Q: My 65 years old mother has a history of heart disease, high blood sugar and hypertension. Her blood sugar level has been around 300 mg/dl for the last few years. She was taking Daonil / Glimmer as prescribed by the doctor. Now she has moved to insulin and the sugar is more controlled. Recently she was admitted to hospital for 45% left ventricular failure (LVF) because water came to her lungs. It was then doctor told us that even the kidneys are also getting affected. Her recent urine and blood sample test showed the following: creatinine level in kidney is 3.3 mg/dl, urea content is 91, calcium is 8.9 and uric acid is 6.8 mg/dl; Phosphorus - 4.6, HDL – 50 mg/dl, LDL – 82 mg/dl, cholesterol – 164 mg/dl, haemoglobin - 12.1 g/l. The doctor says that her kidney is failing and no medicines can help her. Also we have not got the angiography done since it could have resulted in kidney failing. Her previous angiography (done 5 years back) showed 2 blockages and 1 diffused blockage for which she is taking Folvite, Daytor, Arakamin, Miniexpress, Phostat, Angispan, Betabloc, S Numlo, Ecosprin. Please advise.

A:Your mother has progressive chronic kidney disease (CKD) characterised by irreversible kidney damage possibly by diabetes, hypertension and underlying heart disease. The management for CKD involves measures like strict blood pressure and sugar control, and avoidance of kidney toxic medications (for example, avoiding daily continuous intake of common pain medicines like Voveran and Brufen), all intended to delay the progression of her kidney disease. In addition, focus should be on monitoring and treating some of the complications of kidney disease like anaemia and kidney bone disease, which would also have a beneficial effect on her heart disease. She should get evaluated by a Nephrologist who would initiate workup to help ascertain the actual cause, the severity of CKD, address the complications and also the diet.