This article reviews reported evidence on the clinical aspects of chronic renal insufficiency, proffers the relative roles of nephrologist and nonnephroloist in the management of chronic renal insufficiency and highlights common errors in the management of patients with chronic renal insufficiency. A paradigm is proposed for management of individuals with progressive chronic renal insufficiency according to evidence of efficacy of options in intervention. Recognizing the interdependence of generalist/family physician and nephrologist, key issues surrounding the timing of referral for specialized renal care are examined. By preparing the patient for future uremia therapy well in advance of need, the stress of coping with a life-threatening crisis can be muted and selection of a specific modality (peritoneal dialysis, hemodialysis, renal transplantation) can be made with full thought, family support, and the time to effect the regimen. Common errors in handling patients with deteriorating renal function are examined with advice for their avoidance.