[How to prevent the complications of chronic renal insufficiency]

The early diagnosis of renal disease and the treatment of its potential complications are mandatory to postpone end-stage renal failure. The serum creatinine level and its derived Cockcroft's index which allows estimate of glomerular filtration rate, is the variable upon which relies the medical strategy. To slow down the progression of renal insufficiency, both the cause of renal disease and its consequences on hemodynamics and metabolic regulations must be treated. The impact of protocols combining appropriate dietetic recommendations and drugs are well documented to treat hypertension and malnutrition. For metabolic disturbances and anemia, at least before end-stage failure, preventive protocols are less well established. Nevertheless, the renal patient must be educated and prepared for dialysis and renal transplantation since the early beginning of renal insufficiency. He must be immunized against HBV and harboring a functional arterio-venous fistula for those allocated to hemodialysis.