The patient should be referred to an appropriate specialist as early as possible. The underlying disease and any abnormalities causing progressive renal damage must be corrected where possible. The management of CRF is based on the team approach involving specialists and paramedical personnel. The patient is usually faced with years of ongoing care so that an empathic support team based around the patient's general practitioner is very important to the patient who will require considerable psychosocial support. Optimum treatment includes:

• regular review

• good blood pressure control (the most effective way to slow progression)

• keeping plasma phosphate levels in normal range

• maintaining effective fluid and electrolyte balance

• prompt treatment of intercurrent illness

• judicious use of drugs

• avoiding treatment errors, especially with drugs o avoid potassium-sparing diuretics o other drugs that may cause problems include digoxin, tetracyclines, gentamicin, NSAIDs, nitrofurantoin and ACE inhibitors

• rapid treatment of complications, especially salt and water depletion and acute urinary infection

• diet: low protein, sodium and potassium

• treating anaemia with human recombinant erythropoietin.

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