Q: My 60 years old diabetic father has high creatinine level i.e. 4 mg/dL. He has been a patient of diabetes for the last 35 years and his right leg has been amputated. He has a splint in his leg foot too. We have done a kidney, ureter and bladder (KUB) sonography and the report showed: right kidney: normal in size with coarse echotexture, measures 10.8 x 4 mms, no evidence of calculus/hydronephrosis, CMD maintained. Left Kidney: normal in size with coarse echotexture, measures 11.5 x 5.7 mms, no evidence of calculus/hydronephrosis, CMD maintained. Ureters - not visualised, no calculus at ureterovesical junction. Bladder: distended, normal wall thickness noted, no evidence of calculus growth. Impression: both kidneys show normal in size with coarse echotexture, bilateral medical renal disease. What does the report imply and how can my father's creatinine level be reduced? Please advise.

A:Review of your father's history suggests that he has advanced chronic kidney disease, reflecting irreversible kidney damage probably from diabetes and hypertension. Assuming his baseline blood creatinine level to be around 3.8-4mg/dL (if remains at this for more than 3 months), he has approximately less than 20% of normal kidney function left at his age. He would need to continue focussing on strict blood sugar and blood pressure control, avoiding exposure to kidney toxic medications, cutting back on protein intake down to 50-55 grams on a daily basis among several measures intended to delay the progression of kidney disease to the stage of failure. He should consult a Nephrologist.