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Diabetic Renal-Retinal Syndrome pp 41–65Cite as

Clinical imperatives in diabetic nephropathy: the devastating impact of comorbidity

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Abstract

Diabetes makes people sick because of its comorbid complications. Nephrologists and ophthalmologists caring for people with diabetes devote minimal time to metabolic regulation and maximal attention to the consequence of microvasculopathy in the kidney and eye. Fragmented medical management often results from tunnel vision in subspecialists, each handling a component of what should be a comprehensive medical regimen. The patient may be entrapped by conflicting advice, medications that interfere with the action of other drugs, and unneeded repeated expensive laboratory tests. Without a single coordinating physician diabetic patients too often receive fragmented and incomplete care delivered by an otherwise competent high powered team. By constructing a ‘Life Plan’ for each patient with periodic assessment of extrarenal comorbidity, the chances of overlooking an impediment to rehabilitation are reduced. The utility of ranking extrarenal diabetic complications numerically using a Co-Morbidity Index has been demonstrated in studies of hemodialysis and peritoneal dialysis patients and is proposed for kidney transplant recipients.

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  1. Eli A. Friedman
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Editors and Affiliations

  1. Department of Medicine, State University of New York, Health Science Center at Brooklyn, Brooklyn, NY, USA

    Eli A. Friedman M.D. (Distinguished Teaching Professor) (Distinguished Teaching Professor)

  2. College of Physicians and Surgeons, Columbia University, New York, NY, USA

    Francis A. L’Esperance Jr. M.D. (Clinical Professor of Opthalmology) (Clinical Professor of Opthalmology)

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Friedman, E.A. (1998). Clinical imperatives in diabetic nephropathy: the devastating impact of comorbidity. In: Friedman, E.A., L’Esperance, F.A. (eds) Diabetic Renal-Retinal Syndrome. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-4962-4_5

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