Clinical management of early progressive renal failure.

In the era of managed health care, the primary physician will be required to play an active role in the management of patients with early renal failure. This section provides a comprehensive and practical approach to the management of such patients. Early recognition of renal failure and monitoring its progression require an understanding of the pitfalls of commonly used diagnostic tests. Tight control of hypertension, angiotensin-converting enzyme inhibition, and dietary protein restriction play important roles in delaying the progression of renal disease. Avoidance of additional renal insults such as nephrotoxic drugs and radiographic contrast prevents acceleration of renal demise. A variety of clinical manifestations, including dyselectrolytemias, hypertension, malnutrition, secondary hyperparathyroidism, and anemia may develop in patients with early renal failure. Timely referral to a nephrologist will facilitate planning for renal replacement therapy and may favorably affect eventual outcomes.