Abstract
Age-linked renal changes consist in a decrease in glomerular filtration rate (GFR) and limitations in sodium and water equilibrium. They predispose the old patients, over 75 years, to dehydration and acute renal failure. GFR estimation is always necessary and must be available before any drug prescription. Important variations are observed between the different methods of estimating GFR in elderly. Cockcroft and Gault and MDRD are the main formula used in bedside practice. The threshold of 60/ml/min/1.73 m2 is relevant to define renal failure; this of 45 ml/min/1.73 m2 is considered as a sign of frailty. Renal atherosclerosis is responsible of more than 50 % of chronic renal diseases in subjects over 65 years today, mostly in men. Considering the impact of genitourinary tumor treatment in elderly, radical nephrectomy remains an independent risk factor of chronic renal failure after surgery. Lower preoperative GFR, solitary kidney, older age, gender, tumor size, and longer ischemic interval predicted lower GFR after partial nephrectomy. Eligibility to cisplatin treatment depends on e-GFR, comorbidity, and oncological risk. As known and extensively studied for many years, the chief limit of cisplatin is nephrotoxicity which can be limited but not completely avoided by preventive procedures. Lastly, antiangiogenesis drugs need a broader evaluation of their effects on renal function in old people.
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Rainfray, M., Mertens, C., Duc, S. (2013). Renal Function in Elderly and in Relationship with Management of Genitourinary Tumors. In: Droz, JP., Audisio, R. (eds) Management of Urological Cancers in Older People. Management of Cancer in Older People, vol 1. Springer, London. https://doi.org/10.1007/978-0-85729-999-4_4
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