Structural and Functional Changes With the Aging Kidney.
Structural and Functional Changes With the Aging Kidney.
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DOI：
10.1053/j.ackd.2015.08.004
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发表时间：
2016-01
影响因子：
2.9
通讯作者：
Rule AD
中科院分区：
文献类型：
--
作者：
Denic A;Glassock RJ;Rule AD
衰老或正常生理衰老描述了肾脏中预期的与年龄相关的变化，而不是发生在一些但不是所有人的疾病中。随着年龄的增长，肾脏的显微解剖结构变化包括肾硬化症(动脉硬化、肾小球硬化和肾小管萎缩伴间质纤维化)增加所致的功能性肾小球数量减少，在某种程度上，剩余肾单位代偿性肥大。在大体解剖结构变化中，年龄越大，皮质体积越小，中年前髓质体积越大，肾囊肿越大、数目越多。在经过仔细筛选的健康肾捐献者中，肾小球滤过率以每十年6.3ml/分钟/1.73m2的速度下降。有理由担心老年人被误诊为慢性肾脏疾病。除了这种预期的肾功能下降外，最低的死亡风险是55岁的≥肾小球滤过率为75ml/分钟/1.73m2，而≥65岁的肾小球滤过率较低，为45-104ml/min/1.73m2。正常衰老时的变化仍具有临床意义。老年人的肾脏功能储备较少，当他们确实患上慢性肾脏疾病时，他们患急性肾脏损伤的风险也更高。
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 micro-anatomical 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 macro-anatomical structural changes, older age associates with smaller cortical volume, larger medullary volume until middle age, and larger and more numerous renal cysts. Among carefully-screened healthy kidney donors, glomerular filtration rate declines at a rate of 6.3 ml/min/1.73m2 per decade. There is reason to be concerned that the elderly are being misdiagnosed with chronic kidney disease. Besides this expected kidney function decline, the lowest risk of mortality is at a glomerular filtration rate of ≥75 ml/min/1.73 m2 for age <55 years but at a lower glomerular filtration rate of 45-104 ml/min/1.73m2 for age ≥65 years. Changes with normal aging are still of clinical significance. The elderly have less renal functional reserve when they do actually develop chronic kidney disease and they are also at higher risk for acute kidney injury.