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Diagnosed with Grade II Renal Parenchymal. Having hypertension. Advised conservative food management. Suggest the treatment?

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Hi, my friend has been diagnoised with Grade II Renal Parenchymal. He has having Hypertension for the past 1.5 yrs. Few days back Renal Biopsy was planned, but cancelled due to unexplained size reduction of the kidney from the normal size by 1.2 cms within 2 weeks. He has been suggested conservative food management by the doctor and nutritionist. The Renal doppler test mentions as Grade II renal nephropathy. Can I know what could be the cause for the kidney condition ? What is the best treatment available ? Is it reversible and what care needs to be taken ?

Please find the discharge summary, while admitted for biopsy, refer to the attachment.
Posted Fri, 27 Sep 2013 in Kidney Conditions
Answered by Dr. Aditya Bhabhe 15 hours later
Brief Answer:
Likely chronic kidney disease

Detailed Answer:
Hi there

Thank you for sending in the query.

After reviewing the history provided and the scanned discharge summary I can provide the following information to your questions:

1) Cause of kidney problems: The patient has hypertension since the last 1 year. His kidneys are small in size and their appearance is abnormal as well. Both these are pointers to a long standing kidney disease. This is called in medical terms as Chronic kidney disease or CKD.

Do you have any creatinine reports over the last 1 year or so? If the creatinine was elevated back then as well, then it confirms our suspicion.

The common causes of CKD are often allergic diseases of the kidney called in medical terms as Chronic glomerulonephritis or chronic interstitial nephritis.
Another cause can be long standing hypertension.

Once the kidney size is small with altered echotexture there is no point doing a renal biopsy. The procedure is risky and the results often do not yield much information.

2) Further line of treatment is aimed at preventing the progression of the disease. We cannot assure of reversibility at this stage. However we do see a few patients having some decrease in the creatinine with conservative management. So we really have to wait and see the effects of the conservative treatment.

3) The following approach is helpful in patients with CKD:
a) Diet: Low salt diet; Moderate protein intake (Need to see a dietician)
b) Avoiding drugs harmful to the kidney like painkillers (Combiflam, brufen, nise etc); certain antibiotics. Your nephrologist can provide the complete list
c) Strict control of blood pressure (below 135/85)
d) Quit tobacco and alcohol use
e) Use of a class of drugs called ACEi or ARB under the strict supervision of a nephrologist.
f) LDL cholestrol <100 mg/dl
g) Regular monitoring of renal function by blood and urine tests.

One of the favorable signs in the reports is 24 hr urine protein ~570 mg. As long as this is <1gm/day the disease is usually slowly progressive.

Hope this was helpful.
Feel free to contact me if you have more questions.

Aditya Bhabhe
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