Overview: renal physiology and pathophysiology of aging.

Cross-sectional studies in humans have suggested that there is a progressive decline of renal function with age after 40 years. The decline in various functions (eg, tubular maximums, concentrating and diluting abilities, and acidification) tend to parallel the decreases in glomerular filtration rate (GFR) and renal blood (plasma) flow (RPF). Recent observations from the Baltimore Longitudinal Study of Aging suggest that not all individuals follow this pattern, and that, indeed, many show no decline and some even an increase in their renal function over time. Whether the observed decreases in renal function with aging are the results of intervening pathologic processes, eg, immunologic, infectious, and toxic injury and ischemia, or can be related to hyperperfusion and hyperfiltration with resultant glomerulosclerosis, or to some other relentless involutional process, remains unclear. The purpose of this report is to review the descriptive studies documenting the changes in renal morphology and physiology with age and to discuss what is known about mechanisms involved in these losses of renal substance and function.

[1]  A. H. Norris,et al.  The effect of age on creatinine clearance in men: a cross-sectional and longitudinal study. , 1976, Journal of gerontology.

[2]  J. Wetzels,et al.  Renal hemodynamic effects of a short-term high protein and low protein diet in patients with renal disease. , 1988, Clinical nephrology.

[3]  H. Armbrecht,et al.  Effect of age on the conversion of 25-hydroxyvitamin D3 to 1,25-dihydroxyvitamin D3 by kidney of rat. , 1980, The Journal of clinical investigation.

[4]  N. Sawabu,et al.  Intrarenal vascular changes with age and disease. , 1972, Kidney international.

[5]  B. Brenner,et al.  Dietary protein intake and the progressive nature of kidney disease: the role of hemodynamically mediated glomerular injury in the pathogenesis of progressive glomerular sclerosis in aging, renal ablation, and intrinsic renal disease. , 1982, The New England journal of medicine.

[6]  A. Dontas,et al.  The effect of bacteriuria on renal functional patterns in old age. , 1968, Clinical science.

[7]  V. Goyal.  Changes with age in the human kidney , 1982, Experimental Gerontology.

[8]  D. Adams,et al.  Senescence and the Renal Vasculature in Normal Man , 1974, Circulation research.

[9]  R. Burich.  Effects of age on renal function and enzyme activity in male C57BL/6 mice. , 1975, Journal of gerontology.

[10]  L. Hayflick.  The cell biology of human aging. , 1976, The New England journal of medicine.

[11]  N. Shock,et al.  Age differences in the succinoxidase activity of homogenates and mitochondria from the livers and kidneys of rats. , 1960, Journal of gerontology.

[12]  L. Fine.  Preventing the progression of human renal disease: have rational therapeutic principles emerged? , 1988, Kidney international.

[13]  B. Agarwal,et al.  Renal acidification in elderly subjects. , 1980, Nephron.

[14]  A. Donker,et al.  Renal hemodynamics during separate and combined infusion of amino acids and dopamine. , 1986, Kidney international.

[15]  R. Rieselbach,et al.  Factors influencing the increase in glomerular filtration rate in the remaining kidney of transplant donors. , 1973, The American journal of medicine.

[16]  B. Kasiske.  Relationship between vascular disease and age-associated changes in the human kidney. , 1987, Kidney international.

[17]  F. Proverbio,et al.  Ion transport and oxygen consumption in kidney cortex slices from young and old rats. , 1985, Gerontology.

[18]  T. Phillips,et al.  Kidney cell proliferation after unilateral nephrectomy as related to age. , 1967, Cancer research.

[19]  N. Shock,et al.  Aging as a factor in the renal hemodynamic changes induced by a standardized pyrogen. , 1951, Journal of Clinical Investigation.

[20]  P. Weidmann,et al.  Effect on aging on plasma renin and aldosterone in normal man. , 1975, Kidney international.

[21]  N. Shock,et al.  Influence of age, renal disease, hypertension, diuretics, and calcium on the antidiuretic responses to suboptimal infusions of vasopressin. , 1966, The Journal of laboratory and clinical medicine.

[22]  B. Rodriguez-Iturbe,et al.  RESPONSE TO ACUTE PROTEIN LOAD IN KIDNEY DONORS AND IN APPARENTLY NORMAL POSTACUTE GLOMERULONEPHRITIS PATIENTS: EVIDENCE FOR GLOMERULAR HYPERFILTRATION , 1985, The Lancet.

[23]  N. Shock,et al.  Effect of acute acid loading on urinary acid excretion by the aging human kidney. , 1968, The Journal of laboratory and clinical medicine.

[24]  A. Giannoni,et al.  Restricted phosphorus and nitrogen intake to slow the progression of chronic renal failure: a controlled trial. , 1983, Kidney international. Supplement.

[25]  Crane Mg,et al.  Effect of aging on renin activity and aldosterone excretion. , 1976 .

[26]  C. Ronco,et al.  Renal functional reserve in humans. Effect of protein intake on glomerular filtration rate. , 1983, The American journal of medicine.

[27]  S. Klahr,et al.  Role of dietary lipids and renal eicosanoids on the progression of renal disease. , 1989, Kidney international. Supplement.

[28]  A. Raizner,et al.  Functional defects in the aging kidney. , 1972, Annals of internal medicine.

[29]  D. B. MacCallum.  The bearing of degenerating glomeruli on the problem of the vascular supply of the mammalian kidney , 1939 .

[30]  N. Shock,et al.  Glomerular permeability in young and old subjects. , 1962, Journal of gerontology.

[31]  N. Shock,et al.  Age differences in the renal tubular response to antidiuretic hormone. , 1953, Journal of gerontology.

[32]  R. DeFronzo,et al.  The influence of age on the renal response to water deprivation in man. , 1976, Nephron.

[33]  N. Shock,et al.  The glomerular clearance and renal transport of hemoglobin in adult males. , 1961, The Journal of clinical investigation.

[34]  T. A. Anderson,et al.  The effect of dietary sodium chloride on blood pressure, body fluids, electrolytes, renal function, and serum lipids of normotensive man. , 1976, The Journal of laboratory and clinical medicine.

[35]  N W Shock,et al.  Longitudinal Studies on the Rate of Decline in Renal Function with Age , 1985, Journal of the American Geriatrics Society.

[36]  R. Lindeman,et al.  Anatomic and physiologic age changes in the kidney , 1986, Experimental Gerontology.

[37]  N. Shock,et al.  Association between blood pressure and the rate of decline in renal function with age. , 1984, Kidney international.

[38]  J. Bosch,et al.  Short-term protein loading in assessment of patients with renal disease. , 1984, The American journal of medicine.

[39]  D F DAVIES,et al.  Age changes in glomerular filtration rate, effective renal plasma flow, and tubular excretory capacity in adult males. , 1950, The Journal of clinical investigation.

[40]  B. Brenner,et al.  Hyperfiltration in remnant nephrons: a potentially adverse response to renal ablation. , 1981, The American journal of physiology.

[41]  B. Brenner,et al.  Hypertension and proteinuria: long-term sequelae of uninephrectomy in humans. , 1984, Kidney international.