Treatment of diseases affecting the kidney using steroids

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. Diseases 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. In kidney disease, we use two main types of steroids. l 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 l Steroids that you take by mouth are often recommended at high doses for a number of weeks or months if you have inflammation in the kidney. 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 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. 1 2

How is it given and for how long? Methylprednisolone is usually given in the initial treatment of serious kidney diseases such as vasculitis or severe nephrotic syndrome that require intensive treatment. It is given as a drip infusion into a vein once a day for the first 3 days. After this patients usually swap to prednisolone tablets for at least 4 weeks. Prednisolone tablets are given in various doses for different kidney diseases. Your doctor or renal pharmacist will discuss your individual steroid plan with you. Your body will become used to steroid tablets after a few weeks. Your dose might need to be reduced gradually over a period of time under your doctor s instructions. This will only be done when it is safe to reduce your dose and your disease is under control. What precautions must I take and what are the risks and 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 sideeffects 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. It is best to take prednisolone tablets in the morning, preferably with your breakfast. 3 4

How will steroids affect me? All patients receiving steroid therapy are at an increased risk of infection. This is especially important when patients have high doses of steroids. It is important that you avoid contact with anyone who has CHICKENPOX shingles or MEASLES. If you or anyone in your family or close contacts catches chickenpox or measles you must contact your doctor immediately. l If you take steroids for more than 3 weeks you are very likely to see a change in your appearance. You may notice changes to your face especially a fullness to your cheeks and jaw line l You may also have changes in your blood sugar resulting in diabetes or worsening of your blood sugar control if you already have diabetes. It is important that your blood sugar levels are monitored regularly l 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 twelve 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 carry your steroid warning card with you at all times. l 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 l If you are going to be on steroids for a number of months we may also recommend you have medication to strengthen the bone l Muscle weakness, especially of the shoulder muscles and thighs l Rarely, weakening of one or both of the 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 please tell the team l Increases in circulating blood fats (triglycerides) l Increased body fat around the face and trunk l Salt retention leading to leg swelling, raised blood pressure and weight increase l Increased appetite leading to weight gain l Shakiness and tremor l Eye disease, particularly increased pressure in the eye (glaucoma) and increased risk of developing cataracts. If you see an optician regularly please tell them that you are taking high dose steroids l Your skin may become thin resulting in easy bruising, skin tearing after minor injury, slow healing, and stretch marks (striae) l Acne (clusters of small spots on face, chest and upper back) l Effects on your mood including insomnia (being unable to sleep well), mood swings or mood changes such as increased energy, excitement, delirium or depression l Stomach ulcers are more likely if you take steroids. This is more common in patients taking nonsteroidal 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 tummy pains 5 6

What can I do to reduce any side effects: You can take the following steps to reduce the potential sideeffects of steroid treatment: l Eat less salt. Cut down on the amount you add in cooking or at the table. Much of the salt we eat today is hidden in pre-prepared food such as tinned foods, ready-meals, shop-bought sauces and take-aways. Start looking at the salt content of the food you buy and avoid high-salt products. This will help with salt retention, leg swelling and blood pressure l Eat a healthy balanced diet and weigh yourself regularly l If you can, do some regular exercise. This will help prevent weight gain and is good for muscle and bone health General health All immunosuppressant medicines will make you more sensitive to the effects of sun exposure that can lead to skin cancer. This is usually only after many years of treatment. We recommend that you protect your skin from the sun at all times and use a high factor sun screen at least SPF 20+ when you are exposed to the sun. 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 eg yellow fever if you are taking high dose steroids. If you re in your 70s and are offered shingles vaccination (Zostavax) please contact us first - some patients can have this vaccine if you are taking a low dose of steroids. We do recommend that you have a yearly flu vaccine and you should have a Pneumovax vaccine once. This will help protect you against the most common pneumonia and flu. Can I drink alcohol while on steroid tablets? It 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 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 sideeffects, to help you and your family make up your mind about treatment. l If you smoke - now is a great time to quit! Please ask for help or advice on stopping smoking 7 8

Where can I get more information? Your ward doctor, nurse or pharmacist will be happy to discuss your kidney treatment and answer any questions that you have. If you are an outpatient, you can contact the clinical team though your consultant s secretary; the phone numbers are on the clinic letters that you will receive after each appointment. Other useful sources of information for patients National Kidney Federation Helpline: 0845 601 02 09 (local call rate) UK Websites: www.kidney.org.uk www.vasculitis-uk.org.uk/ http://www.britishkidneypa.co.uk/ Notes This booklet has been written by the Renal Pharmacist & Renal Doctors at Salford Royal NHS Foundation Trust and revised in 2014. 9 10

G15030506W. Design Services Salford Royal NHS Foundation Trust All Rights Reserved 2015 This document MUST NOT be photocopied Information Leaflet Control Policy: Unique Identifier: NOE12(15) Review Date: March 2017 For further information on this leaflet, its references and sources used, please contact 0161 206 5223 Copies of this information are available in other languages and formats upon request. If you need this interpreting please telephone In accordance with the Equality Act we will make reasonable adjustments to enable individuals with disabilities, to access this treatment / service. Email: InterpretationandTrans@srft.nhs.uk Salford Royal operates a smoke-free policy. For advice on stopping smoking contact the Hospital Specialist Stop Smoking Service on 0161 206 1779 Salford Royal NHS Foundation Trust Stott Lane, Salford, Manchester, M6 8HD Telephone 0161 789 7373 www.srft.nhs.uk If you would like to become a Foundation Trust Member please visit: www.srft.nhs.uk/ for-members If you have any suggestions as to how this document could be improved in the future then please visit: http://www.srft.nhs.uk/ for-patients