Cyclosporine and Kidney Function

[Rentzi]

Hello all! I am back for some advice. My husband has had a rough December. He had pneumonia, was put on Levaquin- which he was on for months at the start of the AA journey, and his kidneys and tendons reacted severely. His creatinine was at 2.26 and has fallen down to 1.9. Today is was back up to 1.97. His cyclosporine dose is 400 mg daily and his troughs have been acceptable. before the bout with pneumonia, his creatinine was about 1.6 ish. I am wondering if we should lower the dose? Also, we were alarmed today with a drop in platelets. His counts last week were wbc 2.2, hemoglobin 10.7, platelets 59, anc 1144. Today: wbc 2.3, anc 1044, hemoglobin 10.9, and platelets 45. Should we be concerned by such a drop in platelets? He is really upset today. Worrying about relapse and kidney function. I should send a message to his doctor I guess. This is so hard, waiting for every blood test..... hoping for improvement and crushed to see decline. Any advice you can give would be greatly appreciated.

Melissa

[Hopeful]

Hi Melissa,

I am sorry to hear that your husband had such a rough December! Pneumonia will really knock down his HGB and platelets. The important thing is whether his marrow can recover and bring them back up.

I would be more concerned over kidney function vs relapse at this point. How long has his creatinine been elevated? Do you know what his creatinine level was before treatment? What is his current weight? Is he taking more than 5 mg/kg/day?

I remember when my creatinine level was elevated during an illness, my doctor had recommended lowering/stopping my cyclosporine for a few days to allow my kidneys a chance to recover. Of course, this is something to discuss with his doctor, but it is a very reasonable discussion and shouldn't be delayed.

Another thing to ask for from his doctor is a urine protein test. I consulted with a nephrologist at one point who recommended doing this once a year while on higher dosages of cyclosporine.

[Susan]

I can't answer except to say many have their dose lowered at least temporarily. I have PNH and experienced kidney failure a few years ago. After 8 days of IV fluids and pushing oral fluids, drinking as much water as possible was the recovery treatment as well. It really protects the kidneys. But you'll want to check with the treating hem of course. I would wonder if drinking too many fluids might have any negatives such as diluting the med too much.

Maybe someone else who has been on cyclo will answer about the platelets. At least they are still well within a safe range. I hope he's feeling better!

[prayingrbc]

Hi Rentzi,

My father was diagnosed with SVAA at the end of November 2014, since he had H-ATG and Cyclosporine. In Mid December he was admitted back into the hospital and has been in ever since with Sepsis and pneumonia. At one point his kidney function was up to 2.72 and we discontinued Cyclosporine until his levels were back down to a more normal level of 1.5. (That took about a week) Now he is back on Cyclosporine, however it's a lower dose of 150 for now.

As far as the platelets, I can't answer that - My father's platelets and HGB has been lower than they were previously . He went from needing transfusions once a week and platelets 3x week to now every day or every other day. I am not sure if that's from the h-atg or not. Since his diagnosis in nov 2014 we haven't seen any improvement in any counts yet at all.