RECOGNITION AND MANAGEMENT OF REVERSIBLE RENAL-FAILURE

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.