How can chronic kidney disease be managed?

Q: My 64 years old mother is suffering from high blood pressure and severe osteoporosis. Three years back, she was diagnosed with deep vein thrombosis (DVT) in her left leg and is on Acitrom since then. Recently, she underwent kidney function test as her left kidney is smaller in size (6.7 x 3.2 cm) and blood urea nitrogen was found to be 46 mg/dl and creatinine - 2.50 mg/dL. The doctor told us that the kidney is working 30% and after 6 months, dialysis would be required. She is suffering from hypertension for the last 10 years and was taking Telma 40. For the past few days her blood pressure was continuously high so the doctor has replaced Telma 40 with S Numlo 5 and further increased it by 2.5 mg. She is not able to sleep at night for the last 3 days and has got swelling on the back of the leg along with diarrhoea. I have found that these may be it is the side effects of S Numlo 5 and also read that Telma is not good for the kidneys.

A:It is true that if your mother's baseline serum creatinine is around 2.2-2.5 mg/dL (persistently for over 3 months), then she probably has less than 30% of normal kidney function at her age. The focus should remain on strict control of blood pressure and avoidance of exposure to potential kidney toxic medications, including daily continuous intake of pain medications like voveran or brufen. These measures do help to at least delay the progression of CKD (chronic kidney disease) for over an extended period running into several months to few years before one would need dialysis support or more preferably kidney transplant. Telma (Telmisartan) can cause serum creatinine to rise and hence was probably stopped. If she is having side effects of amlodipine as listed, then she may be able to switch to an alternative blood pressure lowering medications. At the end, target blood pressure goal should be <130/80 mmHg. Lastly, make sure that any evidence of dehydration resulting from excessive loss of fluids through diarrhoea is addressed on a timely basis since it can result in worsening of renal disease.