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Methotrexate or possible kidney involvement?

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My Glomerular Filtration Rate (GFR) has decreased from 110 in October to 83 from my latest labs yesterday. My serum creatinine has increased from .78 to 1.1.

My sclero specialist doesn't seem concerned as the GFR is still within "normal" range. I'm not sure what to make of this or how concerned to be about it. She doesn't want to take me off the 15mg of Methotrexate, and I am reducing my 5mg prednisone to 2.5mg a day in hopes of getting off it entirely. 

Not sure what else I can do other than continue to monitor it. 

Has anyone else had a declining GFR? Has anyone had it improve? My understanding is that once it goes lower it does not go back up, but I have read reports of people having an increased GFR.

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Hi Greypilgrim,


I know how worrying the side effects of immune suppressants can be. When I first started taking azathioprine, I had raised liver enzymes, and also my Mean Corpuscular Volume (MCV) level was also raised; we tinkered about with the dosage, which helped the liver enzymes and like your Sclero specialist, my consultant assured me that my MCV levels were with in the 'normal' range. I must admit I've never felt any worse because of this.


I've included a link to our page on Scleroderma Renal (Kidney) Involvement, which includes a section on GFR. According to that link, "Glomerular Filtration Rate (GFR): Your GFR tells how much kidney function you have. It may be estimated from your blood level of creatinine. If your GFR falls below 30 you will need to see a kidney disease specialist (called a nephrologist), Your kidney doctor will speak to you about treatments for kidney failure like dialysis or kidney transplant. A GFR below 15 indicates that you need to start one of these treatments."


It would appear from that quote that your levels of 83 are still within acceptable levels, but even so, it would be worth your Sclero specialist keeping a close eye on it, to ensure that it doesn't fall too low.


Kind regards,

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My EGFR is down around 50-60 and has been for years.   Every time I have a blood test that gets checked and it is about the same all the time.


My general practitioner just shrugs and says, we know it's not marvelous but it is okay and we are watching it.    I am very sure if it drops any further she will tell me.


Best wishes,



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Hi Grey,


That's a good question about Glomular Filtration Rate.  Here is a good link, Understanding GFR, by the National Kidney Disease Education Program.  A quick recap from it is:

  • A GFR of 60 or higher is in the normal range.
  • A GFR below 60 may mean you have kidney disease.
  • A GFR of 15 or lower may mean kidney failure

Basically, when it drops below 60, then they take a closer look at any changes that may need to be made.  When GFR is below 15, most people need either dialysis or a kidney transplant.


Luckily, kidneys are very much like lungs, in that we are born with an abundance of excess capacity, and we can often skim by without treatment, even with pretty severe loss of function. That said, it's always wise to preserve whatever function we can, while still not otherwise jeopardizing our health.


This is another fine example of where knowledge is power, and where the knowledge may also lead to a better night's sleep -- for most of us, or at least those with GFR's over 15 at the present time.



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Thanks.  I am still getting monthly blood work done so I guess I will see where I am at in a few weeks.  Unfortunately, it seems those that have tendon friction rubs are nearly much more likely to have kidney problems.  Staying hopeful though. 

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