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Prednisone elevated bun.What You Need To Know About Prednisone |
Nephron Power: TOPIC DISCUSSION: Blood Urea Nitrogen ( BUN).Prednisone - Uses, side effects, dosage | National Kidney Foundation
Prednisone elevated bun.Gaytri Manek (Formerly Gandotra), MD
Prednisone elevated bun -
Prednisone is part of a group of drugs called corticosteroids often called "steroids". Other steroid drugs include prednisolone, hydrocortisone, and methylprednisolone.
Prednisone can be given in different ways, including pill, injection, and inhaled. It is usually given as a pill when used after a kidney transplant , or for certain kidney disorders. Steroid drugs, such as prednisone, work by lowering the activity of the immune system. Prednisone can help lower certain immune-related symptoms, including inflammation and swelling.
The body recognizes a transplanted organ as a foreign mass. These conditions can lead to nephrotic syndrome. As a result, large amounts of protein leaks into the urine. This in turn reduces the amount of protein in your blood, known as proteinuria. Prednisone is used to help lower proteinuria in these disorders. People taking prednisone can also experience higher blood sugar, which is a special concern for those with diabetes. Therefore, some precautions need to be taken.
Your healthcare provider will weigh the possible benefits and side effects when giving this and other medications. Many people have benefitted from prednisone without serious side effects. Talking to your healthcare provider, using your medication as instructed, and taking the necessary precautions, can help you benefit from prednisone while managing side effects.
Here are some things you can do to keep yourself healthy:. Time is running out: walk to fight kidney disease this fall. Most adverse events occurred in the first 3 months after glucocorticoid treatment, and about half of the adverse events were reported in the first 6 months of follow-up 12 , None of both groups of patients encountered serious adverse events during the month study.
One patient in the FP group was diagnosed with diabetes at the end of the trial, only seven patients suffered from impaired glucose tolerance and nobody had been diagnosed with diabetes in the MCALP group. The STOP-IgA study showed that glucocorticoid could decrease proteinuria but side effects were higher compared with the supportive care group 20 , We thought that the dosage of glucocorticoid in the STOP-IgA study was higher than that in our study and the eGFR of enrolled patients was lower which could make patients be susceptible to kinds of infections.
In the TESTING study 12 , the results also showed that methylprednisolone treatment for 6—8 months could significantly alleviate proteinuria and prolonged the decline of eGFR, but adverse events were serious. Hence, the investigators changed their scheme to decrease the dosage of methylprednisolone as 0. However, this study still has some limitations: single-center enrolled Asian patients; a short follow-up period; insufficient patient cases for some subgroups of Oxford MEST-C kidney pathology classification.
Additionally, a specific podocytopathic variant of IgAN or the existence of features of minimal change disease MCD with diffuse podocyte foot process effacement in IgAN patients were recently reported 33 , 34 , steroid therapy was indicated an appropriate therapeutic strategy in those patients, which was also recommended by the newly-released KDIGO guidelines for the management of glomerular diseases 10 , A multicenter, double-blind, broader inclusion criteria and long-term follow-up trial are needed in the future.
In conclusion, this study suggests that the efficacy of reduction of proteinuria and protection of kidney function is similar between the pulsed intravenous methylprednisolone combined with low-dose prednisone and full-dose prednisone therapy over 18 months in high-risk IgAN patients. However, pulsed intravenous methylprednisolone combined with low-dose prednisone treatment was safer than the full-dose prednisone treatment. Therefore, the treatment of pulsed intravenous methylprednisolone combined with low-dose prednisone is a possible new treatment option for high-risk IgAN patients to the nephrologists in their clinical practice.
The study was carried out in accordance with the Declaration of Helsinki and the principles outlined in the declaration. We conducted a prospective, open-label, randomized, controlled, month trial with a two-group, parallel, group-sequential design. The inclusion workflow of the study was shown in Fig.
One patient in the FP group was lost to follow-up because this patient could not be contacted successfully. In both groups, patients were allowed to take antihypertensive drugs, diuretics, and antiplatelet aggregation drugs when needed. The exclusion criteria included the IgAN patients from a secondary cause; usage of glucocorticoids or immunosuppressive therapy within the three previous years; active gastrointestinal ulcer; viral hepatitis; serious life-threatening infections; other autoimmune diseases; severe heart and lung dysfunction; pregnancy or lactation.
Study recruitment the inclusion workflow of the study. The primary analysis sets and the safety analysis sets excluded patients who did not receive the allocated intervention. A randomization list was scientifically created by a random number table coming from the appendix of the Chinese textbook named Medical Statistics Version 2 with block randomization of 4 subjects as a group.
In the FP group, 0. Two groups are both followed up month. The IgAN patients who used other immunosuppressants like leflunomide, cyclosporine A, cyclophosphamide, and methotrexate were not enrolled. All drugs were administered as part of general medical care and were not donated specifically for the study.
The data for age, gender, blood pressure, body weight, and many laboratory indicators such as albumin, serum creatinine levels at baseline in all patients were collected.
Patients were followed up regularly at months 1, 4, 6, 9, 12, 15 and At each follow-up, the blood pressure, body weight, 24 h urinary protein excretion levels, serum albumin levels, blood urea nitrogen serum BUN levels, serum creatinine levels, eGFR calculated by the CKD-EPI formula, blood routine testing, blood lipids, and fasting blood glucose were assessed and recorded.
The adverse events were recorded as well. The primary endpoint was the complete remission rate at the 6th,12th, and 18th months. Total remission rate was expressed as the rate of complete remission plus the rate of partial remission.
The severe adverse events were defined as follows: death; a life-threatening situation requiring inpatient hospitalization or prolongation of existing hospitalization, or serious infections, or gastrointestinal hemorrhage, or new-onset diabetes mellitus, or new-onset cataract, or severe organ failure events, or significant disability Median with interquartile IQR was used if data were not continuous variables.
The categorical data were summarized as counts and percentages. The t test, Chi-square test, and Mann—Whitney U test were used for comparison between two groups as appropriate.
The correlation analysis was performed by using Spearman rank correlation analysis. A P value less than 0. Barbour, S. Evaluating a new international risk-prediction tool in IgA nephropathy. JAMA Intern. Moriyama, T. Clinical and histological features and therapeutic strategies for IgA nephropathy. Article PubMed Google Scholar. Wyatt, R. IgA nephropathy. Chen, T. Prediction and risk stratification of kidney outcomes in IgA nephropathy.
Kidney Dis. Kee, Y. The association of glomerular glucocorticoid receptor expression with responsiveness to corticosteroid treatment in IgA nephropathy. Lv, J. Natural history of immunoglobulin A nephropathy and predictive factors of prognosis: a long-term follow up of cases in China.
Nephrology 13 , — Reich, H. Remission of proteinuria improves prognosis in IgA nephropathy. Berthoux, F. Predicting the risk for dialysis or death in IgA nephropathy. Li, X. Progression of IgA nephropathy under current therapy regimen in a Chinese population. Rovin, B. Kidney Int. KDIGO clinical practice guideline for the management of glomerular diseases. Article Google Scholar.
JAMA , — Lancet , — Pozzi, C. Corticosteroid effectiveness in IgA nephropathy: Long-term results of a randomized, controlled trial. Sarcina, C. Corticosteroids in IgA nephropathy: A randomised controlled trial. Laranjinha, I. IGA nephropathy—Are intravenous steroid pulses more effective than oral steroids in relapse prevention?. Nefrologia 38 , — Hotta, O. Tonsillectomy and steroid pulse therapy significantly impact on clinical remission in patients with IgA nephropathy.
Hou, J. Mycophenolate mofetil combined with prednisone versus full-dose prednisone in IgA nephropathy with active proliferative lesions: A randomized controlled trial. Rauen, T. Intensive supportive care plus immunosuppression in IgA nephropathy.
After ten years of follow-up, no difference between supportive care plus immunosuppression and supportive care alone in IgA nephropathy. Smets, P. Hwang, J. Steroid-induced diabetes: A clinical and molecular approach to understanding and treatment. Diabetes Metab. Tamez Perez, H. Glucose disturbances in non-diabetic patients receiving acute treatment with methylprednisolone pulses.
Acute and 2-week exposure to prednisolone impair different aspects of beta-cell function in healthy men. Beaupere, C. Molecular mechanisms of glucocorticoid-induced insulin resistance. Liu, Y. Kidney Blood Press. Schena, F. Cai, Q. Severe adverse effects associated with corticosteroid treatment in patients with IgA nephropathy.
Beck, L. Feehally, J. The genetics of IgA nephropathy: An overview from western countries. Tesar, V. Lee, J. Severity of foot process effacement is associated with proteinuria in patients with IgA nephropathy. Kidney Res. Cho, W. Characterization of IgA deposition in the kidney of patients with IgA nephropathy and minimal change. Lee, S. IgA nephropathy: Morphologic predictors of progressive renal disease. Trimarchi, H. Treatment of IgA nephropathy. Tang, C. Long-term safety and efficacy of hydroxychloroquine in patients with IgA nephropathy: A single-center experience.
Download references. You can also search for this author in PubMed Google Scholar. All authors approved the final version of the manuscript. Correspondence to Xuefei Tian or Zhao Chen. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material.
If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Reprints and Permissions. Li, Y. Effect of pulsed intravenous methylprednisolone with alternative low-dose prednisone on high-risk IgA nephropathy: a month prospective clinical trial. Sci Rep 12 ,
Prednisone is a prescription drug. This means your healthcare provider has given it to you as part of a treatment plan. Prednisone is part of a group of drugs called corticosteroids often called "steroids". Other steroid drugs include prednisolone, hydrocortisone, and methylprednisolone.
Prednisone can be given in different ways, including pill, injection, and inhaled. It is usually given as a pill when used after a kidney transplantor for certain kidney disorders. Steroid drugs, such as prednisone, work by lowering the activity of the immune system. Prednisone can help lower certain immune-related symptoms, including inflammation and swelling.
The body recognizes a transplanted organ as a foreign mass. These conditions can lead to nephrotic syndrome. As a result, large amounts of protein leaks into the urine.
This in turn reduces the amount of protein in your blood, known as proteinuria. Prednisone is used to help lower proteinuria in these disorders. People taking prednisone can also experience higher blood sugar, which is a special concern for those with diabetes. Therefore, some precautions need to be taken. Your healthcare provider will weigh the possible benefits and side effects when giving this and other medications.
Many people have benefitted from prednisone without serious side effects. Talking to your healthcare provider, using your medication as instructed, and taking the necessary precautions, can help you benefit from prednisone while managing side effects.
Here are some things you can do to keep yourself healthy:. Time is running out: walk to fight kidney disease this fall. Skip to main content. September 23,pm EDT.
What is prednisone? How does it work? What is prednisone used for? What are the side effects of prednisone? However, prednisone also has possible side effects. These may include: Headaches Changes in mood Slowed healing of cuts and bruises Acne Fatigue Dizziness Changes in appetite Weight gain Swelling face, arms, hands, lower legs, or feet Can prednisone worsen other health conditions?
Before taking prednisone, talk to your healthcare provider about the following: If you have a history of allergies to prednisone or other steroid drugs Other medications you are currently taking If you have diabetes Whether you have high blood pressure If you are pregnant or planning to get pregnant What can I do to stay healthy while taking prednisone?
Here are some things you can do to keep yourself healthy: Take your medication as prescribed. Avoid double dosing. Find out from your healthcare provider what to do if you miss a dose. Usually your dose of prednisone is tapered or slowly reducedto help avoid the effects of withdrawal. A sudden stoppage of using prednisone can lead to withdrawal symptoms including: Fatigue Dramatic changes in mood Reduce the amount salt and sugar in your diet.
Monitor your weight. Find Your Walk.
Azotemic dogs receiving prednisone and azathioprine to enhance renal allograft survival had higher blood urea nitrogen (BUN):serum creatinine (SC) ratios. 1/16 Why do corticosteroids increase the BUN/Cr ratio? Muscles use a lot more high-energy phosphate and need a back-up. Always considered anabolic steroid use with elevated BUN:creat ratio, never a low BUN. Think of all the folks on corticosteroids. As seen in these studies, elevated BUN levels are strongly associated with and drugs such as tetracycline and corticosteroids all increase protein. 'BUN' stands for Blood Urea Nitrogen. Nitrogen is an essential element Kidney failure causes Blood Urea Nitrogen (BUN) to increase. Causes of High BUN. The primary outcome was complete remission CR of proteinuria at 12 months.Thank you for visiting nature. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser or turn off compatibility mode in Internet Explorer. In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.
Full-dose prednisone FP regimen in the treatment of high-risk immunoglobulin A nephropathy IgAN patients, is still controversial. The pulsed intravenous methylprednisolone combined with alternative low-dose prednisone MCALP might have a more favorable safety profile, which has not been fully investigated. Eighty-seven biopsy-proven IgAN adult patients and proteinuria between 1 and 3. All patients were followed up for another 12 months. The primary outcome was complete remission CR of proteinuria at 12 months.
Immunoglobulin A nephropathy IgAN , also known as Berger's disease 1 , is one of the most prevalent types of primary glomerulonephritis in the Asia—Pacific region that is an important cause of end-stage kidney disease ESKD. IgAN occurs at any age, especially in those people at 16—35 years old, and the ratio of male patients is higher than that of female patients 2.
Recurrent gross or microscopic hematuria, varying proteinuria levels, hypertension, and progressive decline of kidney function 3 are usually present in patients of IgAN.
Although the pathogenesis of IgAN has been not yet fully understood, Burgeoning evidence has been furnished that mucosal Infections including tonsil infection and intestinal infection play a key role in the disease progression of IgAN, genetic, environmental factors and complement may be involved in the pathogenesis as well 4. The inflammation in glomeruli caused by an aberrantly galactose deficient IgA1-mediated immune complex deposition is thought to play an essential role in the development and progression of IgAN.
The clinical manifestations and kidney pathological findings of IgAN vary individually, which leads to different approach choices and outcomes 5. To decrease the proteinuria levels in IgAN patients is generally accepted to be associated with slower renal functions decline and lower ESKD risk 7. The results of a prospective NEFIGAN study 13 indicated that a novel targeted-release formation of budesonide, combined with optimized renin-angiotensin system RAS blockade treatment, could effectively reduce proteinuria and preserve the estimated glomerular filtration rate eGFR in IgA patients with persistent proteinuria during the month observational phase.
A study reported by Pozzi et al. A retrospective study from Ivo Laranjinha et al. Another retrospective study designed by Hotta et al. Glucocorticoids treatment has been effective for IgAN patients, especially those whose pathology shows crescents, endothelial proliferation and capsular synechia etc However, the results of prospective STOP-IgA 20 , 21 showed that glucocorticoids treatment has no additional favorable effects on the outcomes but more side events for the high-risk IgAN patients compared to the intensive supportive care alone during the 3-year study phase, and subsequently the extended follow-up phase median follow-up was 7.
In spite of these findings, how to treat high-risk IgAN patients with appropriate glucocorticoid dosages and regimens effectively and safely needs more in-depth investigation.
The baseline demographics, clinical characteristics, and pathologic features of patients were shown in Table 1. The baseline proteinuria levels 2. Meanwhile, there was no difference in the reduction of proteinuria between the two groups at baseline, 1st, 4th, 6th, 9th, and 15th month. There was a similarly significant increase in serum albumin levels in the MCALP group and the FP group at the 6th, 12th, and 18th month after treatment These findings indicated that pulsed intravenous methylprednisolone combined with alternative low-dose prednisone and full-dose prednisone had a similar efficacy on the reduction of proteinuria levels and improvement of serum albumin levels in high-risk IgAN patients during the month observational phase.
Proteinuria and serum albumin changes in follow-up. Data is shown at baseline, 1st, 4th, 6th, 9th, 12th, 15th, and 18th month of follow-up. Clinical remission changes in follow-up. Complete remission rates at each follow-up point between the two groups showed no significant difference during the trial Supplementary Table 1. No patients in these two groups progressed to ESKD during the month observational phase, although 4 patients in the MCALP group and 4 patients in the FP group did not relieve at the end of the trial.
It may be explained that patients had a high catabolism state due to taking the full dose of prednisone, such as abnormal carbohydrate and protein metabolism, which led to an increase in serum BUN, this kind of change in BUN gradually disappeared after reducing the dosage of prednisone There was no difference in the serum BUN levels between the two groups at baseline, 6th, 9th,12th,15th, and 18th month.
No significant difference was detected on the eGFR-EPI between baseline and 1st, 4th, 6th, 9th,12th, 15th, 18th month during the observational phase in either group respectively, neither significant changes between the two groups as well. Next, we assessed the blood pressure and metabolic profiles including body weight, total cholesterol levels, triglyceride levels and fasting blood glucose levels in MCALP and FP groups.
There was no difference in the blood pressure between these groups at baseline, 4th, 6th, 12th, and 18th month shown in Supplementary Fig. Meanwhile, systolic blood pressure levels in the FP group remained stable during the follow-up 0. However, diastolic blood pressure levels in FP group were significantly decreased at 12th month 2.
Changes in body weight from baseline to 18 months in two groups were shown in Supplementary Fig. There was no difference in the body weight between the two groups at baseline, 4th, 6th, 12th, and 18th month. Changes in total cholesterol and triglyceride from baseline to 18 months in two groups were shown in Supplementary Fig.
There was no difference in the total cholesterol levels and triglyceride levels between the two groups at baseline, 4th, 6th, 12th, and 18th month respectively. In the MCALP group, compared to baseline, total cholesterol levels were significantly increased at 4th month 0.
Meanwhile, compared to baseline, triglyceride levels were significantly increased at 4th month 0. Compared to baseline, total cholesterol levels were significantly increased at 4th month 0. Changes in fasting blood glucose levels from baseline to 18 months in two groups were shown in Supplementary Fig. And it remained stable in the FP group during the follow-up observational phase. The slightly higher baseline BMI in the MCALP group patients might in part contribute to the change discrepancy in the fasting blood glucose between these two groups, that likely to increase fasting blood glucose levels The pulsed methylprednisolone used might cause a loss of pancreatic adaptive response due to an acute and supra-physiological steroid load 24 , it also might cause different types of beta-cell dysfunction 23 , 25 , The fasting blood glucose levels in these two groups of patients were within the normal range.
Patients with infection had improvement after receiving appropriate medication. Patients with impaired glucose tolerance and weight gain got improvement after diet control. Patients with hip discomfort were excluded from femoral head necrosis confirmed by X-ray and MRI examination.
None of the death, osteonecrosis, fracture, cataract and ocular hypertension occurred in either treatment group during the observational phase. IgAN, as a common primary glomerular disease in Asia, Europe, and the United States of America, has a heterogeneous clinical manifestation, which is still lacking safe and effective treatment.
Some IgAN patients present few or no clinical manifestations for many years and most IgAN patients have been not diagnosed until progressing to chronic kidney disease CKD with developing many complications such as hypertension, anemia, or even reach renal failure due to their late presentation in hospitals It is very challenging to address what dosage of glucocorticoid should be effectively and safely used in high-risk IgAN patients and how to use it?
Oral administration or intravenous administration or both or in a sequential combination? Hence, the investigation of new treatment strategies for high-risk IgAN patients in the real world is necessary. KDIGO guidelines for the management of glomerular diseases did not provide a recommendation regarding the treatment strategy of how to use the immunosuppressant for high-risk IgAN patients with proteinuria 1—3.
We compared the efficacy and safety who received pulsed intravenous methylprednisolone 0. The remission rate was higher than the findings reported by Pozzi et al. In addition, a retrospective study reported by Laranjinha et al. Our study suggested that pulsed intravenous methylprednisolone combined with alternative low-dose prednisone quickly and effectively reduced proteinuria and might be no inferior to that of full-dose prednisone treatment in high-risk IgAN patients during the month study phase.
There is no difference in the rate of relapse between the two groups, which is different from the aforementioned study, probably because of our shorter follow-up time of 18 months. However, the relationship between the Oxford MEST-C kidney pathology classification and the initiation of appropriate immunosuppressant treatment in IgAN patients needs more studies and evidence.
Meanwhile, serum albumin levels increased significantly after intravenous methylprednisolone compared with full-dose prednisone treatment. As such, we speculate that an increase of serum BUN levels in the FP group might be associated with an improvement of plasma protein levels. The findings have not been mentioned in previously reported studies. Pozzi et al. We found proteinuria was under a lower level consistently during the observational phase of 12 months after 6-month treatment.
The long-term antiproteinuric efficacy and protection of kidney function in these patients between the MCALP and the FP therapy are under further follow-up.
The most common side-effects of systemic glucocorticoid treatment are Cushing syndrome, weight gain and infections. Most adverse events occurred in the first 3 months after glucocorticoid treatment, and about half of the adverse events were reported in the first 6 months of follow-up 12 , None of both groups of patients encountered serious adverse events during the month study.
One patient in the FP group was diagnosed with diabetes at the end of the trial, only seven patients suffered from impaired glucose tolerance and nobody had been diagnosed with diabetes in the MCALP group. The STOP-IgA study showed that glucocorticoid could decrease proteinuria but side effects were higher compared with the supportive care group 20 , We thought that the dosage of glucocorticoid in the STOP-IgA study was higher than that in our study and the eGFR of enrolled patients was lower which could make patients be susceptible to kinds of infections.
In the TESTING study 12 , the results also showed that methylprednisolone treatment for 6—8 months could significantly alleviate proteinuria and prolonged the decline of eGFR, but adverse events were serious. Hence, the investigators changed their scheme to decrease the dosage of methylprednisolone as 0.
However, this study still has some limitations: single-center enrolled Asian patients; a short follow-up period; insufficient patient cases for some subgroups of Oxford MEST-C kidney pathology classification. Additionally, a specific podocytopathic variant of IgAN or the existence of features of minimal change disease MCD with diffuse podocyte foot process effacement in IgAN patients were recently reported 33 , 34 , steroid therapy was indicated an appropriate therapeutic strategy in those patients, which was also recommended by the newly-released KDIGO guidelines for the management of glomerular diseases 10 , A multicenter, double-blind, broader inclusion criteria and long-term follow-up trial are needed in the future.
In conclusion, this study suggests that the efficacy of reduction of proteinuria and protection of kidney function is similar between the pulsed intravenous methylprednisolone combined with low-dose prednisone and full-dose prednisone therapy over 18 months in high-risk IgAN patients.
However, pulsed intravenous methylprednisolone combined with low-dose prednisone treatment was safer than the full-dose prednisone treatment. Therefore, the treatment of pulsed intravenous methylprednisolone combined with low-dose prednisone is a possible new treatment option for high-risk IgAN patients to the nephrologists in their clinical practice.
The study was carried out in accordance with the Declaration of Helsinki and the principles outlined in the declaration. We conducted a prospective, open-label, randomized, controlled, month trial with a two-group, parallel, group-sequential design. The inclusion workflow of the study was shown in Fig.
One patient in the FP group was lost to follow-up because this patient could not be contacted successfully. In both groups, patients were allowed to take antihypertensive drugs, diuretics, and antiplatelet aggregation drugs when needed. The exclusion criteria included the IgAN patients from a secondary cause; usage of glucocorticoids or immunosuppressive therapy within the three previous years; active gastrointestinal ulcer; viral hepatitis; serious life-threatening infections; other autoimmune diseases; severe heart and lung dysfunction; pregnancy or lactation.
Study recruitment the inclusion workflow of the study. The primary analysis sets and the safety analysis sets excluded patients who did not receive the allocated intervention. A randomization list was scientifically created by a random number table coming from the appendix of the Chinese textbook named Medical Statistics Version 2 with block randomization of 4 subjects as a group.
In the FP group, 0. Two groups are both followed up month.
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