Hi doctor, My dad is 78 years old and was diagosed with stage 4 transitional cell carcinoma of left kidney for which he underwent a neprourectomy. It is six months now and he took immunotherapy for the same. He had three doses of Ketruda but with third dose he developed pneumonitis and changes in lung. He had blood culture but no infection was present so they treated with steroids for 10 days, after stopping steroids he developed some tiredness and fever for which he was put on antibiotic Bactrim. But after he took that for a few days, he was better but just two days back he developed extreme drowsiness, slurring of speech and confusion. He was advised to rush to a nephrologist because his creatinine was 3.7 and his HB was 7. His potassium levels were high too and ESR was 120, lymphocytes were low. So, they took out all the drugs he is presently on to stabilise his creatinine and potassium levels and transfused blood. My question is he was on maintainance drugs for 40 years of which Sartel 40 for hypertension, Glyciphage for diabetes, Liofen and Gabantin for trigeminal neuralgia and Ativan for anxiety have been withheld. Do these drugs cause any interference with his kidneys? Please let me know because I want a second opinion and be double sure that this is the right thing to do.
Hello. I have gone through the details about your history. Cause of deranged renal function is multifactorial. First of all, Ketruda that is Pembrulizumab can cause interstitial nephritis, that can cause damage to kidney and rise of creatinine. Sartel is for blood pressurebut it can cause rise in creatinine in acute setting such as after surgical stress, so stopping is a good decision. When there is a damage to kidney, drug such as Gabapentin get accumulated in body and can cause neurological symptoms as you told. It will subside gradually as kidney function improves. So, from current medicines, you stop Parozep until his kidney recover, for blood pressure take Amlodipine 5 mg (as the blood pressure is normal now) (attachment removed to protect patient identity). Get urine routine done and urine protein creatinine ratio and if creatinine continue to rise, a kidney biopsy may be needed. Otherwise, control of potassium and urine output as per regular protocol of treating nephrologist. Take care and would like to know further detail and progress, wishing him a speedy recovery.