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Thread: Got results of Kidney Biopsy

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    Default Got results of Kidney Biopsy

    Today I talked briefly with my nephrologist on the phone to discuss my biopsy results. It was as I expected and he said I showed signs of Stage 3 and stage 5 nephritis. He said that the stages are not really a progressive thing, and that having stage 5 is not really worse than stage 1, but just different. Is this how you all understand it as well?
    Fortunately it is still in the very early stages as my creatinine level is .8-.9 which he says is normal for people, but since I am in a wheelchair and have less muscle mass my levels actually generally hovered in the .5-.6 range. So I have to go in and see him in a couple weeks to discuss medications further, but he said that cellcept is the most likely course of treatment.
    So I am wondering what the stages actually mean and I would like to get more detail on them before I return to see my nephrologist. Does anyone have any great links that discuss this a little further?
    Thanks for your help,
    Brent

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    Here is what I found out:
    "Nearly all forms of acute glomerulonephritis typically progress to chronic glomerulonephritis. The condition is characterized by irreversible and progressive glomerular and tubulointerstitial fibrosis, ultimately leading to a reduction in the glomerular filtration rate (GFR) and retention of uremic toxins. If disease progression is not halted with therapy, the net result is chronic kidney disease (CKD), end-stage renal disease (ESRD), cardiovascular disease, and death."

    Stage 1: This stage is characterized by kidney damage with a normal GFR (>90 mL/min). The action plan is diagnosis and treatment, treatment of comorbid conditions, slowing of the progressing of kidney disease, and reduction of cardiovascular disease risks.

    Stage 2: This stage is characterized by kidney damage with a mild decrease in the glomerular filtration rate (GFR) (60-90 mL/min). The action plan is estimation of the progression of kidney disease.

    Stage 3: This stage is characterized by a moderately decreased GFR (30-59 mL/min). The action plan is evaluation and treatment of complications.

    Stage 4: This stage is characterized by a severe decrease in the GFR (15-29 mL/min). The action plan is preparation for renal replacement therapy.

    Stage 5: This stage is characterized by kidney failure. The action plan is kidney replacement if the patient is uremic.

    Let m know if this answered your questions or if you need more information!

    Saysusie

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    Default Yikes

    That seems a bit different from the impression I got. Since my kidney function is good and we caught it early, I felt a little safe, but the above says that things are more serious. Thanks so much for the information. I have some more studying to do. I guess the upside is I dont have stage 4. Its all about perspective really.
    Thanks
    Brent
    Ganesha is:
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    Brent and Saysusie - I'm not sure these are the same "stages" your doctor was referring to - he might have been referring to the stages in the WHO classification system for lupus nephritis.

    World Health Organization (WHO)
    Classification System for Lupus Nephritis

    I Normal - No evidence of lupus nephritis on the kidney biopsy.

    II Mesangial Nephritis - Most mild form of lupus nephritis; typically responds completely to treatment with corticosteroids.

    III Focal Proliferative Nephritis - Very early stage of more advanced lupus nephritis;
    typically treated with high doses of corticosteroids, with excellent outcome.

    IV Diffuse Proliferative Nephritis
    Advanced stage of lupus nephritis with definite risk of loss of kidney function; typically treated with high doses of corticosteriods combined with immunosuppressive drugs.

    V Lupus Membranous Nephropathy
    Generally associated with excessive protein loss and edema; typically treated with high doses of corticosteroids, with or without immunosuppressive drugs.

    This is what my nephrologist is referring to when he talks about stages - I have mixed stage 4/5 treated with IV prednisone and cytoxan. Cellcept is very effective for most people but I had a reaction to some of the trace ingredients in the drug, so cytoxan is better for me. I am not sure what exactly the GFR measures - the labs my kidney doctor generally reviews are creatinine, BUN, and serum electrolytes.

    Here is a link to an article about kidney disease in lupus that might help

    www.lupus.org/education/brochures/kidney.html#1

    I guess the best answer is to ask your doctor to explain exactly what he means in plain English! :?

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    Default Thnx

    Mary,
    I was thinking that those stages didnt seem to be what my Dr was talking about, so thank you for that clarification. I think you are on the right track, and I will revisit that information and absorb it. I am much relieved by the difference in the 2 sets of "stages". My doc is Indian, but speaks great english But specificity of words can be tricky.

    And one other note, I have just returned to the forums here after a little absence, and I can tell already that you, Mary, are a very well educated, wonderful source of information. Not to take anything away from all the wonderful people here, but you have stood out in my readings of threads. Susie is always a wonderful voice to hear from as well. Thank you all.
    Brent
    Ganesha is:
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    *A colorado medical marijuana patient.
    *As active as possible with handcycling being my primary passion, but Lupus has thrown a wrench in that pursuit for too long.
    *A Certified Therapeutic Recreation Specialist currently working with an adult with a TBI.
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    Brent,

    I also have stage 5 Lupus nephritis and how it was explained to me was that stage 1 is less severe than stage 4 BUT stage 5 isn't necessarily more severe than stage 4. It can range in severeness but the only reason it's called stage 5 is because it isn't like any of the other stages, really!

    Who is your nephrologist? If you don't mind me asking... I go to university hospital's renal clinic and rheumatology clinic, and I think they are doing a great job with me!

    If you want to talk, pm me!
    "All sounds are potentially dangerous.
    All sounds are potentially medicinal.
    All sounds are beautiful." ~Yoko Ono

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    Thanx for the clarification MaryCain and Solesinger.
    Brent, I hope that the clarification put your mind to rest a bit :lol:

    Peace and Blessings
    Saysusie

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    Yes my mind is much more at ease Thanks

    My nephrologist is Dr. Singh with Western Neph. I really like him. I still dont like my rheumy, but Singh is great. He mentioned that Cellcept would be the likely course of treatment, but did not mention prednisone. Would love to avoid that, but well see. Fortunately my uncle is a nephrologist in Indiana, so I will have him looking over everything as well.
    Still planning on trying to make it to a meeting here soon.
    Thanks everyone,
    Brent
    Ganesha is:
    *A T11/12 paraplegic since 2000.
    *A colorado medical marijuana patient.
    *As active as possible with handcycling being my primary passion, but Lupus has thrown a wrench in that pursuit for too long.
    *A Certified Therapeutic Recreation Specialist currently working with an adult with a TBI.
    *And much much more

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    I'm on CellCept Plaquinil and Pred... Also for my kidneys the put me on Cozaar and Lisinopril (BP meds) Because apparently they keep the protein in your blood.... They have taken me off of them because my BP was TOO low (67/30) And I have noticed the swelling coming back... I just hope that the protein stays where it's supposed to! I really don't want to go on the BP meds again... As for prednisone, I think I'm the only person in the world that WANTS to stay on that med! LOL I'm a singer, and once I started pred, my range was so much better! It just opened everything up!! It's great!!! I have dealt with the hunger and other side effects... I just love how I SOUND so much better!!!

    Western Nephrology, that's in Boulder, right? I think my friend Nikki, who also has stage 5 Lupus nephritis, goes there!

    Okay enough babbling from me!
    "All sounds are potentially dangerous.
    All sounds are potentially medicinal.
    All sounds are beautiful." ~Yoko Ono

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    I have Stage 4, too - definitely the WHO stages, that's how my nephrologist refers to it as well.

    I have been on Cellcept for almost 3 years. Also Lisinopril and have weaned off the Prednisone!

    Solesinger - I also am havign to watch my Lisinopril because of low BP. Feels so wierd since it was so high at one time. I've reduced my Cellcept to 500 mg a day. My goal is to get off all my meds but Plaquenil. How ever last week my labs said my Creatinine went up to 1.2. It had been at .9-1.1. So, of course, now I'm worried......

    I had a sinus infection and was on antibiotics (had a bad tummy from the first one so we switched) and read afterwards that the first antibiotic - a Sulfa drug can cause flares in people with Lupus. So, I'm wondering if that started my flare....anybody had that happen? I might have learned something a little too late.
    Missy

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