RESUMO
The kidney undergoes functional and structural changes during the aging process. The factors influencing these changes are currently under active investigation. The renal functional reserve is diminished in the elderly predisposing these individuals to the development of acute kidney injury when the balance of vasconstrictive and vasodilatory hormones are altered, particularly with medications. The development of acute kidney injury in the elderly portends a negative prognosis for the recovery of renal function. The management of end stage renal disease in the elderly is also a topic of intense discussion and clinical investigation. In this review, we explore the mechanisms responsible for the aging of the kidney. We also summarize the renal hemodynamic changes, urine and concentration and dilution alterations, and the changes in sodium and potassium metabolism associated with aging. The role and the consequences of dialysis treatment in the elderly are also explored in this review article.
Assuntos
Envelhecimento , Rim/fisiologia , Injúria Renal Aguda/terapia , Humanos , Diálise Renal , Equilíbrio HidroeletrolíticoRESUMO
Congestive heart failure is the leading cause of hospital admission among patients over the age of 65 years. It affects population within the United States, including Puerto Rico, presenting itself as the leading cause of heart related deaths worldwide. Its management can include pharmacologic agents which will affect neuroendocrine axis mainly but also include novel non-pharmacologic approaches such as ultrafiltration. The coexistence of heart failure and renal dysfunctions are very common within our medical community, especially within the western hemisphere, causing greater concerns amongst the medical field with increased research and investigation activity. This clinical review article will address the theme of congestive heart failure, highlighting the edema formation concept, volume homeostasis, cardio-renal syndrome and neuroendocrine pathways. The management of acute decompensated heart failure is discussed, primarily focusing with available novel non-pharmacologic approaches.