Older Adults with Kidney Disease

Kidney problems are very common in older adults and can significantly diminish the quality of life in one’s later years or even be fatal. While most patients can work with their primary care physicians to manage the symptoms and complications of decreased kidney function, for some patients it is important to consult with a team including both nephrology and geriatric medicine specialists to determine the underlying cause, manage worsening symptoms and complications, and evaluate treatment options. Those include patients with new onset of abnormalities in the urine and loss of kidney function (more rapid than expected), systemic diseases that can affect the kidneys, and patients with advanced loss of kidney function approaching kidney failure.

Michigan Medicine’s Geriatric Kidney Disease Clinic was established to help older patients and their caregivers navigate the challenges of acute and chronic kidney conditions. 

Signs and Symptoms

A number of signs point to problems with kidney function, notably:

• Proteinuria – an elevated level of protein in the urine
• Hematuria – blood in the urine, most often only detected by a specific urine test
• Increased serum creatinine in the blood
• Electrolyte imbalances
• Hypertension (high blood pressure) that is difficult to control with medication

When these symptoms are seen in older patients, physicians may suspect either inflammation of the kidneys – a condition called glomerulonephritis, or damage to the filter unit leading to spilling large amounts of protein in the urine, which is referred to as nephrotic syndrome. Older patients with these conditions may benefit from the more specialized geriatric care our clinic offers.

Diagnosis and Treatment

While there are established methods to diagnose and treat kidney diseases, some level of risk comes with each alternative. For older patients, those risks may outweigh the benefits of standard of care or alternative treatments may be equally effective with less risks. Our team of nephrologists, geriatricians, and social workers is skilled at helping patients and their loved ones weigh their options and determine their best course of action by addressing questions like these:

Should you undergo a kidney biopsy?

A kidney biopsy is the most reliable tool to accurately diagnose the specific cause of your kidney problem. It cannot only distinguish the different types of glomerulonephritis and nephrotic syndrome, but also determine the chances of recovery of kidney function (how much inflammation and scaring is in the kidney?). Therefore, it can be very helpful to guide treatment decisions. But the decision to undergo a kidney biopsy is not an easy one, in particular for an older patient. Like any surgical procedure, there are risks involved, and those risks are greater in patients in poor health, those with other chronic conditions like diabetes, heart disease or hypertension, and those who take multiple medications.

Helping patients and their families make a decision that is right for them is one of our team’s most important goals. Regardless of your choice, we will continue to work with you to manage your condition as effectively as possible.

Once diagnosed, are you a good candidate for standard therapy? 

Medications commonly used to treat kidney disease, which include immunosuppressive medications for glomerulonephritis and nephrotic syndrome, blood pressure lowering medications and diuretics, have side effects and pose additional risk for older patients. Alternative treatment options may have fewer side effects, but also may not be as effective. The geriatric specialists in our clinic, including physicians, social workers and nutritionists, are skilled in both counseling patients on treatment options and providing personalized medication and nutrition management. We make every attempt to coordinate all of these services during the same clinic appointment.

Should you consider dialysis? What about a kidney transplant?

Some of the patients seen in our clinic are at or near kidney failure (end stage renal disease or ESRD) for which the standard treatments are dialysis or kidney transplantation. Our team is here for patients contemplating dialysis, and helping them prepare transition to the care of a nephrologist at a local dialysis center if they choose that step. We are equally supportive of patients who elect not to pursue dialysis and will do all we can to help them manage the complications associated with ESRD. This may include involving physicians and nurses specialized in palliative and hospice care.

While kidney transplants are now more commonly performed in older patients, this option is not right for everyone. An individual’s health status, co-existing medical conditions, and expectations for function and daily living are all factors to consider and discuss.

No matter which option a patient chooses, our team continues to provide whatever support is needed, either through individualized management of the complications of kidney failure or the preparation to transition to dialysis, transplantation, or palliative care.

About the Clinic

• The Geriatric Kidney Disease Clinic is held on Friday afternoons at the East Ann Arbor Health and Geriatrics Center.
• The clinic is open to adults aged 65 years or older with kidney problems.
• Our team includes nephrologists and social workers who work side-by-side with geriatric specialists. This team approach allows us to tailor the care we provide to older patients with decreased kidney function.

Patient Resources

Appointments and Referrals

Referring physicians, patients, and family members can contact the clinic directly at (734) 764-6831 or toll-free (877) 865-2167.  

Symptoms, Causes, Treatment & Prevention

What Is Acute Kidney Failure?

Acute kidney failure is when your kidneys stop working suddenly. Doctors sometimes call it acute renal failure. It can happen over just a few hours or days.

Acute kidney failure isn’t always permanent. If you get treatment right away — and if you don’t have other serious health problems — your kidneys can go back to working normally.

The main job of your kidneys is to filter waste out of your blood. They also remove extra fluid from your blood (this becomes urine) and control blood pressure. Kidneys help make red blood cells. They regulate electrolytes (a type of nutrient) and activate vitamin D, too.

Kidneys don’t work well when they’re damaged. This could happen because of another health condition, like diabetes. A decrease in kidney function that happens over a longer period of time is called chronic kidney failure.

Acute Kidney Failure Symptoms

You may not have any symptoms of acute kidney failure. Your doctor may discover you have this condition while doing lab tests for another reason.

If you do have symptoms, they’ll depend on how bad your loss of kidney function is, how quickly you lose kidney function, and the reasons for your kidney failure. Symptoms may include:

• Peeing less than normal
• Swelling in your legs, ankles, and feet (caused by your body holding on to fluid)
• Feeling drowsy or very tired
• Shortness of breath
• Itching
• Joint pain, swelling
• Loss of appetite
• Confusion
• Throwing up or feeling like you’re going to
• Chest pain or pressure
• Muscle twitching
• Seizures or coma (in severe cases)
• Stomach and back pain
• Fever
• Rash
• Nosebleed

Acute Kidney Failure Causes

There are three main reasons your kidneys fail all of a sudden:

1. Something is stopping blood flow to your kidneys.  It could be because of:

2. You have a condition that’s blocking urine from leaving your kidneys. This could mean:

3. Something has directly damaged your kidneys, like:

Acute Kidney Failure Risk Factors

Most of the time, kidney failure happens along with another medical condition or event. If you fall into any of the following categories, you may have a greater chance of acute kidney failure:

• You’ve been hospitalized for a long time, especially in intensive care.
• You have diabetes.
• You’re elderly.
• You have coronary artery disease.
• You have heart failure or high blood pressure.
• You have chronic kidney or liver disease.

Acute Kidney Failure Diagnosis

Your doctor will start with a physical exam. Then, they’ll order tests of your blood, urine, and kidneys.

Blood tests. These measure substances in your blood.  

• Creatinine is a waste product in your blood that’s made by muscle activity. Normally, it’s removed from your blood by your kidneys. But if your kidneys stop working, your creatinine level rises.
• Urea nitrogen is another waste product in your blood. It’s created when protein from the foods is broken down. Like creatinine, your kidneys remove this from your blood. When your kidneys stop working, your urea nitrogen levels rise.
• Serum potassium is a substance found in your blood that balances water levels in your bloodstream. Kidney disease can cause either high or low potassium levels. 
• Serum sodium is another substance in your blood that helps with fluid balance in your body.  High sodium levels can mean that your kidneys aren’t working properly because your body can’t get rid of the right amount of sodium.

Urine tests. Your doctor will check your pee for blood and protein. They’ll also look for certain electrolytes. The results help your doctor understand what’s causing your kidney failure.

Urine output measurement. This measures how much urine you pass in 24 hours. You will get a container to take home, pee into, and then return to the lab after a full 24 hours. It can help your doctor determine why you’re having kidney failure.

Kidney biopsy (renal biopsy) is a procedure where the doctor pushes a thin needle through your skin and takes a small piece of your kidney to look at under a microscope.  It can show if there is any damage or disease in your kidney.

Imaging tests. Some tests, like ultrasonography or a CT scan, can show whether your kidneys are enlarged or there’s a blockage in your urine flow. An angiogram can tell your doctor if the arteries or veins that lead to your kidneys are blocked. An MRI can show this, too.

Kidney Failure Treatment and Home Remedies

If there aren’t any other problems, the kidneys may heal themselves.

In most other cases, acute kidney failure can be treated if it’s caught early. It may involve changes to your diet, the use of medications, or even dialysis.

• Diet. Your doctor will limit the amount of salt and potassium you get until your kidneys heal. That’s because both of these substances are removed from your body through your kidneys. Changing how and what you eat won’t reverse acute kidney failure. But your doctor may change your diet while they treat the conditions that caused it. This may mean treating a health problem like heart failure, taking you off certain medications, or giving you fluids through an IV if you’re dehydrated. If your doctor has put you on a low potassium diet, you’ll need to cut back on high-potassium foods like bananas, spinach, oranges, potatoes, and tomatoes.  On the other hand, you can eat more low-potassium foods like apples, strawberries, grapes, and cauliflower.  
• Medications. Your doctor may prescribe medicines that regulate the amount of phosphorus and potassium in your blood. When your kidneys fail, they can’t remove these substances from your body. Medications won’t help your kidneys, but they may reduce some of the problems kidney failure causes.
• Dialysis. If your kidney damage is severe enough, you may require hemodialysis until your kidneys can heal. Dialysis does not help kidneys heal but takes over the work of kidneys until they do. If your kidneys don’t heal, dialysis could be long-term.

Acute Kidney Failure Complications

Acute kidney failure can sometimes cause complications. These include:

• Fluid buildup. Acute kidney failure can sometimes cause a buildup of fluid in your body. If fluid builds up in your lungs, this can cause shortness of breath.
• Chest pain. If the lining that covers your heart  becomes inflamed, you may have chest pain.
• Acidic blood (metabolic acidosis). If your blood has too much acid due to acute kidney failure, you can end up with nausea, vomiting, drowsiness, and breathlessness.
• Muscle weakness. When your body’s fluids and electrolytes are out of balance, you can get  muscle weakness.  In serious cases, this can lead to paralysis and heart rhythm problems.
• Permanent kidney damage. Acute kidney failure can become chronic and your kidneys will stop working almost entirely or completely. This is called end-stage renal disease. If this happens, you will need to go on permanent dialysis (to filter your blood and remove toxins) or get a kidney transplant.
• Death. Acute kidney failure can lead to loss of kidney function that is so bad, it can cause death.

Acute Kidney Failure Prevention

You can reduce your risk of getting acute kidney failure by practicing some healthy habits.

• Be careful when taking over-the-counter (OTC) pain medications. Whether you are taking NSAID medications like aspirin, ibuprofen, and naproxen or other types of OTC pain medications like acetaminophen, it’s important to read and follow the recommended dosing instructions on the package. If you take too much of these meds, you could increase your chances of getting acute kidney failure.
• Follow your doctor’s advice. If you have a higher risk of getting acute kidney failure because of pre-existing kidney disease or other conditions, make sure to follow your doctor’s advice for treating and managing your condition.  
• Keep a healthy lifestyle. Exercise, eating right, and drinking little or no alcohol can go a long way to preventing acute kidney failure.

Chronic kidney disease – NHS

Chronic kidney disease (CKD) is a long-term condition where the kidneys don’t work as well as they should.

It’s a common condition often associated with getting older. It can affect anyone, but it’s more common in people who are black or of south Asian origin.

CKD can get worse over time and eventually the kidneys may stop working altogether, but this is uncommon. Many people with CKD are able to live long lives with the condition.

Information:

Coronavirus advice

Get advice about coronavirus and kidney disease from Kidney Care UK

Symptoms of CKD

There are usually no symptoms of kidney disease in the early stages. It may only be diagnosed if you have a blood or urine test for another reason and the results show a possible problem with your kidneys.

At a more advanced stage, symptoms can include:

See a GP if you have persistent or worrying symptoms that you think could be caused by kidney disease.

Find out more about the symptoms of CKD.

Causes of CKD

Chronic kidney disease is usually caused by other conditions that put a strain on the kidneys. Often it’s the result of a combination of different problems.

CKD can be caused by:

You can help prevent CKD by making healthy lifestyle changes and ensuring any underlying conditions you have are well controlled.

Tests for CKD

CKD can be diagnosed using blood and urine tests. These tests look for high levels of certain substances in your blood and urine that are signs your kidneys aren’t working properly.

If you’re at a high risk of developing kidney disease (for example, you have a known risk factor such as high blood pressure or diabetes), you may be advised to have regular tests to check for CKD so it’s found at an early stage.

The results of your blood and urine tests can be used to tell the stage of your kidney disease. This is a number that reflects how severe the damage to your kidneys is, with a higher number indicating more serious CKD.

Find out more about how CKD is diagnosed.

Treatments for CKD

There’s no cure for CKD, but treatment can help relieve the symptoms and stop it getting worse.

Your treatment will depend on how severe your condition is.

The main treatments are:

• lifestyle changes to help you remain as healthy as possible
• medicine to control associated problems such as high blood pressure and high cholesterol
• dialysis – treatment to replicate some of the kidney’s functions; this may be necessary in advanced CKD
• kidney transplant – this may also be necessary in advanced CKD

You’ll also be advised to have regular check-ups to monitor your condition.

Find out more about how CKD is treated and living with CKD.

Outlook for CKD

CKD can range from a mild condition with no or few symptoms, to a very serious condition where the kidneys stop working, sometimes called kidney failure.

Most people with CKD will be able to control their condition with medicine and regular check-ups. CKD only progresses to kidney failure in around 1 in 50 people with the condition.

If you have CKD, even if it’s mild, you’re at an increased risk of developing other serious problems, such as cardiovascular disease. This is a group of conditions affecting the heart and blood vessels, which includes heart attack and stroke.

Cardiovascular disease is one of the main causes of death in people with kidney disease, although healthy lifestyle changes and medicine can help reduce your risk of developing it.

Want to know more?

Information:

Social care and support guide

If you:

• need help with day-to-day living because of illness or disability
• care for someone regularly because they’re ill, elderly or disabled – including family members

Our guide to social care and support explains your options and where you can get support.

Community content from HealthUnlocked

Page last reviewed: 29 August 2019
Next review due: 29 August 2022

Symptoms, Causes, Tests and Treatment

Overview

What is kidney failure?

Kidney failure (also called renal failure) means one or both kidneys can no longer function well on their own. Sometimes, kidney failure is temporary and comes on quickly. Other times, it is a chronic condition that can get worse slowly over a long time.

Kidney failure may sound serious, and it is. But treatments such as dialysis and kidney transplant help many people with limited kidney function continue to live fulfilling lives.

What do the kidneys do?

The kidneys have several jobs. One of the most important is helping your body eliminate toxins. The kidneys filter your blood and send waste out of your body in urine.

The kidneys are bean-shaped organs about the size of your fist. They sit under your ribcage, toward your back. Most people have two working kidneys, but people can live well as long as at least one is working correctly.

When the kidneys don’t work effectively, waste products build up in your body. If this happens, you might feel sick. In the most serious situations, kidney failure can be life-threatening. However, many people can manage kidney failure with the right treatment.

Symptoms and Causes

What causes kidney failure?

The most common causes of kidney failure are diabetes and high blood pressure. Sometimes, though, kidney failure happens quickly due to an unforeseen cause.

When the kidneys lose function suddenly (within hours or days), it’s called acute kidney failure (or acute kidney injury). This type of kidney failure is often temporary. Common causes of acute kidney failure can include:

• Autoimmune kidney diseases
• Certain medications
• Severe dehydration
• A urinary tract obstruction
• Uncontrolled systemic disease like heart or liver disease

Kidney failure usually doesn’t happen overnight. Chronic kidney disease refers to a group of health conditions that affect how well your kidneys function over time. If left untreated, chronic kidney disease can lead to kidney failure.

The biggest causes of kidney failure from chronic kidney disease are:

• Diabetes: Unmanaged diabetes can lead to uncontrolled blood sugar levels. Consistently high blood sugar can damage the body’s organs, including the kidneys.
• High blood pressure: High blood pressure (hypertension) means blood travels through your body’s blood vessels with increased force. Over time, untreated high blood pressure levels can damage the kidneys’ tissue.

Other causes of chronic kidney disease include:

• Polycystic kidney disease, a hereditary condition where cysts (fluid-filled sacs) grow inside your kidneys.
• Glomerular diseases, such as glomerulonephritis, which affect how well the kidneys can filter waste.
• Lupus and other autoimmune diseases that can affect multiple body systems.

What are the symptoms of kidney failure?

In early stages of kidney disease, many people experience few or no symptoms. It’s important to note that chronic kidney disease can still cause damage even though you feel fine.

Chronic kidney disease and kidney failure can cause different symptoms for different people. If your kidneys aren’t working properly, you may notice one or more of the following signs:

• Fatigue (extreme tiredness)
• An upset stomach or vomiting
• Confusion or trouble concentrating
• Swelling, especially around your hands or ankles
• More frequent bathroom trips
• Muscle spasms (muscle cramps)
• Dry or itchy skin
• Poor appetite or metallic taste of food

Diagnosis and Tests

How is kidney failure diagnosed?

Doctors use a variety of tests to measure kidney function and diagnose kidney failure. If your doctors suspect you may be at risk for kidney failure, they may recommend:

• Blood tests, which can show how well the kidneys are removing waste from the blood.
• Advanced imaging, which can show kidney abnormalities or obstructions (blockages).
• Urine tests, which measure the amount of urine or specific substances in the urine, such as protein or blood.

Management and Treatment

How is kidney failure treated?

Kidney failure treatment is determined by the cause and extent of the problem. Treating your chronic medical condition can delay the progression of kidney disease. If your kidneys start losing their function gradually, your doctor may use one or more methods to track your health. By watching you closely, your doctor can help you maintain your kidneys’ function as long as possible.

Your doctor may gauge your kidney function with:

• Routine blood tests
• Blood pressure checks
• Medication

Because the kidneys serve such an important purpose, people in kidney failure need treatment to keep them alive. The main treatments for kidney failure are:

• Dialysis: This treatment helps the body filter the blood (doing the job that the kidneys can no longer perform).
  • In hemodialysis, a machine regularly cleans your blood for you. People often receive this kidney failure treatment at a hospital or dialysis clinic, 3 or 4 days each week.
  • Peritoneal dialysis cleans the blood in a slightly different way using a dialysis solution and a catheter. Sometimes, people can do their treatment at home.
• Kidney transplant: In kidney transplant surgery, doctors place a healthy kidney in your body to take over the job of your damaged organs. This healthy kidney, called a donor organ, may come from a deceased donor or a living donor, who may be a friend or family member. People can live well with one healthy kidney.

Prevention

Can kidney failure be prevented?

While kidney failure from chronic kidney disease can’t be reversed, you can do many things to help preserve the kidney function you have today. Healthy habits and routines may slow down how quickly kidneys lose their functional abilities.

If you have chronic kidney disease or kidney failure, you’ll want to:

• Monitor your kidney function, with your doctor’s help.
• Keep your blood sugar levels under control, if you have diabetes.
• Keep your blood pressure levels in a normal range.
• Avoid smoking.
• Make healthy diet choices, such as limiting foods high in protein and sodium.

Living With

When should I call the doctor?

A nephrologist (kidney specialist) receives special training in kidney evaluation and treatment. You may benefit from a kidney specialist’s expert opinion if:

• You have trouble keeping your blood pressure levels in a normal range, even with medication.
• Your blood sugar levels fluctuate (go up and down) widely.

Caring for someone with kidney failure at the end of life

What is kidney failure?

Normally, the kidneys filter excess water and waste products from the blood. These are then passed out of the body as urine. They also make hormones which help make new red blood cells and regulate the amount of calcium in the body. Kidney failure occurs when the kidneys are damaged, and all these different processes can be affected.

Symptoms of kidney failure include:

Anaemia is common in people with kidney failure and can cause some of the symptoms above. 

How is kidney failure managed?

Sometimes kidney failure can be managed with renal replacement therapy. This is either dialysis or a kidney transplant.

If someone is not fit enough to have a kidney transplant they can usually consider dialysis.

But for some people, dialysis may not be the right approach either. This includes people who:

• aren’t well enough to have dialysis
• are well enough to have dialysis but choose not to
• have started dialysis but due to a decline in their health are no longer well enough to have it
• have started dialysis but it didn’t improve their quality of life, or their symptoms continued to get worse despite dialysis, so they choose to stop.

Sometimes people deteriorate quickly in these situations, so they should all be offered palliative care to help manage their symptoms and prepare them for the end of their lives. People on dialysis can also have symptoms that are hard to manage and may benefit from palliative care alongside dialysis.

How can kidney failure affect someone at the end of life?

Kidney failure can affect different people in different ways – sometimes it can progress very slowly and sometimes very rapidly.

When kidney failure decline is rapid prompt planning regarding the patient’s wishes and potential care at home is vital.

If the patient has kidney failure as well as another advanced condition, such as cancer, this can worsen the patient’s prognosis and lead to a faster deterioration.

Dialysis only addresses the kidney failure part of someone’s illness. If kidney failure is caused by another illness such as cancer, it won’t improve the other symptoms that the illness causes. Dialysis may be challenging for people who are frail or have other advanced conditions.

Supportive measures, such as making sure the patient is as comfortable as possible and that symptoms are well managed, are important.

People with kidney failure at end of life will usually experience an increase in the symptoms listed above. They may become more drowsy and confused.

Managing symptoms for someone with kidney failure can be challenging. Some of the medicines used to treat symptoms can cause further damage to the kidneys. Additionally, some medicines are processed by the kidneys. When the kidneys are damaged, they can’t perform this function and some medicines can build up to toxic levels and cause side effects. It’s important to ask for specialist help from the renal team or palliative care team to make sure that the person is on the most suitable medicines for them. If you’re a prescriber check your local guidelines. You might also find the Scottish Palliative Care Guidelines   useful.

How can I support someone with kidney failure at the end of life?

As someone with kidney failure approaches the end of life, their care needs may be more complex and require careful planning. Early advance care planning can allow someone to express their wishes and preferences for their care at the end of life.

Decisions should be made with the person, those important to them and other health and social care professionals involved in their care.

Palliative care should be holistic, considering the physical, social, psychological and spiritual needs of the person and those important to them. Be aware of what other services are available in your area to support the person’s individual needs. We have more information on caring for people in their last days and hours.

Be able to recognise symptoms of kidney failure and know how to ask for help from specialist teams. Careful choice of medicines can manage symptoms so the person is comfortable and prevent any toxicity.

Useful resources

Scottish Palliative Care Guidelines – Renal disease in the last days of life    

NICE Clinical Knowledge Summary: Chronic kidney disease  

Guidance from NHS England: End of Life Care in Advanced Kidney Disease (pdf)      

Chronic Kidney Disease (CKD) Symptoms, Treatment, Causes & Prevention

37 million people in the United States are living with chronic kidney disease (CKD).

The term “chronic kidney disease” means lasting damage to the kidneys that can get worse over time. If the damage is very bad, your kidneys may stop working. This is called kidney failure, or end-stage renal disease (ESRD). If your kidneys fail, you will need dialysis or a kidney transplant in order to live.

What causes chronic kidney disease (CKD)?

Anyone can get CKD. Some people are more at risk than others. Some things that increase your risk for CKD include:

• Diabetes
• High blood pressure (hypertension)
• Heart disease
• Having a family member with kidney disease
• Being African-American, Hispanic, Native American or Asian
• Being over 60 years old

Return to top

What are the symptoms of kidney failure?

You may notice one or more of the following symptoms if your kidneys are beginning to fail:

• Itching
• Muscle cramps
• Nausea and vomiting
• Not feeling hungry
• Swelling in your feet and ankles
• Too much urine (pee) or not enough urine
• Trouble catching your breath
• Trouble sleeping

If your kidneys stop working suddenly (acute kidney failure), you may notice one or more of the following symptoms:

• Abdominal (belly) pain
• Back pain
• Diarrhea
• Fever
• Nosebleeds
• Rash
• Vomiting

Having one or more of any of the symptoms above may be a sign of serious kidney problems. If you notice any of these symptoms, you should contact your doctor right away.

Return to top

Complications of CKD

Your kidneys help your whole body work properly. When you have CKD, you can also have problems with how the rest of your body is working. Some of the common complications of CKD include anemia, bone disease, heart disease, high potassium, high calcium and fluid buildup. Learn more about the complications of CKD.

Return to top

Stages of CKD

Chronic kidney disease (CKD) refers to all 5 stages of kidney damage, from very mild damage in Stage 1 to complete kidney failure in Stage 5. The stages of kidney disease are based on how well the kidneys can do their job – to filter waste and extra fluid out of the blood. Learn more about the stages of CKD.

Return to top

How can I prevent CKD?

Diabetes and high blood pressure are the most common causes of CKD. If you have diabetes or high blood pressure, working with your doctor to keep your blood sugar and blood pressure under control is the best way to prevent kidney disease.

Living a healthy lifestyle can help prevent diabetes, high blood pressure and kidney disease, or help keep them under control. Follow these tips to lower your risk for kidney disease and the problems that cause it:

• Follow a low-salt, low-fat diet
• Exercise at least 30 minutes on most days of the week
• Have regular check-ups with your doctor
• Do not smoke or use tobacco
• Limit alcohol

Return to top

How do I know if I have CKD?

CKD usually does not have any symptoms until your kidneys are badly damaged. The only way to know how well your kidneys are working is to get tested. Being tested for kidney disease is simple. Ask your doctor about these tests for kidney health:

• eGFR (estimated glomerular filtration rate)

  The eGFR is a sign of how well your kidneys are cleaning your blood.

  Your body makes waste all the time. This waste goes into your blood. Healthy kidneys take the waste out of your blood. One type of waste is called creatinine. If you have too much creatinine in your blood, it might be a sign that your kidneys are having trouble filtering your blood.

  You will have a blood test to find out how much creatinine is in your blood. Your doctor will use this information to figure out your eGFR. If your eGFR is less than 60 for three months or more, you might have kidney disease.

• Urine test

  This test is done to see if there is blood or protein in your urine (pee).

  Your kidneys make your urine. If you have blood or protein in your urine, it may be a sign that your kidneys are not working well.

  Your doctor may ask you for a sample of your urine in the clinic or ask you to collect your urine at home and bring it to your appointment.

• Blood pressure

  This test is done to see how hard your heart is working to pump your blood.

  High blood pressure can cause kidney disease, but kidney disease can also cause high blood pressure. Sometimes high blood pressure is a sign that your kidneys are not working well.

  For most people a normal blood pressure is less than 120/80 (120 over 80). Ask your doctor what your blood pressure should be.

Return to top

How is CKD treated?

Damage to your kidneys is usually permanent. Although the damage cannot be fixed, you can take steps to keep your kidneys as healthy as possible for as long as possible. You may even be able to stop the damage from getting worse.

• Control your blood sugar if you have diabetes.
• Keep a healthy blood pressure.
• Follow a low-salt, low-fat diet.
• Exercise at least 30 minutes on most days of the week.
• Keep a healthy weight.
• Do not smoke or use tobacco.
• Limit alcohol.
• Talk to your doctor about medicines that can help protect your kidneys.

If you catch kidney disease early, you may be able to prevent kidney failure. If your kidneys fail, you will need dialysis or a kidney transplant to survive.

Return to top

Kidney-friendly diet for CKD

You need to have a kidney-friendly meal plan when you have chronic kidney disease (CKD). Watching what you eat and drink will help you stay healthier. A kidney-friendly diet may also help protect your kidney from further damage by limiting certain foods to prevent the minerals in those foods from building up in your body. Learn more about the kidney-friendly diet for CKD.

Return to top

Find kidney-friendly recipes on Kidney Kitchen

In Kidney Kitchen, you can:

• Learn what healthy eating means for people in every stage of kidney disease, including those on dialysis or living with a kidney transplant.
• Take a deep dive into what each nutrient means for people with kidney disease and how much of these nutrients common foods contain.
• Find healthy, delicious recipes.

Return to top

Chronic Kidney Disease and Failure

Diet effect

It is generally agreed that feeding renal failure diets to dogs and cats with kidney disease improves their quality of live and may minimize the progression of the disease resulting in a longer life span. Studies that evaluate the effect of dietary changes on quality and quantity of life typically use commercial diets that differ in their composition of protein, phosphorus, sodium and lipids compared to maintenance diets so that positive effects are not attributable to a single component of the diet but rather to a “diet effect“.

A randomized, double masked, clinical study in 38 dogs with spontaneous stage 3 or 4 kidney disease, half of which were fed a kidney failure diet and the other half a maintenance diet, published in JAVMA in 2002, demonstrated improved quality and increased quantity of life in the group fed the renal failure diet.

• The median interval before development of a uremic crisis was twice as long in the group fed the renal diet
• Dogs fed the renal diet survived at least 13 months longer (average 593 vs 188 days)
• Owners of dogs fed the renal diet reported significantly higher quality of life scores for their dogs

The results of a study of cats with naturally occurring stable chronic renal failure fed a diet restricted in phosphorus and protein compared to cats with CKD fed a maintenance diet reported a median survival of 633 days for 29 cats fed the renal diet compared to 264 days for 21 cats fed a regular diet. The groups were not randomly determined but based on cat & owners willingness to change to the renal diet.

In a study published in JAVMA in 2006, 45 client-owned cats with spontaneous stage 2 or 3 CKD were randomly assigned to an adult maintenance diet (23 cats) or a renal diet (22 cats) and evaluated for up to 24 months. Findings included:

• Significant differences: BUN lower and blood bicarbonate higher in the renal diet group
• No Significant differences
  body weight
  PCV
  urine protein-to-creatinine ratio
  creatinine
  potassium
  calcium
  parathyroid hormone concentrations.
• 26% of cats fed the maintenance diet had uremic episodes (26%), compared with 0% cats fed the renal diet
• At the conclusion of the study, 5 (21.7%) cats in the maintenance diet group had died from renal causes and there were no renal-related deaths in the renal diet group.
• There were no significant differences in quality of life as perceived by owners responding to a questionnaire.
• Owners impressions of cats willingness to consume the diets did not differ between groups

Nursing care for renal failure in a nursing home in Krasnodar

Kidney disease in the elderly is not uncommon. One of these is renal failure. The kidneys are a filter that regulates fluid levels in the human body. This is the most important vital organ. If it starts to work poorly and fails, the person feels it, the work of the whole organism worsens. As a result of the development of a serious illness (for example, kidney cancer), kidney failure can occur in the elderly.

As a rule, it is diagnosed infrequently, since kidney failure in an elderly person is gradual, the symptoms are not pronounced. Due to the aging process, the body gradually turns off parts of the organ. If a person has vascular disease, then the process is faster. There are several stages of the disease: latent, compensated, intermittent and terminal.

Signs of renal failure in older women

The first symptoms of renal failure in older women are: fatigue, sleep problems, weakness, lack of appetite, frequent urination at night, swelling around the eyes.At the next stage, an elderly person regularly has nausea and vomiting, weakness increases, drowsiness, dryness and bitterness in the mouth, twitching of the lower extremities, and blood pressure increase. At the last stage, shortness of breath occurs, a person noticeably loses weight, he is pursued by vomiting and diarrhea, mood changes sharply, bad breath, anemia occurs.

Emergency care for acute renal failure (ARF)

If the disease is difficult, it can at any time lead to a sharp deterioration in the state of human health.Acute renal failure has 4 stages of development. At the first stage, renal colic occurs, there is a violation of the blood circulation of the organ and sepsis. The sooner you seek help, the less negative consequences will arise in the body of a sick person. At the second stage, the amount of urine changes noticeably. It can be either too little, or it can be absent. It is possible to diagnose the disease by high blood pressure, more precisely the doctor will establish the diagnosis. If you do not provide help in time, a person will experience cerebral edema.

The next stage is recovery. A person excretes more than 4 liters of urine per day, which invariably leads to dehydration and loss of essential elements. The last stage of recovery is quite long. With timely diagnosis and proper treatment, a person can restore the full functioning of organs. At this time, even with chronic renal failure, the elderly need care.

It is best to register for the rehabilitation period of a sick person in a boarding house for the elderly and elderly people “Centenarians” in Krasnodar.Here he will be provided with full nursing care for kidney failure. Employees will monitor his health around the clock and track the slightest changes. Sisters of mercy will supervise the intake of medicines and food, help with hygiene, going to the toilet or changing a diaper. We accept people even in grave condition, as we are ready to provide comprehensive care and provide the necessary assistance.

Renal failure care in a nursing home in St. Petersburg

Chronic renal failure in the elderly is a common condition.As a result of its occurrence in a person, the main excretory function of the kidneys is disrupted, and therefore the work of all internal organs, water and electrolyte balance, and metabolism are disrupted. With age, the entire body of an elderly person ages, the work of vital systems deteriorates, and regeneration slows down. This destructive process does not bypass the kidneys, which as a result leads to their gradual degradation. The cells of the organ die off, an accumulation of nitrogenous substances occurs, which leads to toxic processes.The development of the disease can be promoted by the prolonged course of pyelonephritis.

Chronic renal failure occurs in older people whose prognosis has not been diagnosed in time. After 3 months, the disease spills over into a chronic, incurable form. There is also acute renal failure. In fact, it is rather difficult to diagnose CRF at the initial latent stage, but over time, signs of renal failure in older people become more and more noticeable.Most often, the disease affects the female body.

Symptoms and signs of renal failure in older women

There are 4 stages of the development of the disease: latent, compensated, intermittent and the most severe – terminal. Depending on the number of damaged cells, a number of symptoms of the disease appear. At the latent stage, the symptoms are almost invisible, most often the disease is recognized by an external examination. Gradually, a person begins to feel rapid fatigue and weakness, but does not attach any importance to this.The disease proceeds to the next stage, which is characterized by such signs as polyuria and nocturia – an increase in the amount of urine excreted and frequent nighttime urges.

Further, the patient develops dryness and bitterness in the mouth, nausea, swelling, increased pressure. At the terminal stage, among the symptoms, one can distinguish a sharp weight loss, decreased appetite, bad breath, indigestion, swelling, and urine odor. If you do not start resuscitation at this stage, the person may develop pneumonia or coma.Renal failure is common in older women and is often caused by hormones.

Treatment of this ailment is carried out in two ways: active and conservative. In the first case, it is homodialysis (carried out in the last stages of the disease), in the second – diet, hormone therapy, taking diuretics and drugs that lower blood pressure. Nutrition for the elderly is important in renal failure. In our retirement home “Centenarians” in St. Petersburg, we have a reusable balanced diet, which contains a minimum of protein and practically does not contain salt, which delays the excretion of fluid from the body.Our boarding house provides complete nursing care for kidney cancer and after its removal.

Nursing care for renal failure

With timely diagnosis and proper treatment, specialists have a chance to return an elderly person to full-fledged work of internal organs and, in particular, of the kidneys. Rehabilitation for this disease takes a long time, it takes years. To ensure that a sick person is always under control, he can be registered in our private boarding house for the elderly “Centenarians” in St. Petersburg.Here he will be looked after around the clock and provide all the necessary assistance: to monitor compliance with a strict diet and medication. If a person has the last stage of the disease, urinary incontinence, our staff will help him to carry out hygiene, change a diaper or duck.

90,000 When kidneys fail

The kidneys are vital organs that purify the blood and maintain its chemical balance. Healthy kidneys cleanse the blood by removing excess water and waste products.They also produce hormones that keep bones strong and blood healthy.

Renal failure

If the kidneys are damaged, patients either stop urinating altogether, or the amount of urine is significantly reduced, while waste products continue to be produced. These waste products and water accumulate in the blood. This condition is called uremia. Your arms or legs may swell and you may start to choke. Blood pressure can rise and your body no longer produces enough red blood cells.You may experience fatigue, nausea, and loss of appetite. Left untreated, uremia can lead to seizures or coma and ultimately death.

If kidney function is reduced by 15 percent or less, it is called renal failure. Dialysis or transplantation may be the only ways to replace lost kidney function.

Renal function replacement

Patients newly diagnosed with kidney failure can be daunting at the prospect of being on dialysis.To reduce the emotional anxiety caused by upcoming dialysis therapy, it is important to physically, mentally and emotionally prepare yourself for this life-saving therapy in advance. It is best to start planning this process as early as possible to prepare for the next phase of your life.

It is best to start planning this process as early as possible to prepare for the next phase of your life. Your healthcare team will discuss treatment options with you and help you make a decision that meets your personal and medical needs.Often, preparations for dialysis and transplantation begin at the same time.

90,000 Symptoms of renal failure in the elderly

Renal failure in the elderly

The kidneys are an important organ in humans.

They are responsible for the excretory, endocrine and metabolic work of the whole organism.

But with age, there is a violation of these functions, there are changes in the kidneys, filtration slows down, metabolism, blood flow decreases.

We are faced with a problem called renal failure.

For what reasons does such a phenomenon appear and how to deal with it and is it possible? We will cover such issues in our article.

Age-related changes in the body

Basically, if a person did not suffer from chronic kidney disease at an early age, deviations before old age may not occur, but it all starts after 40 years.

With age, the immune system can malfunction and then it is very easy for bacteria and infections to enter the body and settle in the kidneys.

The main task of the elderly is to prevent this and to visit medical institutions in time to monitor their health status.

The kidneys are a filter that cleans the body of toxins, cleans the blood lymph, removes all unnecessary fluid.

During aging, the number of nephrons, which are responsible for the very filtration, decreases, the organs themselves decrease in size, which is why the kidney tissue also contracts.

Stages of development of renal failure

In addition, age-related changes occur in the blood vessels.They become less elastic, which leads to a violation of the outflow of blood through them.

As the body ages, glomerular clearance, that is, filtration, decreases. With every 10 years passed, its speed decreases by 8%, this affects the blood flow.

Also, over the years, there is an imbalance between glucose and acids in the kidneys, an increase in acidity is observed, this phenomenon is called acidosis.

Elderly people should always remember about changes in their body and carefully monitor their health, follow special diets, gymnastics and a number of other medical recommendations.An active lifestyle will help filter water from the body and prevent it from stagnating in the kidneys.

Causes of renal failure

Often the causes of such ailment in the elderly are physiological abnormalities of a chronic nature.

For example, significant renal failure can develop with diabetes mellitus, or with previous infectious diseases.

These diseases can be:

• stones;
• pyelonephritis;
• inflammatory processes of the urinary system;
• prostate adenoma;
• renal tuberculosis;
• cystitis;
• changes in blood pressure;
• tumor formations;
• enuresis;
• deposits of uric acid salts, that is, gout, etc.

Another cause of kidney failure in old people is disorders of the cardiovascular system, since the entire blood circulation fails.

Therefore, in old age, doctors advise especially strictly to monitor the slightest deviations in the body, since the symptoms of age-related renal failure are very weak and difficult to recognize. Sometimes it can be asymptomatic.

Symptoms of the disease

Everything would be fine if the disease proceeds without any special signs, but over time the disease can progress, and then unpleasant symptoms appear that do not allow all elderly people to live peacefully.

The main signs by which you can determine the presence of renal failure include:

1. Frequent urination, mainly at night. Urine is released not, as usual, in a single stream, but in a few drops with strong urge.
2. There is increased fatigue.
3. Appetite disappears.
4. Urine may not drain completely, so swelling of the limbs or face is common.
5. Dizziness, dry mouth.
6. Nausea.

Such observations can be found in the early stages of the disease, then the situation only gets worse.

Hemodialysis in case of renal failure

When examining a patient, doctors state the facts of the presence of insufficiency, which is determined by more serious symptoms:

• Body weight is quite reduced.
• Muscles are atrophied and limb movements are constrained.
• The patient behaves apathetically, lethargy is observed in his actions.
• The skin acquires a yellowish tinge, and in some areas there are peeling, which is constantly itching. Often, the patient combs these problematic lesions, which causes bloody sores to appear.
• The patient exudes the smell of ammonia.

In addition to the external manifestation of the disease, failures occur in all vital systems of the body.

1. A large amount of fluid accumulates in the respiratory organs, which is clearly audible when coughing. Pulmonary edema may occur.
2. The digestive system also suffers. Bloating, nausea, vomiting, intragastric bleeding, peptic ulcers are common.
3. The musculoskeletal system is affected by osteoporosis, gout, since uric acid salts are not filtered out of the body.
4. There are pains in the heart, disorders of the nervous system.

If any of the signs is found, you should immediately consult a doctor in order to diagnose and begin treatment.

Diagnosis of the disease

When you see a doctor, you should tell all your complaints and describe your condition.

Only after analyzing all the causal signs will a diagnosis be made.

In addition, it is necessary to undergo an examination and pass a number of tests:

• general analysis of blood and urine;
• to compare the daily urine output after a certain amount of liquid drunk;
• urine analysis according to Nechiporenko and Zemnitsky;
• biochemical blood test;
• ultrasound examination of the kidneys and heart;
• x-ray of the kidneys;
• fundus examination.

Examining all the results the result will be 100% correct.

Treatment of renal failure

The complex of treatment depends on the stage of the disease. If the symptoms are not significant, then the doctor prescribes drug therapy.

At this stage, you can combine a course of medicines with recipes of traditional medicine at home. And in case of complications, surgery can be prescribed.

Medication

The basis of therapy is antibiotics, diuretics and antispasmodics, which eliminate the inflammatory process, alleviate the patient’s condition, relieve pain and increase the outflow of urine.

These medicines include:

1. Furosemide;
2. Uregit;
3. Oxodolin et al.

If during the illness the patient suffers from drops in blood pressure, the doctor may prescribe pills that normalize it, namely: Enalapril, Captopril.

When the symptoms are complicated by the digestive system, third-party drugs may be prescribed to relieve the upset gastrointestinal tract: Enterosgel and other sorbents.

Furosemide – for the treatment of renal failure

In addition to taking medications, doctors advise adhering to a diet, especially foods that provoke fluid stagnation in the body.

For example, smoked meats, sweets, salty and spicy foods. It will be good to exclude from the diet those foods, the content of proteins and salts in which is increased. An excellent effect during treatment will give physiotherapy exercises. Therefore, treatment should be carried out in a comprehensive manner.

Traditional methods

Often, older people resort to traditional medicine recipes.

This is not contraindicated, but it is worth knowing which herbs will help in this case, knowing the dosage, so self-medication should be carried out under the supervision of a doctor.

The most common herbal recipes that can improve kidney function are:

• Using the herb echinacea, and all its parts. You will need 50 g of dried herb raw material and 1 liter of alcohol.Leave the mixture for 2 weeks in a cool dark place. Drink the drug for half a year, 10 drops a day.
• Melissa, calendula and mint will also alleviate the ailment. Take the collection in equal amounts, make a decoction, take half a glass of infused liquid once a day.

These are just a few recipes that are popular in the treatment of this ailment.

Echinacea tincture – for the treatment of chronic renal failure

But many people also use other medicinal infusions and decoctions, which are prepared using:

1. burdock root;
2. rose hips;
3. dill seeds;
4. sea buckthorn berries;
5. Juniper fruits;
6. flax seeds, etc.

Decoctions and infusions prepared on the basis of these ingredients will not only alleviate the patient’s condition, but also improve immunity, replenish vitamins in the body, and improve the functioning of all human organs of vital activity.

Important!

The use of traditional medicine recipes should be strictly supervised by the attending physician, as some herbs may not be suitable for everyone, as a result of which irreversible side effects may occur.

Conclusion

The understanding that youth cannot be returned comes with age, when health problems begin to appear.

The body changes only for the worse, and in quite old people it does. Senile sores appear, and kidney failure can be attributed to them.

If you find in yourself or your loved ones the symptoms that we highlighted earlier, then there is an ailment, which means that a visit to the doctor is inevitable.

And only the correct implementation of all the recommendations of doctors leads to prolongation of life for many years.

Video: Renal failure, which interferes with kidney function

Diseases of the urinary system in elderly and senile patients

Diseases of the urinary system in elderly and senile patients

Population aging is one of the most important natural processes in the modern world.With increasing age, the problems associated with the changed social status of an elderly person, his physical and psychological state, adaptation to new relationships with family members and society as a whole, and many other aspects, sharply exacerbate.

The UN Principles on Older Persons, adopted by the General Assembly of this organization in 1991, express modern views on the place and role of older people in society, affirming the view of old age as a period of active life, quite productive and interesting.The essence of this document is to make the life of elderly people full of value, ensuring their independence, dignity, participation and dignified care on the part of all members of society, the possibility of realizing their inner potential.

The main task of state structures at all levels responsible for ensuring the social well-being of the population is not only to provide the elderly with the support they require and free services guaranteed by legislation, but also to make the process of transition to old age less painful and problematic, minimizing the negative consequences of the loss of the former “social face” “.

The problem of uronephrology is one of the most important in geriatrics. An increase in the number of elderly and senile people leads to an increase in both the primary morbidity and the general prevalence of urological cancers, benign prostatic hyperplasia, urolithiasis and nonspecific inflammatory diseases of the kidneys and upper urinary tract.

There is an annual increase in persons with diseases of the genitourinary organs by 1.2%. It should be noted that simultaneously with the growth of morbidity, mortality from a number of diseases also increases.

With aging, the consumption of oxygen by the kidneys decreases, the number of mitochondria in cells decreases, and the total ATPase activity decreases, which together reflects a decrease in the intensity of energy metabolism in the organ. The physiological level of renal circulation and glomerular filtration progressively decreases.

Decreases excretory (nitrogen, water, electrolyte) function of the kidneys. In this case, age-related renal hypofunction, torpid (prolonged latent, prolonged recovery periods) type of organ reactions to irritation are formed.This is facilitated by the age-related features of the neurohumoral regulation of the urinary system in old age – a decrease in the specific role of the nervous link, an increase in the importance of the humoral one.

Renal cups, pelvis, ureters thicken with age, lose elasticity, increase capacity. Their rhythmic activity is disrupted, refluxes become more frequent. The wall of the bladder thickens, hardens, its capacity falls, which causes an increase in the urge to urinate. Age-related changes in the bladder weaken the function of its closure apparatus, contributing to urinary incontinence.This is aggravated by a decrease in the function of the higher nerve centers that control the urination reflex.

Age-related structural, metabolic, functional, regulatory changes reduce the reliability of the urinary system: they contribute to the growth of pathological affection of its links in old age, increase the likelihood of their decompensation (especially of the kidneys) under stress conditions.

Inflammatory diseases of the kidneys and urinary tract

Glomerulonephritis and pyelonephritis are among the inflammatory diseases of the urinary and urinary organs.The likelihood of developing diffuse glomerulonephritis in humans after 40 years of age progressively decreases due to age-related decline in the reactivity of the immune system.

Acute senile glomerulonephritis.

The disease is no more than 2-3% in the overall structure of the incidence of glomerulonephritis. In the etiology of the disease, the leading role belongs to nephritogenic strains of 5-hemolytic streptococcus. However, in old age, the role of other microorganisms, viruses, and systemic diseases of the connective tissue increases.A feature of the pathogenesis of glomerulonephritis in an old person is a low degree of activity of the unfolding immune process, therefore, damage to the renal filter is more moderate.

Clinical picture. Diagnosis.

The disease in older people is characterized by smooth manifestations and atypicality. Edema is less common, less massive than in young people, often transient, easily visible. Urinary syndrome is characterized by small (no more than 0.5-1 g / day) proteinuria, cylindruria, erythrocyturia (single in the field of view), often leukocyturia.Cardiac syndrome is clearly defined (arterial hypertension, especially diastolic; symptoms of coronary, cardiovascular, often left ventricular failure).

A characteristic feature of senile glomerulonephritis is a concomitant defeat of other functional systems – nervous, respiratory, digestive, hematopoietic, which masks the underlying disease and makes it difficult to recognize it. The frequency of clinical variants of acute glomerulonephritis in old age is characterized by a tendency to an increase in glomerulonephritis with nephrotic syndrome, hematuric forms.Despite the smoothness of clinical manifestations, the severity of glomerulonephritis increases with the age of the patient at the time of the onset of the disease.

Chronic senile glomerulonephritis.

Chronic glomerulonephritis occurs in geriatric practice more often than acute. It accounts for about 18% of all cases of chronic glomerulonephritis. In connection with a decrease in the activity of immune processes in old age, initially chronic forms of the disease predominate.

Clinical picture. Diagnosis.

The disease usually proceeds monotonously, without a regular change in periods of exacerbation and remission, therefore, it is often recognized at the stage of complications – arterial hypertension, anemia, renal failure.

Of the clinical variants of the disease, latent prevails, although nephritic and hypertensive forms of them are becoming more frequent.

The latent variant is characterized by the absence of clear clinical manifestations. transient hypertension, scanty urinary symptoms are easily seen, and the disease is detected at a later stage.

In the hypertensive variant, the leading symptoms in a geriatric patient are manifestations of coronary, acute or chronic cardiovascular insufficiency, that is, a cardiac “mask” of the disease arises.

In the nephrotic variant, edema, proteinuria, cylindruria in geriatric patients are more moderate, on the contrary, biochemical changes in the blood are more severe. Glomerulonephritis inevitably progresses to renal failure, which in older patients joins early, often at the stage of acute illness.

Difficult to diagnose: in 75% of cases, the disease is recognized on the section. Therefore, the doctor’s vigilance and active confirmation of the diagnosis using modern research methods are necessary. It is important to remember that age-related nephrosclerosis does not give urinary symptoms and the activity of immune processes in the “senile” kidney is low, so even small symptoms should be given diagnostic value, especially if they are detected in dynamics (proteinuria, more often selective, cylindruria, erythrocyturia).It is necessary to conduct a quantitative study of the excretion of blood corpuscles in the urine with the determination of the ratio: leukocytes / erythrocytes. It is useful to investigate the leukocyte formula of urine, uroproteinogram. Clearance tests (a decrease in relation to the age norm of the glomerular filtration rate, filtration fraction) are of some importance in recognizing the disease, and immunological tests in a geriatric patient are less informative. Differential diagnosis of glomerulonephritis is carried out with diseases common in old age.When differentiating glomerulo- and pyelonephritis, the diagnosis of glomerulonephritis is confirmed by the symptoms of diffuse kidney damage, prevailing erythrocyturia, lymphocyturia, decreased glomerular filtration, filtration fraction, early addition of renal failure. The positive dynamics of renal symptoms after therapy with cardiac glycosides indicates cardiac kidney syndrome. Proteinuria, diabetic retinopathy, macroangiopathies, arterial hypertension, progressive renal failure in a patient with diabetes mellitus confirm diabetic glomerulosclerosis.The presence in the patient of a disease that can cause amyloidosis, proteinuria, “empty” urinary sediment, positive color tests, amyloid deposits in the biopsy specimen of the mucous membrane from the submucosa of the gingival margin, colon or kidney itself confirm renal amyloidosis.

Treatment.

It is carried out according to general principles, but taking into account the characteristics of an aging organism. Due to the detraining effect of hypodynamia, the patient’s stay in bed during an exacerbation of the disease should be as short and active as possible.The mode of “hunger and thirst” due to a decrease in the concentration function of the kidneys is not prescribed for the elderly, for the elderly – only for severe extrarenal manifestations of the disease for no more than 1 day. The restriction of table salt due to the threat of extracellular dehydration, intracellular overhydration is more moderate: at least 5-6 g of salt per day is provided. In oligoanuria, fluid intake should correspond to diuresis on the previous day with the addition of 300-400 ml of fluid for extrarenal losses.In connection with the catabolic orientation of metabolism, these patients from the first days of the disease are allowed to enter (taking into account the nitrogen-excreting function) physiological or subphysiological norms of protein. After the disappearance of extrarenal symptoms of the disease, complete nutrition is prescribed.

Modern urology: diagnosis and treatment of the genitourinary system

The diagnostic capabilities of modern urology are at a very high level. To make correct diagnoses, urologists use the latest diagnostic methods: measuring (urofluometry, cystomanometry, spermogram), laboratory (studies of the urethra and urine discharge), instrumental (bougienage, catheterization, puncture biopsy), endoscopic (cysto- and urethroscopy), X-ray diagnostics and Ultrasound.

Only a doctor can diagnose diseases of the urinary system. The effectiveness of treatment depends on the timeliness of contacting a urologist. Therefore, at the first signs of illness, it is necessary to consult a specialist. He will prescribe an examination, which usually includes laboratory tests (urine and blood tests) and instrumental diagnostics (ultrasound, MRI, X-ray). In case of kidney damage, a functional Reberg test is performed. Often, a biopsy is used to examine the kidneys, which allows you to examine the kidney tissue and establish an accurate diagnosis.

Peculiarities of treatment, the doctor determines the tactics of treating diseases of the urinary system based on the causes of their occurrence. Often, therapy is carried out in a hospital under medical supervision. Depending on the characteristics of the pathology, treatment can be conservative or surgical. The patient must undergo complete treatment to prevent recurrence of the disease and the development of a chronic form. It is very important during therapy to follow the diet and diet recommended by the doctor. During the rehabilitation period, they use sanatorium treatment and physiotherapy.Treatment and prevention of diseases of the urinary system are successful if all the doctor’s recommendations are followed. Compliance with the rules of hygiene, complete cure of acute respiratory diseases, timely therapy of infectious diseases guarantee the prevention of the development of many diseases.

Prevention of these complications involves the use of a set of measures: prevention of diseases of the urinary system, bedsores, exercise therapy, combating constipation (dietary recommendations, taking light laxatives of plant origin, slightly alkaline mineral waters).Elderly patients with urinary incontinence require careful care. In cases where it is no longer possible to restore normal urination, it is necessary to constantly use a bed vessel or urine bag.

Proper nutrition is important in caring for elderly and senile patients. The food of the elderly should be varied, easily digestible, biologically valuable, but energetically less saturated than the food of young people.It should contain a sufficient amount of proteins, vitamins and salts, especially calcium, potassium and iron, trace elements, as well as a sufficient amount of liquid. Since the intensity of metabolic processes in the body is reduced in elderly patients, the calorie content of food should be reduced by reducing the content of animal fats and carbohydrates. Products containing coarse fiber must be included in the diet of the elderly [7].

Salt consumption should be limited to 5-8 g per day.Without special indications, you should not limit fluid intake (less than 1-1.5 liters per day), as this can increase constipation. With a tendency to constipation, the inclusion in the diet of fruit juices and compotes, apples, beets and other vegetables and fruits that stimulate intestinal peristalsis is shown. In elderly and senile patients, the recovery processes proceed more slowly than in young people, which also determines a longer period of recovery therapy (rehabilitation). However, with persistent and long-term treatment, significant success can be achieved in the rehabilitation of patients who have suffered even very serious illnesses (myocardial infarction, cerebrovascular accident).In this case, the correct organization of care for elderly patients plays an invaluable role.

In our country, the greatest contribution to the provision of medical care to elderly patients is made by physicians of a therapeutic profile – district therapists, general practitioners, doctors of inpatient departments, etc. Geriatric doctors are entrusted with providing organizational and methodological assistance to the elderly and conducting consultations.
Treatment and prevention of kidney disease are important honey . problem. Free treatment, the development of specialized departments in hospitals and clinics, the creation of nephrological centers, extensive medical examination of patients, a large number of sanatoriums for treating patients with a neurological profile – all this makes it possible to successfully treat and prevent kidney diseases. However, the success of treatment and prevention largely depends on the patients’ compliance with the doctor’s recommendations. Hardening, strict observance of hygienic rules, prevention and careful treatment of acute respiratory diseases, timely treatment of focal infections serve as a reliable guarantee of the prevention of diseases of the urinary system.

The demographic situation, in which the world’s population is aging faster than it is getting younger, makes us think about the need to create acceptable living conditions for older people, because life after 60 does not end, and age is not a reason to give up a full life.
Along with involutionary processes at all levels of a person’s organization, changes and neoplasms of a progressive nature occur, which make it possible to prevent or overcome destructive (destructive) phenomena in old and senile age.Active longevity of an elderly person is promoted by many factors, the leading psychological among which can be considered the development of him as a socially active personality, as a subject of creative activity and a bright individuality. And here a high level of self-organization, conscious self-regulation of one’s way of life and life activity plays a huge role.

YOUR HEALTH IS IN YOUR HANDS!

Head.OMR Toporash V.A.

Diseases of the urinary system in

elderly and senile patients

90,000 Chronic migraine in the elderly. Clinical features and treatment. Part 2.

Our neurologist Daria Zakharovna Korobkova continues to talk about how to choose preventive treatment and drugs to stop an attack in people over 65.If you missed the first part, we recommend starting with it – there is about the features of the manifestation of migraine in the elderly, important points in the selection of therapy.

1. Stop seizure:

Paracetamol 500-1000 mg will be the safest pain reliever for relieving migraine attacks (due to the low number of side effects), but its effectiveness is low.

If paracetamol does not help or you have to take it more than twice a week, you need to select therapy. What’s important:

• The choice of treatment should take into account the presence of comorbid conditions, the risk of side effects and drug interactions.

– Triptans are not officially approved for use in people over 65 years of age. Contraindicated in patients with previous stroke and myocardial infarction, with ischemic heart disease of uncontrolled hypertension and atherosclerosis, however, the consensus of experts does not exclude the possibility of considering triptans for stopping a migraine attack in the absence of risk factors for stroke or myocardial infarction.

– Ergotamine-type drugs (for example, nomigren) are associated with a large number of side effects and the risk of vascular events.Therefore, these drugs are not recommended for use in the elderly.

– Taking combined analgesics (more than 8 days a month) increases the risk of drug-induced headache.

– Non-steroidal anti-inflammatory drugs (NSAIDs) inhibit COX1 and COX2, the most important substances that regulate vascular tone and kidney function. With regular use of NSAIDs in large doses, there is a risk of developing toxic nephropathy, decompensation and aggravation of the course of chronic renal failure already existing in patients, increased blood pressure, since COX 2 is involved in the regulation of blood pressure in the kidneys.According to meta-analysis, naproxen is considered the most cardio-safe drug, and celecoxib causes the least gastrointestinal problems.

More information about the clinical guidelines “Rational use of non-steroidal anti-inflammatory drugs (NSAIDs) in clinical practice” can be found here: https://doi.org/10.14412/1995-4484-2018-1-29

2. Preventive treatment:

Before starting treatment, the doctor should assess the glomerular filtration rate (GFR) and hepatic function, study drug interactions between drugs and, if necessary, consult with related specialists.Further, it is imperative to monitor such a patient throughout the therapy.

Preventive treatment is also carried out taking into account concomitant diseases, taking anticoagulants, antiarrhythmic drugs, it is desirable to evaluate the ECG, somatic status, electrolyte disturbances before starting treatment.

Taking tricyclic antidepressants in the elderly with cardiovascular diseases is not recommended due to the risk of intraventricular conduction disturbances and life-threatening arrhythmias.

There is good evidence on the cardiac safety of monoclonal antibodies to CGRP. In particular, this parameter was assessed in galkanezumab (age bracket 65 years) and in fremanezumab (age bracket 70 years).

The golden rule is a low start and a quiet course, that is, the beginning of treatment with minimal doses with a gradual slow increase in the dosage of the drug.

👩‍⚕️In our clinic, we diagnose and treat all cases of headache, including in the elderly.

Chronic pyelonephritis / Diseases / Clinic EXPERT

Chronic pyelonephritis is a nonspecific infectious and inflammatory process that can develop in one or both kidneys and the upper urinary tract.In this case, the parenchyma of the kidney and the calyx-pelvic system are damaged. Among kidney diseases, pyelonephritis is one of the most common.

As a rule, the cause of this pathology is bacterial. Basically, the infection enters the kidneys through the ureters from the bladder and urethra. Another way of the onset of the inflammatory process is the ingress of microorganisms from the focus of infection with the flow of blood or lymph.

According to statistics, pyelonephritis is more typical for women who suffer from this pathology 6 times more often than men.This is due, first of all, to the anatomical features of the structure of the urethra – in women it is shorter, therefore, the infection quickly enters the renal tissue. In addition, more women are susceptible to pyelonephritis during pregnancy, as well as children under the age of 7 years. In men, this disease often develops against the background of prostate adenoma and chronic prostatitis, which is associated with a difficult outflow of urine. In the presence of urolithiasis, the development of pyelonephritis is equally susceptible to representatives of both sexes.

Classification

Pyelonephritis according to the nature of the course is classified into:

• acute
• chronic

Depending on the number of kidney affected, pyelonephritis happens:

• Bilateral penetration

unilateral infectious agent:

• ascending variant (occurs more often)
• descending variant (occurs less often)

Depending on the conditions of the onset of the inflammatory process:

• primary
• secondary

According to the patency of the urinary tract

:
• obstructive
• non-obstructive

Symptoms of pyelonephritis

Depending on the course of the disease, clinical manifestations may vary.

• In acute form, the patient’s temperature suddenly rises, pains occur in the lumbar region, which can radiate to the groin and the front of the thigh.
• Headache and general weakness may appear, which is associated with the manifestation of intoxication.
• In addition, with acute pyelonephritis, edema may occur, and there may also be an increase in blood pressure.
• In the general analysis of urine, an increase in the level of leukocytes is observed, which is the first sign of the onset of an acute inflammatory process.Less common in urine analysis are erythrocytes, protein, cylinders.
• In the general analysis of blood, changes of an inflammatory nature are recorded, in particular, leukocytosis.

In chronic pyelonephritis, a combination of the following symptoms is observed, the severity of which depends on the severity of the disease:

• Pain syndrome. As a rule, it is characteristic of the phase of active inflammation, while during latent inflammation it may be completely absent.Pain of moderate severity is localized in the lumbar region, as well as in the lateral flanks of the abdomen. Usually, with primary pyelonephritis, pain syndrome is observed on both sides, with secondary – one-sided. The pain does not depend on the position of the body. There may be a tingling symptom in the lumbar region (soreness).
• Chilliness in the lumbar region can often be analogous to pain.
• Intoxication syndrome. It manifests itself as weakness and chills while maintaining normal body temperature.There may be fever in the evening. A significant increase in temperature is observed in only 20% of patients.
• Edematous syndrome. As a rule, ointment occurs in the morning in the face area.
• Syndrome of arterial hypertension. It develops on average in 50-75% of patients, more often observed during exacerbations.
• Syndrome of disturbed rhythm of urine separation. Chronic pyelonephritis is characterized by nocturia (discharge of most of the daily volume of urine at night) and pollakiuria (frequent urination).
• Anemia, the occurrence of which is associated with inhibition of the production of erythropoietic factor in the kidneys due to the inflammatory process.
• Changes in the general analysis of urine are inconsistent, expressed in a low specific gravity of urine in the absence of exacerbation, bacteriuria and leukocyturia during exacerbation of the disease.

If such symptoms appear, it is recommended to undergo an examination to exclude acute or chronic pyelonephritis!

With any severity of the disease, it is necessary to immediately consult a nephrologist for help, since chronic pyelonephritis, especially in the presence of frequent complications and the absence of anti-relapse treatment, can lead to numerous complications, among which the main ones are the following:

• arterial hypertension of the renal origin
• chronic renal failure.

Diagnostics

The EXPERT Clinic has developed a clear algorithm for the diagnosis of chronic pyelonephritis. The necessary comprehensive examination includes:

Laboratory methods

• general urine analysis to detect signs of inflammation in it (bacteria, leukocytes)
• if bacteria are detected in the general urine analysis, urine is cultured for flora and its sensitivity to antibiotics
• are performed clinical, blood chemistry.

You can start the examination with a comprehensive screening for pyelonephritis.

Instrumental studies

Ultrasound of the kidneys, during which ultrasound signs of changes in the structure of the kidneys are evaluated.

Important! The scope of the required examination can only be determined by a nephrologist.

Treatment of pyelonephritis

Given the incidence of pyelonephritis and the high likelihood of complications, the approach to treatment should be carried out exclusively at a professional level. Self-medication is fraught with an increase in the risk of complications, and in the acute form, a transition to a chronic one.

When choosing a treatment regimen, our doctors are guided not only by the basic principles of pyelonephritis treatment, but also take into account a number of other factors: the presence of concomitant diseases, the state of the immune system, the patient’s age.

In acute pyelonephritis, the choice of treatment tactics will depend on the nature of the inflammatory process, the form of the disease, as well as on the individual characteristics of the course. The general approach to treatment is based on the selection of:

• diet
• regimes
• hydration
• detoxification therapy
• antibacterial drugs

Antibiotic therapy is the main tool in the rapid relief of symptoms of acute pyelonephritis.It is combined with drugs that have a detoxifying effect, antihistamines, as well as those agents that help activate the body’s defenses. In order to increase the effectiveness of complex therapy for acute pyelonephritis, hyperbaric oxygenation can also be prescribed.

In chronic pyelonephritis, the approach to treatment is determined by factors such as the duration of the disease, the frequency and duration of exacerbations. The regimen during the period of exacerbation is recommended to be in bed, and in the absence of exacerbation – normal, excluding pronounced physical exertion, professional sports.Dietary nutrition should be adhered to for all patients suffering from chronic pyelonephritis, but during exacerbations, it should be controlled more strictly and in accordance with the doctor’s recommendations. In the case of such a complication as renal arterial hypertension, salt intake should be minimized and water loads should be reduced during the period of edema syndrome.

Drug treatment of acute pyelonephritis is aimed at eliminating the infectious cause of the disease. Another group of drugs that are recommended for the treatment of chronic pyelonephritis are agents that improve microcirculation in the renal tissue and reduce capillary permeability.Adaptogens, multivitamins, phytotherapeutic drugs with uroseptic effect are used as auxiliary agents necessary for anti-relapse treatment.

The EXPERT Clinic adheres to the principle of staged treatment.

At the first stage, a treatment plan is drawn up, which includes:

• regimen
• diet
• selection of basic therapy with antibacterial drugs in combination with herbal uroseptics.

At the second stage, the effectiveness of the therapy is assessed:

• If, against the background of the use of antibacterial drugs, the activity of the disease decreases, the clinical symptoms become less pronounced, then the regimen and diet are expanded, a preventive course of treatment is prescribed and the date of a second visit to the doctor is set.
• If, against the background of the therapy, there is no improvement in well-being, the question of prescribing stronger antibacterial drugs is decided.

The third stage of treatment is carried out after achieving a stable remission. It is a scheme of prophylactic treatment course.

Even after long-term remission is achieved, the patient is advised to be attentive to himself and regularly observed by a nephrologist, since a relapse of the disease is possible.

Almost all patients need to take anti-relapse therapy recommended by a doctor. Some drugs can help reduce the risk of exacerbations and chronic renal failure.

Forecast

If the diagnosis and treatment of acute pyelonephritis begins on time, immediately after the onset of the first symptoms of the disease, then in most cases it allows you to achieve complete recovery. As a rule, such an outcome is observed in 90% of clinical cases.With the development of acute purulent pyelonephritis, a favorable prognosis is provided with timely surgical intervention. In the case when purulent pyelonephritis is complicated by urosepsis or bacteriotoxic shock, which happens in 20% of cases, the prognosis, unfortunately, is unfavorable.

In chronic pyelonephritis, the prognosis is determined by factors such as the duration of the disease and the activity of the inflammatory process. An unfavorable prognosis threatens in cases where the patient’s condition is complicated by arterial hypertension of renal origin and chronic renal failure.

Remember that it is very important to start treatment in the early stages of the disease, since in advanced cases, as a rule, the use of long, difficult and expensive therapy is required.

Advice and prevention

Patients with pyelonephritis are advised to follow a diet. The diet is selected so that food is energetically valuable due to carbohydrates and vegetable fats. The source of protein for such patients is chicken egg proteins, boiled fish and lean meats.Spicy seasonings are absolutely contraindicated. It is also required to reduce salt intake and increase fluid intake to improve the effectiveness of detoxification therapy.

To prevent the development of the disease, it is necessary to eliminate the causes leading to the formation of inflammation and disruption of the normal functioning of the urinary tract (timely treatment of urinary tract infections, regular urination, training in the correct toilet of the external genital organs in girls, etc.).).

In order to prevent relapse, all patients are recommended to consult a nephrologist once a quarter to assess renal function and develop or correct anti-relapse treatment. Methods of restoring normal urination and antibacterial treatment are used to prevent relapses.

Patients suffering from pyelonephritis are recommended to visit the sanatorium at least once a year, as well as to carry out planned treatment in a hospital setting.

Frequently Asked Questions

Can chronic pyelonephritis be cured?

Chronic pyelonephritis is a chronic disease of an infectious nature.Thus, the available drugs are aimed at reducing the intensity of the inflammatory process, allow achieving long-term and sometimes lifelong remission, but cannot completely cure the disease.

What causes the disease?

At the heart of pyelonephritis is an infection of the urinary tract and the formation of disorders of urodynamics (reflux of urine into the overlying parts of the urinary system). More often women are ill, which is associated with anatomical features.In old age, the disease is equally common in both women and men.

Is the disease a contraindication to pregnancy?

Carrying out pregnancy is allowed with stable remission for 2 years without a high degree of increase in blood pressure. During this period, regular monitoring of urine tests, the use of plant uroseptics (cranberries, lingonberries) is necessary.

Frequent exacerbations, hypertension, impaired renal function is an indication for termination of pregnancy at any time.

Can pyelonephritis manifest itself with cuts during urination?

The presence of cramps or pain during urination is a manifestation of cystitis – inflammation of the bladder, which may be a causative factor for further ascending infection, but not a symptom of pyelonephritis.

Does the risk of getting pyelonephritis increase if a close relative suffers from this disease?

It is not pyelonephritis that is inherited, but the peculiarities of the anatomical structure of the urinary tract, which indirectly may further increase the risks of urodynamic disorders.

At the heart of the disease is an infection that is not related to hereditary factors.

Treatment histories

Story No. 1

Patient D., 26 years old, turned to the EXPERT Clinic with complaints of thirst, frequent painless urination at night, fever up to 37 C. urine tests, treatment was carried out (which she does not remember) and so far she has not presented any complaints. From the anamnesis of life it is known that the patient recently got married and the couple spent their honeymoon on a tourist trip in April, living in a tent.She notes the presence of hypothermia, as she wet her feet.

During an objective examination, the doctor revealed a symptom of painful tapping in the lumbar region on both sides. During laboratory and instrumental examination, bacteria and leukocytes were detected in the general analysis of urine, and with subsequent culture of urine, the microflora was determined, which caused an exacerbation of pyelonephritis and sensitivity to antibiotics. Ultrasound of the kidneys established ultrasound criteria for chronic pyelonephritis.

It was explained to the patient that the exacerbation of chronic pyelonephritis was caused by 2 factors important for a woman: a change in the microflora of the urogenital zone (i.e.n. pyelonephritis “honeymoon”) and hypothermia.

Prior to receiving the results of urine culture (the duration of its implementation – up to 8-10 days), the patient was prescribed antibacterial treatment with a broad-spectrum antibiotic in combination with herbal uroseptics. Recommendations were given on the way of life (not to overcool, during the treatment – sexual rest). After receiving the results of the sensitivity of microorganisms to antibiotics, the treatment with the selected drug was continued, since the sensitivity of the isolated microorganism was confirmed to it.

The patient has successfully completed the course of treatment, continues to be monitored at the EXPERT Clinic for 2 years. During the observation period, there were no relapses of the disease. The family is planning the birth of their first child under the supervision of an obstetrician-gynecologist and nephrologist.

History No. 2

Patient Sh., 58 years old, consulted a neurologist with complaints of discomfort in the lumbar region. On examination by a neurologist, a causal relationship between the symptomatology and the state of the peripheral nervous system was not found.With a careful history taking, it was revealed that for several years the patient was worried about difficulty urinating. He was examined by a urologist 8 years ago, at the same time the initial stage of prostate adenoma was revealed with recommendations for dynamic observation, which the patient did not follow.

The neurologist held a correspondence consultation with a urologist and a nephrologist, as a result of which an examination was prescribed: clinical and biochemical blood tests, tumor marker of prostate pathology, general urine analysis and ultrasound of the kidneys and prostate with the determination of residual urine.