Beyond chronic kidney disease: the diagnosis of Renal Disease in the Elderly as an unmet need. A position paper endorsed by Italian Society of Nephrology (SIN) and Italian Society of Geriatrics and Gerontology (SIGG)

Abstract

The dramatic increase in prevalence of chronic kidney disease (CKD) with ageing makes the recognition and correct referral of these patients of paramount relevance in order to implement interventions preventing or delaying the development of CKD complications and end-stage renal disease. Nevertheless, several issues make the diagnosis of CKD in the elderly cumbersome. Among these are age related changes in structures and functions of the kidney, which may be difficult to distinguish from CKD, and multimorbidity. Thus, symptoms, clinical findings and laboratory abnormalities should be considered as potential clues to suspect CKD and to suggest screening. Comprehensive geriatric assessment is essential to define the clinical impact of CKD on functional status and to plan treatment. Correct patient referral is very important: patients with stage 4–5 CKD, as well as those with worsening proteinuria or progressive nephropathy (i.e. eGFR reduction > 5 ml/year) should be referred to nephrologist. Renal biopsy not unfrequently may be the key diagnostic exam and should not be denied simply on the basis of age. Indeed, identifying the cause(s) of CKD is highly desirable to perform a targeted therapy against the pathogenetic mechanisms of CKD, which complement and may outperform in efficacy the general measures for CKD.

Nephrology Consultation for Severe SGLT2 Inhibitor-Induced Ketoacidosis in Type 2 Diabetes: Case Report

“…(3) The availability of renal histopathologic study in this patient; interestingly, the severity of diabetic damage at kidney biopsy, which is compatible with prolonged poor metabolic control latter factor, supports the hypothesis of exhausted insulin reserve also testified by high HbA1c and very low fasting C-peptide. The “unexpected” histopathology findings highlight the major role of kidney biopsy for diagnosis and treatment in albuminuric T2D patients, even at older age [15]. (4) The prominent role of nephrologist in contributing to differential diagnosis and therapy of euDKA.…”

Elderly Patients in a Large Nephrology Unit: Who Are Our Old, Old-Old and Oldest-Old Patients?

“…The presence of proteinuria is an ancillary criterion. Globally, CKD is present in 8–15% of the world’s population, a prevalence that is intermediate between that of diabetes, a much better-acknowledged chronic, non-communicable disease, and that of hypertension, which reaches 50% in high-income, high life-expectancy settings [ 3 ].…”

Design and methodology of the chronic kidney disease as a dysmetabolic determinant of disability among older people (CKD-3D) study: a multicenter cohort observational study

“…Early recognition of CKD through the implementation of an adequate screening and intervention strategy has shown to slow the progression of the disease and improve clinical outcomes especially among vulnerable older patients [ 15 ]. However, it may not be easy to distinguish ageing kidney from CKD, because they share many functional features, such as glomerular filtration rate (GFR) decline and impairment in tubular salt and water reabsorption [ 16 ]. Moreover, even in the absence of a clinically evident nephropathy, normal age-related changes in kidney function might be clinically relevant in the older patients [ 17 ].…”