Nephrologists and doctors generally follow a nine step program in terms of medical management of chronic kidney disease.
Step one: manage the primary etiology of the patient
This involves identifying and treating the primary underlying conditions including: diabetes mellitus, high blood pressure, urinary tract infection or obstruction, glomerulonephritis, renovascular disease, analgesic nephropathy, etc
Step two: Formulate strategies designed to retard the progression of chronic kidney disease
These include strictly controlling blood pressure, and giving the patient medicines to block the production of angiotensin. These include: ACE inhibitors, or angiotensin receptor blockers (ARB II blockers). The patients are also advised to restrict the amount of protein they consume daily, and go on a therapy to reduce their lipid levels and to correct any anemia problems they may have.
Step three: Supportive and symptomatic treatment
Supportive and symptomatic treatment consists of a plan in which the patient is given a water pill (also referred to as a diuretic) to increase daily urine volume and output, and to reduce swelling. The patent is also given medicine designed to control nausea, vomiting, and gastric discomfort. The doctor will prescribe calcium, phosphate binders, and an active form of Vitamin D in the form of vitamin supplements to prevent and correct bone disease caused by chronic kidney disease. The doctor will prescribe iron and vitamin supplements, and erythropoitein injections to address any low hemoglobin issues the patient may have. The doctor will also prescribe a daily dose of aspirin to prevent heart problems from developing, unless the patient is contraindicated.
Step four: Management of reversible factors
Doctors search for and treat those factors which may have worsened the degree of kidney failure. They may be able to reverse the kidney failure somewhat by this measure, and they may even be able to improve overall kidney function to a more stable level. The common causes of kidney failure which can be reversed are: fluid volume depletion, medicines (non steroidal anti-inflammatory medicines, NSAIDs, contra agents, aminoglycosides, and antibiotics), infection, and congestive heart failure.