Internal Medicine

Biography

Biography: Pedro Blandon

Abstract

Diabetic nephropathy affects one third of all diabetics. Evidence has shown that a multi prong approach usually started at the primary care level decreases but does not completely eliminate this problem. It is important for patients to be informed of this silent complication at every stage of the disease since damage is mostly irreversible when physical symptoms are noticed. Nephrologists are usually consulted late when the eGFR is 30 or less and at that point, the management of complications such as anemia, hypertension and bone and mineral metabolism disorders, along with preparation for dialysis is the tasks at hand. We will present a strategy to help patients and primary care physicians develop a partnership in aborting the progressive renal damage that ends up in renal replacement therapy, a life changing and very expensive proposition. Diabetic and blood pressure control, avoidance of nephrotoxic drugs, detection of reversible renal damage that may coexist with diabetes are at the core of this strategy. Many patients when confronted with possibility of dialysis start paying more attention to their neglected diabetes care. This places the Nephrologist in a privileged position when addressing the above named interventions, as such the astute clinician works with patient, primary care and consultants in the management of several of these complications. It is not uncommon for patients to become funded or insured until they start dialysis and nephrologists round on these patients on weekly basis, allowing for a continuous feedback loop that encourages them to prevent additional diabetic complications.