Hepatitis B Kronik

Acute Renal Failure in the Elderly
Review Article From JIACM 2011;12(4): 290-296

Posted by 1. SC Dash 2. D Bhowmik
Presented by Solafide Binsar Hamonangan Lumbantoruan I11107069
Abstract
The aim is to highlight the emerging phenomenon of increasing incidence of AKI/ARF in the eldery population worldwide ARF is a poor prognosic marker in critically ill patients With increase in longevity, proportion of eldery suffering from ARF in Hospitals has risen Newer nephrotoxic drugs, multiple invasive procedures, avoidable radiocontrast studies in modern hospitals have contributed to this phenomenon Altough age-related reduction in GFR is unavoidable, and make the eldery and very old vulnerable
Introduction
ARF is curently undergoing conceptual change to be better termed as AKI For the present, the definition and classification of AKI remain the same as that of ARF which is defined as rapid deterioration of renal function resulting in acumulation of nitrogenous waste products in the body and which are not due to pre-renal factors. ARF occurs in aproximately 5% of all hospitalised patients. Patient above 70 yrs of age have ARF 3,5X more common then the younger.
Intro...
Susceptibility to ARF in the eldery is due to profound change taking place in structure and function of kidneys with age Greater proportion of elderly are now seen occupying hospital beds with renal disorders many of whom are diagnosed as a part of hospital acquired renal failure Common systemic disease observed in elderly make them vulnerable to develop AKI
Pathophysiology of ARF in general
Epidemiological Profile
Community acquired ARF may affect the elderly population in tropical countries due to diarrhoeal illness, pneumonia, and other infection dissease like malaria In some part of the world, animal/plant toxins, alternative medical terapies continue to cause AKI Natural and unnatural disasters (earthquakes, road accidents, gunshot injuries) are on the rise globally, causing Crush syndrome which contributes to high-risk ARF Hospital acquired ARF involving elderly population is on the rise due to increased use of nephrotoxic drugs One important cause is radio-contrast used for coronary angiogram in elderly diabetics
Critical Mechanisms of Ischaemic Renal Tubular Cell Injury
Incidence, Spectrum, and Predictors of mortality a global report

In a study involving 2,722 patients of ARF 1,528 had mild to moderate renal failure It was observed that old age and male gender were comon factors in patients of mild to severe renal failure at admission associated with a variety of co-morbidities Serum creatinine more than 3 mg/dl was significantly associated with higher mortality rate (50%) attributable to bacteraemia compared to those who had less then 3 mg/dl In india recent repost, it was observed that ARF among elderly is a common problem in renal practice and is responsible for 48,9% of nephrology ward and consultations Though ARF complicated is only 1.6% of hospitalized elder patient, it was associated with a high mortality rate of 61%.
...a global report...
An Argentinian report on ARF in the elderly observed multifactorial origin and atypical presentation The authors argued that prophylactid avoidance of nephrotoxic drugs remain the best option combined with Adequate hydration. Dyalisis treatment was found beneficial irrespective of age and carried a good prognosis On the other hand, a multi national study has suggested that criticallyill ICU patients of ARF requiring renal replacement therapy was associated with high mortality rate Since prognosis of this condition is very poor, japanese authors have treated these patients with low dose prednisolone with good outcome, probably through amelioration of inflammatory reaction surrounding affected renal vessels
Prevention and treatment

In each case, the risk and benefit ratio of any contras study must be analyzed. If the study is absolutely essential, hydration by hiposmolar saline before contrast administration has shown to have prevented AKI significantly. Similarly, caution must be exercised in elderly before conducting complex diagnostic and therapeutic procedures. Nephrotoxic drugs should be avoided as much as possible
Fluid Balance in AKI

Recently, the deleterious effect of overzealous fluid therapy has been recognized. It is now known that frequent fluid challanges in an oligoanuric patient produce more interstitial oedema, increase intra-abdominal pressure and delay renal recovery. Thus, a conservative fluid management has been found to be effective in large randomized control trials Thus acurate assessment of fluid status and requirement targets need to be defined on a daily basis for improved outcome
Dyalisis
Several issues in dialytic therapy in ARF are currently being debated Despite this controversies, use of biocompatible membrane is justified in critically ill patients Similarly, CRRT offers advantages of better tolerance to dyalisis, better volume control, increased delivered dose of dyalisis, aggressive nutritionla support, and possible antiendotoxaemic and anti-inflamatory effects
Conclusion
Elderly population is vulnerable to develop ARF due to age-related decline in GFR and RPF Recent studies has refined our understanding of the aetiopathogenesis and natural history of ARF and ability to identify the risk of renal dysfunction early, particularly in hospitals and ICUs. Presence of AKI causes exacerbation of impaired function of other vital organ in high risk patients
Con...
Incidence of ARF is rising in all countries due to newer nephrotoxic drugs, multiple hospital diagnostic and therapeutic procedures, and also due to a rise in natural and unnatural disasters. Rising prevalence of diabetes is a key factor furthering the vulnerability of the middle-aged and elderly people to develop ARF
Truly thanks for the attantion

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Hepatitis B Kronik

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Acute Renal Failure in the Elderly

Review Article From JIACM 2011;12(4): 290-296

Pathophysiology of ARF in general

Critical Mechanisms of Ischaemic Renal Tubular Cell Injury

Incidence, Spectrum, and Predictors of mortality a global report

...a global report...

Prevention and treatment

Fluid Balance in AKI

Truly thanks for the attantion

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