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What is the treatment of chronic renal failure?

Q: My father (74 years old) is suffering from chronic renal failure. Lasix 10 tab a day is prescribed; will it further damage the function of kidneys? Haemodialysis is not preferred. Please advise. The medical history summary is that he has hypertension (since 34 years); with prostatic hypertrophy; obstructive uropathy; chronic renal failure; cellulitis lower limb. Investigations show that - Hb: 8.0 g/dl; TLC: 11,100 cu. mm. DLC: N:75% L:25%; ESR: 70 mm/hr; PLT: 4,06,000/cu. mm; RBS: 95 mg/dl; B. Urea: 159 mg/dl; Creatinine: 8.5 mg/dl; T. Bilirubin : 0.2 mg/dl; SGOT: 7 IU/L; SGPT: 5 IU/L; ACP: 109 IU/L; T. Protein: 6.9 g/dl; S. Albumin: 2.8 g/dl; S. Globulin: 4.1 g/dl; Sodium: 117 mEq/L; Potassium: 5.0 mEq/L; S. Calcium: 8.1 mg/dl. S. Inorganic phosphate: 8.4 mg/dl; S.C3: 138.7 mg/dl; S.C4: 31.3 mg/dl; HIV, HBsAg & Anti HIV: -ve. The ultrasound of Abdomen: Rt. kidney: 8.6 x 3.9 cm, smooth surface; Lt.Kidney: 7.6 x 3.6 cm, no scarring; increased cortical echogenicity with pressed CMD. Cortical thickness: 6 mm; Parenchymal thickness 12 mm; No hydronephrosis or calculi; Parenchymal thickness: 14 mm, increased cortical echogenicity with preserved corticomedullary differentiation. No hydronephrosis or Calculi. Post voidal residue 40 ml. Prostate 50 gms. Pulse rate 68/min. He has normal cardiovascular system, normal nervous system, normal respiratory system. The case was continuos under review since 1999 when the patient had post-infective glomerulonephritis which was fully recovered with creatinine level 1.6 mg/dl. During the present condition he had infection in the left limb (infected eczema) subsequently treated with antibiotics. During in the hospital the Creatinine level had shot up to 13.2 mg/dl. Treatment: Conservatively with diuretics, antibiotics & their supportives. He is taking Lasix 40 mg (5-5-0); Catapress 150 mg(1-1-1), Amlodipine 5 mg (1-0-1), Becosules (1-0-0), T. Sparflox 200 mg (1-0-0 x 7 days), Cap. FEFOL (1-1-1). The clinical symptoms show pedal oedema, facial puffiness; urinary infection since Foley's catheterisation removed at discharge (antibiotic T. Ofloxacin 200 mg prescribed). Please help?

A:In the face of chronic renal failure and the preference of not being on haemodialysis, one of the few ways to get maximum out of the remaining kidney function is to give LASIX. Lasix itself, under this particular circumstance, is not harming the kidneys. However, taking 10 tabs a day will possibly have certain other side effects, most notably on ears and hearing ability. So, I shall recommend to bring down the dose to 3-4 tabs twice a day instead of 5 tabs twice a day unless patient has trouble breathing all the time. Also, it appears patient is severely anaemic due to renal failure. It may be advisable to correct anaemia using Erythropoietin Injections under skin once a month to once in two weeks (considering its high cost) this will help relieving many (if not all) symptoms described herein like weakness and tiredness.


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