CLINICAL MANAGEMENT OF EARLY PROGRESSIVE RENAL-FAILURE

In the era of managed health care, the primary physician will be requi red to play an active role in the management of patients with early re nal failure. This section provides a comprehensive and practical appro ach to the management of such patients. Early recognition of renal fai lure and monitoring its progression require an understanding of the pi tfalls of commonly used diagnostic tests. Tight control of hypertensio n, angiotensin-converting enzyme inhibition, and dietary protein restr iction play important roles in delaying the progression of renal disea se. Avoidance of additional renal insults such as nephrotoxic drugs an d radiographic contrast prevents acceleration of renal demise. A varie ty of clinical manifestations, including dyselectrolytemias, hypertens ion, malnutrition, secondary hyperparathyroidism, and anemia may devel op in patients with early renal failure. Timely referral to a nephrolo gist will facilitate planning for renal replacement therapy and may fa vorably affect eventual outcomes.