is related to early nephritis. Early on in my lupus life I had pretty much the same - mild (around 500mg/24hrs) proteinuria and hypertension ranging about 140/90 to 160/110. At that time, my nephrologist was also pretty relaxed about it and didn't want to biopsy either. However since my other lupus symptoms weren't well controlled and I wanted to cncieve, my rheumatologist added first prednisolone to my plaquenil and later azathioprine, and like magic the blood pressure and urine returned to normal. So - even if treatement 'wasn't needed', my body responded favourably to the more aggressive treatment, and I'm glad about it.

So, my point is, I'd be pushing for at least some intervention. If I remember rightly your lupus is not very well controlled at the moment in other respects either? What meds are you on at the moment?

It would be worth considering an ACE inhibitor to help with the blood pressure. This has the added benifit of renal protection. I wouldn't wait til April to ask aboout this, but try to get onto it ASAP.

The other thing is to consider further lupus drugs. Am I remembering right that your rheumy is considering rixutan (sp:worried:) for you? If the proteinuria was the only issue, I can understand holding off doing anything, but in the light of other serious issues, it makes sense to treat 'aggressively' and halt the progression of the lupus.

It is probably sensible if you invest in your own sphygmomanometer and stethescope (yes, they are more accurate than the machines, and I'm presuming you've learnt at med school to use them:p) and keep an eye on your blood pressure at home. Also, home urine testing is worth doing, daily if there are abnormalities, and less frequently if everything is OK. Certainly this is what my rheumy and nephrologist wanted. For a long time I kept a graph of proteinuria readings. I think it helped demonstrate to them that it was a real issue, not just a fluke finding. It also helped calm me to know I had it under obstervation and could act if it suddenly got worse.

Let us know how you are getting on?

X C X
 

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Right now, I think my lupus is actually doing ok. I'm stiff in the mornings but have had no fevers, rashes, etc. for several weeks. I'm on 5mg prednisone every other day, sulfasalazine, and hydroxychloroquine for the lupus. I do take a potassium sparing diuretic because I have low potassium and that can lower blood pressure but I think in higher doses than I'm on. I do have a sphygmomanometer and stethoscope but I live alone and it is inaccurate to do it on yourself. I will talk to my rheumatologist (I see her on the 16th) and see what she wants to do and if she thinks I should move up my nephrology apt. I think when they had me make the apt that they were assuming nothing would change. They said we would do a biopsy if my lupus became more active or if I developed more sx of active nephritis like proteinuria etc.
 

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I am in a similar situation to you except I have normal blood pressure (used to run too low though so it has increased some). I had a reduced GFR (58-59), +1 protein routinely, and my rheumatologist's recommended treatment was just an ACE inhibitor and to stop treatment with NSAIDs. This bumped my GFR back up to mid 60's and reduced protein leakage to negative to trace on most testings (occasionally I'll see a plus 1).

I second the recommendation to test at home, it feels better to me to know it's being monitored more frequently and if a problem arises it can be treated earlier rather than later.

Sulfasalazine is an odd treatment choice for lupus - do you also have RA or Crohn's? Sometimes SSZ can cause drug induced lupus. It's possible it could be contributing to the proteinuria too, especially if you are on a normal dose of it since people with reduced kidney function will need a lower than normal prescribed dose. Here's a link:

http://www.medicinenet.com/sulfasalazine/article.htm

Some things to ask your doctor about at least... I would want to try to change my meds first before seeing a nephrologist if I was in your shoes... and see how it goes. This may include things like stopping the SSZ, switching to Imuran, or adding a low dose of an ACE inhibitor. There are several options to ask your rheumy about at the next appt. Good luck!
 

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Discussion Starter #5
I don't have RA or Crohns but do have a lot of arthritis. I am also a medical student and have to interact with a lot of patients. Sulfasalazine is less immunocompromising than other lupus medications. I'm not on a very high dose. I'm on 500mg twice a day. Most people take about 2000mgs total a day. I think a reason why I'm not on Imuran is that I've had high liver enzymes with drugs similar to it. Oh, and I forgot to say I'm on 0.8 ml (20 mg) of methotrexate weekly. I already do not take NSAIDs and only take a low dose acetaminophen if I need it for headache etc. For those who test their urine at home where do you get the appropriate test strips?
 

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I ordered mine online from a company. Some local pharmacy stores will carry them though so you can call and ask them too. They will keep them behind the counter. I found the ordering online to be the cheaper option.
 
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