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Ren sanus in corpore sano: the myth of the inexorable decline of renal function with senescence
Hannover Medical School, Hannover, Germany
Correspondence and offprint requests to: Danilo Fliser, MD, Associate Professor of Medicine, Department of Internal Medicine, Hannover Medical School, Carl-Neuberg-Strasse 1, 30265 Hannover, Germany. E-mail: fliser.danilo@mh-hannover.de
Keywords: atherosclerosis; elderly; glomerulosclerosis; hypertension; renal function; renovascular resistance
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Changing structure of the aging kidney |
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The first notion of an inexorable loss of renal mass with age goes back to uncontrolled observations suggesting that the average kidney weight decreases by up to 40% from young adulthood to senescence [1]. It must be emphasized, however, that in none of these early studies were individuals with comorbid conditions excluded. These findings therefore conflict with observations where no significant decrease in renal mass was found in elderly patients who had suffered traumatic death and in whom renal disease and/or important comorbid conditions were excluded [2]. Moreover, imaging studies investigating changes of renal size and structure showed only a modest decrease until the age of 75 years, whereas thereafter kidney size, calculated volume and parenchymal thickness were clearly lower [3]. Thus, loss of renal mass with aging is moderate, at least until the age of 70 years, and it seems to affect the
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Increase of renovascular resistance as a hallmark of renal vascular aging |
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Renal aging and sodium handling |
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The problem of monitoring renal function in the elderly |
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Conclusions |
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