This review will address five selected conditions associated with vari
able degrees of renal insufficiency or renal failure. Early diagnosis,
usually possible in the office setting, should encourage early treatm
ent and/or referral that will be rewarded by substantial improvement o
r return of normal renal function. Hypertensive nephrosclerosis, parti
cularly among black Americans, is now the second leading cause of end
stage renal disease (ESRD) in the United States. Aggressive treatment
of hypertension can prevent progression to rend failure, Obstructive u
ropathy is relatively common at all ages; if not corrected, it can pro
gress insidiously, often without symptoms, to destruction of a kidney.
Glomerulonephritis may involve the kidneys primarily or in associatio
n with a multisystem disorder. Early renal biopsy will help establish
the pathologic diagnosis and guide subsequent therapy. The kidney is v
ulnerable to the nephrotoxic effects of numerous pharmacologic agents
used commonly in the diagnosis and treatment of illness. Potential nep
hrotoxicity to a given class of agents must be recognized if progressi
ve nephrotoxicity is to be avoided. Finally, the frequency of occlusiv
e renovascular disease and ischemic nephropathy is on the rise as the
US population increases in age. Several interventions are available fo
r the treatment of ischemic nephropathy and for the prevention of ESRD
associated with bilateral renal artery occlusion.