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Rückgang der Nierenfunktion im Alter

Teil des physiologischen Alterns vs. Alterskrankheit

Decline in renal function in old age

Part of physiological aging versus age-related disease

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Zusammenfassung

Inzidenz und Prävalenz der chronischen Niereninsuffizienz („chronic kidney disease“, CKD) nehmen bei älteren Menschen weltweit zu. Dabei ist die Abnahme der Nierenfunktion im Alter einerseits Teil des physiologischen Altersprozesses, aber andererseits auch Ausdruck der Multimorbidität vieler älterer Menschen. Die Berechnung der glomerulären Filtrationsrate (GFR) anhand spezifischer, in der älteren Bevölkerung validierter mathematischer Algorithmen und der Nachweis einer gesteigerten Proteinausscheidung über den Urin erlauben auch bei geriatrischen Patienten die gezielte Abschätzung der Nierenfunktion. Die reduzierte Nierenfunktion hat vielfältige klinische Konsequenzen, einschließlich einer verzögerten Ausscheidung harnpflichtiger Substanzen, einer reduzierten Blutbildung, Störungen im Elektrolyt- und Säure-Base-Haushalt oder Knochenstoffwechsel. Darüber hinaus fördert eine reduzierte Nierenfunktion auf vielfältige Art und Weise direkt das Auftreten geriatrischer Syndrome, insbesondere des „Frailty“-Syndroms. Therapeutische Strategien, ein kontinuierliches Fortschreiten einer Niereninsuffizienz zu verhindern, umfassen neben der Therapie der Grunderkrankungen v. a. die konsequente Blutdruck- und Diabeteseinstellung sowie das Vermeiden potenziell nephrotoxischer Medikamente.

Abstract

The incidence and prevalence of chronic renal disease (CKD) in elderly patients are continuously increasing worldwide. Loss of renal function is not only considered to be part of the aging process itself but also reflects the multimorbidity of many geriatric patients. Calculating the glomerular filtration rate using specific algorithms validated for the elderly population and measuring the amount of proteinuria allow an estimation of renal function in elderly patients with high accuracy. Chronic renal failure has many clinical consequences and not only results in a delayed excretion of toxins cleared by the kidneys but also affects hematogenesis, water and electrolyte balance as well as mineral bone metabolism. Furthermore, CKD directly leads to and aggravates geriatric syndromes and in particular the onset of frailty. Therapeutic strategies to halt progression of CKD not only comprise treatment of the underlying disease but also efficient blood pressure and diabetic control and the avoidance of nephrotoxic medications.

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Braun, F., Brinkkötter, P.T. Rückgang der Nierenfunktion im Alter. Z Gerontol Geriat 49, 469–476 (2016). https://doi.org/10.1007/s00391-016-1109-y

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