Geriatrik Nefroloji

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DOI :10.26650/B/CH12CH47.2023.014.02   IUP :10.26650/B/CH12CH47.2023.014.02    Full Text (PDF)

Geri̇atri̇k Nefroloji̇ye Genel Bakış Ve Yaşlanan Toplum

Gizem Kumru, Şule Şengül

Yaşlanma, birçok organ sisteminde yapısal ve hücresel fonksiyonel değişikliklere yol açan doğal, ilerleyici ve kaçınılmaz bir biyolojik süreçtir1 .Böbreklerin yaşlanmasında intrarenal Klotho gen ekspresyonundaki azalma, oksidatif stres, intrarenal renin-anjiyotensin-aldosteron sisteminin kronik aktivasyonu, TGF-β aracılı fibrotik süreçler, nitrik oksit düzeyinin azalması, ileri glikolizasyon ürünlerinin artışı, mitokondriyal kayıp ve telomer kısalması gibi pek çok hasar mekanizması rol oynar2 . İlerleyen yaşla birlikte yalnızca normal organ yaşlanmasının değil, aynı zamanda yaşlı bireylerde daha sık görülen ateroskleroz, hipertansiyon ve diyabet gibi hastalıkların da etkisiyle böbreklerde anatomik değişiklikler ve fonksiyon kaybı görülür. Önlenilebilir ve tedavi edilebilir bir hastalığa bağlı patolojik değişikliklerin, yaşlanmanın kaçınılmaz fizyolojik sonuçlarından ayırt edilmesi bazen zor olmakla birlikte yaşlı hastaların yönetiminde oldukça önemlidir. Yaşlanma ile birlikte böbrek rezervlerinin kaybı, akut böbrek hasarına (ABH) artan yatkınlık, yeni gelişimli nefropatilerde daha ileri hastalık ve renal yoldan elimine edilen ilaçların toksik birikimi gibi riskleri de artırmaktadır. Dünya nüfusu 1950’lerden günümüze yaklaşık 3 kat artmış ve doğumda beklenen yaşam süresi 25 yıl uzamıştır3 . Birleşmiş Milletler dünya nüfus tahminlerine göre 65 yaş üstü yaşlı nüfus oranı dünya ortalaması 2021 yılında %9,6’dır. En yüksek yaşlı nüfus oranına sahip ülkeler Japonya (%28,7), İtalya (%23,6) ve Portekiz (%23,1) iken, yaşlı nüfus oranının en düşük olduğu ülkeler Birleşik Arap Emirlikleri (%1,4), Katar (%1,9) ve Uganda’dır (%2,0). Ülkemizde ise 2021 verilerine göre 8.245.124 kişi (%9,7) 65 yaşının üzerindedir ve doğumda beklenen yaşam süresi 76 yıldır4 . Türkiye’deki yaşlı nüfus oranı dünya ortalaması ile benzer iken, Avrupa Birliği üye ülkeleri ortalamasının (%21,1) altındadır.



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