Preventable Causes of Renal Failure in the Elderly

Abstract

One of the great mental traps for the physician treating elderly patients is his assumption that a clinical syndrome or an evidence of deterioration always is due to a chronic or degenerating disease. He is lured into this trap by a graying patient who introduces his symptoms with some variant of a famous line attributed to Dorothy Thompson, ‘After fifty, it’s patch, patch, patch’. The astute and experienced physician recognizes the senior citizen’s reference to the ‘one horse shay falling apart’ as a method for coping rather than a clue to the diagnosis. Sadly, the contrary assumption or the physician&s acceptance of degenerative disease as the sole explanation for clinical syndromes becomes a self-fulfilling prophecy. To make it happen the doctor needs only to let it happen. For this reason, it is worthwhile reviewing some of the preventable causes of renal failure in the elderly patients. Table I lists some of the causes we will discuss.