Brief Answer:
Diabetic nephropathy

Detailed Answer:
Hello

Thanks for the query

I understand your concern about the raised creat. Here is what you should do

1. First and foremost diabetic related kidney damage has to be confirmed. I would want him to undergo eye check for retinopathy ( diabetes usually damages retina before the kidneys ), get a urine routine done followed by an ultrasound scan to look for size and texture of the kidneys. This will help us locate any reversible causes for increase in creat

2. Shifting him to insulin is an excellent idea at this point. This will prevent hypoglycemic attacks

3. Retarding the progression of the kidney disease can be done by the following way
i. He will need to be on ACE/ARB tablets. I usually start tab telmesartan, it has to be given at the dose most tolerated by him making sure his potassium and blood pressure is under control

ii. He will have to be on sodabicarb replacement
iii. Phosphorus should be under check as well
iv. infections especially urinary tract infection should be treated and prevented as much as possible
v. His blood pressure and diabetes should be under good control

If the above things are done he might progress onto dialysis in maybe 5 years from now. However progression is very subjective and cant be predicted accurately

I am sure you will have many doubts, please get back to me for any further queries

Regards

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Brief Answer:
Iron profile needs to be done

Detailed Answer:
Hello

Thanks for attaching the report. I have gone through them and also the treatment details.
Here are my interpretations

1. There is anemia ( low hemoglbin) which is expected in patients with chronic kidney disease, i recommend you to get a iron profile done. He will require replacement with either Intravenous iron or oral supplementation
2. He is receiving correct treatment for it. However for Vit D i suggest Tab Calcitriol instead of the cholecalciferol. Tab Calcitriol popularly comes as Laretol 0.25, it has to be taken daily
3. In the next check up please get phosphorus and calcium levels as well


I hope I was of help, if you have any further queries please get back to me

Regards

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