Q: My 65 years old mother is a diabetic and has been taking two insulin injections daily. She has recently started passing 4800 mg proteins in urine daily. The doctor says that this is 100 times higher than the normal level. She also has bacterial infection in both her kidneys. What should we do to tackle the situation? What kind of a diet should she take?

A:Your mother has an underlying chronic kidney disease as obvious from increased amount of protein leaking in the urine (proteinuria). Significant proteinuria, as in the above case, is a sign of kidney damage, commonest cause being diabetic. I would advise complete evaluation by a nephrologist who would seek further urine and blood tests (including serum creatinine level) to ascertain the actual cause of proteinuria and the level of kidney function. Irrespective of the cause of proteinuria, one would recommend prescribing specific class of blood pressure lowering medications called Angiotensin converting enzyme inhibitors (ACE Is) or/and Angiotensin receptor blockers (ARBs), which are known to reduce the amount of urine protein leakage thereby delaying the progression of kidney disease over a period of time. Dietary restriction involves low carbohydrate and saturated fat with optimal daily intake of protein (55-60 gm). Lastly, strict blood sugar and blood pressure control (target BP goal <130/80 mm Hg) would be among the most vital factors helping to delay the progression of chronic kidney disease.