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How can one avoid an increase in creatinine levels?

Q: My father's creatinine level is not stable. It sometimes increases and then comes down. How can we avoid the increase in creatinine level as he has diabetes since 15 years?

A:The main function of the kidney is to filter the blood and rid the body of wastes and toxic substances. They also control the blood pressure and secrete a hormone responsible for production of red blood cells. This rate of filtration is measured as glomerular filtration rate (GFR) and this measurement is used to define and grade kidney failure. Irrespective of the underlying cause, kidney failure leads to a progressive decline in GFR and the levels of urea and creatinine in the blood reflect this. They start to show significant increases only after total GFR has decreased to 50% and the plasma creatinine value will double with a 50% reduction in GFR. A rise in plasma creatinine from a baseline value of 0.8 mg/dl to 1.6 mg/dl in a patient, although still within the reference range, actually represents a loss of 50% of kidney function. Care of such patients aims to delay or halt progression of the kidney disease. This is achieved by treatment of the underlying condition, aggressive control of blood pressure and blood sugar, the use of drugs like ACE inhibitors, dietary management and avoidance of drugs/substances toxic to the kidney. Your father is a long-standing diabetic and his kidney disease is likely secondary to the diabetes. Please consult a nephrologist and an endocrinologist who will advise you appropriately regarding the management of your father.

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