### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
HELLO DR. I AM CONCERNED ABOUT MY MOTHERS HEALTH AS SHE HAS BEEN DIAGNOSED WITH CHRONIC KIDNEY DISEASE WITH GLOMERULAR FILTERATION RATE AS 21 AND SERUM CRETININE IS 3.2 .ONE MONTH BACK THE SERUM CRETININE WAS 2.4 AND A WEEK BEFORE IT WAS 2.9 AND NOW IT IS 3.2.SHE HAS HIGH B.P 130/90 AND SHE WAS ADMITTED IN HOSPITAL BECAUSE SHE FAINTED.SHE USED TO HAVE MUSCLE CRAMPS AS WELL.WHAT WOULD YOU SUGGEST TO LOWER DOWN HER SERUM CRETININE AND WHETHER THIS IS THE STAGE FOR DIALYSIS

### output:

DEAR OVERTHINKS FOR WRITING AT HIM UNDERSTAND YOUR CONCERNS HAVE SEEN MANY PATIENTS OF CKD. THOUGH THE TREATMENT OF CKD BY MEDICATIONS ALONE IS DIFFICULT BUT MEDICATIONS HELP TO MAINTAIN A CONSTANT LEVEL OF SERUM CREATININE.BUT NOT IN ALL PATIENTSKIDNEY TRANSPLANT IS THE ULTIMATE TREATMENT BUT IF NOT POSSIBLE DIALYSIS HEREABOUT YOUR QUESTION REGARDING WHEN TO DO DIALYSIS IT IS ASSESSED BY YOUR NEPHROLOGIST DEPENDING ON CLINICAL SITUATION AND NOT ON GREAT LEVELSUSUALLY It's DONE WHEN YOUR NEPHROLOGIST SUSPECT METABOLIC ACIDOSIS, IF EDEMA IS NOT GETTING TREATED WITH MEDICATION, IF THERE IS INCREASE IN GREAT NOT CONTROLLED BY MEDICATION SUGGEST THAT YOUR MOTHER AVOIDS EATING FRUITS AND ALSO TALK TO YOUR NEPHROLOGIST HE CAN HELP EUROPE I ANSWERED SOME OF YOUR QUERIES. YOU CAN MESSAGE ME FOR ANY OTHER CONCERN