Which drugs to avoid with high creatinine in a 78-year-old?

Hi doctor,

My dad is 78 years old and was diagnosed with stage 4 transitional cell carcinoma of the left kidney, for which he underwent a nephroureterectomy. It has been six months now, and he has been taking immunotherapy for the same. He had three doses of Ketruda, but with the third dose, he developed pneumonitis and changes in the lungs.

He had a blood culture, but no infection was present, so they treated him with steroids for 10 days. After stopping steroids, he developed some tiredness and fever for which he was put on the 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 maintenance 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 to be doubly sure that this is the right thing to do.

Please suggest.

Thank you.

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 the 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 advise? His urine and blood culture reports are negative. He has no other problem. They have also given an erythropoietin injection.

Please suggest.

Thank you.

Hi doctor,

Thank you for your reply.

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 the kidney is enlarged with increased cortical echotexture and accentuated corticomedullary differentiation. They have reported grade 2 renal parenchymal disease.

His blood pressure and diabetes are under control. They have reduced the 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 in half. This condition of the kidney is a very acute and sudden onset after taking Bactrim, and he experienced all the symptoms, which 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.

Thank you.

Hi doctor,

I want to update you on 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 a 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.