Aging and the Kidneys: Anatomy, Physiology and Consequences for Defining Chronic Kidney Disease

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Abstract

The varied functions of the kidneys are influenced by the complex process of aging. The glomerular filtration rate (GFR) steadily declines with normal aging, and the progress of this process can be influenced by superimposed diseases. Microscopically, nephron numbers decrease as global glomerulosclerosis becomes more evident. The precise mechanisms underlying nephron loss with aging are not well understood, but derangements in podocyte biology appear to be involved. Classifications of chronic kidney disease (CKD) incorporate GFR values and attendant risk of adverse events. Arbitrary and fixed thresholds of GFR for defining CKD have led to an overdiagnosis of CKD in the elderly. An age-sensitive definition of CKD could offer a solution to this problem and more meaningfully capture the prognostic implications of CKD.

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Structural and Functional Changes With the Aging Kidney.

Aleksandar Denic, Richard Glassock, Andrew D Rule (2016)

Senescence or normal physiologic aging portrays the expected age-related changes in the kidney as compared to a disease that occurs in some but not all individuals. The microanatomical structural changes of the kidney with older age include a decreased number of functional glomeruli from an increased prevalence of nephrosclerosis (arteriosclerosis, glomerulosclerosis, and tubular atrophy with interstitial fibrosis), and to some extent, compensatory hypertrophy of remaining nephrons. Among the macroanatomical structural changes, older age associates with smaller cortical volume, larger medullary volume until middle age, and larger and more numerous kidney cysts. Among carefully screened healthy kidney donors, glomerular filtration rate (GFR) declines at a rate of 6.3 mL/min/1.73 m(2) per decade. There is reason to be concerned that the elderly are being misdiagnosed with CKD. Besides this expected kidney function decline, the lowest risk of mortality is at a GFR of ≥75 mL/min/1.73 m(2) for age <55 years but at a lower GFR of 45 to 104 mL/min/1.73 m(2) for age ≥65 years. Changes with normal aging are still of clinical significance. The elderly have less kidney functional reserve when they do actually develop CKD, and they are at higher risk for acute kidney injury.

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Early recognition and prevention of chronic kidney disease.

Matthew T James, Brenda R. Hemmelgarn, Marcello Tonelli (2010)

Chronic kidney disease is a common disorder and its prevalence is increasing worldwide. Early diagnosis on the basis of presence of proteinuria or reduced estimated glomerular filtration rate could permit early intervention to reduce the risks of cardiovascular events, kidney failure, and death that are associated with chronic kidney disease. In developed countries, screening for the disorder is most efficient when targeted at high-risk groups including elderly people and those with concomitant illness (such as diabetes, hypertension, or cardiovascular disease) or a family history of chronic kidney disease, although the role of screening in developing countries is not yet clear. Effective strategies are available to slow the progression of chronic kidney disease and reduce cardiovascular risk. Treatment of high blood pressure is recommended for all individuals with, or at risk of, chronic kidney disease. Use of angiotensin-converting-enzyme inhibitors or angiotensin-receptor blockers is preferred for patients with diabetic chronic kidney disease or those with the proteinuric non-diabetic disorder. Glycaemic control can help prevent the onset of early stages of chronic kidney disease in individuals with diabetes. Use of statins and aspirin is beneficial for most patients with chronic kidney disease who are at high cardiovascular risk, although research is needed to ascertain how to best prevent cardiovascular disease in this cohort. Models of care that facilitate delivery of the many complex aspects of treatment simultaneously could enhance management, although effects on clinical outcomes need further assessment. Novel clinical methods to better identify patients at risk of progression to later stages of chronic kidney disease, including kidney failure, are needed to target management to high-risk subgroups. Copyright 2010 Elsevier Ltd. All rights reserved.

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The association between age and nephrosclerosis on renal biopsy among healthy adults.

Andrew D Rule, Hatem Amer, Lynn Cornell … (2010)

Chronic kidney disease is common with older age and is characterized on renal biopsy by global glomerulosclerosis, tubular atrophy, interstitial fibrosis, and arteriosclerosis. To see whether the prevalence of these histologic abnormalities in the kidney increases with age in healthy adults and whether histologic findings are explained by age-related differences in kidney function or chronic kidney disease risk factors. Cross-sectional study. Mayo Clinic, Rochester, Minnesota, from 1999 to 2009. 1203 adult living kidney donors. Core-needle biopsy of the renal cortex obtained during surgical implantation of the kidney, and medical record data of kidney function and risk factors obtained before donation. The prevalence of nephrosclerosis (> or =2 chronic histologic abnormalities) was 2.7% (95% CI, 1.1% to 6.7%) for patients aged 18 to 29 years, 16% (CI, 12% to 20%) for patients aged 30 to 39 years, 28% (CI, 24% to 32%) for patients aged 40 to 49 years, 44% (CI, 38% to 50%) for patients aged 50 to 59 years, 58% (CI, 47% to 67%) for patients aged 60 to 69 years, and 73% (CI, 43% to 90%) for patients aged 70 to 77 years. Adjustment for kidney function and risk factor covariates did not explain the age-related increase in the prevalence of nephrosclerosis. Kidney donors are selected for health and lack the spectrum or severity of renal pathologic findings in the general population. Kidney function and chronic kidney disease risk factors do not explain the strong association between age and nephrosclerosis in healthy adults. National Institutes of Health, U.S. Public Health Service.

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Author and article information

Journal

Journal ID (publisher-id): NEF

Journal ID (nlm-ta): Nephron

Journal ID (doi): 10.1159/issn.1660-8151

Title: Nephron

Publisher: S. Karger AG

ISSN (Print): 1660-8151

ISSN (Electronic): 2235-3186

Publication date Subscription-year: 2016

Publication date (Print): September 2016

Publication date (Electronic): 07 April 2016

Volume: 134

Issue: 1

Pages: 25-29

Affiliations

^aDavid Geffen School of Medicine at UCLA, Los Angeles, Calif., and ^bMayo Clinic, Rochester, Minn., USA

Author notes

*Dr. Richard J. Glassock, David Geffen School of Medicine at UCLA, 8 Bethany, Laguna Niguel, Los Angeles, CA 92677 (USA), E-Mail glassock@cox.net

Article

Publisher ID: 445450 Other ID: Nephron 2016;134:25-29

DOI: 10.1159/000445450

PubMed ID: 27050529

SO-VID: 65ae8a70-a9a1-4c9c-9e3b-5a7c3334d371

License:

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

History

Date received : 08 February 2016

Date accepted : 12 March 2016

Page count

Figures: 1, References: 33, Pages: 5

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Aging and the Kidneys: Anatomy, Physiology and Consequences for Defining Chronic Kidney Disease

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Abstract

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Karger: Nephrology

Most cited references 20

Structural and Functional Changes With the Aging Kidney.

Early recognition and prevention of chronic kidney disease.

The association between age and nephrosclerosis on renal biopsy among healthy adults.

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Cited by 57

Most referenced authors 655