QUESTION: 63 year old patient with small cell carcinoma of the prostate. Sustained an injury to his ureter with a biopsy, and now has a nephrostomy tube. Has attempted chemotherapy with immediate increases in creatinine each time. Has successfully had contrast material for CT, but any other drug administered is causing rise in creatinine. Last few creatinine GFR have been 171/34, 151/39 (both in last 2 months). My question is whether we can use a low dose vitamin/mineral IV for pain control and QOL, by following the IV for kidney failure documentation, or whether this case and the nephrostomy tube presents other challenges that make IVs not a problem.
ANSWER: These are tough cases. In regard to the IV’s if the eGFR is over 60 you are free to use any IV (just follow eGFR). CRE can go up and down but is less an issue. I’d consider DCA but only with the DCA-LAMC protocol I wrote (after doing a lot of DCA alone it just isn’t worth it.) You need DCA, LAMC, Retinoid and a keto or keto-adapted diet to make it work. The “DCA-LAMC” protocol should be in the library for your downloading pleasure.