How to prevent progression to end stage renal disease.

Chronic kidney disease (CKD) and end stage renal disease (ESRD) are severe medical conditions, increasing threats to human health and socio-economic burdens in industrialized countries. CKD is assessed by an estimation of the glomerular filtration rate (eGFR). ESRD is an indication for renal replacement therapy by either dialysis or kidney-transplantation. Major risk factors for CKD are arterial hypertension, hyperglycemia and hyperlipidemia. The multifactorial pathogenesis of CKD and ESRD offers various therapeutic interventions: treatment of the underlying disease, anti-hypertensive therapy, glycemic control and anti-diabetic therapy, anti-proteinuric therapy, renoprotection, and life style management. Angiotensin converting enzyme inhibitors (ACE-I) and angiotensin II receptor blockers (ARB) lower the systemic blood-pressure, reduce proteinuria and may slow or even halt the deterioration of renal function. Alert glycemic control is important to avoid or protract diabetic nephropathy. Restricted protein intake, cessation of cigarette smoking and chronic analgesic-abuse may also prevent the progression of chronic nephropathy.