Older Adults with Kidney Disease

Kidney problems are very common in older adults and can significantly diminish the quality of life in one’s later years or even be fatal. While most patients can work with their primary care physicians to manage the symptoms and complications of decreased kidney function, for some patients it is important to consult with a team including both nephrology and geriatric medicine specialists to determine the underlying cause, manage worsening symptoms and complications, and evaluate treatment options. Those include patients with new onset of abnormalities in the urine and loss of kidney function (more rapid than expected), systemic diseases that can affect the kidneys, and patients with advanced loss of kidney function approaching kidney failure.

Michigan Medicine’s Geriatric Kidney Disease Clinic was established to help older patients and their caregivers navigate the challenges of acute and chronic kidney conditions. 

Signs and Symptoms

A number of signs point to problems with kidney function, notably:

  • Proteinuria – an elevated level of protein in the urine
  • Hematuria – blood in the urine, most often only detected by a specific urine test
  • Increased serum creatinine in the blood
  • Electrolyte imbalances
  • Hypertension (high blood pressure) that is difficult to control with medication

When these symptoms are seen in older patients, physicians may suspect either inflammation of the kidneys – a condition called glomerulonephritis, or damage to the filter unit leading to spilling large amounts of protein in the urine, which is referred to as nephrotic syndrome. Older patients with these conditions may benefit from the more specialized geriatric care our clinic offers.

Diagnosis and Treatment

While there are established methods to diagnose and treat kidney diseases, some level of risk comes with each alternative. For older patients, those risks may outweigh the benefits of standard of care or alternative treatments may be equally effective with less risks. Our team of nephrologists, geriatricians, and social workers is skilled at helping patients and their loved ones weigh their options and determine their best course of action by addressing questions like these:

Should you undergo a kidney biopsy?

A kidney biopsy is the most reliable tool to accurately diagnose the specific cause of your kidney problem. It cannot only distinguish the different types of glomerulonephritis and nephrotic syndrome, but also determine the chances of recovery of kidney function (how much inflammation and scaring is in the kidney?). Therefore, it can be very helpful to guide treatment decisions. But the decision to undergo a kidney biopsy is not an easy one, in particular for an older patient. Like any surgical procedure, there are risks involved, and those risks are greater in patients in poor health, those with other chronic conditions like diabetes, heart disease or hypertension, and those who take multiple medications.

Helping patients and their families make a decision that is right for them is one of our team’s most important goals. Regardless of your choice, we will continue to work with you to manage your condition as effectively as possible.

Once diagnosed, are you a good candidate for standard therapy? 

Medications commonly used to treat kidney disease, which include immunosuppressive medications for glomerulonephritis and nephrotic syndrome, blood pressure lowering medications and diuretics, have side effects and pose additional risk for older patients. Alternative treatment options may have fewer side effects, but also may not be as effective. The geriatric specialists in our clinic, including physicians, social workers and nutritionists, are skilled in both counseling patients on treatment options and providing personalized medication and nutrition management. We make every attempt to coordinate all of these services during the same clinic appointment.

Should you consider dialysis? What about a kidney transplant?

Some of the patients seen in our clinic are at or near kidney failure (end stage renal disease or ESRD) for which the standard treatments are dialysis or kidney transplantation. Our team is here for patients contemplating dialysis, and helping them prepare transition to the care of a nephrologist at a local dialysis center if they choose that step. We are equally supportive of patients who elect not to pursue dialysis and will do all we can to help them manage the complications associated with ESRD. This may include involving physicians and nurses specialized in palliative and hospice care.

While kidney transplants are now more commonly performed in older patients, this option is not right for everyone. An individual’s health status, co-existing medical conditions, and expectations for function and daily living are all factors to consider and discuss.

No matter which option a patient chooses, our team continues to provide whatever support is needed, either through individualized management of the complications of kidney failure or the preparation to transition to dialysis, transplantation, or palliative care.

About the Clinic

  • The Geriatric Kidney Disease Clinic is held on Friday afternoons at the East Ann Arbor Health and Geriatrics Center.
  • The clinic is open to adults aged 65 years or older with kidney problems.
  • Our team includes nephrologists and social workers who work side-by-side with geriatric specialists. This team approach allows us to tailor the care we provide to older patients with decreased kidney function.

Patient Resources

Appointments and Referrals

Referring physicians, patients, and family members can contact the clinic directly at (734) 764-6831 or toll-free (877) 865-2167.