Renal - Steroid treatment for kidney disease/condition

This information has been written by the medical and pharmacy team to give you information about the treatment we are recommending for you.

A member of staff will be happy to discuss this leaflet with you and answer any questions you or your family may have.

Renal Patient View

Salford Royal renal team support and encourage our patients to sign up to Renal Patient View (RPV). RPV lets you and your GP use the internet to find pages where you can look at your diagnosis, your blood test results and your clinic letters. You can share this information with anyone you want and view it from anywhere in the world.

You will be given a separate leaflet about this service – please ask for more information.

Disease affecting the kidney

Many diseases that affect the kidney involve inflammation. Steroids are used in a wide range of conditions that involve inflammation, from asthma to arthritis. Your doctor recommends you have steroid treatment for your kidney condition/disease.

What are steroids?

Steroids are sometimes called cortisone or corticosteroids.

Steroids are naturally occurring hormones that are found in your body. For example, cortisol is a hormone produced in the body, particularly in situations of ‘stress’ such as infection.
 
Steroid medicines are manufactured into a wide variety of products. Steroids are used very successfully to treat a wide range of inflammatory allergic and immune diseases.

In kidney disease, we use two main types of steroids:

• If you need a very high dose, you may be given a drip of methylprednisolone for a few days at the start of your treatment
• If you have inflammation of the kidney, then steroids that you take by mouth are often recommended at high doses for several weeks or months. The oral steroid we usually use is called prednisolone. Prednisolone is available in 1mg, 2.5mg, 5mg and 25mg strength tablets or as 5mg soluble tablets

What precautions must I take and what are the side effects of treatment?

Steroids are the most useful and commonest medicine prescribed for the treatment of inflammation in the kidney. They are given to patients when they are first diagnosed and during maintenance and relapse.

There are some side effects associated with steroid treatment. The higher the dose the more side effects you are likely to have.

For some conditions, you may need to take steroids in a high dose (more than 40mg a day) for a long time – weeks, months or even years. It is important to remember that the benefits usually outweigh the side effects.

Steroids are often an essential part of the treatment of many kidney conditions. For some conditions, a course of steroids alone may be enough. Unfortunately, for some renal conditions, especially vasculitis, steroids are not usually powerful enough to treat this on their own. For the best outcome, steroids must be given in combination with other therapies.
 
There is a long list of side effects that can occur with steroid treatment. It is important to note that you are only likely to experience a few side effects and steps will be taken to lessen any side effects you do experience.

A full list of side effects is given below. It is important that you are aware of these potential risks while you are taking steroids.

The medical team will consider your individual risks and potential benefits of steroid treatment.

They will recommend that you have steroids if they consider that the benefits outweigh your risks. If you have any concerns, please discuss these with your medical team.

• During and after steroid treatment, your own adrenal gland responds to the steroids you are taking in tablet form and produces less of its own steroid (cortisol). For up to 12 months after the steroids are stopped, your body may not fully respond to stresses such as infection or trauma and this can result in severe illness

You must not suddenly stop your steroid treatment. Always tell any doctors/nurses or health professionals that are treating you that you are taking or have recently taken steroids. Please always carry your steroid warning card with you.

• Osteoporosis (thinning of the bones) particularly in people who smoke, postmenopausal women, the elderly, those who are underweight or immobile and patients with diabetes or lung problems
• If you are going to be on steroids for several months, we may also recommend you have medication to strengthen the bone
• Muscle weakness, especially of the shoulder muscles and thighs
• Rarely, weakening of one or both hip joints (however, this is usually only after a long period of treatment with steroids). If you develop pain in your hip or groin area, then please tell the team
• Increases in circulating blood fats (triglycerides)
• Increased body fat around the face or trunk
• Salt retention leading to legs swelling, raised blood pressure and weight increase
• Increased appetite leading to weight gain
• Shakiness and tremor
• Eye disease, particularly increased pressure in the eye (glaucoma) and increased risk of developing cataracts. If you see an optician regularly, then please tell them you are taking high dose steroids
• Your skin may become thin, resulting in easy bruising, skin tearing after minor injury, slow healing and stretch marks (striae)
• Acne (clusters of small spots on face, chest and upper back)
• Effects on your mood, including insomnia (being unable to sleep well), mood swings or mood changes such as increased energy, excitement, delirium or depression
• Stomach ulcers are more likely if you take steroids. This is more common in patients taking non-steroidal anti-inflammatory medications, for example Ibuprofen and you should avoid this combination. We will offer you some medication to take to protect your stomach, but you should tell the team if you develop indigestion or stomach pains

General health

All immunosuppressant medicines will make you more sensitive to the effects of sun exposure, which can lead to skin cancer. This is usually only after many years of treatment.

When exposed to the sun, we recommend that you always protect your skin and use a high factor sunscreen of at least SPF20+.

It is important that you continue to attend community health promotion clinics, for example women should continue to have regular cervical smears.

Can I have vaccinations?

We usually recommend that you avoid live vaccines, e.g. yellow fever if you are taking high dose steroids.

If you are in your 70’s and are offered a shingles vaccination please contact us first. There are two available vaccines and which one is suitable will depend on the dose of steroids you are taking.

We do recommend that you have a yearly flu vaccine. You should also have a Pneumovax vaccine once, as these will help protect you against the most common pneumonia and flu.

Can I drink alcohol while on steroid tablets?

If is generally safe to drink alcohol within the recommended safe limits while taking steroids.

Do steroid tablets affect fertility or pregnancy?

Steroid treatment can affect the menstrual cycle for women. If you are planning a family or find that you are pregnant, do not stop taking your steroids but do contact the medical team for advice.

What happens if I decide not to have steroid treatment?

If you decide against treatment with steroids, alternative treatments may be possible, but will not be as effective. Your doctors will listen carefully to your concerns and give you advice about the best possible alternatives and their side effects, to help you and your family make up your mind about treatment.

Other useful sources of information:

Renal Dept - 0161 206 5223
National Kidney Federation – 0845 601 0209

UK Websites

www.kidney.org.uk
www.vasculitis-uk.org.uk/
http://britishkidney-pa.co.uk