Treating Arthritic Cats With Kidney Disease
May 4, 2016 | information centre
Until quite recently, we believed we had a bit of a clinical problem when treating cats for arthritis when they had evidence of kidney disease.
The most common class of drug for treating arthritis in pets are a class of drug called Non-Steroidal Anti-Inflammatory Drugs . These NSAIDs are very effective anti-inflammatories and pain killers, but can have some side-effects elsewhere in the body including the kidneys.
We used to believe that the effects on the kidneys would mean that any cat with evidence of kidney disease couldnt have these medications due to the risk of significant kidney damage, so our treatment of arthritis for cats was very limited.
A recent study has now been published that proves these NSAIDs are just as safe regardless of whether the cat has evidence of kidney disease ore not, and even cats with advanced kidney failure could still be treated safely and effectively with NSAIDs. Cats treated with NSAIDs, even if they had severe kidney disease on averaged lived at least as long as those cats which were not treated with NSAIDs. Many cats even had apparent improved kidney function following NSAID use.
So what does this mean for your cat? If your cat has signs of arthritis, which might include grooming itself less, being less active or not interacting with you as much as before, we now know we can use these NSAIDs safely regardless of whether they have kidney disease or not.
Arthritis Drugs And Kidney Disease
Spokesperson for the National Kidney Foundation
Do you suffer from arthritis and take over-the-counter arthritis drugs? You could be at risk of adverse drug events.
You are not alone. The most commonly used OTC arthritis drugs are non-steroidal anti-inflammatory drugs such as Ibuprofen, Motrin, Advil, Aleve, and Naproxen. The FDA estimates that 17% of adults in the United State took Ibuprofen and 3.5% of adults took Naproxen in any given week. While these drugs are extremely effective in reducing pain and inflammation associated with arthritis, they are also responsible for many adverse drug reactions, and are associated with stomach ulcers, high blood pressure, heart attacks, heart failure and liver failure.
The label instructions for use of both Ibuprofen and Aleve recommend that you consult with your physician if you take these drugs for more than 10 days for arthritis pain. It goes on to say that the drugs temporarily relieve minor aches and pain due to—-minor pain of arthritis. Id like to emphasize the word temporary and advise all with arthritis pain that these drugs are not indicated for long term use unless supervised by your physician.
According to a recent report, the use of these NSAIDs increase the risk of acute kidney injury by 50% in the general population and patients with chronic kidney disease . The report also estimated that the incidence of acute kidney injury doubled in patients over 50 compared to those that did not take NSAIDs.
How Do I Know If Analgesics Have Affected My Kidneys
Your doctor can check your kidneys by doing a simple blood test called a serum creatinine level. This test measures the amount of a waste product in your blood that is normally removed by your kidneys. If your kidneys are not working as well as they should, the creatinine level will be increased in your blood. The results of the serum creatinine test can be used to estimate your glomerular filtration rate . Your GFR number tells your doctor how much kidney function you have.
A urine test for the presence of protein may also be done. Persistent protein in the urine may be an early indication of kidney damage.
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If You Have Kidney Problems
But for people with kidney disease, aspirin can increase the risk of bleeding. And in those with reduced kidney function, aspirin is not recommended unless prescribed by a physician. The recommended alternative can vary depending on the type and severity of kidney problems that you have.
Often, acetaminophen is the preferred alternative. But its encouraged that you use the lowest dose possible that still manages pain or fever symptoms. And likewise, you should not exceed more than 3,000 milligrams per day.
Alternatively, if an OTC acetaminophen drug doesnt control pain symptoms, a physician may suggest a temporary prescription alternative like tramadol.
Pain Management For Rheumatoid Arthritis With Cardiovascular Or Renal Comorbidity
This summary of a Cochrane review presents what we know from research about the safety of using pain-relieving drugs in people with rheumatoid arthritis who also have either heart or kidney disease, or both.
What is rheumatoid arthritis and what is pain management?
When you have rheumatoid arthritis, your immune system, which normally fights infection, inflames the lining of your joints making them painful, stiff and swollen. People with rheumatoid arthritis often need to use painkillers and anti-inflammatories such as paracetamol or ibuprofen to control this pain and inflammation.
Pain can be managed with several drugs including non-steroidal anti-inflammatory drugs , ) opioids and opioid-like drugs , paracetamol , and neuromodulators .
The review shows that in people with rheumatoid arthritis and heart or kidney problems:
We do not have precise information about side effects and complications because no studies were found that looked at side effects of pain drugs in these people. There are well documented side effects with many commonly used pain medications such as stomach, kidney and heart problems associated with NSAID use, and gastrointestinal problems associated with the use of opioids.
There were no trials that specifically compared the efficacy and safety of pain pharmacotherapies for patients with rheumatoid arthritis, with and without comorbid cardiovascular or renal conditions.
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Inflammatory Arthritis & Kidney Diseases
Inflammation due to arthritis has long been associated with kidney function. The chronic, systematic inflammation that targets the joints in inflammatory arthritis can also affect other parts of the body like the heart, lungs, and kidneys the two bean-shaped organs located below the ribcage, behind the abdominal organs and help in the purification of blood by filtration of waste from the bloodstream.
Inflammation is the response of the bodys immune system to protect the body against things that may harm it, such as toxins, infections, and injuries. Uncontrolled inflammation may cause damage to the cells that line blood vessels and contribute to a disease where plaque can build up inside the arteries of the kidneys, or renal arteries, known as atherosclerosis. Over time, this plaque tends to harden and narrow the arteries, limiting the flow of oxygen-rich blood to the kidneys leading to kidney disease.
Amyloidosis is another potential kidney problem for people with long-standing, poorly controlled inflammatory arthritis. It occurs when amyloid, an abnormal protein, builds up in the kidneys.
According to research, patients with inflammatory arthritis also have a higher risk of developing glomerulonephritis an inflammation of the filtering units of the kidneys known as glomeruli. This inflammation can impair kidney function, leading to chronic kidney disease.
Safe Nsaids & Pain Relievers For Kidney Disease Pain Management
More than 30 million people in the US take over-the-counter and prescription NSAIDs for pain relief, headaches and arthritis. Nevertheless, with kidney disease, theres more you need to know before taking any pain medications.
People dealing with CKD may use NSAIDs to manage the pain that comes with kidney disease. Patients under the use of NSAIDs can experience negative outcomes due to their altered drug metabolism. Nonsteroidal anti-inflammatory drugs are considered threatening for kidney patients as it puts them at a higher risk of developing nephrotoxicity. Opioids are a common pain management choice among kidney disease sufferers.
Electrolyte imbalance, acute kidney injury , accelerated loss of GFR, are among some unfavorable outcomes from using NSAIDs with kidney disease. NSAIDs are only suggested to be carefully used among people with serious chronic kidney disease. The improper use of pain medications with damaged kidneys may only worsen things for those with CKD. Omega 3s and curcumin are two products that can help with inflammation in kidney disease.
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If I Need Pain Medicines What Can I Do To Keep My Kidneys Healthy
Kidney disease caused by pain relievers is often preventable. Here are some things you can do to help keep your kidneys healthy.
How you take these medicines makes a difference:
- Make sure you read the warning label before using any overthecounter analgesics.
- Do not use overthecounter pain relievers more than 10 days for pain or more than three days for fever. If you have pain or fever for a longer time, you should see your doctor.
- Avoid using pain medicines that contain a combination of ingredients, like aspirin, acetaminophen and caffeine mixed together in one pill.
- If you are taking pain medicines, increase the amount of fluid you drink to six to eight glasses a day.
- If you are taking pain medicines, avoid drinking alcohol.
Talking with your doctor about pain medicines can also make a difference:
- If you have kidney disease, ask your doctor before taking a pain medicine, particularly NSAIDs and higher dose aspirin.
- If you have high blood pressure or heart disease, make sure you only take NSAIDs under your doctors supervision. This is especially important if you take diuretic medications or are over 65 years of age.
- Make sure your doctor knows about all medicines you are taking, even over-the-counter medicines.
Diseases Treated With This Medication
This medication is primarily used to prevent kidney transplant rejection and to treat severe rheumatoid arthritis. Other kidney diseases treated with this medication, although not FDA approved indications, include lupus nephritis and systemic vasculitis. It is also used to treat autoimmune diseases although not FDA approved including idiopathic thrombocytopenic purpura, autoimmune hemolytic anemia, multiple sclerosis, and Crohns disease.
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Nsaids Arthritis Stomach Pain And Ulcers
If you use NSAIDs to help manage your arthritis pain, you probably use high doses over a long period. This usage could increase your risk of stomach upset and even ulcers. Your risk is further increased if youre older than 65 years, have had ulcers or kidney problems, or take blood thinners. Talk to your doctor if you get an upset stomach while taking NSAIDs. They may suggest a different NSAID or other drug.
For example, celecoxib is considered safe for long-term arthritis pain. It does less damage to the stomach than other NAIDs. However, there are some concerns about the increased risk of heart attack and stroke from this drug. If you have a history of heart attacks or strokes or risk factors for these conditions, your doctor may consider another drug for you.
Other Immune Complex Diseases
Arthritis and nephritis are also common in other types of immune complex diseases such as postinfectious immune complex disease, Henoch-Schönlein purpura, cyroglobulinemia or endocarditis. While the latter example has its own diagnostic and treatment algorithms, all other types of immune complex disease may benefit from a renal biopsy, because the standard histological work-up of the obtained renal tissue often provides diagnostic clues to the underlying systemic disease. Examples include endocapillary GN in postinfectious immune complex disease, IgA nephropathy in Henoch-Schönlein purpura, and membranoproliferative GN in cyroglobulinemia.
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Musculoskeletal Manifestations Of Renal Disease
Mineral and bone disorders are a central complication of CKD , because renal failure impairs renal phosphorus clearance and the activation of 25-OH vitamin D. The resulting hyperphosphatemia and hypocalcemia both induce secondary hyperparathyroidism, which is associated with two major consequences: bone mineral loss and extraosseous calcifications. Parathyroid hormone-induced bone mineral loss is often associated with osteoporosis due to immobilization during hemodialysis and due to CKD-associated systemic inflammation. Both increase the risk of fracture-related morbidity .
Table 4 Treatment of crystal arthropathies in chronic kidney disease and dialysis patients
Carpal tunnel syndrome, bone cysts, and destructive spondyloarthropathy or joint arthropathy used to be classical complications for end-stage kidney disease patients affected by dialysis-related amyloidosis, but their prevalence declined upon broad use of high-flux dialysers . Impaired clearance of small proteins like 2-microglobulin leads to -sheet amyloid fibrils. Symptomatic amyloidosis rarely developed before 5 years of hemodialysis but the use of high-flux dialysis filters has recently delayed the onset of dialysis-related amyloidosis. 2-Microglobulin amyloid deposition in bone, joints, and tendons causes pain, stiffness, and arthritis. Bone cysts can cause fractures and tendon deposits cause tears in ligaments and tendons .
Patient Disposition And Nsaid Treatment
Of 628,488 patients diagnosed with OA or CLBP who used analgesics at least once in the JMDC database, 180,371 met the eligibility criteria and were included in this analysis . A total of 32.9% patients had OA, 53.8% had CLBP, and 13.4% had both OA and CLBP. Diabetes was reported in 11.8% patients, and hypertension in 21.9%. Renal comorbidities were present in 1454 patients .
Fig. 1
Patient disposition. CLBP chronic low back pain, ICD-10 International Classification of Disease-10, JMDC Japan Medical Data Center, LBP low back pain, OA osteoarthritis
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Can Arthritis Medicines Affect Kidneys Which Arthritis Meds Are Safe For Kidneys
Yes, arthritis medication elevates the risk of severe kidney problems. Plus, kidney problem complicates the treatment in arthritis patient.
Also, people who have arthritis have more chances of developing kidney diseases. NSAIDs , e.g., ibuprofen and naproxen, are usually included in the treatment of arthritis.
These drugs lower the blood flow to the kidneys, which diminishes their proper functioning, and also their extensive use may lead to cardiovascular diseases.
Moreover, corticosteroids, e.g., hydrocortisone and prednisone, increase blood pressure by retaining the fluid in the kidneys. This retention of fluids increases kidney problems.
Methotrexate is also used in arthritis treatment. In individuals with healthy kidneys, it is eliminated from the body.
But if the kidneys are not functioning correctly, methotrexate levels in the blood increase, decreasing the number of WBCs , and the body is at risk of getting infections.
Some immunosuppressant like cyclosporine decreases the glomerulus filtration in the kidney, affecting its role. Thus, patients with renal problems and arthritis must be treated with care.
Rare But Serious Side Effects Of Nsaids
In rare instances, NSAIDs can damage your liver and kidneys. The higher the dosage and the longer the treatment, the higher the risk. If you have liver or kidney problems, you may not be able to take NSAIDs.
An allergic reaction to these drugs is also possible, but not common. A reaction is serious if you experience:
- swelling of your face or throat
- difficulty breathing
If you have any of these symptoms while taking an NSAID, contact your doctor right away. If you think that any of these symptoms are life-threatening, call 911.
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Vigilance For Kidney Problems Key For Rheumatoid Arthritis Patients
MULTIMEDIA ALERT: Mayo Clinic study finds rheumatoid arthritis patients at higher risk of kidney disease
ROCHESTER, Minn. Rheumatoid arthritis patients are likelier than the average person to develop chronic kidney disease, and more severe inflammation in the first year of rheumatoid arthritis, corticosteroid use, high blood pressure and obesity are among the risk factors, new Mayo Clinic research shows. Physicians should test rheumatoid arthritis patients periodically for signs of kidney problems, and patients should work to keep blood pressure under control, avoid a high-salt diet, and eliminate or scale back medications damaging to the kidneys, says senior author Eric Matteson, M.D., Mayo rheumatology chair. The study is published in the American Journal of Kidney Diseases, the National Kidney Foundation journal .
Researchers studied 813 Mayo Clinic patients with rheumatoid arthritis and 813 without it. They found that over a 20-year period, people with rheumatoid arthritis have a 1 in 4 chance of developing chronic kidney disease, compared with the general populations 1-in-5 risk.
Journalists: Sound bites with Dr. Matteson are available in the downloads.
That might not seem like a lot, but in fact thats quite a big difference, and it has important implications for the course of rheumatoid arthritis and for the management of the disease, Dr. Matteson says.
MEDIA CONTACT: Sharon Theimer, Mayo Clinic Public Affairs, 507-284-5005, Email:
How To Protect Kidneys With Ra
An RA diagnosis does not necessarily mean that you will definitely develop kidney disease. In fact, there are ways to protect your kidneys that include exercising regularly, eating a balanced, healthy diet with plenty of fresh produce, limiting your sodium intake, monitoring and controlling your cholesterol levels, and staying hydrated. Regular testing and checkups with your doctor can also help to keep your kidneys healthy and prevent your condition from worsening.
Devon Andre has been involved in the health and dietary supplement industry for a number of years. Devon has written extensively for Bel Marra Health. He has a Bachelor of Forensic Science from the University of Windsor, and went on to complete a Juris Doctor from the University of Pittsburgh. Devon is keenly aware of trends and new developments in the area of health and wellness. He embraces an active lifestyle combining diet, exercise and healthy choices. By working to inform readers of the options available to them, he hopes to improve their health and quality of life.
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Inflammation From Arthritis Can Take A Toll On Your Kidneys Heres What You Need To Know To Avoid Kidney Disease
Your two kidneys are each the about the size of a fist, the shape of a bean, and packed with a million or so tiny filtering units called nephrons. Their main job: to remove waste and extra water out of your blood to make urine. They also help balance your bodys salts and minerals and produce hormones that regulate blood pressure, make red blood cells, and help keep your bones strong.
So, what does a joint condition like arthritis have to do with these hard-working organs? More than you may think.
People with rheumatoid arthritis are at a significantly higher risk of developing chronic kidney disease, according to data from a meta-analysis presented at the American College of Rheumatologys annual meeting in 2018. In one study, researchers found that over a 20-year period, people with RA have a one in four chance of developing chronic kidney disease, compared with a one in five risk among people who dont have rheumatoid arthritis.