O'Sullivan Eoin D, Hughes Jeremy, Ferenbach David A
Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom;
Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
J Am Soc Nephrol. 2017 Feb;28(2):407-420. doi: 10.1681/ASN.2015121308. Epub 2016 Nov 15.
Individuals age >65 years old are the fastest expanding population demographic throughout the developed world. Consequently, more aged patients than before are receiving diagnoses of impaired renal function and nephrosclerosis-age-associated histologic changes in the kidneys. Recent studies have shown that the aged kidney undergoes a range of structural changes and has altered transcriptomic, hemodynamic, and physiologic behavior at rest and in response to renal insults. These changes impair the ability of the kidney to withstand and recover from injury, contributing to the high susceptibility of the aged population to AKI and their increased propensity to develop subsequent progressive CKD. In this review, we examine these features of the aged kidney and explore the various validated and putative pathways contributing to the changes observed with aging in both experimental animal models and humans. We also discuss the potential for additional study to increase understanding of the aged kidney and lead to novel therapeutic strategies.
65岁以上的人群是整个发达国家中增长最快的人口群体。因此,与以往相比,更多的老年患者被诊断出肾功能受损以及肾脏出现与年龄相关的组织学变化——肾硬化。最近的研究表明,老年肾脏会经历一系列结构变化,并且在静息状态以及对肾脏损伤作出反应时,其转录组、血流动力学和生理行为都会发生改变。这些变化损害了肾脏承受损伤并从损伤中恢复的能力,导致老年人群对急性肾损伤的高易感性以及他们随后发展为进行性慢性肾脏病的倾向增加。在这篇综述中,我们研究了老年肾脏的这些特征,并探讨了在实验动物模型和人类中导致随衰老而观察到的变化的各种已证实和推测的途径。我们还讨论了进一步研究的潜力,以增进对老年肾脏的了解并带来新的治疗策略。