Nieren und Alter

Zusammenfassung

Mit zunehmendem Wissen über altersbedingte Veränderungen der Nierenfunktion wird deutlich, dass die „gesund alternde” Niere erheblich weniger Funktion einbüßt als bisher angenommen. Vor allem bekannte Risikofaktoren für Kreislauferkrankungen wie Hochdruck, Diabetes und Rauchen scheinen auch ausschlaggebend für eine stärkere Abnahme der Nierenfunktion im Alter zu sein. Bei älteren Personen mit solchen Begleiterkrankungen kann aber das Auftreten einer primären chronischen Nierenerkrankung, oder eines akuten Nierenversagens zum erheblichen Nierenfunktionsverlust führen. Weiterhin stellt die alterbedingt eingeschränkte Bandbreite der Salz- und Wasserhomöostase in Extremsituationen (z. B. fieberhafter Infekt mit Durchfall) eine Gefahr für den älteren Menschen dar. Nicht zuletzt sind Ältere auch empfindlicher für Nebenwirkungen von potentiell nephrotoxischen Medikamenten wie z. B. nicht-steroidalen Entzündungshemmern.

Summary

With more detailed knowledge on renal function at advanced age it became clear that age-related changes of renal function are less severe than previously thought. However, these changes are significantly aggravated by classical cardiovascular risk factors such as hypertension, diabetes and smoking. As a consequence, in elderly with such co-morbidity the appearance of a primary kidney disease or acute renal failure may cause a serious deterioration of renal function. In addition, impaired homeostasis with respect to salt (and fluid) balance has important consequences for the management of the elderly who is exposed to the twin risks of dehydration and fluid overload. Finally, the kidney is the main route of excretion for many drugs and their active metabolites. Diminution of renal function with age underlies, at least in part, the known predisposition of the elderly to side effects of their medication such as non-steroidal anti-inflammatory drugs.

Schlüsselwörter

Altern - Atherosklerose - Glomerulosklerose - Hypertonie - Nierenfunktion

Key words

aging - atherosclerosis - glomerulosclerosis - hypertension - renal function

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