Q: I am a 50 years old diabetic, hypertensive patient since last ten years. My blood sugar fasting level fluctuates from 120 to 130 and post prandial from 130 to 160. All these years I have been taking Daonil 5 mg twice, Metformin glucophaze 500 mg thrice and Rosiglitazone 2 mg once a day. My blood pressure fluctuates from 130 to 150 systolic and diastolic 66 to 79 with Amlodipine 5 mg once, Ramipril 2.5 mg twice, losartan potassium 50 mg twice and atenolol 25 mg with hydrochlorthiazide 12.5 mg once. I take Zeevitcap and Ecosprin 150 mg after lunch. My cholesterol level is 230, triglycerides are 120, HDL is 40, LDL is 166, VLDL is 24, urea is 26 mg and creatinine is 0.9 mg as tested 15 days back. Further albumin trace is found in urine without sugar. I was advised to stop atenolol and increase Ramipril 5 mg twice with amlodipine 5 mg twice and lovostatin 20 mg. Can kidney function improve with this increased medicines and reduce the albumin trace? I go for brisk walks daily with no difficulty. I am a vegetarian and take 500 ml of toned 3 percent fat milk in tea and curd. Can I continue this? Do I need dietary changes? I am a smoker.

A:You are suffering from diabetic nephropathy (damage to the kidney nephrons as a result of diabetes). The presence of albumin or protein in the urine (called albuminuria or proteinuria) is a marker of kidney disease. Even small amounts of albumin in the urine, called microalbuminuria, may be an early sign of kidney damage. Use of specific medications called angiotensin converting enzyme (ACE) inhibitors (Ramipril total 10 mg as single dose or divided dosages) or angiotensin receptor blockers (ARBs) like losartan reduces blood pressure and levels of protein in the urine, and can slow the progression of kidney disease better than other medications used to treat high blood pressure. We usually do not recommend combination of both that Ramipril and losartan, which you are taking, as evidence is still not enough to use the combination together. I do not see any harm in taking a health diet of milk and usual carbohydrates. Blood pressure should be targeted with in 130/70 or even lower to 125/70. This can be done with increasing dose of amlodipine to 10 mg rather than using losartan. The combination of losartan and Ramipril can cause increased risk of high potassium in blood. Stopping smoking also may help to slow progression of kidney disease.