Brief Answer:
Unable to open reports

Detailed Answer:
Hello

Thanks for the query

Diet is the most important entity when it comes to managing Chronic kidney disease. The diet is simple
1. Salt restriction.
One has to consume less than 3 grams of salt in a day. An average XXXXXXX diet contains 11g of salt, 1 tea spoon contains 2 grams of salt
2. Water restriction.
It is important to take less than 1 litre of water in day
3. Protein restriction
Vegetarian protein and lean meat is allowed. However one has to avoid red meat
4. Weight reduction
It is important to stay within normal weight. I encourage walking daily for 45 min including sundays to maintain a healthy body

I have been trying to open the reports in PDF since last night but unfortunately it is not opening. Please e mail it to me YYYY@YYYY or you could just type the reports while getting back

Regards

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Brief Answer:
Several parameters needs treatment

Detailed Answer:
Hello

Thanks for getting back and typing out the reports

The following issues need immediate attention.

1. Severe iron defieciency

Transferrin saturation should be atleast 20%, 11% is very low. In such situations I correct with parenteral iron over 3 days. I give in Encicarb 500mg for 3 days. This should be followed by oral iron for atleast 3 months

2. High uric acid
Tab Febuxostat 40 mg once a day should reduce the uric acid over next month

3. Uncontrolled sugars

HbA1C is very high. Please make sure correct diabetic diet is followed and I suggest long acting insulin like Inj Insultard at night for better control of diabetes. The aim of HbA1C should be at least below 7. Please speak to an Endocrinologist


As the serum creat is beyond 2, it is customary to meet a nephrologist atleast once in 2 months, preferably once a month. Tab Acigard is most likely to be an ayurvedic tablet, please make sure from the ayurvedic doctor that it is not toxic to the kidneys as some herbal medicines do cause renal impairement.

She must be on ACE/ARB group of tablets. I usually start Tab Enalapril 5mg once a day and titrate it upwards, it is known to protect the kidneys. Please speak to your doctor regarding this.

I hope I was of help, please get back to me for any further doubts

Regards

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Brief Answer:
High phosphorus

Detailed Answer:
Hello

Thanks for getting back

I have gone through the reports attached by you and it looks like the patient has uncontrolled sugars. I recommend increasing the insulin further to 18 units BBF and checking sugar value again after a week. Discuss with your treating doctor before making changes.

It is customary to change lifestyle as explained in my earlier post. Hba1c of 10 is extremely high and it has to be atleast within 7.

Please get back to me with the contents of Acigard.

Regards

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Brief Answer:
Good prescription

Detailed Answer:
Hello

Thanks for getting back


1.The prescription what he has received is ideal. It takes care of anemia, high phosphorus, vit D and uric acid. Please continue this prescription .
The only thing I do differently is I put my patients on Insulin rather than oral diabetic agents. But Galvus (without metformin) can be given in patients with kidney disease
2.Please make sure Sevcar is taken along with food. i.e for example he has to eat a chapathi, take the tablet and then continue to have meals.

3. Laretol 0.25 is a generic drug for calcitriol.

Regards

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Brief Answer:
Anti diabetic measures

Detailed Answer:
Hello

Thanks for getting back with the clarification. What I meant to say was I dont put my patients on tablets for control of sugars, they will only be on insulin. I have seen more episodes of hypoglycemic episodes with tablets than on insulin. I must add here that it is just my preference and not any standard guideline

Regards

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