Interpretation of the biopsy is done collaboratively with an expert Renal Pathologist at Yale. Ongoing management of the patient is most often directed by the attending nephrologist as a principal caregiver. This care is typically consultative and time-limited, but if the condition is chronic, care will involve a longitudinal relationship between patient and nephrologist. Patients with refractory hypertension, hypertension associated with suspected renal artery stenosis, hypertension with renal insufficiency, and hypertension associated with genetic defects are seen frequently by members of the Yale Nephrology Group. As indicated, patients are evaluated for curable causes of hypertension.
Management involves longitudinal care relationships.
This entails first uncovering the etiologic cause of the renal disease and treating that process specifically, then employing more generic interventions such as tight blood pressure control, dietary restriction of phosphorus, sodium, and potassium, early use of calcitriol to mitigate evolving bone disease, and treatment of anemia with erythropoietin and iron. Dietary protein restriction is employed according to the discretion of the nephrologist. Yale Nephrologists prefer to engage the diabetic patient as soon as albuminuria is detected. Care is rendered collaboratively with a comprehensive diabetic care plan that includes tight blood pressure control, optimal control of blood glucose, control of hyperlipidemia, and careful employment of ACE inhibitors. This includes patient and family counseling, tight blood pressure control, prompt treatment of infection, and cyst decompressions as necessary.