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Is there any treatment for Parkinsonism?

Q: My 75 years old father is suffering from Parkinsonism for the past 7 years. His serum creatinine value is 1.8 mg/dl and blood urea is 52 mg/dl, which is high. He is not a diabetic and his ultra sound of kidney, ureters and bladder shows blurring of corticomedullary distinction, which may be due to early medical renal disease with BHP Grade II and insignificant residual urine. Corticomedullary distinction appears to be somewhat blurred in both kidneys. He is taking medicine Levodopa 100 mg and Carbidopa 25 mg three times a day; Ropark 0.25, Losartan Potassium 50 mg twice a day; and, Escitalopram 5 mg, Lonazep tab 0.5, Mirtaz 7.5, Qutipin 25 mg and Tamsulosin hydrochloride and Finasteride each daily. Please advise if we can reduce the dose of Levodopa.

A:Based on the medical information provided, your father has chronic kidney disease (CKD), which reflects longstanding underlying irreversible impairment of kidney function. It is a diagnosis made on the basis of persistently elevated serum creatinine level for more than 3 months. Among the causes and potential risk factors of CKD would include hypertension and old age as in your father’s case. None of the medications listed are known to be kidney toxic. Further evaluation of urine for any signs of increased protein leakage (a sign of kidney damage) may sometimes help in nailing down the potential cause of CKD at his age. The management goal for CKD is intended to delay the progression of an established CKD by measures which include strict control of blood pressure (goal BP <130/80 mmHg) and avoidance of potential kidney toxic medications including daily continuous intake of common pain medicines like Voveran and Nimulid. In addition, one would need to focus on managing any complications of CKD including anaemia and kidney bone disease. It would be helpful to have an evaluation by a nephrologist whose intervention may help to keep his CKD progression under check.

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