Aging kidney-structural-and-functional-changes ayman seddik

1. Dr Ayman Seddik , Msc , MD
Assistant Professor of Nephrology Ain Shams University , Consultant nephrologist
Dubai Hospital , Dubai Hospital Dubai Health Authority

2. OUTLINE
1. Prevalence of CKD and other comorbidties with
aging
2. Our kidneys and aging structural and functional
changes

3. Hilary Cronin and Rose Anne Kenny
Part 2: The Aging Kidneys
Morphological and Functional Changes
Gross
granularity and
pitting of the
external surface
Loss of Mass &
Loss of Function
But with preserved
homeostasis

4. Diabetes prevalence
in the aging

5. Hypertension
and the aging

6. High cholesterol and statin use in the aging

7. Prevalence of Chronic Kidney Disease (CKD) Stages by Age
Group in NHANES 1988-1994 and 1999-2004

8. Effects of CKD on mortality and cardiovascular
disease in the elderly - mean 75yr
0
1
2
3
4
5
6
7
8
All cause
death
CV death Non-CV
death
Heart failure MI Stroke
Events/100yrs
Normal kidney function
CKD 1-2
CKD 3-5
Shilpak at al Ann Int Med 2006;145:237

9. Baseline eGFR threshold below which risk for ESRD
exceeded risk for death for each age group
O’Hare 2007 JASN 18: 2758–2765

11. .,
Sir William Osler, M.D
1849 -1919

14. The Hallmarks of the Aging Kidney
Intimal Thickening
of Interlobular Artery
Hyaline Atherosclerosis Reduplication of
Internal Elastica Lamina
Glomerulosclerosis, Tubular Atrophy,
Vascular Changes
Hypertrophic Glomerulus,
Compensating for Obsolete Ones

15. KI (2008) 74, 710–720
Global glomerulosclerosis
Moderate IF/TA
Arteriolar reveal hyalinosis

19. • Age‐associated
decrease in GFR
is due to
reduction in RPF
and in Kf (UF
coef)

23. Factors that mediate and moderate age-related
glomerulosclerosis and tubulointerstitial fibrosis.
Brenner and Rector's The Kidney, 9th ed.

25. CONCLUSION
 In conclusion, a large and growing number of elderly
people meet criteria for CKD. However, many of these
patients are less likely than their younger counterparts
with similar levels of renal function to progress to
ESRD.

26. CONCLUSION
 HOWEVER a subset of older patients with CKD will
EVENTUALLY progress to ESRD and these individuals
account for a growing proportion of the ESRD
population.
 Thus, a major challenge for nephrologists is to
somehow identify the small proportion but large and
growing number of older patients with CKD who are
most likely to experience progressive loss of renal
function and benefit from aggressive efforts to slow
progression and to prepare for ESRD management .