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Author Topic: Kidneyfailiure (GFR39) and fatty liver  (Read 3169 times)

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Offline Aida

  • Member
  • Posts: 8
Kidneyfailiure (GFR39) and fatty liver
« on: November 26, 2009, 07:41:32 PM »
My doctor has me on Truvada, Reyataz and Norvir. Retrovir has been tried but made me very anemic.
Doctor means there are no better solutions for me. My creatininlevel has now risen to 140.
Any good ideas
22.03.04 Tested positive VL 100 000
02.02.06 CD4 377 VL2100
06.10.06 CD4 398 VL7600
27.03.07 CD4 174 VL29700
10.05.07 CD4 144 VL5190
29.08.07. CD4 159. OI in stomack,operation, complications
22.11.07. CD4 293 Long recovery
01.08.08 Kidney failure due to dehydration and Bactrim.
09.03.09 CD4 329 VL2640 Retrovir, Reyataz and Norvir
01.07.09 change due to anemi to Truvada, Reyataz and Norvir
10.12.09 CD4 363 VL 0 Kidney damage GFR40

Offline Ann

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Re: Kidneyfailiure (GFR39) and fatty liver
« Reply #1 on: November 26, 2009, 08:53:29 PM »
Hello, Aida, welcome to the forums.

It's difficult for anyone to attempt to give you any alternatives when we know so little of your hiv or treatment history. Could you please give us more details? Could you, for example, let us know what your resistance profile is like? You must be resistant to some of the meds; otherwise, your doctor would not give you such a restricted option list, unless he doesn't know what he's talking about.

Please give us more details so we can help you.

Ann
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Offline jm1953

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Re: Kidneyfailiure (GFR39) and fatty liver
« Reply #2 on: November 26, 2009, 09:03:44 PM »
Hello Aida:

My partner is in the same boat you are.  This involves getting a great nephrologist who will work in congress with your HIV doc.  All the medications you take, including any for high blood pressure should be reviewed and those that are not needed probably eliminated, as per my partner's physicians.  He is taking I think once a month injections for his anemia....  I can find out what it is and let you know. 

Drink tons of water, go on a low sodium diet.  My partner's nephrologist sent him to kidney class, where he learned about what his diet should be, and all sorts of stuff.  Probably if you saw a good nutritionist you can get the same information.

I'm in stage three chronic kidney disease with a GFR in the 40's.  I've completely changed my diet and eat very healthy, exercise, and drink a lot of water. 

Your physicians should be giving you more input as to how to improve your kidney functions in my opinion.

Stay strong,

jm1953
Positive 25 years. 7/21/2012 Current CD 4: 780 Viral load: less than 50. 38 to 40%
Current drug regimen, Isentress, , Emtriva, Sustiva Wellbutrin, Klonipin, Allegra, Ambien, Testosterone, Nandrolone, Vicodin, Benedryl, Aspirin, lots of vitamin supplements.

Offline Inchlingblue

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Re: Kidneyfailiure (GFR39) and fatty liver
« Reply #3 on: November 26, 2009, 10:52:17 PM »
Truvada (due to the Viread part) has been associated with some loss of kidney function in some people (HIV itself affects kidney function, too).

It seems that if you are able to find an alternative to Truvada and take the excellent advice from jm1953 that would be a start, kidney damage can be reversible if caught early enough.

Are you saying that your doctor is telling you that there are no alternatives to this combo available to you? As Ann says, can you please explain further? Many times, if it's in accordance with the resistance profile, Epzicom can be used instead of Truvada when there are kidney concerns. And with Epzicom, Reyataz does not have to be boosted with Norvir (although with some patients it's still good to do so).

In the meantime, try staying away from all NSAID medications (aspirin, Aleve, Motrin, Advil) since those can also adversely affect kidney function and, as jm says, drink lots of water.
« Last Edit: November 26, 2009, 10:55:35 PM by Inchlingblue »

Offline Aida

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Re: Kidneyfailiure (GFR39) and fatty liver
« Reply #4 on: November 27, 2009, 07:07:55 AM »
Thanks a lot, I really appreciate your answers. I have been feeling very alone with this.
I was possibly infected as early as 2002, but discovered in 2004 due to an examination of the liver that was fatty from drinking heavily for some years. I was 38 this year and did not have any worries. I stopped drinking and had a healthy and good life and never worried about the infection.
I slowly had a declining CD4 rate and signs of infection in my bloodwork, until the autumn 2007 when I had a severe infection in my stomack (OI, wrongly diagnosed as bowl cancer) with a lot of complications and several operations. All this led to severe dehydration and  complete  after a year. At this time my CD4 counts were 150. After the last operation (autumn 2008), and re hydration my kidneys stabilized at GFR45 . I then initialized using Truvada, Reyataz and Norvir.( After 4 months of trying Retrovir that failed because of anemia).
I have now used this combination since march and my GFR is 39  and seems to be stable there. My doctor said there was never done any resistance testing, and now my virus count is undetectable so it is not possible to do it. I have been for examination at an nefrologist and she said the damage done to the kidneys is irreversible but not getting worse, and that I can live with a GFR 39, but she has no idea about HIV-meds.
The lesson learnt for me is that I started learning  about this a bit late and that it is risky to rely on a small rural hospital when it comes to serious illnesses.
I still hope I can go on with this combo because I do not have any other  side effects now. Again thanks a lot.

   
22.03.04 Tested positive VL 100 000
02.02.06 CD4 377 VL2100
06.10.06 CD4 398 VL7600
27.03.07 CD4 174 VL29700
10.05.07 CD4 144 VL5190
29.08.07. CD4 159. OI in stomack,operation, complications
22.11.07. CD4 293 Long recovery
01.08.08 Kidney failure due to dehydration and Bactrim.
09.03.09 CD4 329 VL2640 Retrovir, Reyataz and Norvir
01.07.09 change due to anemi to Truvada, Reyataz and Norvir
10.12.09 CD4 363 VL 0 Kidney damage GFR40

Offline Aida

  • Member
  • Posts: 8
Re: Kidneyfailiure (GFR39) and fatty liver
« Reply #5 on: November 27, 2009, 07:28:50 AM »
Again thanks a lot for the advices.
I have got some injections for the anemia, Aranesp,(EPO) 50microgr a month. And I avoid all UNSAID drugs.
I wish I knew if my kidneys got bad because of the dehydration or the virus itself. I am very good at drinking, water nowadays. But if it is the virus that is affecting my kidneys it is a different story isn't it?
Best wishes Aida  
« Last Edit: November 27, 2009, 04:52:37 PM by Aida »
22.03.04 Tested positive VL 100 000
02.02.06 CD4 377 VL2100
06.10.06 CD4 398 VL7600
27.03.07 CD4 174 VL29700
10.05.07 CD4 144 VL5190
29.08.07. CD4 159. OI in stomack,operation, complications
22.11.07. CD4 293 Long recovery
01.08.08 Kidney failure due to dehydration and Bactrim.
09.03.09 CD4 329 VL2640 Retrovir, Reyataz and Norvir
01.07.09 change due to anemi to Truvada, Reyataz and Norvir
10.12.09 CD4 363 VL 0 Kidney damage GFR40

Offline Inchlingblue

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Re: Kidneyfailiure (GFR39) and fatty liver
« Reply #6 on: November 27, 2009, 11:18:42 AM »
Truvada is an excellent drug combo but, as mentioned above, it is usually avoided when there are concerns about kidney function. It seems that with your kidney issues it would be a good idea for you to switch to something to replace the Truvada. There should be other choices available to you.

Epzicom is one alternative. Before going on Epzicom, there is a simple blood test that must be performed to make sure a person is not allergic to one of the components (abacavir).

There have been some studies showing a link between abacavir and heart issues but these are not conclusive at all. Many people are on Epzicom and doing very well. A good friend of mine is on it and has no side effects, 800+ CD4s and undetectable.

I'm not suggesting that you go on Epzicom, I'm only mentioning it as an example. There are also other choices.

Does your primary doctor specialize in HIV/AIDS? Are you in the US?

Offline Aida

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  • Posts: 8
Re: Kidneyfailiure (GFR39) and fatty liver
« Reply #7 on: November 27, 2009, 04:48:47 PM »
My doctor specialises in infectious diseases, I just think she has not been updated the last years. Small hospital. I am in scandinavia and do not have to pay for health services nor medicine, but I think it might be a good idea to get a second opinion.
Thanks again
22.03.04 Tested positive VL 100 000
02.02.06 CD4 377 VL2100
06.10.06 CD4 398 VL7600
27.03.07 CD4 174 VL29700
10.05.07 CD4 144 VL5190
29.08.07. CD4 159. OI in stomack,operation, complications
22.11.07. CD4 293 Long recovery
01.08.08 Kidney failure due to dehydration and Bactrim.
09.03.09 CD4 329 VL2640 Retrovir, Reyataz and Norvir
01.07.09 change due to anemi to Truvada, Reyataz and Norvir
10.12.09 CD4 363 VL 0 Kidney damage GFR40

Offline hotpuppy

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  • Posts: 555
Re: Kidneyfailiure (GFR39) and fatty liver
« Reply #8 on: December 15, 2009, 11:06:42 PM »
Aida,
   You are in the right place to learn.  It's good that you are here. 

Perhaps you could get your kindey specialist to talk to your HIV doctor.  You might also look for studies about HIV and Kidney disease and forward them to her.  While both doctors are involved, utlimately you are committed!  Sort of like the Chicken and the pig with breakfast.  The chicken is involved in making Bacon and Eggs, but the pig is committed!

The important thing is that your viral load is undetectable, this means your HIV is under control and gives you a comfort factor and leeway to balance your other concerns.
Don't obsess over the wrong things.  Life isn't about your numbers, it isn't about this forum, it isn't about someone's opinion.  It's about getting out there and enjoying it.   I am a person with HIV - not the other way around.

Offline Inchlingblue

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Re: Kidneyfailiure (GFR39) and fatty liver
« Reply #9 on: December 16, 2009, 12:23:55 PM »
Aida, I sent you a PM. In the meantime, this is an excellent link with information about HIV and the kidneys:

http://www.catie.ca/tu.nsf/df739470490ae50d8525717f0061769d!OpenView

Offline newt

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  • the one and original newt
Re: Kidneyfailiure (GFR39) and fatty liver
« Reply #10 on: December 16, 2009, 01:36:47 PM »
140 is barely out of normally range, so I wouldn't worry. After 6 months things tend not to get worse. If they do there are formulas for adjusting the dose of tenofovir (the drug in Truvada most likely to be causing problems), eg taking it every other day, twice a week etc.

Your current GFR suggest moderate kidney damage, and perhaps some dose adjustment is appropriate.

If your cardiovascular risk is low you might choose an alternative drug like abacavir, this is much kinder to the kidneys (but not the heart, there you go).

I also note that treating the anaemia is likely to improve kidney function/creatinine levels (well, in non-tenofovir taking people it often does) so I would look at a couple more test results before getting alarmed.


Quote
There have been some studies showing a link between abacavir and heart issues but these are not conclusive at all.

Well, perhaps not conclusive but the D:A:D study showed a very strong association between use of abacavir (one of the drugs in Epzicom)  and doubling of risk of heart attack, which, as far as I am concerned, suggests keep of the abacavir if your risk of heart disease is high (if possible).

All the best to

 - matt
« Last Edit: December 16, 2009, 01:43:12 PM by newt »
"The object is to be a well patient, not a good patient"

Offline Inchlingblue

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Re: Kidneyfailiure (GFR39) and fatty liver
« Reply #11 on: December 16, 2009, 04:17:53 PM »


If your cardiovascular risk is low you might choose an alternative drug like abacavir, this is much kinder to the kidneys (but not the heart, there you go).

 




Well, perhaps not conclusive but the D:A:D study showed a very strong association between use of abacavir (one of the drugs in Epzicom)  and doubling of risk of heart attack, which, as far as I am concerned, suggests keep of the abacavir if your risk of heart disease is high (if possible).
 


The jury is still out on that, link below. I do agree that at least for now, since it is not conclusive, it's a good idea to stay off abacavir if one already has other cardiovascular risk factors.

Kidney disease itself is a risk factor for heart attacks, which according to one of the studies discussed in the link, could in part account for the skewed results linking abacavir with heart attacks. Doctors were more likely to prescribe abacavir to their patients with kidney disease so if these people had disproportionately higher heart attack rates, it could have been the underlying kidney disease, among other things, and not necessarily the abacavir.

At the 2008 Conference on Retroviruses and Opportunistic Infections, researchers first reported that participants in the large D:A:D study who used abacavir had more heart attacks than people who took other nucleoside reverse transcriptase inhibitors (NRTIs). Several subsequent studies examining this link, however, have produced conflicting results.

LINK:

http://www.aidsmap.com/en/news/B125FC65-35B6-4347-9394-306E6B1F09F6.asp
« Last Edit: December 16, 2009, 04:32:07 PM by Inchlingblue »

Offline newt

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  • the one and original newt
Re: Kidneyfailiure (GFR39) and fatty liver
« Reply #12 on: December 16, 2009, 05:14:09 PM »
The BICOMBO study is so underpowered as to be of no value. The Veterans' study tho is not, and confounds the picture, so much so it may become undecidable.

This said, the D:A:D study is of greater power than the Veterans' one, and veterans are a particular population (this is important, compare death/serious illness among Americans vs Europeans in the SMART study, where the Americans did much worse).

But I do agree with your point on kidney/heart diease etc.

h- matt
"The object is to be a well patient, not a good patient"

Offline Aida

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  • Posts: 8
Re: Kidneyfailiure (GFR39) and fatty liver
« Reply #13 on: January 08, 2010, 06:14:03 PM »
Thanks again. My nephrologist concluded that the kidney damage was done by the drug Bactrim. Used as a prophylactic for two years, but the damage happened when I was dehydrated after an operation. Still stable with a creatininlevel 124.
If there exists a formula for using tenofovir with damaged kidneys I would like to see it.
and a happy new year Aida 
22.03.04 Tested positive VL 100 000
02.02.06 CD4 377 VL2100
06.10.06 CD4 398 VL7600
27.03.07 CD4 174 VL29700
10.05.07 CD4 144 VL5190
29.08.07. CD4 159. OI in stomack,operation, complications
22.11.07. CD4 293 Long recovery
01.08.08 Kidney failure due to dehydration and Bactrim.
09.03.09 CD4 329 VL2640 Retrovir, Reyataz and Norvir
01.07.09 change due to anemi to Truvada, Reyataz and Norvir
10.12.09 CD4 363 VL 0 Kidney damage GFR40

 


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