Epstein M
Nephrology Section, Department of Veterans Affairs Medical Center, Miami, Florida 33125, USA.
J Am Soc Nephrol. 1996 Aug;7(8):1106-22. doi: 10.1681/ASN.V781106.
A host of abnormalities of renal structure and function accompanies advancing age. An appreciation of methodologic considerations, including population selection, that might confound the assessment of the effects of aging on renal function has prompted a recent reappraisal. Earlier studies assessed the effects of aging by utilizing cross-sectional studies and institutionalized elderly subjects, with their attendant drawbacks. Recent longitudinal studies have utilized appropriate patient cohorts, selected for lock of renal disease, including potential kidney transplant donors. These studies indicate that the morphological and functional changes of aging tend to be less marked than previously thought. The common denominator of these functional changes is a diminution in renal reserve, along with constraints on the kidney's ability to respond appropriately to challenges of either excesses or deficits. Although these alterations are unlikely to be of major clinical consequence under everyday conditions, they attain clinical significance when residual renal function is challenged by the superimposition of an acute illness. Finally, it should be emphasized that elderly patients frequently suffer from comorbid conditions, such as hypertension and heart disease, that may be additive to the changes of aging, thereby amplifying these abnormalities.
随着年龄的增长，会出现一系列肾脏结构和功能异常。认识到可能混淆衰老对肾功能影响评估的方法学因素，包括人群选择，促使最近进行了重新评估。早期研究通过横断面研究和机构化老年受试者来评估衰老的影响，但存在相应的缺点。最近的纵向研究使用了合适的患者队列，这些患者因没有肾脏疾病而被选中，包括潜在的肾脏移植供体。这些研究表明，衰老的形态学和功能变化往往没有以前认为的那么明显。这些功能变化的共同特征是肾储备减少，同时肾脏对过多或过少挑战做出适当反应的能力受到限制。虽然在日常情况下这些改变不太可能产生重大临床后果，但当残余肾功能受到急性疾病叠加的挑战时，它们就具有了临床意义。最后，应该强调的是，老年患者经常患有合并症，如高血压和心脏病，这些合并症可能会加剧衰老的变化，从而放大这些异常情况。
