73 m2) despite “normal” serum creatinine level.”
“In the elderly, age-associated kidney dysfunction in addition to primary/secondary kidney diseases leads to the frequent occurrence of CKD stages 3–5. It is important to recognize urinary tract malignancy in the elderly with hematuria. Notable points in elderly

CKD patients In the elderly, kidney function (GFR) declines with age. In patients with GFR less than 50 mL/min/1.73 m2, the GF120918 concentration decline rate of GFR is at least twice as fast as that in patients with GFR 60–70 mL/min/1.73 m2 (Fig. 13-1). Fig. 13-1 Simulation of age-associated decline of kidney function. Data are quoted from: Epidemiology Working Group, CKD Management Committee, the Japanese Society of Nephrology 2006 Blood pressure control and modification of diet are important for the diagnosis and management of primary disease. Physicians attempt to detect ischemic heart disease Selleckchem MAPK inhibitor in cooperation with cardiologists. In cases of severe atherosclerosis, blood pressure is gradually lowered, because these patients often develop orthostatic hypotension or transient cerebral ischemic attack. Volume depletion or volume expansion is carefully controlled to avoid exacerbation of kidney function.

Kidney function tends to be worsened click here by various drugs, such as anti-bacterial drugs, analgesic drugs like NSAIDs, calcium-containing agents, and active vitamin D. In some elderly CKD patients aged 70 years or older, CKD control can be awaited until the eGFR is 40 mL/min/1.73 m2. Kidney diseases prevalent in the elderly

(Table 13-1) The number of elderly dialysis patients has increased remarkably: the mean age of dialysis induction in 2007 was 66.4 years. Of 36,909 patients, 59.9% were elderly, aged 65 years these or older. Among the major causes of ESKD, chronic glomerulonephritis is decreasing, while nephrosclerosis and diabetic nephropathy are increasing (Fig. 13-2). Fig. 13-2 The prevalence of primary diseases responsible for chronic dialysis therapy by age group. Quoted, with modification, from: The Current Status of Chronic Dialysis Therapy in Our Country (as of December 31, 2006) edited by The Japanese Society for Dialysis Therapy The incidence of renal and urinary tract malignancy increases with aging, so physicians need to pay more attention. In a case of malignancy, the main urinary finding is hematuria. Ultrasonography, DIP and urine cytology are of diagnostic value. Consultation with urologists is recommended. Among kidney diseases in the elderly, nephrosclerosis, gouty kidney, drug-induced kidney dysfunction, and urological disease often do not show significant urinary abnormalities. Hence, evaluation of eGFR is essential for the diagnosis of CKD. In myeloma kidney or renal amyloidosis in the elderly, urinary protein may be negative with the dipstick test, but positive with a quantitative method. Acute decline in kidney function in the elderly is seen in rapidly progressive glomerulonephritis and acute interstitial nephritis.