Q: I am suffering from chronic renal failure. My right kidney was removed 13 years back. At present, my creatinine is 4.1, potassium is 4.2, BUN is 28. I am taking following medicines: Amlopin, Laxis 40, Sodamint and Sandocal 500 and Mini pressx. I am on a 30 grams protein and low potassium diet. Kindly suggest any precautions and the present status of my kidney?

A:The management plan including the measures to delay the progression of your chronic kidney disease (CKD) depends on the stage of your kidney disease and any other accompanying medical conditions you may have. Based on the limited laboratory data and medical history information provided and assuming that your baseline serum creatinine level is 4.0, you probably have less than 25% of the normal kidney function at your age. This does signify advanced kidney disease. Hence the management plan will include: 1. Exercising a good blood pressure (BP) control with a target goal of less than 130/80 mmHg. This can be achieved by strictly monitoring your BP at home with a combination of current medications you are on and life style modifications. The latter includes regular exercise and a change in your diet, namely a low salt diet. Strict compliance with a low salt diet is as effective as taking one additional blood pressure lowering pill. Among the blood pressure medications, you may benefit from the addition of medications called angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs). Studies have shown that these medications help to delay the progression of your kidney disease usually via the reduction of protein leakage in the urine and also reduce the risk of cardiovascular disease. 2. Treating complications arising out of the current stage of your kidney disease, namely anaemia and bone disease. You definitely need to closely monitor your haemoglobin and may become a candidate for erythropoietin (EPO) hormone injection, whose production is hampered at the current stage of your kidney disease, and iron supplements depending on the severity of anaemia. EPO however is a relatively costly treatment. Regarding the onset of bone disease known to be prevalent at the current stage of CKD, you may need to limit the amount of high-phosphorous foods in your diet, take a type of medication called phosphate-binder with your meals and snacks and take a form of vitamin D. 3. Avoiding all potential kidney toxic medications. This includes all non-steroidal anti-inflammatory pain medications like Voveran, Brufen & Nimulid, and consumption of which should be avoided especially on a continuous basis. 4. Dietary modifications including 30-40 gms of protein daily and low potassium diet as prescribed in your case in addition to the above mentioned modifications. 5. Managing high serum cholesterol level if you suffer from hypercholesterolaemia, which can be diagnosed by testing fasting lipid panel. You need to see a nephrologist if you haven't seen one already since besides helping manage your CKD, she or he can provide you with the information about various treatment options namely dialysis and kidney transplant, should you progress to end stage renal disease (ESRD).