Objective: To investigate the glomerular and proximaltubular renal function and the prevalence of urinarabnormalities in the elderly. Design: Cross-sectional study.Setting: General community in the city of SãoPaulo.
Managed care, geriatrics and nephrology have not yet been integrated although limited, fragmentary efforts in this regard include nephrology consultation, ESRD services, and early efforts in disease prevention.
‘Obstructive nephropathy’ refers to the renal disease caused by impaired flow of urine or tubular fluid. ‘Obstructive uropathy’ refers to the structural or functional changes in the urinary tract that impede the normal flow of urine. ‘Hydronephrosis’ describes dilatation of the urinary tract [1].
Urinary incontinence is abnormal at any age. The prevalence of urinary incontinence increases with age due to functional impairments and concurrent medical disease. A detailed history and physical is essential in evaluating these patients. Urinary incontinence is treatable in all age groups when a logical, multifactorial and persistent approach is undertaken.
The prognosis of acute renal failure (ARF), as judged by mortality rates, has not improved over the last few decades. This is remarkable in view of the improvement in dialysis techniques, better blood access, the use of hyperalimentation and more efficient antibiotics. This lack of continued improvement has been attributed to two major factors: An increase in the age of patients who develop ARF, and an increase in the proportion of patients who present with other significant illnesses, complicated by ARF. Elderly patients, in particular, are likely to suffer from these types of diseases and therefore are at greater risk of developing ARF in response to ischemic or nephrotoxic insultsAs the mean age of the general population advances, this category of ARF patient will continue to grow. It is not easy to estimate the incidence of ARF in an elderly population. In a recent analysis of renal disease in the elderly, Moothy and Zimmerman (1) found 32 patients with ARF among 97 elderly persons with renal disease who were selected for study because renal biopsies were available. Most of those with ARF suffered from crescentic glomerulonephritis. Acute tubular necrosis (ATN) and atheromatous renal embolic disease were exceptional as the causes of ARF. Due to their selection criteria (renal biopsies) these numbers do not reflect the true incidence of ARF in the elderly people. Many data suggest that prognosis in ARF worsens with age and both earlier (2-8) and recent papers (9-12) report a higher mortality rate in older than in younger patients. However, this view is not shared by others (13-17). Kumar et at (14) described a series of patients with ARF over 70 years of age; in them, the mortality was 57.3070, a figure comparable with the overall mortality in ARF, irrespective of age, as reported at that time. Since this paper deals specifically with ARF in the elderly, it is worth analysing it in more detail. These authors described a relatively early experience - data collected between 1961 and 1972; this explains in part the low incidence of dialysis in their patients (only 24.6(70)
Study of hospital activity analysis data over a ten‐year period in a district general hospital show that nephrotic syndrome is uncommon in the elderly. The spectrum of histology, however, is no different from the younger adults. The other interesting findings were: 1) diabetic elderly with nephrotic syndrome may have minimal change, therefore should have renal biopsy; and 2) occurrence of sero‐negative lupus nephritis in a 90‐year‐old male and a focal glomerulo‐nephritis in a 75‐year‐old female.
The management of benign prostatic hyperplasia has undergone a rapid evolution over the past decade from a surgical emphasis to a medical emphasis. Great strides in the development of α-adrenergic blockers, 5α-reductase inhibitors and a variety of phytotherapeutics have fueled this evolution. This article reviews the past, present and future of the medical management of benign prostatic hyperplasia.
Peritoneal dialysis is a viable alternative to hemodialysis for managementof elderly patients requiring renal replacement therapy. Peritoneal dialysisconfers several advantages over hemodialysis for the elderly -- namelyindependence, home treatment and perhaps preservation of residual renal function. Although there are a few contraindications, these are minimaland can largely be overcome with attention to special training and theuse of healthcare partners to perform the technique of peritoneal dialysisexchanges.
Background: Short-acting nifedipine was found to be associated with increased mortality in elderly patients in some studies.
Quantification of hypovolemia by physical examination has limited validity. We explored the use of non-invasive measurement of blood pressure (BP) response to Valsalva's maneuver in monitoring hypovolemia in nine healthy elderly volunteers, recruited from participants of the Nijmegen Annual Four-Days Marches. Heart rate (HR), systolic and diastolic BP, and mean arterial pressure (MAP) response (FinapresR) to a Valsalva's maneuver as well as clinical and laboratory assessment of fluid balance were determined 5 minutes before, and 3, 5, and 48 hours after administration of 40 mg furosemide orally. Subjects' (4 males, aged 74.2±3.0 years) weight was 66.1±9.7 kg, mean BP was 139±21 over 76±12 mm Hg. A maximum weight loss of −2.8±0.9% occurred 5 hours after furosemide administration. Systolic and diastolic BP, HR, clinical assessment scores, and serum creatinine and urea nitrogen did not change during the total study period. Significant changes occurred in Valsalva phase I to phase II systolic BP response (difference +14.2±11.3 mm Hg, ratio difference −0.09±0.07 after 5 hours, P < 0.01). Changes after 48 hours did not differ from baseline values. FinapresR measurement of Valsalva BP response may be useful in monitoring hypovolemia in the elderly.
This brief review discusses the problem of atherosclerotic renal artery obstruction in the elderly. This disorder is common in the elderly; the overall incidence is estimated to be 10%. The disorder presents with new onset hypertension, a loss of control of BP or a decline in renal function in some patients. In others, the obstruction may be unmasked by the use of angiotensin converting enzyme inhibitors or angiotensin receptor blocker agents. The current approach to the diagnosis of renal artery obstruction is discussed as are the indications for invasive procedures. Careful patient selection for any invasive procedures is particularly important in the elderly since this population has a propensity to higher morbidity.
The `demographic imperative' of a progressively aging society willplace unprecedented demands on the health care system in the 21stcentury. Although improved education, public health measures,personal lifestyles, and health care will result in a large proportionof those born surviving to old age in robust health and vitality, thesheer numbers of `baby-boomers' who will become the elderly and theinevitable association between aging and the associated multiple,especially chronic diseases and physiological impairments of oldage will require more efficient and more effective systems of healthcare to meet the needs of the aging population. Generalists, specialists,and medical and surgical subspecialists will play important rolesin meeting these needs, often in the multidisciplinary mode.Geriatricians will directly provide but a small minoritty of thecare, focusing upon education, research, and consultation and indelivering primary care to the frail elderly and especially inlong term care. Collaboration with subspecialists will be frequentin all these domains. Nephrologists, who already practice multidisciplinaryteam care of frail, complicated, chronically in patients with end-stagerenal disease, have much to contribute as their patient populationprogressively grows in numbers and age. Hence geriatricians and nephrologists have much to learn from and contribute to each other in addressing the `age wave' of the 21st century.
Over 30 million men and their partners suffer the effects of erectile dysfunction. Erectile dysfunction results in significant psychological, social and physical morbidity; requiring a comprehensive and compassionate approach by the health care provider.
The excessive use of analgesics and non-steroidal antiflammatory agents (NSAIDs) is strongly associated with an increased prevalence of chronic renal insufficiency, some cases requiring long term replacement therapy (dialysis/transplantation). Analgesic nephropathy (AN) is now a well defined entity characterized by papillary necrosis and/or chronic interstitial nephritis. The elderly are especially susceptible and more frequently use these medications. Although the overall incidence of AN is low considering the widespread usage and pain and suffering alleviated by their ready availability over-the-counter (OTC), the need, as public policy, to better protect our citizens by restricting free access to these drugs remains open to debate.
Objective: To assess the efficiency of nandrolone decanoate (ND) in the control of anemia in elderly male patients on hemodialysis (HD), and to determine its influence on nutritional parameters.
There are an increasing amount of data which are compelling us to consider the issue of age in dealing with decisions regarding both renal transplant recipients and donors. These geriatric issues in transplantation can be summarized as follows: (1) The explosion of a geriatric population of patients with ESRD, in association with data showing a survival advantage of transplantation over wait-listed dialysis patients, demands an increase in expertise in transplantating patients over 60 years old. (2) The critical shortage in cadaveric organ supply is creating a variety of solutions including expanding the donor pool with older kidneys in which long term survival may be shorter than in kidneys from younger donors. (3) The donor shortage, in association with data demonstrating improved survival of living related and unrelated donor transplants, is generating an increased number of older (> 60 years old) individuals who want to donate to a relative, spouse or friend. Future efforts should be directed toward continued research designed to evaluate the efficacy and safety of these trends. We also need to provide improved training in geriatrics for nephrologists so that we and transplant surgeons can deliver better medical care to an aging population of patients with ESRD.
While the rate of growth of the end-stage renal disease (ESRD) in the United States has slowed from the 8–9
