[How to slow the progression of chronic renal insufficiency].
In patients with chronic renal failure, three kinds of treatments can slow the progression of renal insufficiency: optimal control of blood pressure; use of converting enzyme inhibitors; low-protein diet. The MDRD study strongly suggests that blood pressure should not be higher than 130/85 mmHg in patients with chronic renal failure, and than 125/75 mmHg in patients with chronic renal failure and proteinuria above 1 g/d. Converting enzyme inhibitors have been shown to be beneficial to patients with IDDM and either microalbuminuria or overt diabetic nephropathy and to patients with chronic renal failure and proteinuria above 1 g/d. A diet containing less than 1 g/kg/d of proteins should be prescribed to patients with chronic renal failure, and this protein content should be lowered to 0.75 g/kg/d (or to 0.60 g/kg/j in some cases) when creatinine clearance falls below 25 mL/min.
Rossert
J
J
Service de néphrologie B, Hôpital Tenon, AP-HP, Université Paris-VI et INSERM U 489, 75020 Paris. jerome.rossert@tnn.ap-hop-paris.fr
Ronco
P
P
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D003404:Creatinine / Q000378:metabolism / Q000652:urine; D004032:Diet; D018450:Disease Progression; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D007676:Kidney Failure, Chronic / Q000473:pathology* / Q000517:prevention & control; D011507:Proteinuria / Q000209:etiology
D000806:Angiotensin-Converting Enzyme Inhibitors; D003404:Creatinine