The Treatment of Reversible Uremia *

Few clinical problems tax the ingenuity, judgment, and patience of the physician as much as does the treatment of the patient with renal decompensation. The inexorably downhill course of patients in the terminal stages of chronic glomerulonephritis is well known. It has been summed up in the words of Page: "It is, I think, a therapeutic achievement when the patient walks into the hospital and dies a few days or weeks after admission."' Perhaps understandably, the attitude of the physician called upon to treat such a patient is often tinged with hopelessness and resignation. It is not widely enough appreciated that even in a patient with advanced nephritis, renal decompensation can be at least partially reversible. Far from being standardized or consisting chiefly of masterful neglect, treatment of the uremic patient should and can be highly individualized, predicated on sound physiological principles, and motivated by a careful and systematic search for those contributory causes of renal decompensation which can be completely or partially reversed by treatment. Table 1 lists some of these causes.