Publisher Summary This chapter discusses the general presentation of acute renal failure (ARF), paying special attention to its peculiarities in the elderly. ARF is defined as the abrupt interruption of renal function to the extent that the kidney is unable to maintain the control of the internal milieu. The aging kidney is more susceptible to develop ARF because of the morphological and functional renal changes occurring with age. The high incidence of systemic illnesses such as hypertension, diabetes mellitus, and arteriosclerosis is also responsible for ARF, as is the polypharmacological treatment often administered to the elderly. The pathogenesis of ARF is frequently multifactorial and thus, renal failure is much more common in an older hospitalized population. From the observations drawn from ischemic and nephrotoxic experimental models of ARF, the following mechanisms have been proposed as responsible for the establishment and maintenance of ARF: reduction of RBF by persistent vasoconstriction, tubular obstruction, tubular back-leak, and diminution of the glomerular ultrafiltration coefficient. The influence of these factors varies depending on the experimental model, but some of the factors can act simultaneously.

Acute renal failure in old people

Nine patients between the ages of sixty and seventy-one years, with end-stage renal failure, received kidney grafts during a five year period. Five received related donor kidneys and four received cadaver donor kidneys. Six of these patients are still alive—four of the five (80 per cent) with related kidneys and two of the four (50 per cent) with cadaver kidneys. All six patients have normal kidney function an average of twenty-seven months after transplantation. We believe the elderly uremic patient should not be categorically excluded as kidney graft recipients on the basis of age alone. The prognosis of these patients treated by transplantation far exceeds that for uremic patients of the same age who are restricted to hemodialysis therapy.

Renal transplantation in high risk patients older than sixty years

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Hemodialysis, renal homotransplantation, or both were employed at the Peter Bent Brigham Hospital as treatment modalities for renal failure in 100 patients of the 50–80 age group. Complicating nonrenal disorders were common. Despite the infirmities of advanced age, rehabilitation was achieved in 68 per cent, and the cumulative mortality was only 31 per cent. The success of this program establishes the fact that age alone should no longer be a barrier to the use of these forms of therapy.

Hemodialysis and renal transplantation in patients of the 50-80 age group.

Older persons with chronic uremia tolerate hemodialysis or a renal transplant as well as younger patients. However, this is not true in acute renal failure. One of the most distressing problems dur...

Julio E. Figueroa

Papers

Dialysis in older patients.