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Review
. 2012 Aug;82(3):270-7.
doi: 10.1038/ki.2012.65. Epub 2012 Mar 21.

The implications of anatomical and functional changes of the aging kidney: with an emphasis on the glomeruli

Richard J Glassock  1 , Andrew D Rule
Affiliations
Review

The implications of anatomical and functional changes of the aging kidney: with an emphasis on the glomeruli

Richard J Glassock et al. Kidney Int. 2012 Aug.

Abstract

Aging is both a natural and inevitable biological process. With advancing age, the kidneys undergo anatomical and physiological changes that are not only the consequences of normal organ senescence but also of specific diseases (such as atherosclerosis or diabetes) that occur with greater frequency in older individuals. Disentangling these two processes, one pathologic and the other physiologic, is difficult. In this review we concentrate on the glomerular structural and functional alterations that accompany natural aging. We also analyze how these changes affect the identification of individuals of advancing age as having chronic kidney disease (CKD) and how these changes can influence prognosis for adverse outcomes, including all-cause mortality, end-stage renal disease, cardiovascular events and mortality, and acute kidney injury. This review describes important shortcomings and deficiencies with our current approach and understanding of CKD in the older and elderly adult.

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Conflict of interest statement

DISCLOSURE

All the authors declared no competing interests.

Figures

Figure 1
Figure 1. Mosaic plot of sclerosis scores by age group among 1203 living kidney donors
Sclerosis score defined as the total number of chronic histological abnormalities between (1) any global glomerulosclerosis, (2) any tubular atrophy, (3) interstitial fibrosis >5%, and (4) any arteriosclerosis. In the figure, a score of 0 is white, a score of 4 is orange, and intermediate scores are on a color intensity scale. The figure is used with permission.
Figure 2
Figure 2. Logarithmic glomerular density by age for persons with ≤ 10% (solid smoothing spline) or with >10% (dashed smoothing spline) glomerulosclerosis among 1046 living kidney donors
The figure is used with permission.
Figure 3
Figure 3. A comparison of estimated glomerular filtration rate (GFR) in two ‘normal’ cohorts according to age
(a) Men; (b) Women. Blue lines indicate mean, 90% UPL and LPL estimated glomerular filtration rate (eGFR; modification of diet in renal disease formula (MDRD), re-expressed equation) in healthy living donors. Orange lines indicate median, 5th, and 95th percentiles for ‘normal’ Caucasian community living adults from the Nijmegen Biomedical Study. UPL, upper probability limit; LPL, lower probability limit. The figure is used with permission.
See this image and copyright information in PMC

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