Understanding geriatric nephrology

Geriatric nephrology is a specialized branch of medicine focused on diagnosing and treating kidney diseases in older adults, typically those over 65. As people age, their kidneys naturally undergo changes, leading to a decrease in kidney function. This makes older adults more susceptible to kidney-related issues, necessitating specialised care and attention. Here to explain more is esteemed consultant nephrologist, Mr Andrew Coutinho. 

Age-related changes in kidney function

As individuals age, the kidneys experience structural and functional changes. There is a gradual decline in glomerular filtration rate (GFR), which measures how well the kidneys filter blood.

This decline in GFR is a normal part of ageing, but it can make older adults more vulnerable to kidney diseases. Additionally, the kidneys' ability to concentrate urine decreases, leading to a higher risk of dehydration. Blood vessels within the kidneys may also stiffen, reducing their ability to regulate blood pressure effectively.

Common kidney diseases in the elderly

Chronic kidney disease (CKD) is prevalent among older adults, often coexisting with other conditions like diabetes and hypertension. CKD in the elderly can progress to end-stage renal disease (ESRD), where the kidneys can no longer function adequately, requiring dialysis or a kidney transplant. Acute kidney injury (AKI), a sudden decline in kidney function, is also more common in the elderly, often triggered by infections, medications, or dehydration.

Managing kidney disease in older adults

Treatment of kidney diseases in older adults requires a careful balance. The presence of comorbidities, like heart disease or diabetes, and the potential for polypharmacy—using multiple medications simultaneously—complicate treatment strategies. Doctors must consider the potential side effects of medications on kidney function and adjust dosages accordingly. Lifestyle modifications, such as dietary changes and fluid management, are also crucial in managing kidney health.

The importance of early detection and monitoring

Early detection of kidney disease in older adults is vital for preventing progression to more severe stages. Regular monitoring of kidney function, blood pressure, and electrolyte levels is essential. Healthcare providers should work closely with patients to develop personalized care plans that address both kidney health and overall well-being, ensuring a better quality of life for the elderly.