Meyer B R
Division of Clinical Pharmacology, North Shore University Hospital, Manhasset, New York 11030.
J Am Geriatr Soc. 1989 Aug;37(8):791-800. doi: 10.1111/j.1532-5415.1989.tb02244.x.
A variety of age-related anatomic and functional alterations in the kidney have been described. Anatomic abnormalities in the aging kidney include a decrease in kidney size, increased glomerular sclerosis, altered tubular structure, and an altered pattern of vascular flow. These anatomic abnormalities are associated with renal functional abnormalities, including decreased renal blood flow, and glomerular filtration rate. Altered renal tubular function, including impaired handling of water, sodium, acid, and glucose, may also be present. Impaired "endocrinologic" functioning manifested by changes in the renin-angiotensin system, vitamin D metabolism, and antidiuretic hormone responsiveness have been reported. The kidney is constantly exposed to the effects of a variety of potentially toxic processes. These range from environmental toxins and drugs, to a variety of chronic medical illnesses including hypertension, diabetes, and atherosclerotic disease. In this context, differentiation of "aging" effects from nephrotoxic effects resulting from these other processes is difficult. It has been argued that hypertension is an important factor in the development and progression of renal insufficiency in the elderly. The relationship between hypertension, glomerular hyperfiltration, atherosclerosis, and progressive renal dysfunction needs further study. Further research may allow the rational recommendation of interventions designed to control age-associated changes in renal function.
已有研究描述了肾脏中多种与年龄相关的解剖学和功能改变。老年肾脏的解剖学异常包括肾脏体积减小、肾小球硬化增加、肾小管结构改变以及血流模式改变。这些解剖学异常与肾功能异常相关，包括肾血流量减少和肾小球滤过率降低。还可能存在肾小管功能改变，包括对水、钠、酸和葡萄糖的处理受损。据报道，肾素 - 血管紧张素系统、维生素D代谢和抗利尿激素反应性的变化表现出“内分泌”功能受损。肾脏不断受到各种潜在毒性过程的影响。这些过程包括环境毒素和药物，以及包括高血压、糖尿病和动脉粥样硬化疾病在内的各种慢性疾病。在这种情况下，很难区分“衰老”效应与这些其他过程导致的肾毒性效应。有人认为高血压是老年人肾功能不全发生和进展的重要因素。高血压、肾小球高滤过、动脉粥样硬化和进行性肾功能障碍之间的关系需要进一步研究。进一步的研究可能会使我们能够合理推荐旨在控制与年龄相关的肾功能变化的干预措施。
