My husband's kidney markers after induction therapy and an autologous stem cell transplant are hanging around creatinine 1.3 and BUN 13-17. They are in the normal range, but high normal. Our myeloma specialist seems fine with this, and my husband shows no symptoms of kidney distress.
At the time of his diagnosis, my husband's kidneys were badly affected. Creatinine was 5.0 and BUN was 54. This may be his new norm now, maybe?
My husband achieved no detectable disease in the marrow after induction therapy, with all normal myeloma labs, and we will be at the 90-day mark post transplant in a couple of weeks, so no news about the stem cell transplant yet.
What can we expect in terms of my husband's kidney-related lab results going forward? Does anyone have any experience similar to ours that might be helpful?
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dogmom - Who do you know with myeloma?: husband
- When were you/they diagnosed?: December 2015
- Age at diagnosis: 58
Re: Creatinine & BUN levels after initial treatment
Hi Cathy,
Glad the post transplant course is going so well.
In my primary care practice I check the BUN and creatinine a lot. I see many patients with diabetes and hypertension and other causes/cases of renal disease.
A high normal result is still a normal result.
The increase within the normal range can be due to so many things: relative dehydration, the trimethoprim / sulfa (Bactrim) he is likely taking 2 days a week, even lab variation, but yes, it may be his new normal.
It may mean he has some mild residual kidney damage from his pre-diagnosis myeloma renal insult. It may mean he has had muscle loss / muscle mass reabsorption from the transplant process. It might be he has a meat craving as he recovers and builds back his bone marrow (my husband is still eating and craving more meat than was our pre-myeloma norm), but I don't think his numbers are worrisome.
I understand that you are being vigilant (as am I). In this case you need to be concerned if he bumps up or trends out of normal, or if he develops proteinuria or hypertension.
My husband has the same Day Zero as yours. We've already had our post transplant bone marrow biopsy (which went well; still minimal residual disease negative). We have an appointment tomorrow to plan for chemotherapy consolidation starting in September. This summer has been so much nicer than I imagined when the doctors spelled out the diagnosis and treatment plan!
You and your husband remain in my prayers. Your posts led to me joining the forum.
Rick
Glad the post transplant course is going so well.
In my primary care practice I check the BUN and creatinine a lot. I see many patients with diabetes and hypertension and other causes/cases of renal disease.
A high normal result is still a normal result.
The increase within the normal range can be due to so many things: relative dehydration, the trimethoprim / sulfa (Bactrim) he is likely taking 2 days a week, even lab variation, but yes, it may be his new normal.
It may mean he has some mild residual kidney damage from his pre-diagnosis myeloma renal insult. It may mean he has had muscle loss / muscle mass reabsorption from the transplant process. It might be he has a meat craving as he recovers and builds back his bone marrow (my husband is still eating and craving more meat than was our pre-myeloma norm), but I don't think his numbers are worrisome.
I understand that you are being vigilant (as am I). In this case you need to be concerned if he bumps up or trends out of normal, or if he develops proteinuria or hypertension.
My husband has the same Day Zero as yours. We've already had our post transplant bone marrow biopsy (which went well; still minimal residual disease negative). We have an appointment tomorrow to plan for chemotherapy consolidation starting in September. This summer has been so much nicer than I imagined when the doctors spelled out the diagnosis and treatment plan!
You and your husband remain in my prayers. Your posts led to me joining the forum.
Rick
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rick - Name: rick
- Who do you know with myeloma?: husband
- When were you/they diagnosed?: nov 2015
- Age at diagnosis: 50
Re: Creatinine & BUN levels after initial treatment
Rick,
Thank you so much for your response! It was so helpful.
He is taking Bactrim on the weekends twice a day. He has had some muscle loss we can tell, but he seems to be getting some of that back a little at a time. His blood pressure has been great and no swelling or fluid build up. I am a MLT so I am used to looking at lab values and I would have not have been worried about any patient who had these that I ran, but knowing his history.
I was so afraid at the beginning his kidneys would not recover, but during his induction treatments they bounced back quickly. He had cyclophosphamide, Velcade, and dexamethasone (CyBorD) as induction. The cyclophosphamide was used due to the kidney impairment. His values now are what they held steady at after his kidneys recovered during induction. They did get down to BUN 8 and creatinine 0.9 for a brief time right after the stem cell transplant. I guess I was hoping they would stay there and the upward move (even if still normal) threw me a little.
I have to admit I am getting nervous about the 90 day test coming up. His doctor says by all indication so far he will be on a maintenance dose of chemo. He said it would be a lower dose than induction, but did not mention the drug , how it will be given, or how often taken.
I so wish you and your husband well.
Thank you so much for your response! It was so helpful.
He is taking Bactrim on the weekends twice a day. He has had some muscle loss we can tell, but he seems to be getting some of that back a little at a time. His blood pressure has been great and no swelling or fluid build up. I am a MLT so I am used to looking at lab values and I would have not have been worried about any patient who had these that I ran, but knowing his history.
I was so afraid at the beginning his kidneys would not recover, but during his induction treatments they bounced back quickly. He had cyclophosphamide, Velcade, and dexamethasone (CyBorD) as induction. The cyclophosphamide was used due to the kidney impairment. His values now are what they held steady at after his kidneys recovered during induction. They did get down to BUN 8 and creatinine 0.9 for a brief time right after the stem cell transplant. I guess I was hoping they would stay there and the upward move (even if still normal) threw me a little.
I have to admit I am getting nervous about the 90 day test coming up. His doctor says by all indication so far he will be on a maintenance dose of chemo. He said it would be a lower dose than induction, but did not mention the drug , how it will be given, or how often taken.
I so wish you and your husband well.
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dogmom - Who do you know with myeloma?: husband
- When were you/they diagnosed?: December 2015
- Age at diagnosis: 58
Re: Creatinine & BUN levels after initial treatment
Hi Dogmom,
Those numbers look pretty good to me. I don't think you have too much to worry about. They may improve, but if they stay just where they are, I think they are perfectly fine. As another poster said, they are in the normal range, and normal is normal. Especially in light of the fact that his creatinine and BUN were so high at diagnosis, I think these values are great. I would add the advice to drink more water, as a way to help the kidneys stayed flushed.
At diagnosis, my creatinine was about 1.7, which is not that high. My kappa light chains were over 12,000, so even though the creatinine was not seriously elevated, I did sustain some mild kidney damage. My creatinine now hovers between 1 and 1.1, which is also high normal, but I am a small woman, with not too much muscle mass to speak of.
My creatinine before myeloma was 0.8 or 0.9. My BUN also varies from 16 to 25. So, many times it is in the abnormal range. My GFR is usually in the 50's. However, I have no ill effects from this mild kidney damage. Of course, it is closely monitored, but I think many people in their 50's, 60's and beyond have mild kidney issues from other sources. My GP and oncologist both think my numbers are perfectly acceptable.
Try not to stress over test results, if you can. Hubby had a serious disease and serious treatments. He may not be exactly as he was before, although I can tell he has great energy and recuperative powers, as well as having you in his corner, which is a great asset!
You are a wonderful wife and caregiver. I hope you know that. He is a very, very, lucky man!
Best,
Ellen Harris
Those numbers look pretty good to me. I don't think you have too much to worry about. They may improve, but if they stay just where they are, I think they are perfectly fine. As another poster said, they are in the normal range, and normal is normal. Especially in light of the fact that his creatinine and BUN were so high at diagnosis, I think these values are great. I would add the advice to drink more water, as a way to help the kidneys stayed flushed.
At diagnosis, my creatinine was about 1.7, which is not that high. My kappa light chains were over 12,000, so even though the creatinine was not seriously elevated, I did sustain some mild kidney damage. My creatinine now hovers between 1 and 1.1, which is also high normal, but I am a small woman, with not too much muscle mass to speak of.
My creatinine before myeloma was 0.8 or 0.9. My BUN also varies from 16 to 25. So, many times it is in the abnormal range. My GFR is usually in the 50's. However, I have no ill effects from this mild kidney damage. Of course, it is closely monitored, but I think many people in their 50's, 60's and beyond have mild kidney issues from other sources. My GP and oncologist both think my numbers are perfectly acceptable.
Try not to stress over test results, if you can. Hubby had a serious disease and serious treatments. He may not be exactly as he was before, although I can tell he has great energy and recuperative powers, as well as having you in his corner, which is a great asset!
You are a wonderful wife and caregiver. I hope you know that. He is a very, very, lucky man!
Best,
Ellen Harris
Re: Creatinine & BUN levels after initial treatment
Thank you Ellen. You are so kind, and I have valued your input and support throughout our ordeal.
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dogmom - Who do you know with myeloma?: husband
- When were you/they diagnosed?: December 2015
- Age at diagnosis: 58
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