Dextromethorphan and Silymarin in Chronic Kidney Disease (CKD) Patients

Inclusion Criteria: 1. Patients with Stage 3 or 4 chronic kidney disease as measured by a Modification in Diet in Renal Disease Study (MDRD) estimate of between 15 ml/min and 59 ml/min and and 0.5 g/day\<proteinuria\<3g/day. 2. Age between 18 and 75 years old. 3. Patients without hospitalization for cardiac or infection related morbidity over the previous 2 months(due to the potential confounding effects on baseline study variables). 4. Patients who are able to provide consent to participate in the study.- Exclusion Criteria: 1. patients will significant mental illness, pregnant women, and other vulnerable populations. 2. Patients with active hepatic disease and/or ALT \> 2.5 times upper limit of normal. 3. Patients with history of congestive heart failure and NYHA Class III-IV symptoms at any time. 4. Patients for whom living donor renal transplantation is already scheduled or in the process of being evaluated, as these patients will be unlikely to complete study protocols before transplantation. 5. Patients with severe co-morbid conditions (eg, symptomatic hepatic cirrhosis, metastatic cancer, HIV infection with AIDS). 6. Patient with active inflammatory process (eg., SLE, rheumatoid arthritis, gout) for which they are currently receiving immune modulating medications. 7. Patients who are on corticosteroid therapy. 8. Patients who do not consent to participate in the study.