Geriatric Nephrology

This issue of Clinics in Geriatric Medicine features expert clinical reviews on Renal Disease in Older Adults which includes current information on topics such as Anatomic/ Physiological Changes with Aging, Acute Kidney Injury in Older Adults, Electrolyte Problems in Older Adults, Glomerular Disease in Older Adults, Hypertension in Older Adults, Chronic Kidney Disease in Older Adults, End-stage Renal Disease in Older Adults, Decision Making in the Older Adult Patient with Advanced Kidney Disease, Obstructive Uropathy in Older Adults, Drug Dosing, Transplantation in Older Adults, and Slowing the Aging Process.

The year was 1943. As a third-year medical student at Stanford, I was about to witness the beginning of a medical miracle. Dr. Arthur Bloomfield, Professor of Medicine, had selected my patient, a middle aged man, who was dying of acute pneumococcal pneumonia, as one of the first patients to receive miniscule doses (by today's standards) of his meagre supply of a new drug - penicillin. The patient's response amazed everyone especially this impressionable medical student. The rest of the story is history. With one stroke, the introduction of penicillin removed from the medical scene the 'friend of the aged' - lobar pneumonia. The consequences, which no one could have imagined at the time, are still becoming manifest as other 'miracles' such as respirators, artificial kidneys and many potent new antibiotics have come upon the scene. All of us are aware that these miracles have created a variety of new challenges around the states of dying and near dying. We have no easy answers for these problems. Nevertheless as dialysis techniques, especially CAPD, are applied more widely to the treatment of the elderly, the task of helping the patient meet death with dignity becomes increasingly important and vexing because once begun, dialysis is difficult to terminate.

Because of many advances in medicine and biotechnology, an increasing number of individuals are surviving into old age, and we are now challenged to apply sophisticated medical knowledge to the care of the elderly citizen. In nephrology, individuals older than 65 are the fastest-growing group of patients requiring dialysis. Similarly, in increasing numbers, elderly persons present themselves with renal complaints to their family doctor, the geriatrician or the nephrologist. In August 1998, with the financial support of the John A. Hartford Foundation, leaders in geriatrics, nephrology and urology met in Jasper, Alberta, for one week to discuss their areas of special knowledge and to learn from each other. Geriatricians learned from nephrologists, nephrologists learned from geriatricians, and both came to see that they had much in common. All participants discovered a common interest, challenge and commitment, namely, to provide the best renal care to a progressively aging population and to teach their fellows the principles of the other collaborating specialties. This book contains all the papers presented at this meeting and also the text of group discussions on Training and Education, Special Clinical Problems in Geriatric Patients, and Recommendations in Basic and Clinical Research. Nephrology and Geriatrics Integrated will prove useful to both nephrologists and geriatricians in their efforts to manage the renal complaints of the elderly, who come to them in increasing numbers.

This issue of Clinics in Geriatric Medicine features expert clinical reviews on Renal Disease in Older Adults which includes current information on topics such as Anatomic/ Physiological Changes with Aging, Acute Kidney Injury in Older Adults, Electrolyte Problems in Older Adults, Glomerular Disease in Older Adults, Hypertension in Older Adults, Chronic Kidney Disease in Older Adults, End-stage Renal Disease in Older Adults, Decision Making in the Older Adult Patient with Advanced Kidney Disease, Obstructive Uropathy in Older Adults, Drug Dosing, Transplantation in Older Adults, and Slowing the Aging Process.

The increase in average life expectancy observed over recent decades has brought new challenges to nephrology practice. Several renal diseases are more frequent in elderly patients today, and even in healthy older individuals renal physiology has its own peculiarities. This leads to the need for a specific approach on renal aging and renal function in the elderly. However, despite the relevance of this topic, there are few books exclusively dedicated to geriatric nephrology. This book fills this gap by presenting a comprehensive overview of the differences between normal renal aging and chronic renal disease in the aged, and describes the particular aspects of nephropathy in the elderly, addressing it in a practical and clinically applicable fashion. Clinical Nephrogeriatrics bridges the gap between nephrology and geriatrics, discussing the most important issues concerning the relationship between these two medical specialties. This evidence-based resource, written by prominent specialists with extensive clinical experience, offers nephrologists, geriatricians, family physicians, and other medical professionals valuable practical guidelines and insights to enhance their clinical practice and provide optimal care.

The master tool of logic is the syllogism. If A> Band B> C, then it must follow as the night the day that A > C. If the major and minor premises are true or scientifically correct by current knowledge, the conclusion is true or at least scientifically correct by current knowledge. The demographer of today beams a clear message, which if not true is at least scientifically correct by current knowledge. In the first 80 years of the Twentieth Century, the 'over-65' population of Americans increased eight fold. By century's end it will have increased 12-fold and shortly thereafter will include one in five Americans. While initially a fact of the developed world, the pace of similar graying is accelerating even more rapidly in the Second and Third Worlds. This gray delta constitutes about 35 million living Americans, who may use one-half or more of the health care resources. A would have to be a lot more foolish than B if they failed to recognize that in the coming decade the causation, case-mix, and area of the gray delta demands a change from early, mid-or even later-century medicine. If Homer Smith was right in saying, "We are what we are because we have the kind of kidneys we have" and "The kidneys make the stuff of philosophy", then the who, what, where, when, and why the gray delta will be cared for must focus on the stuff of geriatric nephrology.