title: Conservative treatment to slow deterioration of renal function: evidence-based recommendations.
abstract: Despite current specific therapy, progressive deterioration of renal function in patients with primary glomerulonephritis occurs. Nonspecific renoprotective interventions that have been studied include blood pressure control, antihypertensive medications, and protein-restricted diets. To prepare this article, a MEDLINE search was conducted, followed by secondary and tertiary searches. Research papers were assessed for level of evidence, and graded recommendations were formulated. Protein-restricted diets (to 0.4 to 0.6 g/kg/day) are not recommended for all patients with reduced renal function (grade A). Very low-protein diets of 0.4 g/kg/day should be considered for patients with severe renal dysfunction (serum creatinine of more than 350 micromol/liter; grade A). However, there are concerns about recommending these diets for all patients because of the potential for long-term negative outcomes such as nutritional deficiencies. Target blood pressure for persons with proteinuria of more than 1 g/day should be less than 125/75 mm Hg [mean arterial pressure (MAP) < 92 mm Hg; grade C]. For persons with proteinuria of less than 1 g/day, the target blood pressure should be approximately MAP 98 mm Hg (less than 130/80; grade C). Angiotensin-converting enzyme inhibitor (ACEI) therapy is recommended in preference to placebo, conventional, or beta-blocker therapy for renoprotection (grade A). ACEI therapy cannot be recommended above calcium channel blockers in patients with nondiabetic renal disease (grade A).
authors.affiliation: Department of Medicine, University of Calgary, Alberta, Canada.
authors.forename: E
authors.initials: E
authors.lastname: Burgess
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D018450:Disease Progression; D019317:Evidence-Based Medicine; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000178:diet therapy* / Q000188:drug therapy*; D017410:Practice Guidelines as Topic
chemical_list: D000959:Antihypertensive Agents; D000960:Hypolipidemic Agents