Book contents
- Frontmatter
- Contents
- Editorial Advisory Committee
- Contributors
- Acknowledgments
- 1 Essential Principles in the Care of the Elderly
- 2 Assessment of the Older Patient
- 3 Prevention for Older Adults
- 4 Common Complaints in the Elderly
- 5 Appropriate Use of Medications in the Elderly
- 6 Nutrition and Aging
- 7 Using Exercise as Medicine for Older Adults
- 8 Diabetes Mellitus in the Older Adult
- 9 Lipid Management in Older Patients
- 10 Hypertension
- 11 Diagnosis and Management of Heart Disease in the Elderly
- 12 Peripheral Arterial Disease in the Elderly
- 13 Stroke in the Older Adult
- 14 Neurological Problems in the Elderly
- 15 Recognition and Management of Delirium
- 16 Evaluation and Management of Dementia
- 17 Clinical Geropsychiatry
- 18 Alcohol and Other Drug Abuse in Older Patients
- 19 Aging in Adults with Developmental Disabilities
- 20 Pulmonary Issues in the Elderly
- 21 Gastroenterological Disease in the Older Adult
- 22 Serious Infections in the Elderly
- 23 Human Immunodeficiency Virus in the Elderly
- 24 Principles of Fluid and Electrolyte Balance and Renal Disorders in the Older Patient
- 25 Urological Issues in Older Adults
- 26 Urinary Incontinence
- 27 Geriatric Gynecology
- 28 Disorders of the Endocrine Glands
- 29 Osteoporosis and Other Metabolic Disorders of the Skeleton in Aging
- 30 Common Rheumatic Diseases in the Elderly
- 31 Musculoskeletal Injuries in the Elderly
- 32 Foot Health for the Elderly: Podogeriatric Overview
- 33 Geriatric Dermatology
- 34 Pressure Ulcers: Practical Considerations in Prevention and Treatment
- 35 Anemia and Other Hematological Problems of the Elderly
- 36 Cancer in the Elderly
- 37 Eye Problems of the Aged
- 38 Geriatric Ear, Nose, and Throat Problems
- 39 Geriatric Dentistry
- 40 Surgical Principles in the Aged
- 41 Rehabilitation in Older Adults
- 42 Community-Based Long-Term Care
- 43 Institutional Long-Term Care
- 44 Care for the Elderly Patient at the End of Life
- 45 Assessment of Decision-Making Capacity
- 46 Injuries in Older Adults
- 47 The Mistreatment of Older Adults
- 48 Driving and the Older Adult
- 49 Integrative Medicine in the Care of the Elderly
- 50 Successful Aging: Optimizing Strategies for Primary Care Geriatrics
- 51 Cell Biology and Physiology of Aging
- 52 Implications of an Aging Society
- 53 Ethnogeriatrics
- 54 Retirement
- 55 Geriatric Sexuality
- 56 The Elderly, Their Families, and Their Caregivers
- 57 Systematic Approaches to Preventing Errors in the Care of the Elderly
- 58 Health Care Organization and Financing
- 59 Advance Care Planning: Values and Families in End-of-Life Care
- 60 Ethical Decision Making in Geriatric Medicine
- Index
- Plate section
24 - Principles of Fluid and Electrolyte Balance and Renal Disorders in the Older Patient
Published online by Cambridge University Press: 19 May 2010
- Frontmatter
- Contents
- Editorial Advisory Committee
- Contributors
- Acknowledgments
- 1 Essential Principles in the Care of the Elderly
- 2 Assessment of the Older Patient
- 3 Prevention for Older Adults
- 4 Common Complaints in the Elderly
- 5 Appropriate Use of Medications in the Elderly
- 6 Nutrition and Aging
- 7 Using Exercise as Medicine for Older Adults
- 8 Diabetes Mellitus in the Older Adult
- 9 Lipid Management in Older Patients
- 10 Hypertension
- 11 Diagnosis and Management of Heart Disease in the Elderly
- 12 Peripheral Arterial Disease in the Elderly
- 13 Stroke in the Older Adult
- 14 Neurological Problems in the Elderly
- 15 Recognition and Management of Delirium
- 16 Evaluation and Management of Dementia
- 17 Clinical Geropsychiatry
- 18 Alcohol and Other Drug Abuse in Older Patients
- 19 Aging in Adults with Developmental Disabilities
- 20 Pulmonary Issues in the Elderly
- 21 Gastroenterological Disease in the Older Adult
- 22 Serious Infections in the Elderly
- 23 Human Immunodeficiency Virus in the Elderly
- 24 Principles of Fluid and Electrolyte Balance and Renal Disorders in the Older Patient
- 25 Urological Issues in Older Adults
- 26 Urinary Incontinence
- 27 Geriatric Gynecology
- 28 Disorders of the Endocrine Glands
- 29 Osteoporosis and Other Metabolic Disorders of the Skeleton in Aging
- 30 Common Rheumatic Diseases in the Elderly
- 31 Musculoskeletal Injuries in the Elderly
- 32 Foot Health for the Elderly: Podogeriatric Overview
- 33 Geriatric Dermatology
- 34 Pressure Ulcers: Practical Considerations in Prevention and Treatment
- 35 Anemia and Other Hematological Problems of the Elderly
- 36 Cancer in the Elderly
- 37 Eye Problems of the Aged
- 38 Geriatric Ear, Nose, and Throat Problems
- 39 Geriatric Dentistry
- 40 Surgical Principles in the Aged
- 41 Rehabilitation in Older Adults
- 42 Community-Based Long-Term Care
- 43 Institutional Long-Term Care
- 44 Care for the Elderly Patient at the End of Life
- 45 Assessment of Decision-Making Capacity
- 46 Injuries in Older Adults
- 47 The Mistreatment of Older Adults
- 48 Driving and the Older Adult
- 49 Integrative Medicine in the Care of the Elderly
- 50 Successful Aging: Optimizing Strategies for Primary Care Geriatrics
- 51 Cell Biology and Physiology of Aging
- 52 Implications of an Aging Society
- 53 Ethnogeriatrics
- 54 Retirement
- 55 Geriatric Sexuality
- 56 The Elderly, Their Families, and Their Caregivers
- 57 Systematic Approaches to Preventing Errors in the Care of the Elderly
- 58 Health Care Organization and Financing
- 59 Advance Care Planning: Values and Families in End-of-Life Care
- 60 Ethical Decision Making in Geriatric Medicine
- Index
- Plate section
Summary
THE AGING KIDNEY
An age-associated decrease in renal mass is common, although most studies done to explore this issue did not exclude individuals with comorbid conditions. Population selection and design type have limited the assessment of renal changes in the elderly, as many have used hospitalized or otherwise institutionalized elders in a cross-sectional design. Interestingly, in elderly patients who suffered traumatic death and in whom renal disease and/or important comorbid conditions were excluded, there was no significant decrease in renal mass. In patients with decreased renal mass, the number of functioning glomeruli decreases with a greater proportion lost in the cortex and relative sparing of medullary glomeruli. Although the number of glomeruli decline, the remaining glomeruli increase in size. Consequently, any injury to remaining nephrons is more consequential. There is an increase in glomerular hyalinization or sclerosis in apparently healthy elderly individuals. Once again, the change in the number of glomeruli varies greatly in elders, although the presence of glomerulosclerosis is indicative of subclinical renal injury from comorbid conditions affecting renal structure.
RENOVASCULAR CHANGES
There is a decrease in glomerular filtration rate (GFR) in elderly patients, although this may occur to a lesser extent in the aging of healthy individuals. Nevertheless, an age-related decline in GFR is an independent predictor of adverse outcomes such as death and cardiovascular disease. Blood flow decreases more than the GFR, leading to an increased filtration fraction and subsequent increase risk of nephron damage.
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- Chapter
- Information
- Reichel's Care of the ElderlyClinical Aspects of Aging, pp. 254 - 265Publisher: Cambridge University PressPrint publication year: 2009