Geriatric nephrology
The discipline of geriatric nephrology includes normal renal ageing changes, their clinical consequences, and renal diseases that occur in the older adult population as a result of these changes. The mesangium increases to nearly 12% by age 70, and microangiographic examination shows the obliteration particularly of the juxtamedullary nephrons, which is followed by the formation of a direct channel between afferent and efferent arterioles. Primary glomerulonephritis was the most frequent biopsy-proven renal disease in this population, even more frequent than primary glomerulonephritis in younger adults. Prearterioles show subendothelial deposition of hyaline and collagen fibres that produce intimal thickening. Chronic kidney disease is a syndrome characterised by progressive and generally irreversible deterioration of renal function due to the reduction of the nephron mass. The success of transplantation in geriatric end-stage renal disease patients requires improved patient selection, the use of new immunosuppressive drugs, and lower doses of corticosteroids.
