animal research has developed our understanding of CKD and led to preventive measures. The notion of renoprotection has resulted in a dual approach to renal diseases based on effective and sustained pharmacological control of blood pressure and reduction of proteinuria. Lowering blood lipids, stopping smoking, and maintaining tight glucose control for diabetes form part of the multimodal protocol for managing renal patients monitored by specific biological markers (Ruggenenti, Schieppati, and Remuzzi 2001). Abnormal urinary excretion of protein is strongly associated with the progression of CKD in both diabetic and nondiabetic renal diseases. Clinical studies have established that a reduction in proteinuria is associated with a decreased rate of kidney function loss. A specific category of drugs that lower blood pressure, the angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers, appear to be more effective than Diseases of the Kidney and the Urinary System | 699 other antihypertensive drugs in slowing the progression of both diabetic and nondiabetic CKDs (Brenner and Zagrobelny 2003). The administration of an ACE inhibitor (or of an angiotensin receptor blocker) is an important treatment for controlling blood pressure and slowing the rate of progression of chronic kidney failure. Other drugs to lower blood pressure are added as necessary to achieve current targets of 120/80 to 130/80 millimeters of mercury. Concurrent diuretic therapy is often necessary in patients with renal insufficiency, because fluid overload is an important determinant of hypertension in such cases. Dyslipidemia accelerates atherosclerosis and may promote the progression of renal disease. Careful control of the blood glucose level in diabetic patients can be beneficial and may limit other complications. Obesity has not been directly linked to the progression of CKD but is an important risk factor for diabetes and cardiovascular morbidity and mortality. Many patients and health care professionals do not appreciate the benefits of smoking cessation, an important measure in protecting the kidneys from progressive disease resulting from cardiovascular disease (CVD). Additional elements of secondary prevention measures include the treatment of anemia and of abnormal calcium and phosphorus metabolism. The International Society of Nephrology is developing a program that can be implemented according to the specific needs of a given developing country. The program has two objectives: (a) to identify the prevalence of renal disease among seemingly healthy subjects using a communitywide screening program, especially among populations at risk, and (b) to initiate interventions to prevent the progression of renal disease and affect both renal and CVD outcomes in subjects with or at risk of developing renal disease based on the screening program (Weening 2004). The Kidney Help Trust of Chennai, India, has undertaken a screening program for a population of 25,000. All those who tested positive for high blood pressure, diabetes, or both (about 15 percent) were further studied and then treated with inexpensive antihypertensive and antidiabetic drugs. The cost of the one-year program was Rs 300,000 (US$7,500) or a per capita cost of US$0.27, well within the limits of the Indian government’s per capita annual health expenditure of US$7.67 (Mani 2003). A similar program in Bolivia examined a population of 14,000 and also found that 15 percent were hypertensive, diabetic, or both. An extremely successful program of detection and treatment of renal and cardiovascular diseases among Australian Aborigines was conducted from 1995 to 2000. The ESRD rate among Aborigines is 3 to 10 times that in developed countries. Treatment consisted of long-acting ACE inhibitors to lower blood pressure. After an average of 3.4 years of follow-up, the incidence of ESRD was reduced by 63 percent and nonrenal deaths were reduced by 50 percent. Hoy and others (2003) estimate that this two-year program may have saved US$500,000 to US$2.7 million in avoided or delayed dialysis costs. Trained staff members can carry out screening programs inexpensively. Economic analysis, however, suggests that largescale programs should be restricted to screening and treating only specific high-risk populations. Screening programs can be implemented using simple, cheap, and reliable tests consisting of measurements of bodyweight, blood pressure, blood glucose, and creatinine. Screening includes testing urine for hemoglobin, glucose, leukocytes, and protein (repeat tests may be necessary on a spot urine sample); calculating albumin to creatinine ratios; testing positive results for increased serum creatinine and fasting glucose (or glycosylated hemoglobin A1c test); and reassessing the urine protein excretion rate, a cornerstone of kidney assessment. Resulting albumin to creatinine ratio categories would indicate a scale of severity of glomerular disease, with a cardiovascular risk score based on body mass index, hypertension, fasting glucose level, microalbuminuria or gross albuminuria, and serum creatinine. Patients with positive markers for kidney disease would receive the best treatment available at the screening center. Incorporating screening for kidney disease within screening programs developed for CVD and diabetes is