Maintenance drugs in kidney carcinoma patient has been stopped. What is your opinion?

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.

Hi doctor,

Thank you very much for your reply. I have further queries. They had done an ultrasound which showed grade 2 renal parenchymal changes and mild ascites. Bilateral basal consolidations in lung and minimal pleural effusions. They have restarted Activin and Gabantin, the creatinine level was 3.49, and all other parameters were improving. Overall my father is feeling much better. His urine output is good, and general parameters are all stable. Can you please advice? His urine and blood culture reports are negative. He has no other problem. They have also given erythropoietin injection.

Hi doctor,

Sorry, I do not have any reports. But, I know his kidney was normal until a few weeks back, normal in size and normal echotexture. This change in appearance is very acute, and now kidney is enlarged with increased cortical echotexture and accentuated corticomedullary differentiation. They have reported as grade 2 renal parenchymal disease. His blood pressure and diabetes are in control. They have reduced dosage of Gabapentin and Activin because my dad has been on them for 40 years and he cannot handle withdrawal, so they have cut the dosage to half. This condition of the kidney is a very acute and sudden onset after taking Bactrim, and he experienced all the symptoms that we found out that he had raised creatinine. They have been testing urine and blood and even performing a regular ultrasound for the three doses of Ketruda. All these happened before he went for the 4th dose. I do not have films because I am not with him.

Hi doctor,

I want to update you with the present situation. My dad's creatinine was 3.4 yesterday and today 3.49. The Nephrologist has said that they will not do a biopsy and they are treating with Nodosis DS, Bistla, Alfaren, and Silodal D. Otherwise, his blood pressure and diabetes are in control. His urine showed gram-negative rods and few pus cells but the culture was sterile. Overall he is feeling good. There are no other complaints. Any of your suggestions would be useful. Thank you.