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. 2010 Jul;17(4):308-19.
doi: 10.1053/j.ackd.2010.03.008.

Electrolytes in the aging

Lynn E Schlanger  1 , James L Bailey, Jeff M Sands
Affiliations

Electrolytes in the aging

Lynn E Schlanger et al. Adv Chronic Kidney Dis. 2010 Jul.

Abstract

The elderly population in the United States continues to grow and is expected to double by 2050. With aging, there are degenerative changes in many organs and the kidney is no exception. After 40 years of age, there is an increase in cortical glomerulosclerosis and a decline in both glomerular filtration rate and renal plasma flow. These changes may be associated with an inability to excrete a concentrated or a dilute urine, ammonium, sodium, or potassium. Hypernatremia and hyponatremia are the most common electrolyte abnormalities found in the elderly and both are associated with a high mortality. Under normal conditions, the elderly are able to maintain water and electrolyte balance, but this may be jeopardized by an illness, a decline in cognitive ability, and with certain medications. Therefore, it is important to be aware of the potential electrolyte abnormalities in the elderly that can arise under these various conditions to prevent adverse outcomes.

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Figures

Fig 1
Fig 1
Under normal conditions the various transporters/co-transporters and water channels play a role in water balance. The UT-A1 urea transporter, AQP2, AQP3, and NKCC2/BSC1 transporters are influenced by ADH secretion. The selective permeability of the loop of Henle to water and the medullary thick ascending loop to NaCl allows for the creation of the countercurrent system. The presence of AQP2 and the high concentration of NaCl and urea in the inner medulla allows for the reabsorption of water free solute in the collecting tubules for the final concentrated urine. The selective permeability of the NKCC2/BSC1 co-transporter in the medullary thick ascending limb permits the formation of dilute urine.
Fig 2
Fig 2
The putative changes in the renal transport system in the elderly are shown. In animal studies there is a decrease in the abundance of AQP2, AQP3, NKCC2/BSC1 and UT-A1, A2, A3. The arrrows represent the transporters and water channels known to be downregulated in animal studies. These changes may be present in the elderly population affecting the diluting and concentrating capacity.
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