Q: My query is regarding my dad who is 55 years old. He has diabetes over a long period of time. He had not checked over last 3 years. Upon doing the regular check up it was found that his kidney was damaged by 70%. There was formation of water in chest, therefore we got him admitted in the hospital and following are the reports: The Pleural fluids routine results are- Volume: 6 ml Colour: pale yellow Appearance: slight hazy , After centrifugation pale yellow clear supernatant with small reddish button. Clot formation: present Total Proteins: G% 4.9 Glucose: mg% 175 Red cells: Present (+++) Number of cells : cu. mm 2200 cells Different count: Polymorphs 15 % Lymphocytes 85 % The liquid contained in the pleural, pericardial and peritoneal cavities is called serous fluid, because it some what resembles serum. Present result: Indicate the fluid to be Transudate / Exudate. After the above we started giving him anti TB medication which has to be continued for 6 months. Following were the blood test results- Sodium -113 Potassium -6.2 Chlorides -83.7 Bicarbonates -10.2 F. Blood Sugar -174 Blood urea -214 S. Creatinine -6.2 S. Uric Acid -7.3 S. Calcium -8.1 S. Phosphorous -5.6 Total protein -6.8 Haemoglobin -8.4 After seeing the above reports we were suggested to go in for a dialysis or my dad. So we started the dialysis. Its been done 2 times a week. We did a few test to see his present S. Creatinine level has come down to 5.7 And sugar is 211. Kindly advice on the following issues: 1) What is the future of such patients ? 2) Is there any other treatment for him other than dialysis? 3) When the patients has started doing dialysis what diet should be given? should one follow the diet of a kidney that less salt, oil, etc., or can he have any thing he wishes to as my dad like Punjabi food, likes breads, oily food, outside food, doesn't eat vegetables. 4) Should one go for kidney transplant? Is it advisable at this age? 5) Please tell me what can we do?

A:1) Concerning the future of such patients, patients with kidney failure and combination of illnesses that your father has, continue to be some of the difficult cases. But with the advancement of medicine and available treatment options, the outlook is certainly better than it used to be. If taken care properly, they may survive for years. But, without proper precautions and treatment, 25% of such patients may die in first 1-2 years after starting dialysis. 2) For the diet, now that he is on haemodialysis which certainly helps him feel better, he still needs to exercise dietary precautions. Most importantly, restrict salt (e.g. pickles, table salt), restrict phosphorus e.g. white of eggs, dairy products, beans. However, these foods can be consumed occasionally and in moderation, excess consumption should be avoided. But his protein intake should not be compromised and be 1 gm/kg of his body weight. A good dietician can help you design the menus considering the fact he is diabetic. 3) Should one go for a kidney transplant? Other alternatives to haemodialysis include peritoneal dialysis which can be done at home and the advantage is less dietary restrictions are required and can done at home. Disadvantage is that you or your father will have to do it and it is still not widely available in India. Kidney transplant is very much a vivid option for him but given the fact he had tuberculosis recently, he will need to complete the course of his medications. But if his diabetes is not too extensive and has not involved his blood vessels, he can do well on transplant. But you should be aware of the fact that kidney transplant is not cure of his diseases. Only big advantage will be he will not require dialysis. He will still need to take all his medicines including diabetes and blood pressure and other transplant medicines which in the beginning will make him prone to infections. But overall, kidney transplant is a better option than dialysis provided his heart and blood vessels are ok. 5) Currently, he is anaemic and his Haemoglobin is very low. Is he being prescribed Erythropoietin injections? That will build up his Haemoglobin and give him lot of strength. His phosphorus is high. He needs to take CaCO3 tab every time he eats (with the food). How long does he get dialysed? How fluid is being removed? How much weight does he gain between dialysis? Does he get short of breath? What medicines is he on? I shall need all this info to make further suggestions.