Q: I am diabetic for more than 10 years. I am 72 years old and suffer from chronic diabetic nephropathy. This was diagnosed recently through renal biopsy. The biopsy result says: sections show renal tissue containing a total of eight to nine glomeruli of which 2 are ischaemically sclerosed. The glomeruli are enlarged and show irregular increase in mesangial matrix with early mesangial nodule formation. Multiple foci of tubular atrophy are seen with wrinkled and thickened tubular basement membranes. The arterioles show marked luminal narrowing with foci of hyaline change. The larger artery also shows hyaline change and subintimal fibrosis. Impression: Renal (needle) biopsy showing features consistent with chronic diabetic nephropathy. My serum creatinine is 1.8; Urea - 90; Calcium - 14.8 (got reduced to 12.5 after getting saline treatment in the hospital). How serious is the disease and how fast will it progress? Is any treatment possible?

A:On the basis of the information provided, you suffer from chronic kidney disease secondary to diabetic nephropathy. Assuming the baseline serum creatinine value of 1.8 mg/dL, you probably have around 40% of normal kidney function at your age. It is neither possible to retrieve the lost kidney function especially in view of the chronic irreversible changes noted in the kidney biopsy, nor to comment on the chances of the progression of the kidney disease. However, various measures directed towards controlling the risk factors of chronic kidney disease help in delaying the progression of the underlying disease process. These include exercising a good blood pressure (BP) control with a target of less than 130/80 mmHg; strict blood glucose control; aggressive management of high serum cholesterol level if you suffer from hypercholesterolaemia, which can be diagnosed by testing fasting lipid panel; avoiding all potential kidney toxic medications including all non-steroidal anti-inflammatory pain medications like Voveran, Brufen & Nimulid, and consumption of which should be avoided especially on a continuous basis and dietary modifications including 30-40 gm of protein daily. Lastly among the blood pressure medications, you may benefit from the addition of medications called angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs). Studies have shown that these medications help delay the progression of your kidney disease usually via the reduction of protein leakage in the urine and also reduce the risk of cardiovascular disease.