Hi, After going through your father s case- Possible causes for kidney problem are- 1) Long standing diabetes and blood pressure. 2) Prostatomegaly may have aggravated the kidney problem. In CKD stage 4 treatment depends on - 1) Daily urine output. 2) Signs of water retention (fluid overload) - removing extra water from body is a important function of kidney. 3) Level of substance like various electrolytes (mainly potassium high level of which are not good for heart), acids (which can be known from blood gas test). 4) Associated heart condition. I would like to advise you to consult nephrologist. Till that time - 1) Restrict daily water intake to 1 liter per day. 2) Good nutrition with adequate veg proteins. 3) Strictly monitoring and control of blood sugar level, blood pressure and cholesterol. 4) Following test will play important role in decision making - - Serum electrolytes, calcium, phosphorus, uric acid. - Arterial blood gases (ABG) - Ultrasonography of kidneys. - 2DEcho of heart. - Urine examination for infection and protein loss. If prostatomegaly is associated with significant obstruction to the urine flow and causing back pressure changes on kidney, some improvement in kidney function may be possible with releaiving obstruction. He may require dialysis. Though final decision will be taken by Nephrologist.