PREVENTING DISEASE PROGRESSION IN CHRONIC-RENAL-FAILURE

Progression toward end-stage renal disease is usually inexorable in pa tients with diabetic and nondiabetic nephropathy. These patients can b e identified at an early stage based on history, abnormal urinalysis o r reduced glomerular filtration. Recent advances have made it possible to slow the progression of chronic renal failure. Major interventions include antihypertensive therapy, dietary protein restriction and, in patients with diabetes, strict glycemic control and angiotensin-conve rting enzyme inhibitor therapy. Collaboration with a nephrologist carl help guide the family physician in the appropriate use of these modal ities and help avoid common complications, Major efforts in slowing th e progression of renal failure may lead to a decreased incidence of en dstage renal disease, with savings in morbidity, mortality and cost.