ASK THE DOCTOR

by Wesley W. Wilson, MD

NOTE: If you have any questions for "Ask the Doctor," please send them to the VOICE editorial office. The only questions Dr. Wilson will be able to answer are the ones used in this column.

Wesley Wilson, MD is an Internal Medicine practitioner at the Western Montana Clinic in Missoula, Montana. Dr. Wilson was diagnosed with type I diabetes in 1956, during his second year of medical school.

Q: I am told that my kidneys are starting to fail. I have taken ibuprofen for my general aches and pains and am now told that I can't. Why? And what pain pills can I take with these bad kidneys?

A: I am sorry to hear that you have kidney disease. The key strategy for you now must be to preserve your kidney function as long as possible. The DCCT (Diabetes Control and Complication Trial) showed that even in the early stages of kidney disease, tight control of blood sugars slowed further progression of kidney disease. Some persons without diabetes show signs of kidney damage with prolonged and heavy use of anti-inflammatories. Ibuprofen is a member of this drug family called non-steroidal anti-inflammatory drugs (NSAIDs).

Since this class of drugs can cause kidney injury in persons with normal kidneys, it seems appropriate to avoid these drugs if there is any kidney disease present. For your interest, Aleve, also available over the counter, is another member of the same anti-inflammatory drug family.

Your question of which drug should be used for pain relief is more difficult. You certainly should not be forced to suffer severe pain without some type of treatment. On the other hand, especially if there is any kidney disease, the fewer drugs that you take, the better. Many of the medications that we use for pain or for other conditions can increase kidney damage, or the drug's medicinal effect can be harder to predict because the drug may be retained in the blood by the poorly functioning kidneys. Certainly do not take any drug unless you need it, and be sure to discuss your choice of medications with your physician. In addition to careful restriction of over-the-counter drugs, other measures are felt to be important in preserving kidney function in persons with kidney disease related to their diabetes. You should avoid dehydration, reduce dietary protein, and keep careful control of diabetes and blood pressure. All of these are very important factors. Also, many physicians feel that a class of antihypertensive drugs, the ACE inhibitors, has a particular benefit in protecting the kidneys from diabetic damage. These ACE inhibitors (the most well-known is Capoten) seem to be quite effective in protecting damaged kidneys from further harm caused by diabetes.