Practical management of chronic renal failure.

Initial evaluation of patients with chronic renal failure demands a careful search to exclude reversible causes such as dehydration, obstruction and nephrotoxins. Subsequently, strict management of sodium and fluid intake is necessary to avoid either dehydration or congestive heart failure. As renal failure advances, restriction of dietary protein and potassium and binding of phosphate are indicated. Referral to an end-stage renal disease center should be accomplished early, before and appearance of uremic symptoms, to facilitate a smooth transfer to the next phase of rehabilitative therapy.