Senile chronic renal failure

　　The causes of senile chronic renal failure are similar to those of patients in other age groups, but in the elderly stage, the incidence of secondary kidney disease caused by age-related diseases increases, making chronic renal failure more common. Some causes are less common in younger patients, such as prostatic cancer or benign prostatic hyperplasia leading to hydronephrosis, renal vascular hypertension or renal failure caused by atherosclerosis, multiple myeloma, and renal failure caused by drugs. Congestive heart failure or anemia caused by insufficient blood volume is also common in the elderly.

　　Patients with this disease often have complications such as hypertension, anemia, heart failure, pericarditis, cardiomyopathy, electrolyte disorder, acid-base imbalance, renal osteopathy, fractures, infection, and so on. Therefore, during the treatment period of the disease, attention must be paid to the treatment of complications of this disease to ensure that the disease can be fundamentally recovered.

　　The clinical characteristics of elderly chronic renal failure, in addition to anemia, metabolic acidosis, hypertension, and general uremic symptoms, are more prominent in neurological and psychiatric symptoms, such as indistinct speech, epilepsy-like seizures, muscle tremors, hemiplegia, and consciousness disorders, which are often seen in uremic encephalopathy. The following is a detailed description of the clinical manifestations of each system:

　　1. Electrolyte Imbalance

　　Patients often manifest secondary infection, fever, vomiting, diarrhea, and are prone to fluid loss. If it is not timely and adequately supplemented, it is easy to develop hypovolemia.

　　2. Acid-Base Balance

　　When patients have severe acidosis, they may show symptoms such as fatigue, weakness, dullness of sensation, deep breathing, and in more severe cases, coma may occur.

　　3. Digestive System

　　When this disease occurs, almost every part of the digestive system can be involved. Early symptoms are often loss of appetite, glossitis, diarrhea, nausea, vomiting, black stools, and so on.

　　4. Cardiovascular System

　　Cardiovascular disease is a common complication in patients with chronic renal failure, about 50% die of cardiovascular disease, and the elderly are more prominent. The cardiovascular complications of this disease include pericarditis, cardiac insufficiency, cardiomyopathy, cardiac damage caused by metabolic abnormalities, and hypertension.

　　5. Respiratory System

　　Due to metabolic acidosis during uremia, it often causes hyperpnea of the lungs, resulting in large and deep breathing or tidal breathing, and pulmonary edema is very common.

　　6. Nervous System

　　During uremia, almost 100% of patients have neurological symptoms, including malaise, fatigue, dizziness, and headache.

　　7. Hematopoietic System Manifestations

　　Severe anemia is one of the important symptoms of patients with this disease. In the late stage, patients often have a tendency to hemorrhage, and common symptoms include subcutaneous ecchymosis, nosebleeds, gum bleeding, and even hematemesis, hematochezia, hematuria, intracranial hemorrhage, menorrhagia, and a few cases of pericardial hemorrhage.

　　8. Changes in Endocrine Function

　　This disease can cause decreased sexual function, testicular atrophy, menstrual disorders, and so on.

　　9. Metabolic Disorders

　　In chronic renal failure, there may be disorders of lipid metabolism, protein and amino acid metabolism, and carbohydrate metabolism.

　　10. Skin Manifestations

　　Patients with this disease may show dry skin, desquamation, and lack of luster. Some patients have darker skin, which is caused by diffuse melanin deposition. Urea excreted from sweat glands will condense into white crystals, known as urea frost, which stimulates the skin to produce uremic dermatitis and pruritus (pruritus is also related to secondary hyperparathyroidism).

　　Only with reasonable prevention can we stay away from the invasion of diseases. So how should elderly chronic renal failure be prevented? The following will introduce it for everyone:

　　1. Early prevention

　　With the progress of nephrology epidemiology and treatment, the early prevention of chronic renal failure has attracted the attention of scholars. So-called early prevention, also known as 'primary prevention', refers to the beginning of prevention before the occurrence of chronic renal failure, including early general screening for kidney disease, actively controlling kidney disease or diseases that may affect the kidneys (such as hypertension, diabetes, etc.), correcting lipid metabolism disorder, avoiding certain triggers, etc. It is obvious that giving sufficient attention and serious treatment to early prevention and taking corresponding measures will further control the occurrence and development of chronic renal failure.

　　2. Secondary prevention

　　This mainly includes: strengthening follow-up, avoiding or eliminating certain risk factors; a reasonable dietary plan; controlling systemic or glomerular hypertension; controlling hypermetabolism of renal units; eliminating lipid disorder or hypercoagulable state; persisting in the treatment of the primary disease.

　　The diagnosis of elderly chronic renal failure generally requires the following examination methods:

　　1. Renal function test: The clearance rate of endogenous creatinine is significantly reduced, and the blood creatinine, blood urea nitrogen, uric acid, etc., are significantly increased.

　　2. Blood routine: When GFR

　　3. Urinalysis: There may be proteinuria, red blood cells, white blood cells, or casts. The above changes may not be obvious. The urine specific gravity is usually below 1.018, and in severe cases, it is fixed at 1.010～1.012, with more nocturnal urine than diurnal urine volume.

　　4. Blood biochemistry test: The plasma protein level is reduced, especially the albumin level, and the electrolyte test shows significant abnormalities.

　　5. Renal scan and renal scan: They can understand the size, blood flow, secretion, and excretion function of the kidneys.

　　6. X-ray: There may be heart enlargement, etc.

　　7. Other examinations: urinary system plain film or contrast, renal biopsy, etc., are helpful for etiological diagnosis.

　　In order to achieve better recovery for elderly chronic renal failure, patients should pay attention to the following dietary principles:

　　1. Limit protein intake

　　For patients who have not undergone dialysis, since the kidneys cannot excrete the waste products produced by protein metabolism, the condition of renal failure will become more severe. Therefore, it is recommended to reduce the intake of protein; however, if dialysis is performed, attention must be paid to the loss of protein in the body during dialysis, so it is necessary to follow the advice of a nutritionist to maintain the body's needs.

　　2. Limit the intake of sodium

　　Due to the high sodium content in salt, if there is an excessive amount of sodium in the body of renal failure patients, it can cause water retention, leading to respiratory and cardiac failure, and exacerbating renal failure. However, do not use low-sodium salt, as it contains a high amount of potassium ions.

　　3. Limit the intake of potassium

　　The accumulation of potassium in the body can cause muscle weakness, and in severe cases, it can lead to irregular heartbeat, which may further cause heart failure.

　　4. Limit the intake of phosphorus

　　Because excessive phosphorus in the body can cause calcium loss, doctors will use medication to assist in controlling the phosphorus content in the blood, preventing the occurrence of osteoporosis.

　　5. Water Intake

　　If too much water is consumed and the kidneys cannot excrete it, edema or heart and lung failure may occur, so controlling water intake is a very important issue. Doctors will decide the amount of water intake based on the amount of urine or the amount of water excreted during dialysis, generally adding 500-750cc to the previous day's urine output.

　　The causes of chronic renal failure are primarily various primary and secondary glomerulonephritis, and the main treatment methods include the following three:

　　1. Treatment Foundation

　　Although primary chronic kidney disease itself is difficult to reverse, it is still necessary to strive to find and correct certain reversible factors that exacerbate chronic renal failure, and to provide timely and effective treatment to improve the patient's renal function. This includes correcting disorders of water, electrolyte, and acid-base balance, especially water and sodium deficiency; timely and effective control of infection; relief of urinary tract obstruction; treatment of heart failure; and cessation of nephrotoxic drug use, etc.

　　2. Dialysis Therapy

　　Dialysis therapy can replace the excretory function of the kidneys, but cannot replace the endocrine and metabolic functions. The efficacy of hemodialysis and peritoneal dialysis is similar, but each has its advantages and disadvantages, which can complement each other in clinical applications. The selection of dialysis timing is still without a consensus. When conservative therapy cannot make the patient asymptomatic at the end stage of chronic renal failure, dialysis therapy should be considered.

　　With the improvement of dialysis technology and medical standards, old age is no longer a contraindication for dialysis. According to the records of the European Dialysis and Transplantation Association in 1983, the percentage of elderly patients over 65 years old receiving dialysis (HD) treatment had reached 8.7%, with an average age of 72.6 years. In the United States, the percentage of elderly patients over 75 years old who began dialysis therapy in 1987 had reached 13.5%. The 2-year survival rate of hemodialysis patients over 65 years old reached 61%, while the 2-year survival rate of continuous ambulatory peritoneal dialysis (CAPD) was over 56%; there have been reports of elderly patients over 75 years old surviving for more than 10 years after hemodialysis.

　　3. Kidney Transplantation

　　If the patient is suitable for surgery (meets the indications) and there is a suitable donor, kidney transplantation surgery can be performed.