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.

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.

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.