How long for kidney improvement RTX?

[mrtmeo]

Has anyone had kidney function improve after rituxan treatments?
If so, how long did it take and what were the improvements?

Thanks

[Pete]

Not really sure if this answers your question. If not, somebody else will chime in. Last fall, I experienced some blood in the urine and an elevated creatinine level. I had two rtx infusions during the second half of October. My labs started showing improvement in early January. I've never had a kidney function test, but other than these symptoms, my docs haven't been overly concerned. Labs are nearly normal now.

[mrtmeo]

Hi Pete,
Many with vasculitis suffer from rapidly progressive crescent glomerulonephtrits which can cause end stage renal failure very quickly.
My mom ended up in 4th stage renal failure and it has only improved with the blood transfusions and extra protein.
She is dumping too much protein and blood from her kidneys which causes anemia, low albumin and further regression of kidney function.
I give her higher protein to help compensate for the extra protein she is dumping and it helps all the blood work except the blood urea nitrogen gets too high.
So, I was wondering if anyone has had a lowering of their creatinine from Rtx treatments.
Creatinine is the level used to monitor kidney function.

[Pete]

Hi,

Yes, rtx should help lower creatinine levels. Mine dropped from 1.45 mg/dL before rtx to 1.23 mg/dL a month after infusions. Also cleaned up the blood in the urine. I've experienced a slight trend upward in creatinine during the past few months. I had tapered down to 3 mg/day prednisone. Rheumy suggested that I go back up to 5 mg/day. I feel more energetic, and creatinine level at first lab after increasing pred dosage was lower.

[mrtmeo]

my mom's creatinine was going up on rituxan until I added more protein to her diet and then, it went down from 2.6 to 1.9.
Her BUN got too high due to the prednisone and extra protein, so I had to lower the protien and her creatinine is climbing again.
She had to hold off on her last infusion due to an unknown rash, but it seems to be going away very slowly since stopping the bactrim and acyclovir.
I wish she could do the plasmaphoresis to help her kidney function.
Before her last infusion, her lymphocytes went down to .9 but the next week they went up to 2.
I know that the disease activity is said to be gone when the lymphocytes are below 2.
She also, had one dose 1000mg of Cytoxan until she got approval for the Rituxan.
I would think with all of this she would be feeling better, but she is no better at all.

[mrtmeo]

Just before my mom's last rtx infusion, her creatinine improved to 1.8.
I sure hope this trend continues.

[Bing505z]

I can tell you that I responded very well to Rituxan. My Docs next step for me was to order a kidney biopsy, he canceled it after my first blood work results came back. My blood tests were taken a month after my last Rituxan dose.

[drz]

My kidney function and anemia slowly improved over many months after having Rituxan, Cytoxan, and Azathioprine. My kidneys were damaged but over the past year they function about 50% better than at my lowest levels when i was initially diagnosed according to my monthly labs.

[sbeach78]

I had major kidney involvement, at their lowest they operated at 5%. I don't know about RTX, but improvements are possible. My kidneys were permanently damaged, but six months ago I was near dialysis now I have 30% function. The sooner they treat you the less damage done, but kidney involvement is no death sentence, do keep your head up, and start a good renal diet. I wish you luck

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[gilders]

I also had major kidney involvement (inc dialysis and plasmatheris). I was originally put on a low protein diet due to this. That was 19 years ago and I only really stuck to it during the first year (I love meat and dairy too much). Although my kidneys aren't doing well, my nephrologist is very surprised they haven't totally given up yet. They are struggling more than usual at the moment and another kidney biopsy is likely. Because of this I asked my specialist if I should cut back on the protein again (I'm leaking LOTS in to my urine). He said studies have now shown that limiting protein intake is no longer the recommended course of action. Eating a "regular" amount is the best way.
Therefore before any drastic changes in how much protein you eat, check with your own Dr as having extra protein has never been a good idea in my Dr's opinion for people with poor kidney function.

[mrtmeo]

Hi Everyone,
Thanks for your responses.
As far as protein reduction, this is only possible if you consume enuf protein to support your lean body mass, plus the loss in the urine.
If our body does not get enuf protein to support the muscle we have left, it will take from it.
My mom has so little muscle left and she needs at least 50gms of protein per day to keep her balanced, so far.
The Neph said she should eat 40gms per day, but this was causing her albumin to go too low which causes swelling in her feet badly.
Without enuf protein, her red blood cells can't regenerate either.
I noticed that when I was giving her a little too much protein, she was still dumping alot of protein in the urine, but the blood in the urine went to the normal range.
Her BUN went too high, but her rbc's, albumin, hemoglobin, hemocrit and others looked great.
I know the prednisone can cause BUN to raise too, so hoping this will reduce when she tapers the prednisone.
Too much protein produces too much phosporus, but a ketogenic diet (adequate protein high fat low carb) has proven to reverse kidney disease in Type 1 and Type 2 diabetics here
Low carbohydrate diet may reverse kidney failure in people with diabetes -- ScienceDaily (http://www.sciencedaily.com/releases/2011/04/110420184429.htm)

[mrtmeo]

Hi gilders,
Do you periodically use urine dip strips to check your if your kidneys are dumping blood and/or protein?

[mrtmeo]

I found this graph showing kidney improvement over the months after RTX treatment

http://rheumatology.oxfordjournals.org/content/45/11/1432/F1.medium.gif

Here is the website
Long-term observation of patients with anti-neutrophil cytoplasmic antibody-associated vasculitis treated with rituximab (http://rheumatology.oxfordjournals.org/content/45/11/1432.full)