Ask The Doctor

Ask The Doctor

ASK THE DOCTOR

by Wesley
W. Wilson, MD

NOTE: If you have any questions
for "Ask the Doctor," please send them to the VOICE editorial office.
The only questions Dr. Wilson will be able to answer are the ones used in this
column.

Wesley Wilson, MD is an Internal Medicine practitioner

at the Western Montana Clinic in Missoula, Montana. Dr.

Wilson was diagnosed with type I diabetes in 1956, during

his second year of medical school.

Q: I am told that my kidneys are starting to fail. I

have taken ibuprofen for my general aches and pains and am

now told that I can't. Why? And what pain pills can I take

with these bad kidneys?

A: I am sorry to hear that you have kidney disease.

The key strategy for you now must be to preserve your kidney

function as long as possible. The DCCT (Diabetes Control

and Complication Trial) showed that even in the early stages

of kidney disease, tight control of blood sugars slowed

further progression of kidney disease. Some persons without

diabetes show signs of kidney damage with prolonged and

heavy use of anti-inflammatories. Ibuprofen is a member of

this drug family called non-steroidal anti-inflammatory

drugs (NSAIDs).

Since this class of drugs can cause kidney injury in

persons with normal kidneys, it seems appropriate to avoid

these drugs if there is any kidney disease present. For

your interest, Aleve, also available over the counter, is

another member of the same anti-inflammatory drug family.

Your question of which drug should be used for pain

relief is more difficult. You certainly should not be

forced to suffer severe pain without some type of treatment.

On the other hand, especially if there is any kidney

disease, the fewer drugs that you take, the better. Many of

the medications that we use for pain or for other conditions

can increase kidney damage, or the drug's medicinal effect

can be harder to predict because the drug may be retained in

the blood by the poorly functioning kidneys. Certainly do

not take any drug unless you need it, and be sure to discuss

your choice of medications with your physician. In addition

to careful restriction of over-the-counter drugs, other

measures are felt to be important in preserving kidney

function in persons with kidney disease related to their

diabetes. You should avoid dehydration, reduce dietary

protein, and keep careful control of diabetes and blood

pressure. All of these are very important factors. Also,

many physicians feel that a class of antihypertensive drugs,

the ACE inhibitors, has a particular benefit in protecting

the kidneys from diabetic damage. These ACE inhibitors

(the most well-known is Capoten) seem to be quite effective

in protecting damaged kidneys from further harm caused by

diabetes.