Cheng, Zhen

Summary at a GlanceAs the population ages, large numbers of elderly patients will present with kidney diseases. Kidney biopsy for elderly patients is generally well tolerated and informative. Compared with younger adults, IgA nephropathy in the elderly carries a poor prognosis. In patients with intercurrent infections, IgA‐dominant postinfectious GN should be carefully differentiated from idiopathic IgA nephropathy. Existing ESRD and mortality prediction models/scoring systems for IgA nephropathy may not be generalized to elderly patients.

Both vitamin D deficiency and cognitive impairment are common in patients with chronic kidney disease (CKD). Vitamin D exerts neuroprotective and regulatory roles in the central nervous system. Hypovitaminosis D has been associated with muscle weakness and bone loss, cardiovascular diseases (hypertension, diabetes and hyperlipidemia), inflammation, oxidative stress, immune suppression and neurocognitive impairment. The combination of hypovitaminosis D and CKD can be even more debilitating, as cognitive impairment can develop and progress through vitamin D-associated and CKD-dependent/independent processes, leading to significant morbidity and mortality. Although an increasingly recognized comorbidity in CKD, cognitive impairment remains underdiagnosed and often undermanaged. Given the association of cognitive decline and hypovitaminosis D and their deleterious effects in CKD patients, determination of vitamin D status and when appropriate, supplementation, in conjunction with neuropsychological screening, should be considered integral to the clinical care of the CKD population.