{"id":9671,"date":"2019-11-26T11:26:55","date_gmt":"2019-11-26T11:26:55","guid":{"rendered":"https:\/\/jurmed.ro\/medici\/?p=9671"},"modified":"2019-11-26T11:26:55","modified_gmt":"2019-11-26T11:26:55","slug":"trecut-si-prezent-boala-renala-diabetica","status":"publish","type":"post","link":"https:\/\/jurmed.ro\/medici\/trecut-si-prezent-boala-renala-diabetica\/","title":{"rendered":"Trecut \u0219i prezent \u00een boala renal\u0103 diabetic\u0103"},"content":{"rendered":"<p><a href=\"https:\/\/jurmed.ro\/medici\/wp-content\/uploads\/sites\/2\/2019\/11\/Interviu2.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-9672 alignleft\" src=\"https:\/\/jurmed.ro\/medici\/wp-content\/uploads\/sites\/2\/2019\/11\/Interviu2.jpg\" alt=\"\" width=\"158\" height=\"208\" \/><\/a><em><strong>Prof. univ. dr. Cristian Serafinceanu<\/strong><\/em><\/p>\n<ul>\n<li><strong>Medic primar de diabet, nutri\u0163ie \u015fi boli metabolice<\/strong><br \/>\n<strong> \u2022 Medic primar nefrologie<\/strong><\/li>\n<\/ul>\n<p><strong>\u00a0<\/strong><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p style=\"text-align: justify\"><strong><u>Stimate Domnule Prof. Univ. dr. Cristian Serafinceanu povesti<\/u><\/strong><strong><u>\u0163<\/u><\/strong><strong><u>i-ne pe scurt cum a ap<\/u><\/strong><strong><u>\u0103<\/u><\/strong><strong><u>rut ideea \u00eenfiin<\/u><\/strong><strong><u>\u0163\u0103<\/u><\/strong><strong><u>rii unei sec<\/u><\/strong><strong><u>\u0163<\/u><\/strong><strong><u>ii dedicate exclusiv diagnostic<\/u><\/strong><strong><u>\u0103<\/u><\/strong><strong><u>rii <\/u><\/strong><strong><u>\u015f<\/u><\/strong><strong><u>i trat<\/u><\/strong><strong><u>\u0103<\/u><\/strong><strong><u>rii pacien<\/u><\/strong><strong><u>\u0163<\/u><\/strong><strong><u>ilor cu boal<\/u><\/strong><strong><u>\u0103<\/u><\/strong><strong><u> cronic<\/u><\/strong><strong><u>\u0103<\/u><\/strong><strong><u> de rinichi diabetic<\/u><\/strong><strong><u>\u0103<\/u><\/strong><strong><u>, atunci c\u00e2nd nimeni nu se g\u00e2ndea la a<\/u><\/strong><strong><u>\u015f<\/u><\/strong><strong><u>a ceva?<\/u><\/strong><\/p>\n<p style=\"text-align: justify\">\u00cen Rom\u00e2nia anilor 1992-1993, ideea de a ini\u0163ia pe terapii de substitu\u0163ie renal\u0103 cronic\u0103 pacien\u0163i cu diabet zaharat era oarecum subversiv\u0103, deoarece pe de o parte capacit\u0103\u0163ile de hemodializ\u0103 erau foarte limitate iar pe de alt\u0103 parte pacien\u0163ii cu diabet zaharaterau considera\u0163i \u201ela limit\u0103\u201d ca av\u00e2nd contraindica\u0163ie (relativ\u0103!) de dializ\u0103. Cu toate acestea, \u00een cadrul clinicii eram confrunta\u0163i cu realitatea crud\u0103 a num\u0103rului foarte mare de pacien\u0163i cu boal\u0103 renal\u0103 diabetic\u0103 \u00een stadiu final care se stingeau sub ochii no\u0219tri c\u00e2te 1-2 \u00een fiecare s\u0103pt\u0103m\u00e2n\u0103. Pentru mine \u201eprima dragoste\u201d medical\u0103 a fost nefrologia, a\u0219a c\u0103 am \u201eprofitat\u201d de faptul c\u0103 \u0219eful meu de atunci prof. Iulian Mincu era Ministrul S\u0103n\u0103t\u0103\u0163ii \u0219i i-am prezentat datele care ar\u0103tau c\u0103 peste 30% dintre pacien\u0163ii dializa\u0163i \u00een lume erau cu diabet zaharat; de asemenea, i-am propus s\u0103 \u00eencepem \u0219i \u00een Rom\u00e2nia o metod\u0103 alternativ\u0103 de substitu\u0163ie renal\u0103, dializa peritoneal\u0103, dealtfel foarte potrivit\u0103 pentru pacien\u0163ii cu diabet zaharat. \u00cemi face pl\u0103cere s\u0103 recunosc \u0219i aici meritul prof. Mincu \u00een dezvoltarea formidabil\u0103 a sistemului de dializ\u0103 \u00een Rom\u00e2nia \u00eentre 1994 \u0219i 1996; probabil c\u0103 mii de oameni \u00eei datoreaz\u0103 efectiv via\u0163a. \u00cen mai 1994 a fost \u00eenfiin\u0163at \u00een cadrul noului Institut Nicolae Paulescu Departamentul de Hemodializ\u0103, iar \u00een ianuarie 1995 \u0219i cel de Dializ\u0103 peritoneal\u0103, unde a fost ini\u0163iat pentru prima dat\u0103 \u00een Rom\u0103nia un pacient pe aceast\u0103 metod\u0103 modern\u0103 de terapie. A\u0219a s-a scris aceast\u0103 mic\u0103 dar zbuciumat\u0103 istorie.<\/p>\n<p style=\"text-align: justify\">\n<p style=\"text-align: justify\"><strong><u>C\u00e2<\/u><\/strong><strong><u>\u0163<\/u><\/strong><strong><u>i pacien<\/u><\/strong><strong><u>\u0163<\/u><\/strong><strong><u>i cu boal<\/u><\/strong><strong><u>\u0103<\/u><\/strong><strong><u> renal<\/u><\/strong><strong><u>\u0103<\/u><\/strong><strong><u> cronic<\/u><\/strong><strong><u>\u0103<\/u><\/strong><strong><u> diabetic<\/u><\/strong><strong><u>\u0103<\/u><\/strong><strong><u> au fost trata<\/u><\/strong><strong><u>\u0163<\/u><\/strong><strong><u>i \u00een institut?<\/u><\/strong><\/p>\n<p style=\"text-align: justify\">Peste 2.500 de pacien\u0163i cu boal\u0103 renal\u0103 diabetic\u0103 din toat\u0103 \u0163ara au fost ini\u0163ia\u0163i pe dializ\u0103 \u0219i aproximativ 15.000 au fost sau sunt \u00een eviden\u0163\u0103\/monitorizare cronic\u0103.<\/p>\n<p style=\"text-align: justify\">\n<p style=\"text-align: justify\"><strong><u>Care este principala dificultate legat<\/u><\/strong><strong><u>\u0103<\/u><\/strong><strong><u> de boala renal<\/u><\/strong><strong><u>\u0103<\/u><\/strong><strong><u> diabetic<\/u><\/strong><strong><u>\u0103<\/u><\/strong><strong><u>?<\/u><\/strong><\/p>\n<p style=\"text-align: justify\">Boala renal\u0103 diabetic\u0103 este prin defini\u0163ie o afec\u0163iune interdisciplinar\u0103, numai un diabetolog cu cuno\u0219tin\u0163e solide de nefrologie poate trata adecvat un asemenea pacient. Teoretic se poate \u0219i invers, adic\u0103 un nefrolog cu interes special pentru diabetul zaharat, dar s\u0103 nu uit\u0103m c\u0103 marea majoritate a acestor pacien\u0163i sunt \u00een primul r\u00e2nd diabetici cu durat\u0103 lung\u0103 de evolu\u0163ie a bolii metabolice \u0219i abia apoi renali. Din acest punct de vedere au nevoie de un \u201eochi\u201d foarte avizat \u00een leg\u0103tur\u0103 cu complica\u0163iile \u0219i managementul diabetului zaharat care este totu\u0219i\u201eboala de baz\u0103\u201d.<\/p>\n<p style=\"text-align: justify\">O a doua rela\u0163ie interdisciplinar\u0103 obligatorie este cea cu colegii cardiologi, pentru c\u0103 este prefect adev\u0103rat c\u0103 at\u00e2t diabetul zaharat c\u00e2t \u0219i boala cronic\u0103 de rinichi pot fi definite ca st\u0103ri de exces de risc cardiovascular.<\/p>\n<p style=\"text-align: justify\"><strong><u>Cu ce este asociat<\/u><\/strong><strong><u>\u0103<\/u><\/strong><strong><u> aceast<\/u><\/strong><strong><u>\u0103<\/u><\/strong><strong><u> afec<\/u><\/strong><strong><u>\u0163<\/u><\/strong><strong><u>iune?<\/u><\/strong><\/p>\n<p style=\"text-align: justify\">Cum spuneam, boala cardiovascular\u0103 \u0219i riscul evenimentelor cardiovasculare majore \u00eenso\u0163esc pacientul cu boal\u0103 renal\u0103 cronic\u0103 exact ca o umbr\u0103, care se \u201elunge\u0219te\u201d pe m\u0103sur\u0103 ce trece timpul. Deci: infarctul de miocard, accidentul vascular cerebral, moartea subit\u0103, boala arterial\u0103 periferic\u0103 \u0219i insuficien\u0163a cardiac\u0103.<\/p>\n<p style=\"text-align: justify\">\n<p style=\"text-align: justify\"><strong><u>Este managementul bolii renale diabetice complicat? Dar reu<\/u><\/strong><strong><u>\u0219<\/u><\/strong><strong><u>ita terapeutic<\/u><\/strong><strong><u>\u0103<\/u><\/strong><strong><u>?<\/u><\/strong><\/p>\n<p style=\"text-align: justify\">Cred c\u0103 din cele afirmate p\u00e2n\u0103 acum a rezultat complexitatea \u00eenalt\u0103 a managementului bolii renale diabetice. Reu\u0219ita terapeutic\u0103 este condi\u0163ionat\u0103 \u00een cazul acestor pacien\u0163i de calitatea \u00eengrijirilor din \u201eamonte\u201d, adic\u0103 de momentul stabilirii diagnosticului de boal\u0103 renal\u0103 diabetic\u0103, echilibrul glicemic din ultimii ani \u0219i mai ales eficien\u0163a terapiei hipertensiunii arteriale prin blocarea sistemului renin\u0103-angiotensin\u0103 (\u0219i nu numai).<\/p>\n<p style=\"text-align: justify\">\n<p style=\"text-align: justify\"><strong><u>A<\/u><\/strong><strong><u>\u0163<\/u><\/strong><strong><u>i \u00eenfiin<\/u><\/strong><strong><u>\u0163<\/u><\/strong><strong><u>at Asocia<\/u><\/strong><strong><u>\u0163<\/u><\/strong><strong><u>ia de Studii Reno-Metabolice <\/u><\/strong><strong><u>\u015f<\/u><\/strong><strong><u>i Nutri<\/u><\/strong><strong><u>\u0163<\/u><\/strong><strong><u>ionale. \u00cen ce scop?<\/u><\/strong><\/p>\n<p style=\"text-align: justify\">Principalul scop, a\u0219a cum rezult\u0103 \u0219i din lectura statutului ASRMN este \u00eembun\u0103t\u0103\u0163irea calit\u0103\u0163ii vie\u0163ii persoanelor cu diabet zaharat \u0219i boal\u0103 cronic\u0103 de rinichi, prin toate mijloacele legale care ne stau la \u00eendem\u00e2n\u0103, de la conferin\u0163e \u0219tiin\u0163ifice \u0219i p\u00e2n\u0103 la \u201elobby\u201d dac\u0103 se va legaliza \u0219i va fi necesar.<\/p>\n<p style=\"text-align: justify\">\n<p style=\"text-align: justify\"><strong><u>Boala cronic<\/u><\/strong><strong><u>\u0103<\/u><\/strong><strong><u> de rinichi este mult subdiagnosticat<\/u><\/strong><strong><u>\u0103<\/u><\/strong><strong><u>. Aveti \u00een plan demararea unui program de screening astfel \u00eenc\u00e2t boala s<\/u><\/strong><strong><u>\u0103<\/u><\/strong><strong><u> fie depistat<\/u><\/strong><strong><u>\u0103<\/u><\/strong><strong><u> \u00eentr-un stadiu ini<\/u><\/strong><strong><u>\u0163<\/u><\/strong><strong><u>ial?<\/u><\/strong><\/p>\n<p style=\"text-align: justify\">Cum spuneam, prognosticul pacien\u0163ilor cu boal\u0103 cronic\u0103 de rinichi diabetic\u0103 depinde \u00een primul r\u00e2nd de momentul diagnosticului \u0219i de calitatea \u00eengrijirii medicale, \u00een special echilibrul glicemic \u0219i tensiunea arterial\u0103. Bine\u00een\u0163eles c\u0103 lucrurile sunt mai complexe, dar aceasta r\u0103m\u00e2ne principala direc\u0163ie de ac\u0163iune: depistarea precoce a complica\u0163iilor renale prin proceduri specifice de screening periodic (anual) la to\u0163i pacien\u0163ii cu diabet zaharat tip 2 (\u0219i \u00een tipul 1 cu mai mult de 5 ani durata de evolu\u0163ie). O a doua prioritate este cre\u0219terea gradului de cooperare interdisciplinar\u0103 diabetologi-nefrologi \u0219i cardiologi la patul acestor pacien\u0163i, pentru c\u0103 f\u0103r\u0103 asta orice eforturi sunt sortite e\u0219ecului. Un lucru care m\u0103 preocup\u0103 \u00een ultima vreme este c\u0103 ar trebui f\u0103cut \u0219i screening invers, adic\u0103 s\u0103 c\u0103ut\u0103m diabetul zaharat \u0219i prediabetul la pacien\u0163ii cunoscu\u0163i cu boal\u0103 cronic\u0103 de rinichi, inclusiv \u00een dializ\u0103.<\/p>\n<p style=\"text-align: justify\">\n<p style=\"text-align: justify\"><strong><u>C\u00e2t de important<\/u><\/strong><strong><u>\u0103<\/u><\/strong><strong><u> este colaborarea dintre diabetolog <\/u><\/strong><strong><u>\u015f<\/u><\/strong><strong><u>i al<\/u><\/strong><strong><u>\u0163<\/u><\/strong><strong><u>i speciali<\/u><\/strong><strong><u>\u0219<\/u><\/strong><strong><u>ti?<\/u><\/strong><\/p>\n<p style=\"text-align: justify\">Este extrem de important\u0103, \u00eenc\u0103 o dat\u0103 subliniez, colaborarea dintre medicii de diferite specialit\u0103\u0163i, pentru c\u0103 niciodat\u0103 nu po\u0163i s\u0103 \u00een\u0163elegi \u00een profunzime \u2013 de exemplu, ai un pacient cu diabet zaharat \u015fi boal\u0103 cronic\u0103 de rinichi \u2013 niciodat\u0103, ca diabetolog, nu po\u0163i s\u0103 abordezi cu aceea\u0219i expertiz\u0103 boala renal\u0103 cum o face un nefrolog. Pe de alt\u0103 parte, un nefrolog cu experien\u0163\u0103 nu poate s\u0103 \u00een\u0163eleag\u0103 la fel de bine ca un diabetolog problemele importante, profunde, ale diabetului zaharat.<\/p>\n<p style=\"text-align: justify\">\u015ei atunci, fie cum sunt eu, \u015fi diabetolog \u015fi nefrolog, fie trebuie s\u0103 se \u00eent\u00e2lneasc\u0103 un diabetolog cel pu\u0163in cu un nefrolog la patul pacientului, adic\u0103 nu s\u0103 trimitem pacientul de la unul la altul, ci s\u0103 discut\u0103m \u00eentre noi pe baza datelor concrete ale unui pacient. La fel este vorba \u015fi despre cardiologi \u2013 aceast\u0103 colaborare o vizez \u00een viitor, este extrem de necesar\u0103, de important\u0103 \u2013 \u015fi bine\u00een\u0163eles, pneumologi, endocrinologi, toate aceste specialit\u0103\u0163i trebuie neap\u0103rat s\u0103 colaboreze.<\/p>\n<p style=\"text-align: justify\">\n<p style=\"text-align: justify\"><strong><u>C\u00e2t de frecvent<\/u><\/strong><strong><u>\u0103<\/u><\/strong><strong><u> este asocierea \u00eentre diabet <\/u><\/strong><strong><u>\u015f<\/u><\/strong><strong><u>i boala de rinichi la pacien<\/u><\/strong><strong><u>\u0163<\/u><\/strong><strong><u>ii rom\u00e2ni? C\u00e2<\/u><\/strong><strong><u>\u0163<\/u><\/strong><strong><u>i dintre bolnavii de diabet fac boal<\/u><\/strong><strong><u>\u0103<\/u><\/strong><strong><u> renal<\/u><\/strong><strong><u>\u0103<\/u><\/strong><strong><u>?<\/u><\/strong><\/p>\n<p style=\"text-align: justify\">Din datele pe care le avem acum, datele la linia de start a Studiului MENTOR despre care am amintit, cam 30% dintre pacien\u0163ii cu diabet zaharat de tip I au o form\u0103 sau alta, mai grav\u0103 sau mai pu\u0163in grav\u0103, de boal\u0103 cronic\u0103 de rinichi. Este un procent care se \u00eencadreaz\u0103 \u00een datele din literatur\u0103 \u2013 \u00eentre 25% \u015fi 40%. Deocamdat\u0103 noi avem cam 30% din aceast\u0103 fotografie de moment. Nu \u0219tim cum evolueaz\u0103 lucrurile, adic\u0103 \u00een ce m\u0103sur\u0103 inciden\u0163a \u015fi prevalen\u0163a cresc \u00een timp. Trebuie s\u0103 urm\u0103rim evolu\u0163ia acestor pacien\u0163i, cum spuneam, timp de 3 ani, 3 ani \u015fi jum\u0103tate, ca s\u0103 ne facem o idee. Nu este un lucru simplu. \u00cen acest moment, boala cronic\u0103 de rinichi asociat\u0103 cu diabetul zaharat, pe care o numim boal\u0103 renal\u0103 diabetic\u0103, nu mai este o complica\u0163ie a diabetului zaharat, neap\u0103rat, ci este o asociere patologic\u0103. Este vorba, de fapt, despre un complex patologic, diabet cu boal\u0103 cronic\u0103 de rinichi, pentru c\u0103 ele se intercondi\u0163ioneaz\u0103. Diabetul predispune la boal\u0103 cronic\u0103 de rinichi, dar \u015fi boala cronic\u0103 de rinichi predispune la diabet zaharat, iar efectul lor \u00eempreun\u0103 este de cre\u0219tere abrupt\u0103, o cre\u0219tere absolut \u00eengrozitoare a riscului cardiovascular. Riscul de evenimente majore cardiovasculare &#8211; infarct miocardic, accident vascular cerebral, moarte subit\u0103, boal\u0103 arterial\u0103 periferic\u0103 &#8211; toate acestea cresc abrupt, foarte ascu\u0163it, \u00een momentul c\u00e2nd diabetul zaharat se asociaz\u0103 cu boala renal\u0103 sau invers. Ideea este s\u0103 descoperim aceast\u0103 asociere, s-o trat\u0103m cum trebuie \u015fi s-o monitoriz\u0103m \u00een evolu\u0163ie.<\/p>\n<p style=\"text-align: justify\">\n<p style=\"text-align: justify\"><strong><u>Exist<\/u><\/strong><strong><u>\u0103<\/u><\/strong><strong><u> \u00een momentul de fa<\/u><\/strong><strong><u>\u0163\u0103<\/u><\/strong><strong><u> un program de screening astfel \u00eenc\u00e2t boala cronic<\/u><\/strong><strong><u>\u0103<\/u><\/strong><strong><u> de rinichi s<\/u><\/strong><strong><u>\u0103<\/u><\/strong><strong><u> fie depistat<\/u><\/strong><strong><u>\u0103<\/u><\/strong><strong><u> \u00eentr-un stadiu incipient?<\/u><\/strong><\/p>\n<p style=\"text-align: justify\">Dac\u0103 vorbim despre boala de rinichi diabetic\u0103, teoretic, da, se \u015ftie, exist\u0103 protocoale dup\u0103 care un pacient cu diabet zaharat tip 1 trebuie examinat cel pu\u0163in anual dup\u0103 5 ani de evolu\u0163ie a diabetului, iar cei cu diabet zaharat tip 2 trebuie examina\u0163i anual din punctul de vedere al func\u0163iei renale, \u00eenc\u0103 de la debutul clinic al diabetului zaharat, iar dac\u0103 au probleme \u015fi se observ\u0103 o sc\u0103dere a func\u0163iilor renale, atunci consultul \u015fi monitorizarea se fac mult mai frecvent, la 3 luni, la 6 luni, teoretic. Practic, cum spuneam, av\u00e2nd \u00een vedere aceast\u0103 \u00eenc\u0103rcare a medicilor diabetologi \u00een anumite zone, r\u0103m\u00e2ne de v\u0103zut din studiul MENTOR \u00een ce m\u0103sur\u0103 ea se face efectiv sau, \u00een anumite zone, se face mai pu\u0163in \u015fi \u00een ce m\u0103sur\u0103 boala renal\u0103 diabetic\u0103 este cu adev\u0103rat o mare problem\u0103 \u00een Rom\u00e2nia. Chiar este, din c\u00e2te am v\u0103zut p\u00e2n\u0103 acum este, dar urmeaz\u0103 s\u0103 demonstr\u0103m acest lucru.<\/p>\n<p style=\"text-align: justify\">\n<p style=\"text-align: justify\"><strong><u>Ar trebui pus accent pe problema tulbur<\/u><\/strong><strong><u>\u0103<\/u><\/strong><strong><u>rilor metabolice asociate cu boala cronic<\/u><\/strong><strong><u>\u0103<\/u><\/strong><strong><u> de rinichi? Exist<\/u><\/strong><strong><u>\u0103<\/u><\/strong><strong><u> o interdisciplinaritate \u00eentre diabetologi <\/u><\/strong><strong><u>\u015f<\/u><\/strong><strong><u>i nefrologi?<\/u><\/strong><\/p>\n<p style=\"text-align: justify\">Da, sigur c\u0103 trebuie pus accent, pentru c\u0103 boala cronic\u0103 de rinichi seam\u0103n\u0103 foarte mult cu diabetul zaharat, \u00een sensul c\u0103 este o boal\u0103 care afecteaz\u0103 profund toate metabolismele. Dac\u0103 se suprapune diabetul zaharat, deja de lung\u0103 durat\u0103, cu boala cronic\u0103 de rinichi, perturb\u0103rile metabolice vor fi complexe, foarte grave, \u015fi este foarte greu de pus diagnosticul \u015fi de st\u0103p\u00e2nit ca management. \u00cen ceea ce prive\u015fte colaborarea dintre diabetologi \u015fi nefrologi, ea teoretic exist\u0103. Eu sunt de p\u0103rere c\u0103 solu\u0163ia ar fi poate ca o parte dintre diabetologi s\u0103 ob\u0163in\u0103 \u015fi a doua specialitate, de nefrologie. Eu, de exemplu, sunt \u015fi diabetolog \u015fi nefrolog. \u00cen cadrul Institutului Na\u0163ional de Diabet \u015fi Boli Metabolice \u201eNicolae Paulescu\u201d avem 4-5 colegi care au aceast\u0103 dubl\u0103 specialitate \u015fi mai sunt c\u00e2\u0163iva care sunt reziden\u0163i la a doua specialitate, nefrologia. Dar \u015fi nefrologii se pot specializa \u00een diabet, ca a doua specialitate. Altfel este foarte greu, pentru c\u0103 ace\u015fti pacien\u0163i au nevoie oarecum \u00een acela\u015fi timp de nefrolog \u015fi de diabetolog, nu succesiv, ci concomitent. Dar, sigur c\u0103 \u015fi un consult periodic competent poate s\u0103 rezolve \u00een bun\u0103 m\u0103sur\u0103 situa\u0163ia.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Prof. univ. dr. Cristian Serafinceanu Medic primar de diabet, nutri\u0163ie \u015fi boli metabolice \u2022 Medic primar nefrologie \u00a0 &nbsp; &nbsp; Stimate Domnule Prof. Univ. dr. Cristian Serafinceanu povesti\u0163i-ne pe scurt [&hellip;]<\/p>\n","protected":false},"author":9,"featured_media":9672,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[276],"tags":[],"class_list":["post-9671","post","type-post","status-publish","format-standard","has-post-thumbnail","category-interviu"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.0 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Trecut \u0219i prezent \u00een boala renal\u0103 diabetic\u0103<\/title>\n<meta name=\"description\" content=\"Trecut \u0219i prezent \u00een boala renal\u0103 diabetic\u0103 Prof. univ. dr. 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