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

### input:
My daughter has diabetes, uses the insulin pump, also has high blood pressure, takes meds to control this, and her kidney is not functioning properly. My concern is her kidney. How can she prevent further damage to her kidney? I understand she was under certain meds her initial primary doctor (now resigned) had placed her on. Her kidney specialist has taken her off all the meds effecting her kidneys in attempt to reverse any kidney damage? Is there hope here? My questions,.. What happens next in what order if her kidney do not get better? Is there anything she can do now to reverse any kidney damages?

### output:

Hi, In your daughter case there is high possibility of CKD (chronic kidney disease). Chronic Kidney Disease (CKD) is due to persistent underlying disease like diabetes, uncontrolled high blood pressure. Staging of CKD is done by estimating glomerular filtration rate (GFR). For calculation of GFR following factors taken into consideration-1) Age and gender.2) Weight.3) Serum creatinine level. I want to know-1) Her age.2) Height & weight.3) Duration of diabetes.4) Any heart disease.5) Habits like smoking, alcohol.6) Her diabetes control (fasting, postprandial blood sugar level, HbA1c).7) Her blood pressure control for her blood pressure target is below or equal to 125/75.8) Lipid profile.9) Current kidney function test profile (serum creatinine, blood urea, electrolytes, calcium, phosphorus, uric acid, urinary protein level, ultrasonography of kidneys - size, shape, echo, cortico-medullary differentiation).10) Blood acid levels by doing - Arterial blood gas (ABG).11) 24 hours urine volume.12) Symptoms like breathing difficulties, puffiness of face, swelling over body. Treatment of CKD is to prevent or to slow the process of deterioration of kidney function. It requires-1) Diet with adequate vegetarian proteins.2) Control of Diabetes, blood pressure, cholesterol.3) Avoidance of nephrotoxic food and medicines like pain killers4) Water intake needs to restrict if there is tenancy to retain water.5) Low Potassium intake (avoid intake of fruit and fruit juices, coconut water) in case there is potassium retention in body.6) Maintain calcium, phosphorus, uric acid levels under control.7) Avoid smoking, alcohol. 8) Screening for complication on heart.9) Proper treatment of acute illness using medicines safe Chat Doctor. 