hi thanks for posting in HCM I have understood your concern 1.first diagnosis of kidney disease in 2006 but you have not mentioned about the cause of kidney disease at that time whether it is because of diabetes or hypertension or any other causes. there are so many causes to aggravate the kidney disease like 1.uncontrolled diabetes 2.uncontrolled hypertension 3.use of NSAID group of pain killers 4.use of nephrotoxic antibiotics 5.uncontrolled diet 6.urinary tract infection 7.bladder outlet obstruction some patients response to the medications is not complete. we can t blame neither doctor nor patient. I can suggest you to get done 1.hemogram 2.urine routine and culture 3.USG abdomen and pelvis 4.arterial blood gases 5.cardiac evaluation with ECG and ECHO she is in a situation that she needs renal replacement therapy like 1.hemodialysis or 2.peritoneal dialysis or 3. kidney transplant hope this helps you any further questions please let me know thanks