Q: My father is 52 years old. He is suffering from diabetes for the past 15 years. He follows a controlled diet and controlled sugar level by medication and regular physical activity. His blood pressure is normal, but he is underweight. He was suffering from fever for the last ten days, and now his creatinine level is 2. How should the creatinine level be controlled? How will high creatinine affect his kidneys?

A:Your father’s kidney function is 28% (GFR 28 ml/min). This is most likely due to diabetes affecting the kidney (diabetic nephropathy). One requires more detailed investigations like urine protein estimation, any evidence of eye changes due to diabetes or any laser therapy of fundus in eyes, etc. He should see a nephrologist who should look for any reversible factors. Recent history of fever might suggest some reversible factor like infection either in urine or anywhere else. For this, it is important to examine the patient. Diabetic kidney disease is usually progressive. One can slow down the progression by keeping blood pressure to less than 120 / 75 mmHg preferably using drug like ACE inhibitors or ARB’s (e.g. Losartan and Ramipril) and keeping blood sugar well controlled (monitored below 7 %). The diet should have total calories - 35 kcal /kg body weight, 0.7 gm protein / kg weight (50% of this should be high biological proteins (milk and milk products, fish, chicken and eggs). By following the above guidelines, it is possible to slow down the rate of progressive decline in kidney function.