Q: My father is 70 years old and a diabetic patient. He is having some problem with sleep, urine and stools. He has some problem with his kidneys too. The creatinine serum level is 2.39 mg/dl, creatinine clearance is 13.72, haemoglobin is 9.7, the cortical echogenicity is increased, the right kidney is 7x4.0 and the left kidney is 8.4 and 4.8. Kindly comment on kidney damage. He is having pain in his chest and the blood pressure is fluctuating between 140/60 and 120/70.

A:Based on the limited information provided, your father has an advanced chronic kidney disease with 25-30% kidney function left at his age. Management of you father’s illness should include: firstly, measures to delay further worsening of kidney disease and secondly, treating the complications of kidney disease. Strict blood sugar and blood pressure (BP) control (target BP <130/80 mmHg), avoidance of kidney toxic medications especially on a continuous basis including some of the pain medications like voveran, brufen and nimulid and strict control of blood cholesterol level if elevated with appropriate medications are some of the specific recommendations intended to delay the worsening of kidney disease to the stage of kidney failure. These also help in reducing the risk of a probable accompanying cardiovascular disease (heart disease). Complications of advanced kidney disease including anaemia (noted in your father with haemoglobin of 9.7%) and bone disease needs to be thoroughly investigated and adequately treated by a nephrologist. In fact, he should be immediately evaluated by a cardiologist in view of ongoing complaint of chest discomfort in the background of multiple risk factors for heart disease.