What could be the best treatment for a stroke?

Hello doctor,

My cousin has a tingling-type effect on his left side. He was admitted to the hospital three months back, and a lot of investigation was done, but nothing abnormal was found. He was kept under blood thinner. Again after one month, he complained that he was having problems in walking, particularly on the left side of his leg and hand. Other features were normal. Again he was admitted to hospitals, MRI of the brain confirmed that he had a stroke. But the surprise was despite being on blood thinners, he had a stroke. The doctor suggested a CT(computed tomography) scan, angiography, and TRODAT scan, for we had his KFT (kidney function test) profile done, in which we found that his creatinine was 1.5. The nephrologist asked not to go for any CT analysis of the brain and TRODAT scan unless creatinine is controlled. He was given an antacid, and a tablet of Acetylcysteine 600 mg one tablet BD, after two days KFT was repeated. The creatinine was found to be 1.4. After two days KFT was repeated and it was found 1.30. The doctor gave permission to go for a CT brain, angiography, and TRODAT scan. After a gap of two days and scanning, KFT was repeated and it was found 1.2. The doctor has given him only antacids once daily for a month. But after a month, his creatine was found to be 1.27, the doctor advised CUE (complete urine examination) and UPCR (urine protein creatinine ratio). I have attached both reports. After seeing these reports, the doctor advised him to stop antacids and start Telmisartan 40 mg. and review after three months.

His blood pressure was quite stable on these days with a reading of 130/80 mm Hg and pulse- 80/min bpm. The patient did not find satisfaction with the prescription of adding Telmisartan 40 mg and consulted another nephrologist. The doctor was not in favor of adding Telmisartan 40 mg, as the patient is already taking Bisoprolol fumarate 2.5 mg for BP which is stable. He is under the impression that if Telmisartan 40 mg is added, his BP will go down and will create problems for his mental condition. He advised not to add it, he suggested taking an anti-oxidant at night for 30 days, and suggested USG (ultrasonography) of the abdomen or pelvic region. But when they consulted the third nephrologist he suggested using Telmisartan 40 mg and stopping Bisoprolol fumarate 2.5 mg. From the neurological side, he is on the following medicines: Acetylsalicylic acid 75 mg at 2 PM, Rivoraxaban 10 mg at 9 AM, Atorvastatin 20 mg at 10 PM, and Bisoprolol fumarate 2.5 mg at 9 AM.

Doctors have advised him to go for physiotherapy. He has improved a lot and is

almost walking normally now. His other reports are also normal now. I would like to request your advice on the following:

1. As his creatinine is 1.27, does he require any kidney protection tablet for the treatment?

2. Shall we start Telmistran 40 mg, and stop Bisoprolol fumarate 2.5 mg, or we can continue it along with Telmistran 40 mg?

3. But the patient has a doubt if both the medicines are taken simultaneously the blood pressure may fall down but Bisoprolol fumarate 2.5 mg was prescribed by the cardiologist, keeping in view his brain stroke.

4. What is the role of tablet Benfotiamine in a kidney patient?

Your proper suggestion can get them out of this confusion. Please help.

Thank you.