Should I reduce my medications if my kidney improves at 68?

Question

Hello doctor,

My mom is 68 years old, and she has lupus nephritis. She has been getting treatment for some time. Recently, we got her lab results. They actually look better than they have in a while. Her proteinuria has decreased significantly, and her kidney function has improved compared to last year.

Now she is asking if this means she can finally reduce some of her medications because the side effects, especially from steroids, have been difficult to manage. However, her rheumatologist is being cautious about making changes too quickly.

For people with lupus nephritis, if kidney function starts improving, does that usually mean medications can eventually be reduced or stopped?
Or do most people still need long-term maintenance treatment even when their lab results improve?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your query and understood your problem.

It is likely to be lupus nephritis. Please carry out the following tests every three months:

24-hour urine protein.
Urinalysis.
Anti-dsDNA (double-stranded DNA).
C3 and C4 complement.
Creatinine.
Erythrocyte sedimentation rate (ESR).
C-reactive protein (CRP).
Alanine aminotransferase (ALT).
Aspartate aminotransferase (AST).

Usually, medications are not stopped unless the patient is in complete remission, which is defined as proteinuria of less than 500 mg (milligrams) for two consecutive years, with steroids completely discontinued throughout that period. Unfortunately, this rarely happens in clinical practice.

Treatment generally starts with induction treatment for six months, followed by maintenance treatment using Mycophenolate mofetil (2 g/d or grams per deciliter) or Rituximab (1 gram every six months). There is another regimen of Azathioprine 2 mg/kg/day (milligrams per kilogram per day), together with Hydroxychloroquine, Captopril, and reducing steroids down to the minimum effective dose.

The following precautionary actions can be recommended:

Stay away from nephrotoxic drugs.
Avoid unnecessary analgesics, especially NSAIDs (non-steroidal anti-inflammatory drugs).
Maintain good hydration.

Follow-up every three months with repeat investigations is mandatory, even when the patient is doing well, because lupus nephritis can flare up at any time, especially in patients with a history of poor disease control.

I hope that I have answered your question.

Thanks.