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Kidney Roles Maintenance of blood volume Maintenance of blood nutrients Excretes waste Regulates blood pressure Participates in red blood cell production Activates Vitamin D
Citation preview
Renal Genitourinary Problems in Aging
Chapter 9
The Kidney
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, 2004, NIH Public. No. 04-4807. Washington, DC: U.S. Department of Health and Human Services.
Kidney
• Roles– Maintenance of blood volume– Maintenance of blood nutrients– Excretes waste– Regulates blood pressure– Participates in red blood cell production– Activates Vitamin D
Kidney
• Medical conditions affecting the renal system– Urinary incontinence– Urinary tract infections– Prostate disease– Genitourinary malignancies– Sexual dysfunction– Stone disease– Electrolyte imbalance– Renal disease/failure
Kidney
• Changes with age– Decrease in size and weight– Functional disability
• Decline in GFR
Urinary Tract Problems
• Incontinence– Common in older adults– No evidence-based approach to prevent
• Urinary Tract Infections– One of the top 10 principle hospital diagnosis of
older adults– Prevention of UTIs
• Cranberry products• Vitamin C• Estrogen
Prostate Disease
• Benign prostatic hyperplasia– Common among aged men– BPH interferes with the quality of life– Managed with medication or surgery
• Impotence and Erectile Dysfunction– Moderate to severe and managed with
medication
Prostate Disease
• Stones– Urolithiasia
• Urinary tract– Nephrolithiasia
• Kidney– Not clear why they develop
• Dehydration may contribute• Diet high in protein, sodium, calcium, and
oxalate
Genitourinary Malignancies
• Kidney Cancer– Surgery is the only option for treatment
• Prostate Cancer– Many treatment options
• Bladder Cancer– Cystoscopy may be considered
Kidney Problems
• Usually related to other health problems• Loss of renal function effects
– Body’s metabolism– Nutrition requirements– Nutrition status
• Metabolic acidosis• Anemia is common
Hypertension
• Prevalence is highest in older African Americans and women
• Sodium-sensitive hypertension• Orthostatic hypotension• Postprandial hypotension• Renovascular disease• Treatment
– Medication– Lifestyle modifications
Fluid and Electrolyte Problems
• Hyponatremia– An excess of fluid as indicated by serum sodium– Management
• Find and treat underlying cause
• Hypernatremia– Dehydration– Management
• Measure and correct input and output imbalance
Fluid and Electrolyte Problems
• Hypokalemia– Low serum potassium levels– Commonly occurs with diuretics– Management includes potassium replacement
• Hyperkalemia– High serum potassium levels
Renal Disease and Failure
Renal Disease and Failure
• Acute renal insufficiency/failure
Renal Disease and Failure
• Acute tubular necrosis– Caused by ischemia or nephrotoxins– Occurs after surgery– Associated with trauma or sepsis– Precipitant of acute renal failure– Dialysis may be necessary
Renal Disease and Failure
• Chronic Renal Failure– Irreversible loss of kidney function– Effects nearly all body organ systems– Progressive to the point of ESRD– Goal of therapy
• Slow progression of kidney failure– Early diagnosis
• Serum creatine levels, creatine clearance
Renal Disease and Failure
• Chronic Renal Failure (cont.)– Chronic Kidney Disease
• Renal function declines as the number of nephrons decline
• Occurs with aging, hypertension, and diabetes• GFR effects excretion of water-soluble drugs
–Estimating creatinine clearance–Cockcroft-Gault Formula
Renal Disease and Failure
• Chronic Renal Failure (cont.)– Problems associated with GFR
• Anemia of chronic kidney disease• “The silent crippler”• Renal osteodystrophy
End Stage Renal Disease
• Occurs when kidneys can no longer function on their own
• Usually caused by– Diabetes– Hypertension– Glomerulonephritis
End Stage Renal Disease
• Dialysis– African Americans are more likely to develop
kidney disease– Numerous assessment tools used for evaluation
• Serum creatinine and creatinine index
– Nutrition intake recommendations• 30 – 35 kcal/kg body weight• 1.2 – 1.3 g protein/kg body weight• Supplementation as needed
End Stage Renal Disease
Conclusion
• Renal Genitourinary Problems in Aging– Diet and nutrition therapy can help in the
management of many of these problems