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When would my friend need to undergo dialysis / transplantation?

Q: My 42 years old friend has been suffering from higher serum creatinine that is from 2.5 to 3 mg/dl for the last a year. His blood urea has also increased from 51 to 78. He is not suffering from diabetes and his blood pressure is well controlled below 130/85 mmHg. Other blood chemistry parameters are within range. He has been diagnosed with chronic renal failure. His kidney biopsy suggests chronic glomerulonephritis probably secondary to tubulointerstitial nephritis. When would my friend need to undergo dialysis / transplantation?

A:Your friend has slowly progressive Chronic Kidney Disease (CKD) signifying less than 25 % of normal kidney function at his age. Eventually, he would need dialysis or preferably a kidney transplant once he has lost more than 85-90% of kidney function or if he starts having symptoms resulting from the failing kidneys (called End Stage Renal Disease, ESRD). It is difficult to foresee the time period before he reaches the stage of ESRD. Instead, focus should be on measures intended to slow the progression of CKD, including strict control of blood pressure and continued avoidance of exposure to kidney toxic medications.

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