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The aging kidney

Authors
Andrew D Rule, MD, MSc
Richard J Glassock, MD, MACP
Section Editor
Gary C Curhan, MD, ScD
Deputy Editor
Albert Q Lam, MD

INTRODUCTION

The aging kidney has become a topic of great interest in geriatric medicine and clinical nephrology. In 1999, glomerular filtration rate (GFR)-estimating equations started to replace serum creatinine for the evaluation of kidney function. Since that time, more and more older adults have been identified as having acute or chronic kidney disease (CKD), and the prevalence of diagnosed kidney disease in this population has increased. About half of adults over the age of 70 years now have a measured or estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, a threshold often used to diagnose CKD [1].

This higher prevalence of diagnosed CKD is not simply due to increased recognition of diseases that tend to cluster in older adults, such as antineutrophil cytoplasmic antibody (ANCA)-positive small-vessel vasculitis, amyloidosis, diabetic nephropathy, and tubulointerstitial disorders. Rather, much of the increased rate of CKD diagnoses in the elderly population results from the normal structural and functional changes that occur in the kidney with aging [2]. Many have argued that this increased recognition of CKD is a positive development and leads to better care in elderly populations [3]. Others have argued that this is a harmful development that has led to unnecessary labeling of far too many older patients as "diseased" without any proven clinical benefit [4].

This review describes the structural and functional changes in the kidney with normal aging and the clinical significance of these changes. Issues related to estimation of GFR, the definition of CKD, and evaluation of patients with CKD are discussed elsewhere. (See "Assessment of kidney function" and "Definition and staging of chronic kidney disease in adults" and "Diagnostic approach to the patient with subacute kidney injury in an outpatient setting".)

NORMAL AGING VERSUS CHRONIC DISEASE

Aging is a natural and inevitable biological process that results in structural and functional changes in many organ systems. The kidney systematically loses function (eg, glomerular filtration rate [GFR]) with age. In addition to specific kidney diseases that are common in older adults, such as diabetic nephropathy, physiological senescence of the kidney occurs, even with healthy aging [2]. A similar process occurs in the lung, which systematically loses function (ie, forced expiratory volume in one second), even among "healthy" adults [5]. (See "Selecting reference values for pulmonary function tests".)

It can sometimes be difficult to distinguish the structural and functional changes of a kidney affected by a specific preventable or treatable disease from those of a kidney undergoing the inevitable consequences of aging. However, even if the reduction in function is not preventable or treatable, senescent changes in the kidney are relevant and important to managing older patients. Specifically, loss of renal reserves with aging has the following clinical significance (see 'Clinical significance of the aging kidney' below):

                               

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Literature review current through: Nov 2016. | This topic last updated: Fri Apr 15 00:00:00 GMT+00:00 2016.
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