General practice management is appropriate for patients with early stage renal impairment who are at low risk of progression to end stage renal failure. Investigation of patients is aimed primarily at determining their level of risk, rather than the causative pathology.
- Patients at risk of early renal impairment should be offered annual screening for proteinuria.
- Renal function can be estimated from serum creatinine using the modified Cockcroft-Gault formula.
- Patients with early renal impairment should be advised to stop smoking, take regular exercise and maintain a normal protein intake.
- Nonsteroidal anti-inflammatory drugs and COX-2 inhibitors should be avoided in early renal impairment. ACE inhibitors, angiotensin II receptor antagonists, diuretics and radiological contrast agents should be prescribed with care.
- Strict control of blood pressure and careful management of proteinuria, diabetes and anaemia improve outcomes for patients with early renal impairment.
- Patients with severe renal impairment should be referred promptly to a nephrologist. Referral should also be considered for younger patients or if renal function is declining rapidly, proteinuria is heavy, there is significant comorbidity or treatment targets prove difficult to achieve.