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What precautions should I take to protect my kidneys?

Q: I am 57 years male with 15 years history of gout. Also for last 5 years I am suffering from hypertension. In August 2004 I was detected for chronic renal disease. GFR was 66.4 at that time. Since then I have been periodically testing various parameters and they are as follows:

  • Serum creatinine fluctuating between 1.5 to 2.2 (ref. 0.8 to 1.5)
  • Serum urea fluctuating between 58 to 92 (ref. 15 to 40)
  • Potassium fluctuating between 4.6 to 5.9 (ref. 3.5 to 5.5)
  • Uric acid fluctuating between 4.6 to 7.7 (ref. 2 to 7)
  • I am controlling uric acid by diet and medication. Also I am on low potassium diet. I used to smoke 2-3 cigarettes a day but stopped completely from 3 years back. I take two small pegs of whisky once a week. I take 30 minutes of brisk walk every evening. My health is otherwise fine and I have no symptoms of chronic kidney disease like swelling of feet, reduced urine output etc. except a bit of tiredness. My blood pressure is maintained at 140/85 mmHg. My questions are what medicine should I take to control BP? Why do the values of creatinine and urea keep fluctuating? I was told that ACE inhibitors or ARBs slow down kidney damage while controlling BP. Is it advisable for me to take them considering my tendency for higher potassium? Can my kidneys be saved and what further I should do for the same? How long before I have to go for dialysis?

    A:You should ask your doctor about ACE inhibitors / ARB. I think it should be added to control your blood pressure and it should also help you to slow down the kidney damage. You obviously need to monitor potassium. Use a diet low in potassium (avoid dry fruits, fruit juices, soups, chocolates, green leafy vegetable). Also boil all vegetables and throw the water and cook them again (this leaches potassium out). The co-efficient of variation for creatinine is 15-20 % and thus there are variations in tests. Urea is also affected by water content & various factors. Dialysis is required when kidney function is less then 10-12 % (eGFR 10 ml/min), your current eGFR is (35 ml/min). If you control you blood pressure to 120/80 mmHg and there are no other aggravations like infections or drugs then it could be many years before you might require dialysis.

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