Rowland Joshua, Akbarov Artur, Maan Akhlaq, Eales James, Dormer John, Tomaszewski Maciej
Division of Cardiovascular Sciences, Faculty of Medicine, Biology and Health, University of Manchester, Manchester, United Kingdom.
University Hospitals of Leicester NHS Trust, Leicester, United Kingdom.
Kidney Blood Press Res. 2018;43(1):55-67. doi: 10.1159/000486907. Epub 2018 Jan 24.
Ageing of the kidney is a multi-dimensional process that occurs simultaneously at the molecular, cellular, histological, anatomical and physiological level. Nephron number and renal cortical volume decline, renal tubules become atrophic and glomeruli become sclerotic with age. These structural changes are accompanied by a decline in glomerular filtration rate, decreased sodium reabsorption and potassium excretion, reduced urinary concentrating capacity and alterations in the endocrine activity of the kidney. However, the pace of progression of these changes is not identical in everyone - individuals of the same age and seemingly similar clinical profile often exhibit stark differences in the age-related decline in renal health. Thus, chronological age poorly reflects the time-dependent changes that occur in the kidney. An ideal measure of renal vitality is biological kidney age - a measure of the age-related changes in physiological function. Replacing chronological age with biological age could provide numerous clinical benefits including improved prognostic accuracy in renal transplantation, better stratification of risk and identification of those who are on a fast trajectory to an age-related drop in kidney health.
肾脏老化是一个多维度的过程，在分子、细胞、组织学、解剖学和生理学水平上同时发生。随着年龄的增长，肾单位数量和肾皮质体积会下降，肾小管会萎缩，肾小球会硬化。这些结构变化伴随着肾小球滤过率下降、钠重吸收和钾排泄减少、尿液浓缩能力降低以及肾脏内分泌活动改变。然而，这些变化的进展速度在每个人身上并不相同——年龄相同且临床特征看似相似的个体，在与年龄相关的肾脏健康下降方面往往表现出明显差异。因此，实际年龄很难反映肾脏中随时间发生的变化。肾脏活力的理想指标是生物学肾龄——一种衡量生理功能中与年龄相关变化的指标。用生物学年龄取代实际年龄可以带来诸多临床益处，包括提高肾移植预后的准确性、更好地进行风险分层以及识别那些肾脏健康快速下降至与年龄相关水平的人群。
