[Extra-hospital nephrology: a challenge for our near future].

The Spanish nephrology is one of the medical specialties that have experienced a greater development in the last years. Defined initially as an activity in the hospital and consolidated in this sense, at the present time the "Libro Blanco of the Spanish Nephrology" makes a call of attention on the necessity of a change of welfare direction. The attention was called on the little development of the prevention activities and the delay in the arrival of the patient to the Service of Nephrology, which causes a worsening of his pathology. In order to approach us this reality it is necessary to give priority to the attendance of the patient out of the hospital and to guarantee a logical continuity between welfare levels. The welfare initiatives that have been carried out in the Spanish territory are scarce and still insufficient. The progressive increase in the incidence and prevalence of the ERD associated with a bad evolution and elevated costs is converting ERD in an important problem of public health, that requires specific plans of detection and prevention. The improvement of the coordination between general practioners and nephrologists is necessary. Multiple papers show a delayed reference of the patients with renal disease to the nephrologists. The initiatives of coordination between both levels should be centered in studies epidemiologists that clarify the real meaning of the renal pathology and in educating the GP on the early reference to the nephrologist of the patients with renal failure.