Hello XXXXXXX

Thanks for writing in,

Diabetes is a multisystem disease where 50% of diabetic patients may have kidney involvement. One of the early sign of kidney involvement is protein/albumin in urine. If left untreated these patients start developing fall in glomerular filtration rate (GFR after 10 years and another 10 years before the patient reaches End stage kidney disease.

But there are lot of factors which can influence the rate of renal failure. They include:
1. Uncontrolled blood pressure. Target blood pressure under 130/70. Your current BP seems OK.
2. Uncontrolled sugar. Glycosylated hemoglobin (Hba1C) needs to be monitored frequently and it needs to be kept under 6.5%. Your current sugar levels seem fine, but I would be pleased if your Hba1c level is also fine.
3. Smoking - increases rate of damage by 10 times faster.
4. Cholesterol - keep LDL cholesterol <100mg/dl
5. Treat urine infections early.
6. Use of Pain killers- like diclofenac, ibuprofen needs to be restricted if not avoided.
7. Do not take any medications over the counter. Discuss with a doctor if they are nephrotoxic.
8. Restrict/avoid non vegetarian diet.

From the above list, I hope you can see that you are doing fine your age is not mentioned though.
In any case you should not be disheartened. 30% patients revert to normal protein excretion after treatment. Another 30% stabilize and the others have progressive disease. Generally it takes three to 6 months to see response.

So do not worry. Avoid bad influences and continue to live normally.

Hope this helps. Let me know if you have any other queries.

Regards

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Hello XXXXXXX

I must inform you that even anxiety and tension can worsen proteinuria. So relax and do not worry.

I would suggest that:
- Your Hba1c can improve further - get in touch with doctor and keep sugar monitored.
- If you are taking non-veg food, take only one or two pieces once a week. Do not test your urine sample the morning after the non-veg intake
- Cholesterol medicine is fine.

Other treatment is going fine. As I have answered earlier effect on proteinuria is visible after 3 to 6 months. Keep in touch with your nephrologist.

Hope this helps. If you have any more queries, feel free to ask.
If all your queries are answered, please close this discussion.

Regards,

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Dear XXXXXXX

You should first understand that you are perfectly normal. Human body may have some damage, but life goes on normally. For example, you are diabetic, so you have to take diabetes medicines for long time. But this should not stop you from leading a normal life. Similarly with kidney disease you should be able to lead a normal life. The society attaches a lot of stigma to "Kidney disease" but is not true. So please relax yourself.

Cardace is a good medicine for proteinuria and yes protein in urine is a sign of kidney disease. But as I told you it can improve with treatment.

Common side effect or Cardace (Ramipril) is on serum keratinise and potassium levels. This has to be monitored during regular OPD visits. Please follow up with your doctor regularly.

A patient in your disease profile should XXXXXXX the doctor once in 2 months and rest of the things will fall into place. So don't get disheartened at all, and continue your life normally.

Don't worry,

Hope this helps. Let me know if you have any further concerns.

Regards

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Hello XXXXXXX

Thanks for the query.

With presence of microalbumin you already have a nephropathy, but moving on to next stage which is "OVERT nephropathy" will take at least 5 to 10 years. If the risks persist, kidney function is expected to drop after another 10 years.

- The weight loss is Ok; no problem with it.

- Sweating after eating is a feature of autonomic disturbance. So do not worry. But at the time of sweating please do blood sugar levels once or twice to rule out low blood sugars.

- Microalbumin may or may not come to normal range and you are already on treatment for the same. In addition I have already listed the measures which regulate microalbumin- including avoiding nonveg, better control of BP and sugar.

- We cannot completely avoid kidney problem; but we can control it with medicines. So for now, do not worry about future kidney problems and strictly consider the measures which I listed earlier.

Hope this answers all your queries.

Regards

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Hi,

Nimesulide should be avoided. Instead we can use paracetamol(crocin) or tramadol

Kindly test TSH (thyroid stimulating Hormone) to rule out hypothyroid which is generally associated with renal disease. This could be one of the causes of sleepiness. Serum sodium level should also be seen - if it is low, it can cause sleepiness.

Mild darkness in urine colour is generally of no clinical relevance.

If your BP is above 130/80 an attempt can be made to increase the dose of car dace but this should be done under strict guidance of your nephrologists.

Hope this helps.
If all your queries are answered satisfactorily, please close this discussion.

Regards

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Hi XXXXXXX
I am sorry for the delay i was travelling.

Water - you can can take upto 1.5 to 2 litres/day
Protein - take 0.7gm/kg/day, amounts to 40 -50 gm/day. You can take all vegetarian protein but restrict non veg to once a week. avoid palak and sarson in diet
All other south indian food products can be eaten but with less salt
Carbohydrates - should avoid free sugar containing food stuffs like rice and potato
Avoid fruit juices
Avoid tobacco products
Decrease salt in diet
You can definitely go on holidays
Hope this answers your query


take care,

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