Q: I am a 31 years old man having a blood creatinine level of 2.7 mg/dl, blood urea 49 mg/dl and I have diabetes for the last 3 years. Other test results are: HBA1c - 8.5%, blood sugar - 110 mg/dl (fasting) and 160 mg/dl (post lunch), urine sugar – nil. The doctor said that chronic kidney disease (CKD) is not due to diabetes as I am a diabetic only for the last 3 years. I suffered with some kidney problem in my childhood, my kidneys were filled with water and my body swelled completely. But with proper medication I recovered and never faced the problem again till date. The doctor prescribed some renal vitamin supplements and calcium tablets for a month. I have no other symptoms like swelling of legs, urine burning, etc. What kind of diet should I take along with the above medications? I have started morning walks and yoga? What other precautions should I take?

A:Diabetes happens to be the commonest cause of chronic kidney disease (CKD) and is most often characterised by increased leakage of protein into the urine. So you are advised to have 24-hour urine collection to quantify amount of protein leakage, if any. In addition, series of blood tests intended to rule out other causes of CKD including chronic nephritis (inflammation of kidneys) can help to rule out potential types or causes of CKD. Definite cause would be known only by doing kidney biopsy. Further, focus should remain on strict blood sugar and blood pressure control (target BP <130/80 mmHg) while avoiding exposure to potential kidney toxic medications including daily continuous intake of common pain medications like Brufen and Nimulid. These measures do help to prevent progressive weakening of kidney function over years. As part of managing CKD, you would need regular evaluation by series of blood tests and intervention for some of the common complications of CKD like kidney bone disease and anaemia. Lastly, your diet should be low in carbohydrates and saturated fat, should have low salt intake (3-4 grams/day) with daily protein intake of 55-60 grams.