Q: My 34 years old wife’s serum creatinine was 160 micromoles/l four months back and the doctor told us that both her kidneys are small in size but functioning well. Now, her serum creatinine level is 506 micromoles/l and the sodium/potassium levels are within normal range. Her total protein and serum albumin levels are also normal. But in urine test, the albumin shows +++ while the normal is nil. I noticed that her haemoglobin is also low measuring 8.91 g/dl (normal range 11.5-16.5). I do not know what to do. She is doing fine and not complaining about anything. Is there a cause for concern?

A:Your wife has advanced kidney disease, which is progressive. A serum creatinine of 506 micromoles/l suggests roughly a kidney function of 15%. When kidney function is less than 15% and patient has symptoms like loss of appetite, weakness, weight loss, breathlessness, then one requires dialysis or a kidney transplant. It is much better to plan ahead about these modalities for better outcomes.