Geriatrik Nefroloji

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DOI :10.26650/B/CH12CH47.2023.014.13   IUP :10.26650/B/CH12CH47.2023.014.13    Tam Metin (PDF)

Geri̇atri̇k Di̇yabeti̇k Hastalarda Böbrek Tutulumu Ve Tedavi̇si̇

Onur Tunca, M. Sena Ulu

İçinde bulunduğumuz evren ve üzerinde nefes aldığımız dünya giderek yaşlanırken, bu yaşlanma ortalama insan ömrüne de yansımış gibi gözükmektedir. 20.yy. ortalarından günümüze dek ortalama yaşam süresinin oldukça arttığı bilinmektedir. 21.yy. ortalarında ise bu sürenin 30 yıla kadar uzaması öngörülmektedir. Çeyrek yüzyıl sonra 60 yaş üzeri nüfusun toplam dünya nüfusunun 5’te 1’inden fazla olacağı tahmin edilmektedir1,2. Diğer bir deyişle 2050 yılında 60 yaş üzeri nüfusun 2 milyarın üzerinde olacağı ön görülmektedir1 . Yaşlı nüfusta onkolojik problemler, kardiyovasküler hastalıklar ve de geriatrik sendromlar oldukça sık görülür3 . Özellikle düşmeye bağlı kırıklar, işitme-görme problemleri, depresyon, bilişsel fonksiyonlarda gerileme, kas kayıpları, çoklu ilaç kullanımı ve idrar inkontinansı ön sıralarda yer almaktadır4,5. Ek olarak sadece yaşlanmanın kendisinin bozulmuş glukoz toleransı ile ilişkili olduğunu bildiren görüşler mevcuttur6 . Giderek uzayan bu ömürde özellikle 75 yaş üzeri insanlarda diyabetes Mellitus (DM) prevalansının ve hatta can sıkıcı komplikasyonlarından birisi olan böbrek tutulumunun arttığı aşikardır. Diyabetik böbrek hastalığı ya da diyabetik nefropati (DN) olarak adlandırılan bu durum ne yazık ki son zamanlarda yaşlı bireylerde gözlenen olmazsa olmaz hastalıklar arasında yer almaktadır. Geriatrik hastalarda DN açısından koruyucu önlemler oldukça dar bir alana hapsolmuş durumdadır. Progresyonun yavaşlatılması adına glisemik kontrol, kan basıncı (KB) kontrolü, lipid düşürücü tedavi ve diyet yaklaşımları nispeten daha genç kuşak diyabet hastalarından elde edilen deneyimler ile sınırlıdır. Sadece 60 yaş üzerinde diyabet hastası olmak, iyi bir kardiyovasküler koruma sağlanmış olsa bile tek başına diyabet komplikasyonları açısından bağımsız bir risk faktörü olarak değerlendirilmektedir. Bu nedenle yaşlı diyabetik hastalarda daha bütüncül bir bakış açısıyla tedavi hedeflerinin gözden geçirilmesi gerekmektedir.7



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