Peña RJC

Language: Spanish
References: 24
Page: 23-31
PDF size: 227.80 Kb.

ABSTRACT

The aging kidney courses with a progressive decline in function. It is not clear if this loss is part of the aging process or if it is secondary to diseases that frequently affect this population (diabetes, hypertension and others). In this review, we analyze the main publications in the last three decades. What variables or methods to estimate the renal function are the most reliable? For instance, the GFR measured with endogenous creatinine clearance overestimates, in aging patients, end stage renal disease (ERD). To confirm this diagnosis, it is necessary the use of cystatin C and the application of formulas to estimate GFR, instead of creatinine clearance alone. For instance, the data of N Ebert from Berlin in an aging population established that patients older than 85 years with GFR below 60/mL/min not necessarily have renal failure. Furthermore, the new FAS (full age spectrum) formula, just recently developed, included patients from one to 90 years of age in a large population. This formula allows the estimation of renal function in older patients, with more precision and less variation. The natural course of the kidney in the aging population (above 65 years) is characterized by progressive glomerular sclerosis, tubular atrophy, interstitial fibrosis and arteriosclerosis. It is important to establish and distinguish if these lesions are part of the aging process or are just the result of diseases that frequently affect this population.

REFERENCES

1. Davies DF, Shock NW. Age changes in glomerular filtration rate, effective renal plasma flow, and tubular excretory capacity in adult males. J Clin Invest. 1950; 29 (5): 496-507.

2. Lindeman RD, Goldman R. Anatomic and physiologic age changes in the kidney. Exp Gerontol. 1986; 21 (4-5): 379-406.

3. Lindeman RD, Tobin J, Shock NW. Longitudinal studies on the rate of decline in renal function with age. J Am Geriatr Soc. 1985; 33 (4): 278-285.

4. Goyal VK. Changes with age in the human kidney. Exp Gerontol. 1982; 17 (5): 321-331.

5. Wesson LG. Renal hemodynamics in physiological states. In: Wesson LG, editor. Physiology of the human kidney. New York, NY: Grune & Stratton; 1969. pp. 96-108.

6. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013; 3: 1-150.

7. Ebert N, Loesment A, Martus P, Jakob O, Gaedeke J, Kuhlmann M et al. Iohexol plasma clearance measurement in older adults with chronic kidney disease-sampling time matters. Nephrol Dial Transplant. 2015; 30 (8): 1307-1314.

8. Ebert N, Jakob O, Gaedeke J, van der Giet M, Kuhlmann MK, Martus P et al. Prevalence of reduced kidney function and albuminuria in older adults: the Berlin Initiative Study. Nephrol Dial Transplant. 2017; 32 (6): 997-1005.

9. Shlipak MG, Sarnak MJ, Katz R, Fried LF, Seliger SL, Newman AB et al. Cystatin C and the risk of death and cardiovascular events among elderly persons. N Engl J Med. 2005; 352 (20): 2049-2060.

10. Peralta CA, Katz R, Sarnak MJ, Ix J, Fried LF, De Boer I et al. Cystatin C identifies chronic kidney disease patients at higher risk for complications. J Am Soc Nephrol. 2011; 22 (1): 147-155.

11. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976; 16 (1): 31-41.

12. Levey AS, Gassman JJ, Hall PM, Walker WG. Assessing the progression of renal disease in clinical studies: effects of duration of follow-up and regression to the mean. Modification of Diet in Renal Disease (MDRD) Study Group. J Am Soc Nephrol. 1991; 1: 1087-1094.

13. Pottel H, Hoste L, Dubourg L, Ebert N, Schaeffner E, Eriksen BO et al. An estimated glomerular filtration rate equation for the full age spectrum. Nephrol Dial Transplant. 2016; 31 (5): 798-806.

14. Schwartz GJ, Muñoz A, Schneider MF, Mak RH, Kaskel F, Warady BA et al. New equations to estimate GFR in children with CKD. J Am Soc Nephrol. 2009; 20 (3): 629-637.

15. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009; 150 (9): 604-612.

16. Rule AD, Bailey KR, Lieske JC, Peyser PA, Turner ST. Estimating the glomerular filtration rate from serum creatinine is better than from cystatin C for evaluating risk factors associated with chronic kidney disease. Kidney Int. 2013; 83 (6): 1169-1176.

17. O’Hare AM, Choi AI, Bertenthal D, Bacchetti P, Garg AX, Kaufman JS et al. Age affects outcomes in chronic kidney disease. J Am Soc Nephrol. 2007; 18 (10): 2758-2765.

18. Darmady EM, Offer J, Woodhouse MA. The parameters of the ageing kidney. J Pathol. 1973; 109 (3): 195-207.

19. Denic A, Lieske JC, Chakkera HA, Poggio ED, Alexander MP, Singh P et al. The substantial loss of nephrons in healthy human kidneys with aging. J Am Soc Nephrol. 2017; 28 (1): 313-320.

20. Kremers WK, Denic A, Lieske JC, Alexander MP, Kaushik V, Elsherbiny HE et al. Distinguishing age-related from disease-related glomerulosclerosis on kidney biopsy: the Aging Kidney Anatomy study. Nephrol Dial Transplant. 2015; 30 (12): 2034-2039.

21. Denic A, Glassock RJ, Rule AD. Structural and functional changes with the aging kidney. Adv Chronic Kidney Dis. 2016; 23 (1): 19-28.

22. James MT, Hemmelgarn BR, Wiebe N, Pannu N, Manns BJ, Klarenbach SW et al. Glomerular filtration rate, proteinuria, and the incidence and consequences of acute kidney injury: a cohort study. Lancet. 2010; 376 (9758): 2096-2103.

23. Berger JC, Muzaale AD, James N, Hoque M, Wang JM, Montgomery RA et al. Living kidney donors ages 70 and older: recipient and donor outcomes. Clin J Am Soc Nephrol. 2011; 6 (12): 2887-2893.

24. Hoste L, Dubourg L, Selistre L, De Souza VC, Ranchin B, Hadj-Aïssa A et al. A new equation to estimate the glomerular filtration rate in children, adolescents and young adults. Nephrol Dial Transplant. 2014; 29 (5): 1082-1091.