Kidney Problems

Kidney damage that lasts for more than three months is considered chronic kidney disease. Common causes include diabetes, hypertension (high blood pressure), inflammation in the kidneys (such as glomerulonephritis), and other conditions. Slowing or preventing CKD is possible. About 10 percent of older adults have CKD. Twenty percent of adults with high blood pressure have it, as do 35 percent of people with diabetes.

Chronic kidney disease diagnosis and progression can be monitored using a blood test called a basic metabolic panel (BMP).

Five Stages of CKD

The stages are based on the glomerular filtration rate (GFR).  The GFR shows how well your kidneys are working.

• Stages 1 and 2 are mild; GFR >60 mL/min shows appropriate renal function.
• Stage 3 happens when the GFR drops below 60 mL/min. At this point, a nephrologist is usually consulted to evaluate and treat chronic kidney disease.
• At stage 4, when the GFR is between 45-59 mL/min, a nephrologist is needed to help manage the complications of CKD.
• By stage 5, the kidneys have failed, and hemodialysis often becomes necessary.

People with CKD have increased risk of:

• Heart disease
• Anemia
• Medication adverse events
• Bone disease such as osteoporosis
• Depression and fatigue
• Nutrition problems

Electrolyte imbalances happen when salt or potassium levels in the body are too high or too low. This can have many causes. Among the types of imbalances are:

Hyponatremia

This condition happens when there are low salt levels in the blood and can be caused by:

• Hypothyroidism (under active thyroid)
• Low salt diet
• Changes in the body’s anti-diuretic hormone due to illness
• Medications like NSAIDs (non-steroidal anti-inflammatory drugs), thiazides (a type of diuretic or water pill), and antidepressants.
• Volume overload leading to dilution of sodium levels from excess fluid

Up to 25 percent of older adults in hospitals have hyponatremia. Even mild, low sodium concentrations in the blood can cause health problems with attention. Fluid restriction may be engaged in addition to other medications to normalize sodium levels.

Hypernatremia

This occurs due to high salt levels in the blood and its causes include:

• Reduced fluid intake
• Physical problems that make it difficult to drink fluids such as trouble swallowing
• Diseases like infections (with fevers) and dementia
• Some medications, like diuretics
• Uncontrolled blood sugars leading to volume contraction and dehydration

Treatments generally involve taking more fluids.

Hyperkalemia

This condition happens when there is too much potassium in the blood. The causes include:

• Medications such as NSAIDs, heart disease drugs, certain diuretics
• Some low hormone levels

Treatments include medications, more fluids, dialysis, or hospitalization in severe cases. Fluid imbalances are also common in older people, leading to dehydration, swelling, or other harmful conditions.

Kidney stones are small, hard, pieces of materials that form in one or both kidneys. They may result from dehydration, infection, or stress to kidneys.

Nephrotic syndromes are common in older adults. Nephrotic syndromes involve proteins leaking out of the kidneys due to damage to the filtration barrier that separates the blood from the nephron. 

Nephrotic syndrome takes different forms:

• Membranous nephropathy: when the body’s immune system attacks the filtering membranes in the kidney
• Diabetic nephropathy: damage from diabetes over time
• Amyloidosis: accumulation of special proteins around blood vessels in the kidney
• Glomerulonephritis: inflammation of the filtering structures in the kidney
• Minimal change syndrome: damage to the filtering structures in the kidney

Renovascular disease affects the blood vessels that supply the kidneys. Kidney damage results from decreased or poor circulation. People at risk for this disease include older adults, people with heart and circulatory diseases, smokers; those with a history of blood clots, high blood pressure, or high cholesterol also have higher risk.

Aggressive treatment of these underlying conditions can delay more serious illness. 

Acute (sudden) kidney failure happens when a person has quick decrease in kidney function. Causes include:

• Dehydration: not enough fluids due to acute illness or decreased fluid intake
• Infection
• Urinary blockage: common in older men with enlarged prostate glands or those with kidney stones
• Surgery
• Heart failure or rhythm problems
• Certain medicines including narcotic pain medication, antihistamines, and antidepressants.

Quick treatment of the cause of acute kidney failure often can restore kidney function. Dialysis treatment may be needed until the kidneys recover. 

Older adults are most at risk for ERSD due to long-standing uncontrolled high blood pressure, uncontrolled diabetes, or other hereditary conditions affecting renal function (such as polycystic kidney disease).

This disease cannot be cured and requires hemodialysis or a kidney transplant. A nephrologist will guide the patient in making the best choice while closely considering their goals of care.

Almost 600,000 people are being treated for ESRD at any point in time. Each year, about 18,000 people have a kidney transplant, and close to 90,000 people with ESRD die.