Nephrogeriatrics: central concepts

Abstract

Nephrogeriatrics is a discipline which has emerged from the combination of three other ones: nephrology, geriatrics, and gerontology; and its activity in the clinical field it is ruled by the following particular principles: an old organism has poor homeostasis which makes he/she frail and less adaptable, his/her tendency to have many simultaneous disorders can lead him/her to polyfarmacy and its potential complications, his/her diseases can be low symptomatic or showing a not classical clinical presentation (confusion, falls, etc) which makes more difficult their diagnose, finally in the bioethical field, the elderly must not be excluded of any of the diagnostic and/or therapeutic alternatives just because of his/her age. In the research field, it has documented that senescence leads to a progressive reduction in the glomerular filtration rate (senile hypofiltration), medullar hypotonicity, urinary sodium loss, potassium retention (senile tubular dysfunction), and tubular cells vulnerability to damage ( ischemic or toxic ) and also to a more slowly recovery from acute tubular necrosis (tubular frailty). In summery, nephrogeriatrics consists of a new discipline which represents a challenge for current nephrology.