Q: My mother is diabetic for the past 10 years. She is 56 years old. Recently, a scan of her kidneys was taken and the right kidney was found to be smaller than the left. A renogram was also done which showed a pattern of bilateral parenchymal disease with moderately decreased function. What is the best course of treatment in her case? Can the reduction in the size and function be arrested, if so then what is the best method of doing so?

A:Your mother's right kidney is small. The kidney may have been small at birth (dystrophic kidney) or may have been small because of infection (pyelonephritis) or because of narrowing of the artery carrying blood to kidney (renal artery steonosis). Diabetes predisposes to the latter two conditions but more commonly also affects kidneys directly what is called diabetic nephropathy of which protein in urine is the hall mark and usually eyes also show changes of diabetes in this condition. So I would suggest the following: 1) Eye check up by an ophthalmologist to look for diabetic retinopathy. 2) Spot urine albumin to creatinine ratio 3) DMSA scan 4) Renal artery Doppler or MR angiography.