Επιστημονική Εκδήλωση

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Επιστημονική Εκδήλωση 18 Φεβρουαρίου 2012 Κομοτινή «Ο Νεφρολόγος ως Σύμβουλος- III» Ηλίας Δ. Θώδης Καθηγ. Νέφρολογίας αν/κη Νεφρολογική Κλινική Δ.Π.Θ. της: καθ.Βασ. Α. Βαργεμέζης

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Επιστημονική Εκδήλωση. « Ο Νεφρολόγος ως Σύμβουλος-III ». Ηλίας Δ. Θώδης Καθηγ. Νέφρολογίας Παν/κη Νεφρολογική Κλινική Δ.Π.Θ. Δ/ντης: καθ. Βασ. Α. Βαργεμέζης. 18 Φεβρουαρίου 2012 Κομοτινή. Τρίτη Ηλικία. - PowerPoint PPT Presentation

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  • 18 2012 -III . . / .../: .. .

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  • Aging seems to be the only available way to live a long life *** ,

    The Mount Sinai Journal of Medicine vol. 70 no 1 Jan.2003

  • 21%Medicare 2010 50+ 1900-2040

  • 80/ 2030

  • Carlos Musso, Int Urol Nephrol 34:2002Geriatrics from the Beginning, Glosa 2001 - : -- -

  • Carlos Musso, Int Urol Nephrol 34:2002Geriatrics from the Beginning, Glosa 2001 - : -- -

  • - 1985: 1 1990: 1990: : Int J Urol Nephrol1994: 1 John Hartford Foundation 2000-2003: 2004: Geriatric CME credits

  • ACGME Accreditation Cancel for Graduate Medical Education

    . . . Geriatric Nephrology be added to the core curriculum

    . . . Fellows must have formal instruction clinical experience in disorders related to the aging kidney and unirary trait . . .

    Renal ASN Week:2-day courses on Geriatric Nephrology 2008,2009,2010,2011Donald Kohan: Chair of the Commitee D.G. Oreopoulos: Co-Chair

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  • Wendy EHoy et al. Kidney International (2003) 63, S31S37

  • Wendy EHoy et al. Kidney International (2003) 63, S31S37

  • Elderly NeprhosclerosisRule AD, et al: Ann Int Med 152:2010n: 1203 Kidney Donors

    Age GroupCrude Prevalence (95% Cl), %Crude Prevalence After Exclusion of Persons Who Received Therapy for Hypertension 18-29 y 2.7 2.7 %30-39 y 16 15 40-49 y 28 26 50-59 y 44 42 60-69 y 58 55 70-77 y 79 75 Overall 28 26

  • Characteristics Assoc with NephrosclerosisRule AD., et al: Ann Int Med 152:201024 hours urinary AE: P:0.010Nocturnal hypertension: P:0.019Hypertension P:0.002...a 32 mg increase in urinary albumin excretion,

    a 21 mmHg increase in nocturnal diastole blood pressure,

    a 32 mmHg increase in nocturnal systolic blood pressure and treated hypertension,

    ..has the same association with nephrosclerosis as an 8 year increase in age...

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  • -E. M. Darmady et al. J. Path.-Vol. 109 (1973)

  • B. Kappel and S. Olsen , Virchows Arch. Path. Anat. Histol. 387, (1980)

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  • Age and the Absolute GFR of males and Females Berg, U. B. Nephrol. Dial. Transplant. 2006 21:2577-2582

  • Barton, M. Nephrol. Dial. Transplant. 2005. 20

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    MDRDLevey AS et al Ann Intern Med 130:461-470, 1999

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    Estimating renal function in older people: a comparison of three formulas Pedone C et al Age and aging 2006;35:121-126 CG, MDRD1, MDRD2 51.2ml/min 54.9ml/min 64.7ml/min ..

  • 1 mg% GFR 120ml/min 20

    eGFR Am J Kidn Dis,Vol 49,No 2,2007 GFR 60ml/min 80

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    Pedone C et al Age and aging 2006;35:121-126 Epo Vi-D

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    the decline in Renal function with age can be clinically insignificant unless other acute/chrome diseases that affect the RF are overlapped:arterial hypertensiondiabetes mellitus (II)CHF

  • Coresh J., et al: JAMA 298:2007Zhang L., et al: Am J Kidn Dis 51:2008 : 10% China 4% USA

  • Zhang Q., et al: MBC Public Health 8/2010 26 : USA, Europe, Asia

    . . . >64 23.4%-35.8% GFR MDRD vs CCG

  • eGFR 40% 52% Tertiary Care Hospitals - 63.2 vs 59.3 300% e-GFR

    35% e-GFRNoble E. Et al: Nephrol Dial Transpl 23/2010Richards N., et al: Nephrol Dial Transpl 24/2011

  • GFR ;13,1% 5% 1 27,7% 30,4% 4 5 GFR 60

  • Kidney International (2007) 72, 632637 60 GFR
  • Nephrol Dial Transplant (2010) 25: 28322836

  • Nephrol Dial Transplant (2010) 25: 28322836 ; combine all levels of eGFR with ACR measurements..

  • o Cores et al, JAMA,2011 . . . GFR 60-89 ml/min

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  • GFR Levey AS et al Kidney Int 2005;67:2089-00 2005 GFR..

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  • Seminars in Dialysis 23: 129133, 2010

  • http://www.cdc.gov/diabetes/pubs/estimatesNational Diabetes Fact Sheet 2011 27% > 65

  • 9, NPHS1, HSPG2, SELL, CNDP1, LAMNA, ELMO1ACE, ANP, AGTAKR1B1, GFPT2, SLC2A1, GECCR5, IL1, IL6, IL1RN, TGFBR, RANTESAPOENOS3, ENPP1, MnSODPPARG, TSC22, PRKCB, BDKRB2P22phox, SLC12A3

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  • Nephrol Dial Transplant (2009) 24: 12121219 Japan Diabetes Clinical Data Management study (JDDM15)

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  • Diabetes,52,2003 Type I Diabetes Melitus

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  • (%) - NHANES III Franklin SS, Jacobs M, Wong ND, et al. JACC. 2000; 35: 334A020406080100 ()8070-79

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  • Journal of Hypertension 2009, 27:21212158

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  • American Journal of Kidney Diseases, Vol 49, No 2, Suppl 2 (February), 2007

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  • Nephrol Dial Transplant (2010) 25: 39773982 RAS

  • Physicians should remember that the most common cause of end-stage renal disease among elderly persons with preexisting CKD is acute kidney injury secondary to radiocontrast procedures, anti-inflammatory drugs, or worsening heart failure, not a gradual decrease consistent with the natural history of CKD itself. Use of RAS blockers in such patients puts them at increased risk for worsening CKD.Sarafidis PA & Bakris GL, Ann Intern Med 2009

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  • / Ferrario CG: Geropharmacology: AACN Adv Crit Care 19:134149, 2008Ferrario CG: Geropharmacology: AACN Adv Crit Care 19: 2335, 2008

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  • The issue in treating elderly patients with kidney disease is not efficacy but safetyGolden Rule

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