[Chronic renal failure: when do patients need a nephrologist?]

Renal insufficiency is a fairly frequent problem, whether it is due to a kidney disease per se or to an extrarenal disease or to a combination of both. In contrast, chronic renal failure requiring renal replacement therapy is a rare condition in the practitioner's office. Considering this, the question is important to the practitioner, when in the course of the disease there is need for referral to a nephrologist. In this context two main questions have to be raised: first, is the disease curable or at least partially reversible (depending on the etiology of the renal disease) and second, when has the time arrived to prepare the patient for a renal replacement therapy. The cooperation with a nephrologist has to be sought early enough in order to choose the best moment for these actions. There are several European and American studies dealing with these problems and proving the benefit of a timely referral and a timely start of treatment. We extract some of the relevant data considering own data collected at the University Hospital of Berne (Inselspital), Switzerland.