Consult Dr. Anderson

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Calcinosis of Chronic Renal Failure
2 Oct 2017

Renal Disease – Renal Failure Therapies

First, thank you so much for responding to my questions so thoroughly. You have no idea how much this support helps me and can’t appreciate it enough.

I asked you about this case 1.5 months ago. 32 YO Female with Lupus Nephritis that recently flared up. Dx originally about 6 yrs ago. Labs were WNL until 3 months ago after a few episodes of cold. She began to go downhill. Most recent labs –> DNA Ds Ab = 70. ACR = 360 (normal is < 2.5). UA –> lots of abnormals.
Increased urinary frequency; more fatigue. No joint symptoms.

About 1.5 months ago after consultation with you, I started her on Redox Support (NAC, Vitamin C, E, D, B’s, minerals, curcumin).

Nephrologist last week prescribed Prednisone 50 mg for 1 month and then to taper. Increased Mycophenolate to 1000 mg BID. My question is: is Prednisone 50 mg for one month too excessive of a dose and how much Hydrocortisone should I prescribe once she start to taper down the prednisone. Would 20 mg BID of Hydrocortisone be appropriate?

Also, what else can I be doing to support the kidneys, besides the Redox protocol as you had suggested?

Dr. Paul S. Anderson:

I am going to give the scientific as well as an experiential basis for the therapy I am proposing in the first portion of this plan considering the significant medical consequences of this case. I want to underscore that although we have experience with these cases each is treated individually.

A cross section of the kidney with labels

The Kidney

I include use of l-glutamine as mentioned in the plan section below. The use and safety of l-glutamine in kidney disease is well reported, extensively studied and considered both safe and effective [1-11]. Although some misguided reports relate concern regarding the use of glutamine in the case of CKD high parenteral doses (14 to 28 grams) have not only been tolerated but clinically helpful in kidney disease [4].

I also recommend specific dosing of both oral acetyl-l-carnitine as well as parenteral l-carnitine based on experience in this situation as well as significant data. Carnitine (as both l-carnitine and Ac-l-carnitine) metabolism id deranged in CKD and has been shown to be nephroprotective when administered in that patient setting [15-22]. Doses of parenteral l-carnitine have been given efficaciously in end stage renal disease (20 mg/kg) [17].
Pyridoxine and its active metabolite P-5-P are additionally deranged and necessary in the treatment of CKD due to long term renal transaminase dysfunction as well as many other factors [23-27].

Curcumin as renoprotective: Curcumin has been shown in many papers in human and animal studies to be renoprotective [30-35]. In our experience a liposomal oral preparation is an appropriate addition to therapeutic protocols in diminished renal function. The “Meriva” product at 2-3 PO BID or the “CuraPro” type product at 1-2 PO BID are commonly used. Intravenous curcumin is also in trials currently for human use in renal failure, but we have no data as of yet.

Close up of Calcinosis of Chronic Renal Failure

Close up of Calcinosis of Chronic Renal Failure

Chelation: Only in some cases and if physician experience and comfort allows. I employ the use of specific low dose chelators therapy in a very specific formulation and formula progression as listed below. I want to underscore my appreciation of the concern regarding these therapies and also reiterate that this therapy has safely and successfully been used in patients with eGFR as low as 15. The use of specifically designed doses of chelators such as EDTA have been shown to be safe in renal disease [12] and effective at low dose to remove metals [13]. In our clinical practice with renal failure patients we have had no adverse events using renally adjusted doses of IV chelators in renal disease spanning eGFR of 9 to 45 as well [14]. Former ACAM guidelines for the use of high dose EDTA contraindicated use over serum creatinine of 2.5, the use of eGFR calculations and specific renal adjustment of doses has yielded safe (when cautiously applied [14]) low dose chelation in patients with eGFR as low as 15 [28].

Consider for oral regimen:
• l-glutamine powder dosed prior to a meal 3-4 grams in juice or cold to room temperature food TID
• Acetyl-l-carnitine dosed 400-600 mg BID prior to food.
• Rentone 1 tablet TID prior to a meal ( [12]
• Chinese Kidney Formula 3 BID prior to or with a meal [12,29]
• “Meriva” product at 2-3 PO BID or the “CuraPro” type product at 1-2 PO BID [30-35]

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