Results of skeletal survey, Kidney Function

Today Doug had his Zometa infusion done at the hospital infusion center. It takes about an hour for the infusion because Doug needs extra fluids given to help protect his kidneys. A blood draw is always done first to check his creatinine. More on kidneys later in this post.

Dr Myers gave us the results of yesterday's skeletal survey: scattered small lesions in the skull, pelvis, upper femurs. The largest lesion was seen in the upper right arm. The small ones are not expected to be a problem; the Zometa should encourage bone repair in those areas. The radiologist could not see if the bony cortex is involved in the right arm - we don't know if that area could be in danger of pathological fracture. So Dr. M ordered a CT scan of the right upper arm; luckily we were able to get that done while we were at the hospital. If it looks serious enough, Doug might need more radiation therapy. I have a gut feeling that won't be necessary but we'll wait and see.

The big concern today is kidney function. Doug had kidney damage from lack of blood flow when he had the complete heart block in 2009; the kidneys recovered fairly well from that. The myeloma itself can cause kidney damage -- especially light chain myeloma which Doug has now. Zometa is also hard on kidneys; that's why extra fluids are administered along with the Zometa.
Today's blood test showed creatinine of 1.4, BUN 20 and eGFR 54. According to one of my sources, BUN and creatinine will not be raised above the normal range until 60% of total kidney function is lost.
Our local oncologist Dr. M conferred with the super-specialist in Denver, Dr. Jeff. Doug will need to do a 24 hour urine test to get a better read on the GFR.

Glomerular filtration rate (GFR) describes the flow rate of filtered fluid through the kidney. It tells what the renal (kidney) function is - a more sensitive test.

Both doctors say that if the GFR is less than 60, Doug won't be able to get the full dose of Revlimid. Revlimid is a nephrotoxic drug, meaning that it can harm the kidneys. This is a catch-22. Doug needs the highest dose of Revlimid (25 mg) to attack the cancer. But he also needs his kidneys to keep functioning! A lower dose would be less damaging to the kidneys, but not as effective against the myeloma.

All those out there who pray for us, please pray for adequate kidney function so Doug can get the full dose of Revlimid to fight the cancer.

Our spirits are good. Doug looks very good - just by looking at him, no one would ever know he has cancer.

"We who have fled to God for refuge can have great confidence as we hold to the hope that lies before us. This hope is a strong and trustworthy anchor for our souls. It leads us through the curtain into God’s inner sanctuary." Hebrews 6:18-19