[Diagnostic strategies in kidney disease with chronic renal failure]

Chronic kidney disease affects large numbers of individuals in countries across the world. Recent reports from the United States indicate that 30% of the adult population has a mild or moderate degree of chronic renal failure and more than 600,000 patients are projected to have end-stage renal disease by the year 2010. Similar elevated rates have been reported in Europe, Asia and Australia. Optimal management of chronic renal failure is mandatory. It requires a correct diagnosis of the underlying nephropathy and specific strategies to slow the progression of renal damage and to prevent cardiovascular events. The differential diagnostic approach to chronic renal failure consists of serologic studies, renal biopsy, and urinary tract imaging, which, however, may exacerbate the pre-existing nephropathy or have severe adverse effects. The challenge for the nephrologist is to balance the need to correctly identify chronic nephropathy against the risks related to aggressive diagnostic procedures. In order to optimize the diagnostic strategies in patients with chronic renal disease, consensus guidelines will be needed.