Older people are at risk of developing kidney problems because of a variety of reasons, including medication intake and electrolyte imbalance, writes Dr Yew Shiong Shiong, Consultant Physician and Nephrologist Mahkota Medical Centre.
For about one-third of older people, kidney (also called renal) function remains steady throughout life. But for the rest of us, kidney function gradually starts to decline around age 35, sometimes worsening quickly in later years with increasing structural and hormonal changes.
Our kidneys are normally more than capable of meeting the body’s demands, so there is a built-in reserve of kidney function, even as we age.
Older kidneys, however, may not be as resilient as younger ones if they have been stressed. The result may be a higher risk of fluid imbalances, build-up of waste products, and other serious consequences in later years.
Doses of medications must also be reduced if kidney function has declined.
A person mature in age could accumulate those medications to “overdose” levels if the kidneys cannot get rid of drugs efficiently.
Because the kidneys are important for regulating a variety of bodily functions, one may eventually develop problems requiring medical attention if your kidneys are not working well.
These problems may include:
- Fluid and electrolyte imbalance, for example, having too much or too little sodium, potassium, or water in your body.
- Build-up of waste products in body, for example, urea or acids.
- Loss of protein through your kidneys.
- High blood pressure.
- Anaemia or low red blood cell counts.
- Brittle bones.
If these problems become severe enough, one may need renal replacement therapy or dialysis such as hemodialysis, a procedure that uses a machine to cleanse the blood to make up for the loss of kidney function.
Types of kidney diseases
Chronic kidney disease (CKD) refers to kidney damage that lasts for more than three months. It is classified into five stages based on how well the kidneys are able to filter your blood. In stage one, your kidneys retain much of their ability to filter blood.
In stage one, your kidneys retain much of their ability to filter out wastes. In stage five, however, the filtration rate is inadequate and the kidneys are considered to have failed.
Chronic kidney disease is very common in older people, with a prevalence of around 10 per cent. Slowing or preventing its progress is an important and attainable goal. In people aged 65 through 74 worldwide, it is estimated that one in five men, and one in four women, have CKD.
Electrolyte imbalances, such as sodium concentrations that are either too high or too low, are found in about a quarter of all older people arriving at the emergency department. Even when mild, low sodium concentrations are associated with problems with gait and attention, falls, and increased fracture risk in older adults. Fluid imbalances are also common in older people, leading to dehydration, swelling, or other harmful conditions.
Nephrotic syndrome is a kidney disease common among adults. Nephrotic syndrome causes your kidneys to excrete too much protein into your urine due to damage of tiny kidney blood vessels. Nephrotic syndrome occurs in various forms, which can be seen by examining a biopsy of your kidneys under a microscope, including:
- Membranous nephropathy
- Diabetic nephropathy
- Amyloidosis (special proteins that accumulate around blood vessels in the kidney)
- Glomerulonephritis (inflammation of the filtering structures)
- Minimal change syndrome
Each form of nephrotic syndrome requires different types of treatment of which, if done timely, may even reverse or cure the kidney disease.
Renovascular disease is a disease of the blood vessels that supplying the kidneys. It occurs mostly in older adults, especially in people with heart and circulatory diseases, and those who smoke.
Acute (sudden) kidney failure is increasingly common in older people, occurring about twice as often as end-stage kidney disease. If not treated well, it will cause permanent and irreversible kidney damage.
The incidence of end-stage renal disease (ESRD) is now rising dramatically in our country.
According to Malaysian Dialysis & Transplant Registry data (2014), we have 7000 new ESRD cases every year and now more than 35000 patients receiving treatment.
The main contributing factors to kidney problems in the country are diabetes and hypertension. Around 18 per cent of dialysis patients suffer from hypertension and 61 per cent suffer from diabetes.
Your kidney probably aren’t getting enough attention. More often than not, most Malaysian adults have some form of kidney disease but they may not know it
Caring for your kidneys
It is much easier to take a proactive approach on kidney health. Here are some ways to take better care of your kidneys.
- Up your water intake: Water is essential in keeping your kidneys healthy as it helps the kidneys remove waste from your body and helps blood carry nutrients to it. It also prevents kidney stones and urinary tract infections.
- Watch your weight: Weight indirectly affects your kidneys. Excess weight, especially around your waist, increases the risk of other conditions. Chronic illnesses such as diabetes and hypertension are main causes of chronic kidney diseases.
- Keep your blood pressure down: High blood pressure is a leading cause of kidney failure in the country. To avoid this risk, work to keep your blood pressure below 120/80.
- Get moving: Exercise is one effective way to reduce your blood pressure. About 30-45 minutes of aerobic exercise on most days can help.
- Say no to cigarettes: Although many people usually only associate cigarettes with lung health, smoking also affects the kidneys. Smokers are more likely to have protein in their urine – a sign that the kidneys are being overworked. This is intensified if you drink and smoke. That means you are five times more likely to get chronic kidney disease than people who don’t do either.