Identifying and slowing progressive chronic renal failure.
OBJECTIVE
To help inform primary care physicians about how to identify and slow progressive chronic renal failure.


METHODS
The National Library of Medicine (1996 to 2000) was searched using PubMed with search terms pertinent to studies on identification, course, and management of chronic renal failure. References in retrieved papers and older literature known to the authors supplemented the searches. In general, sufficient high-quality studies, systematic reviews, or guidelines based on such evidence were available to support our main points.


RESULTS
End-stage renal disease (ESRD) poses a large and growing morbidity, mortality, and financial burden. Almost all patients reach ESRD as a result of chronic progressive conditions, particularly diabetic nephropathy, hypertensive-vascular renal disease, and glomerular disorders. Patients at risk merit regular renal assessment with serum creatinine tests and urinalysis. Persistent high blood pressure and heavy proteinuria are the strongest predictors of progression of chronic renal failure. Patients with renal disease should be examined and treated for vascular disease and vice versa. Blood pressure lowering, ACE inhibition, and avoidance of further renal insults (such as use of nephrotoxins) can slow the decline of renal function. Restricting dietary protein has a weak effect on slowing renal failure and is not easy to apply in primary care. Timely involvement of specialized nephrology teams is important.


CONCLUSIONS
Family physicians play an important role in recognizing patients with potential for renal failure, in demonstrating progressive chronic renal failure, and in initiating therapy early to improve outcomes.
Curtis
B
B
Division of Nephrology, St Paul's Hospital, Vancouver.
Barrett
B J
BJ
Levin
A
A
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D003404:Creatinine / Q000097:blood; D003928:Diabetic Nephropathies / Q000150:complications*; D003937:Diagnosis, Differential; D004044:Dietary Proteins; D018450:Disease Progression; D005194:Family Practice; D006801:Humans; D006973:Hypertension / Q000209:etiology; D006977:Hypertension, Renal / Q000150:complications*; D007676:Kidney Failure, Chronic / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology; D008511:Medicine; D010347:Patient Care Planning; D010819:Physician's Role; D011507:Proteinuria / Q000209:etiology; D012307:Risk Factors; D013038:Specialization; D016482:Urinalysis
D000959:Antihypertensive Agents; D004044:Dietary Proteins; D003404:Creatinine