Q: My 73 years old father-in-law is suffering from diabetes for the last 18 years and is on oral medicines. But for the last two months, he has become very weak. He also suffers from high blood pressure. He underwent kidney function test (KFT), which showed blood urea of 71, serum creatinine - 1.82, uric acid was 7.6, blood sugar was 140 mg/dL and Hb 8.5. What diet should be taken to lower high uric acid and serum creatinine level? What does his kidney function test suggest?

A:Based on serum creatinine level, your father in law has stage 3 (moderate) chronic kindey disease with estimated kidney filtration rate (GFR) of about 40 ml/min (normal value for his age should be above 75 ml/min). Most patients usually require dialysis when their kidney disease advances to stage 5 (GFR less than 15 ml/min). Given long standing history of diabetes, his kidney disease is most likely due to diabetes. High blood pressure will also cause decline in kidney function over time. Importantly, you should work with your nephrologist to make sure there is no other cause of kidney disease. If so, there is no specific treatment of kidney disease other than strict control of diabetes and high blood pressure. In diabetic kidney disease, we routinely monitor urine protein. All attempts should be made to lower urine protein.

Medications from family of angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) are particularly effective in this context. Your father in law's uric acid level is not particularly high but consuming low fat dairy products, avoiding red meat/fish/alcoholic beverages especially beer would help lower uric acid level. Losartan is a medicine from family of ARB that treats urine protein, high blood pressure and also helps lower uric acid level. Please discuss these options with your nephrologist and I suggest your father in law follows closely with a nephrologist to help delaying progression of his kidney disease as much as possible.