Americans seem so inured to the experience of self maintenance and often treat their doctor as if they were veterinarians whose patients do not speak or report conditions or symptoms. This leaving ALL analysis and responsibility in the hands of a physician is almost (no, actually) criminal. How does the physician deal with this? The physicians and care givers have come to depend on third hand information such as lab tests and obvious or outright symptomology, the patient more often than not present themselves to the practitioner with the veterinary approach of "Heal Me, I am here" when something is not right.
As a nurse, it irritates me no end that most patients are utterly ignorant of family history or even decent self care skills, including diet, weight, use of many medications (OTC and recreational) with no knowledge of side effects and more.
Stage III to Stage IV is tiny, 30 is stage III, 29 is stage IV. There are almost NO medications to enhance or significantly improve renal function, salvage is the only thing left and that is often done with diet, reduction in offensive medications and other relatively passive measures such as weight management and diabetes actions with diet.
My brother died after 10 years on dialysis (ESRD) following cancer of the kidney, my father was compromised by Stage III CRF related to malarial disease and died as a result of that failure. My renal values have improved (33 to 39) by passive measures such as diet, reduction in offensive medications and a collegial approach with my caregivers on options for the future. I would like to think I will make 100 years old, only 24 to go in spite of my asbestosis/COPD/emphysema, minimal diabetes now well controlled by diet and only one minor cholesterol drug (Livalo) with minimal renal effect.