Q: My husband’s age is 50 years and has a GFR of 30 and creatinine level of 1.4 mg/dL. He is suffering from high BP, which is under control in the range of 130/90 through regular medication. Otherwise he is active and alert. Is it possible that if he maintains the BP levels and his low-protein regimented diet, he may never require kidney transplant? Or will he require kidney transplant? If so how soon?

A:Assuming the baseline serum creatinine of 1.4 mg/dL, the estimated Glomerular Filtration Rate (GFR) of your husband’s kidneys is approximately 50-55%. This means that he has over 50% of normal kidney function at his age, reflecting significant functioning of his kidneys. It is possible to delay the progression and many times halt the disease process if the risk factors for the kidney disease are kept in check. This includes strict blood pressure control (goal BP <130/80 mmHg) and avoidance of kidney toxic medications including continuous intake of common pain medications like Brufen, Nimulid and Voveran. In addition, he would need to undergo urine analysis test for any significant albumin (protein) leakage. Increased protein in urine is a marker of kidney damage and would make it necessary to be treated with particular class of blood pressure medications like Angiotensin Converting Enzyme inhibitors (ACE) or Angiotensin Receptor blockers. Kidney transplant or dialysis intervention is offered at the stage of kidney failure (end stage kidney disease) when one is left with less than 10% of normal kidney function at her or his age. It is certainly premature to worry about the end stage in your husband’s case while focusing on preventive measures.