a decent article on this test here
https://labs.selfdecode.com/blog/bun-creatinine-ratio-high-low-levels-normal-range/
i would guess that dapsone could either have a direct effect on the kidneys - though i think we might see references for that in the literature if it did - as it is an old drug with lots of data
or
it may be that when a person has intracellular infections and then take a strong enough drug to kill a lot of those intracellular organisms - there is a substantial amount of host cells that will die - either through damage from the remnants of dead bacteria inside them, or via apoptosis due to the bacteria inside no longer able to prevent it ( several intracellular bacteria - eg Bart are known to prevent apoptosis as part of their survival strategy ) or via phagocytosis by white blood cells - which mop up damaged or infected cells.
all of these mechanisms are modes of tissue breakdown that will increase the amount of nitrogen products in the blood and impact the above ratio
if this happens in the kidneys it could well slow down how much work they could do for a while - and further impact the ratio ( reduced creatinine clearance rate )
i notice internal bleeding is one of the possible causes- due to breakdown of the blood in the digestive tract - this makes me suspect that if a person has bartonella and you take a drug good at killing bart in the blood then you could have a similar effect from the body absorbing a lot of blood products in the liver and spleen.
dark urine and raised bilirubin are common in people treating bart for this reason - as are raised liver enzymes from killing bart in the liver.
i think if it were me, and the ratio was just a little outside range - i would make sure i did the things that should help - like drink enough and probably continue treatment - though monitor with regular testing
if it was a long way outside range i would take a break and regroup - with a view to restarting and monitoring closely going forward
if liver enzymes and full metabolic panel have not been done as part of the safety labs ( they should be with dapsone) then i would do these and keep an eye on the liver enzymes and well as bilirubin t help understand what may be happening.
this is of course not medical advice - just an attempt to indicate possible useful lines of enquiry to pursue with your doctor
Post Edited (Garzie) : 5/4/2022 3:41:52 AM (GMT-6)