Hormone Therapy with CKD and a Single Kidney.

Hello Dedalus 

It's an issue, however as another CKD (Chronic kidney disease) sufferer you have my sympathy. If I were in your shoes I would:

* Go for the HT/RT treatment and have my GFR checked ever 3 months - if there was a significant drop in the GFR I would stop the HT.

* I have my GFR checked every 6 months (on my insistence) and since recovering from 8 - I managed a maximum of 58. My last check before Christmas it was down to 50 however the pharmacist at the GP practice has put this down to a medication clash and it's one of the medications for my type 2 diabetes. This has been changed and a GFR test booked in for March.

It's only my humble opinion but I hope it helps.

Best wishes - Brian.

Thanks Brian

I do remember about your GFR because it was close to that of my brother.  He was 10.  Your suggestion is relevant.  Sorry to hear that your GFR has dropped a little.

Dedalus.

Hi Dedalus.

Some more little light reading for you.

https://www.nature.com/articles/s41391-021-00348-x?utm_medium=affiliate&utm_source=commission_junction&utm_campaign=CONR_PF018_ECOM_GL_PHSS_ALWYS_DEEPLINK&utm_content=textlink&utm_term=PID100090071&CJEVENT=96424d21ae3811ee836301420a18b8fc

1. My husband has 1.5 kidneys now thanks to prostate cancer. He has a nephrologist who has been on board with all treatments including HT, EBRT and chemotherapy and has so far seen no detrimental effect on the kidneys from these treatments. His eGFr was 27 when first diagnosed and with diet changes plus epoetin alpha treatment it is now up to 58.

Hi Alwayshope

Thanks for the reference and the details re your husband's kidney function.  I have been told that my single kidney eGFR cannot improve.  It has been 6.5 years since my nephrectomy and that has proven to be the case.  I have therefore been very protective of my solitary kidney.  Thankfully, and possibly via a fairly healthy lifestyle, I have been able to maintain my eGFR between 38 and 42.

The reference you provided is interesting.  If I had 2 working kidneys and a better eGFR then I would have more confidence to take H.T. as it is, there is a considerable element of risk if my single kidney is detrimentally affected.  There are physiological connections between the kidney and heart health, so that is also a concern.  Despite my quite significant health travails and my age, I have managed to maintain a good level of health and fitness.  I am 'really' concerned about being projected into a lower and possibly declining health status.  I think I have been so worried about this, and the test delays, it has resulted in my present shingles episode.

It is difficult to find research specific to my situation.  The appended link lists numerous studies on the negatives of HT and kidney function.  I appreciate we all take risks with medication and it is a question of balancing the risk/benefit.  At the moment I consider the risk of omitting HT with RT a more acceptable one, however, I remain open to discussion and alternative evidence.

Ideally, (and depending on my imminent full diagnosis - I am hoping for intermediate risk at worst) I would choose the newer no HT- 5-day radiotherapy treatment that was pioneered by the Royal Marsden, but that is not available to me unless I could fund £30,000 for private RT treatment.

https://www.researchgate.net/publication/249966642_Androgen_Deprivation_Therapy_and_Risk_of_Acute_Kidney_Injury_in_Patients_With_Prostate_Cancer

Dedalus

Hi Dedalus.

I can understand that you want to protect your remaining kidney. My husband had to have a pigtail inserted (a catheter between the kidney and bladder). He was sent to a top urological surgeon to try and get one inserted into both kidneys but this was not possible and they decided that quality of life would be impacted negatively if they did an external drain. He sat down with us for a long time and said that my husband could live with one kidney and have prostate cancer treatments. Failing to get the pigtail inserted meant that the kidney started to die so there was the possibility of having to have it removed. They were extremely surprised when, during a pigtail change, they found that they could get into the damaged kidney - the EBRT had reduced the cancer mass and released the constriction on the ureter. We are also in a different position to you in that we had no option - it was hormone therapy or death.

From reading the link you have supplied I can understand your concern. They seem to relate to Acute Kidney Injury AKI which I think relates to a temporary situation as opposed to Chronic Kidney Injury CKI which is long term. A difficult decision for you.