Acute renal failure in the elderly

The prevalence of acute renal failure (ARF) in the elderly is much greater than in the general population. Important structural and functional changes are present in the aging kidneys and predispose the elderly patient to multiple types of acute renal disease. Prerenal failure, hemodynamically-mediated acute tubular necrosis, nephrotoxic ARF, ARF of vascular origin and obstructive ARF are of special importance in the geriatric population. In the present review we analyze some aspects of interest for the nephrologist and urologist regarding diagnosis and management of these severe but often reversible diseases. Elderly patients with ARF appear to have a moderately worse prognosis than younger patients, but age should not be used as a discriminant factor in therapeutic decisions concerning ARF. Instead, early clinical features such as hypotension, assisted respiration or coma are decidedly related to mortality in ARF patients of any age. Although elderly patients who survive after an ARF episode appear to need more time for total recovery and exhibit a lower level of renal function than younger survivors, long-term prognosis is quite good.