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It is estimated that 3 million Americans will have chronic renal failure by the year 2008. Diabetes and hypertension account for two thirds of persons with chronic renal failure. Other high-risk patients include those with chronic glomerulonephritis or a family history of renal disease. High-risk patients should be screened with quarterly blood pressure measurements, and annual urinalysis, serum creatinine and 24-hour urinary microalbumin measurements. McCarthy reviewed the literature on managing chronic renal failure and developed a helpful mnemonic, "BEANS," to help physicians remember the steps that should be taken in at-risk patients to slow the progression of renal disease.
Blood Pressure Control. Blood pressure should be reduced to 130/85 mm Hg in patients with renal disease. The blood pressure should be no more than 125/80 mm Hg in patients who have more than 3 g per day of protein in their urine. Angiotensin-converting enzyme inhibitors are the preferred antihypertensive therapy in patients without hyperkalemia and...