Progressive renal failure.

Abstract

Blood pressure control is important and lower target values are required in those with proteinuria. ACEI are suitable agents provided the doctor is aware of the risks of renovascular disease in the elderly. Renal function should be checked after two weeks treatment; deterioration calls for cessation of ACEI treatment and investigation for renal arterial disease. Low protein diet should not be used routinely but high protein diet should be avoided. If a highly motivated patient wishes to try protein reduction in case it is beneficial, no less than 0.6 g protein/day should be prescribed. The patient must be reviewed regularly by a specialist dietitian who can check nutritional state. Regular medical follow-up is essential; it has been shown to slow progression of renal failure probably because patients become more compliant with therapy, particularly antihypertensives. When should this follow-up be transferred to the renal unit? Studies from many countries have shown that late referral and/or emergency first dialysis are associated with substantially increased mortality and morbidity. Patients in whom the primary diagnosis is in doubt should be seen early; those in whom the cause is known, conservative treatment in place and without uraemic symptom should be transferred by the time the serum creatinine reaches 300 mumol/l.