Nephrotic Syndrome and Cellcept

[UNDRH20]

I have a student who has disclosed she has been diagnosed with Nephrotic Syndrome and is prescribed Cellcept. I can find almost nothing about this condition and diving--have checked DAN and other sites. Cellcept usually appears to be prescribed for transplant patients, but she has not had one. I see that it does lower the body's ability to fight infection.

Does anyone have any knowledge/experience about whether this is a contraindication to diving? Thanks

 

[PineNut]

I am guessing that the dose they will use for nephrotic syndrome is quite a bit lower than that used in organ transplant. So the risk for skin infection and other infection is relatively low. You might want to get a release from her nephrologist to be on the safe side. My guess is that the dose is much lower than usually recommended for transplant patients.

Aside from that, this class of medication is known to greatly increase the risk of skin cancer. In fact, skin cancer risk is like at least 10 times the general population in transplant patients. The highest risk is in squamous cell cancer. In transplant patients, these squamous cell cancers are much more aggressive than regular skin cancers.

So, on the surface, she should be careful with avoiding the sun, and using sun screen. Down below, she should try her best to avoid injuries, especially skin injuries.

Here is a summary of a recent study on heart transplant and skin cancers. Essentially, the same type of risk extend to this class of medications (Cellcept, Protopic, etc). Fortunately, most of these cancers do not kill:

# During a total of 2097 person-years, 312 heart transplant patients had 1395 new skin cancers (mean, 0.43 per year per patient).
# Range was 0 to 306 for squamous cell carcinoma and 0 to 17 for basal cell carcinoma.
# Of the 1395 new skin cancers, 1236 were squamous cell carcinoma, 151 were basal cell carcinoma, 5 were malignant melanomas, and 3 were other types.
# At 5, 10, and 15 years after heart transplant, the cumulative incidence rates of any skin cancer were 20.4%, 37.5%, and 46.4%, respectively.
# After the first basal cell carcinoma, the cumulative incidence of squamous cell carcinoma was 98.1% within 7 years.
# Of the 312 patients with skin cancers, 76 (24.4%) had 1 or more squamous cell carcinomas, 24 (7.7%) had only 1 squamous cell carcinoma, and 19 (6.1%) had 10 or more squamous cell carcinomas.
# In addition, 54 (17.3%) had 1 or more basal cell carcinomas, 23 (7.4%) had only 1 basal cell carcinoma, and 2 (0.6%) had 10 or more squamous cell carcinomas.
# Despite the considerable tumor burden, the rate of death from skin cancer was surprisingly low, and only 1 patient died of skin cancer (melanoma).

 

[DocVikingo]

Hi UNDRH20,

Some issues to be considered:

- There are a number of causes of nephrotic syndrome, both directly kidney-related and secondary to broader systemic diseases. For clearance for SCUBA it is important to know the basis of the student's condition proper and its implications for diving.

- Like nearly all medications, "CellCept" has side effects. Its most common ones include diarrhea, lowered white blood cell count and vomiting. Also reported is an increased likelihood of opportunistic infection as the drug suppresses the body's immune system. This is worrisome as it is easy to be exposed to infectious organisms while diving.

- RE the skin cancer issue, the student may wish to read the following that looked at CellCept":

Skin Cancer Risk High After Heart Transplant
Medical News: Skin Cancer Risk High After Heart Transplant - in Dermatology, General Dermatology from MedPage Today

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.