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