Q: I am 36 years old male. Last month, I was diagnosed with chronic renal failure as a result of preventive health package done to know the cause of low Hb levels. My baseline creatinine level is 5 and BUN is about 100. My Hb before medication was 10.9. My right kidney is about 6.3 cm and left kidney is 9.5 cm. My blood pressure before starting medication was 150/90 and now its 130/80. I am following the diet plan as advised by my nephrologist at AIIMS. The other specialist has prescribed anabolic steroids (5 injections weekly for a month). Please tell me if these steroids are safe for kidney patients? Also, what is the level of creatinine for haemodialysis to be prescribed by the doctor? Is there any chance the kidney which has not shrunk will regain some of its functions? The DTPA scan shows global GFR of 10 ml/min for both kidneys. When do doctors suggest transplantation? I am also getting acupressure done side-by-side as this does not require taking any medication. Is there any harm if I try some herbal medicines. Regarding diet plan, the AIIMS dietician has ruled out all pulses except 'masoor' and 'urad'. Please tell me the logic as it is a high protein pulse. Also, what is the logic of consuming arrowroot and saboodana, apart from being low protein? Is sooji / maida / jhangora rice low in protein? Can I take palak / mustard leaves?

A:You have an estimated GFR (kidney function) of 15-20 ml/min (15-20%). Your GFR on DTPA scan is 10 ml/min (10%). A person usually requires to go on total dialysis or transplantation at a kidney function of less than 10%. Most patients have usually symptoms of weakness, lethargy, nausea, decreased appetites, anaemia and high blood pressure. I would suggest that you should directly plan for kidney transplant with a compatible blood group family donor, without going on dialysis. This has the best outcome and is also more cost-effective. However, this needs planning. It not, then you should get an AV fistula made to prepare for dialysis. From what you have written, there does not seem to be any reversible factor. It is therefore unlikely that your kidney function will improve. Protein restriction should be modest in the Indian setting, if at all any, as Indians anyway eat low protein diet. You should eat about 45-50 gms of protein 50% of which should be good quality proteins, which is in milk products, egg, meat. For vegetarians, the only significant proteins are in milk, dals & cereals. The greater problem in patients with chronic kidney disease is malnutrition, which has for more telling effects on survival and the morbidity in kidney disease patients. So protein restriction needs to be looked into in great detail in each patient and will vary depending on what the patient’s usual diet is and in many patients requires only modification of salt, potassium and liquids. No herbal medicine has been shown to be beneficial and surely can be detrimental. So I would not recommend it. You can do acupressure if it provides any psychological help. There is again no specific beneficial effect. Masoor & Urad are lower in potassium. Sooji, Maida, Saboodana have higher calories and lower phosphorus and potassium, and are thus preferred. Palak / Mustard leaves could be boiled and water thrown & then recooked. That takes away the high potassium and then one can use it.