Sunday, January 15, 2006

renal failure

Aging has a variety of effects on the kidneys and renal function. The diagnosis of renal failure is complicated by the presence of other systemic diseases that produce similar symptoms or by symptoms that are nonspecific.
Management of fluid and electrolyte balance is of the utmost importance to guard against dehydration and cardiovascular overload. Dialysis may be necessary for proper management. Mortality in acute renal failure is as high as 55 percent to 60 percent and is due primarily to infection.
Chronic renal failure can result from any cause of acute renal failure. The nephrotic syndrome is characterized by edema, albuminuria (excess of serum proteins in urine), decreased plasma albumin, and usually increased blood cholesterol. The diagnosis is often obscured in elderly patients for various reasons, including cardiovascular disease.
The nephrotic syndrome may be associated with primary renal disease or with other systemic disease involving the kidney. Malignant tumors, renal vein thrombosis, amyloidosis (protein in tissue and organ), and diabetes mellitus are frequent secondary causes of nephrotic syndrome.
Improvement may often be seen with treatment of the underlying cause. Bed rest and restriction of salt and water intake may decrease edema formation. Patients who do not respond to conservative measures may respond to diuretic therapy. Elderly patients, however, may be more sensitive to shifts in vascular fluids; thus, therapy should be initiated gradually and assessed frequently.
Since the nephrotic syndrome eventually results in end-stage renal failure, the patient should be managed conservatively to avoid further renal damage prior to dialysis.
Covington, T., and Walker, J. Current Geriatric Therapy. Philadelphia: W. B. Saunders, 1984.

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