1
|
Radwan GAE, Yousef AES, Bayomy MF. Serum interleukin 18 level in kidney diseases and age. Urol Ann 2024; 16:133-139. [PMID: 38818428 PMCID: PMC11135346 DOI: 10.4103/ua.ua_140_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/11/2023] [Accepted: 09/02/2023] [Indexed: 06/01/2024] Open
Abstract
Background Interleukin-18 (IL-18), also known as interferon-gamma inducing factor is a protein which in humans is encoded by the IL18 gene, it is a member of the IL 1 family and has a molecular weight of 18 kDa. Innate and adaptive immunity can be regulated by IL-18, and disorders involving its dysregulation might result in inflammatory or autoimmune conditions. Aim of the Work To distinguish between acute kidney injury (AKI) and chronic renal failure (CRF), this research investigates the utility of IL-18 as a novel biomarker and examines how age affects its level. Materials and Methods Three hundred participants were included and divided into three groups using the following methodology. Group I consisted of 100 control subjects who were split up by age and gender. Group II consisted of 100 AKI patients who were divided into two groups and subgroups based on age and gender. Group III, which consisted of 100 CRF (hemodialyzed patients), was divided into two groups and subgroups, as patients with acute renal injury and previously healthy people. Patients' blood was drawn to conduct a laboratory investigation blood urea, serum creatinine, sodium, potassium, pH, GFR and PCO2. Results Patients with CRF had higher serum levels of IL-18 than patients with AKI, regardless of gender, and both groups of patients had levels of IL-18 that rise with age. Conclusion IL-18 is a reliable indicator for the differentiation between AKI and CRF patients receiving hemodialysis and its level correlates with age independent with gender.
Collapse
Affiliation(s)
| | - Ali El-Said Yousef
- Department of Rheumatology and Immunology, Internal Medicine, Teaching Benha Hospital, Banha, Egypt
| | - Mohamed Fathy Bayomy
- Department of Zoology, Faculty of Science, Menoufia University, Shibin El Kom, Egypt
- Department of General Biology, Center of Basic Sciences, Misr University for Science and Technology, 6 of October, Banha, Egypt
| |
Collapse
|
2
|
Rodriguez-Sanchez N, Galloway SDR. A randomised trial to assess fluid and electrolyte balance responses following ingestion of different beverages in young and older men. Eur J Appl Physiol 2023; 123:2331-2340. [PMID: 37294517 PMCID: PMC10492686 DOI: 10.1007/s00421-023-05241-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/23/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Older adults are susceptible to dehydration and fluid overload due to a reduced ability to maintain homeostatic control of fluid and electrolyte balance. PURPOSE To assess fluid and electrolyte balance responses in young and older men following ingestion of commonly consumed beverages differing in composition. METHODS 12 young and 11 older men were recruited. Euhydrated body mass was recorded. Participants consumed 1L (250 ml every 15 min) of water, fruit juice, a sports drink or low-fat milk in a randomized cross-over design. Urine and blood samples were obtained before and after the drinking period and every hour thereafter for 3-h. Samples were used to determine osmolality, electrolytes (Na+ and K+), water clearance, and glomerular filtration rate. RESULTS Free water clearance was significantly higher in Young than Older at 1 and 2 h after the ingestion of W and S (p < 0.05). Net Na+ and K+ balance were not different between Young and Older (p = 0.91 and p = 0.65) adults, respectively. At 3 h Na+ balance was negative after ingesting water and fruit juice, but neutral after sport drink and milk. Net K+ balance was neutral at 3 h after ingesting milk, but negative after water, fruit juice and sport drink. CONCLUSIONS Milk was retained longer than other beverages in Young, but not in Older, despite similar net electrolyte balance responses. Older had higher fluid retention in the first 2 h after the ingestion of all beverages, except for milk when compared to Young, indicating an age-related loss of ability to regulate fluid balance under current study conditions.
Collapse
Affiliation(s)
- Nidia Rodriguez-Sanchez
- Physiology, Exercise and Nutrition Research Group, Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, UK.
| | - Stuart D R Galloway
- Physiology, Exercise and Nutrition Research Group, Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, UK
| |
Collapse
|
3
|
Saldaña-Villanueva K, Méndez-Rodríguez KB, Zamora-Mendoza BN, Gómez-Gómez A, Díaz-Barriga F, Pérez-Vázquez FJ. Health effects of informal precarious workers in occupational environments with high exposure to pollutants. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023:10.1007/s11356-023-27769-6. [PMID: 37247138 DOI: 10.1007/s11356-023-27769-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 05/16/2023] [Indexed: 05/30/2023]
Abstract
The aim is to investigate and describe the health conditions of workers who are employed in precarious work settings in Mexico. Specifically, the study aims to provide insight on the health status of workers who are vulnerable due to the informal nature of their employment. Through the evaluation of three different scenarios of precarious employment (n = 110), including workers in mercury miner (workers A), brick-kilns (workers B), and quarries workers (workers C). The study analyzes clinical parameters to determine the workers' renal health condition and assesses their pulmonary function using spirometry. Multivariate analyses and Spearman correlation are performed to determine the contribution of length of service to workers' health parameters. Workers B have the highest incidence of clinical health alterations, with the highest BMI and prediabetes/diabetes index, albumin creatinine ratio, and eGFR. Moreover, pulmonary function parameters show a decrease in %FEV1/FVC in workers B and C compared to workers A, while workers A demonstrate a more significant decrease in %FEV1. Additionally, a negative correlation is observed between the length of service in precarious work settings and lung parameters (r = -0.538, p < 0.001). In conclusion, this study highlights the need to address the issue of precarious employment in Mexico by improving working conditions, access to healthcare and promoting social protection for workers, which can reduce the number of work-related illnesses and deaths and ensure the safety and health of workers.
Collapse
Affiliation(s)
- Kelvin Saldaña-Villanueva
- Coordination for the Innovation and Application of Science and Technology (CIACYT), Autonomous University of San Luis Potosi, 550 Sierra Leona Av., CP 78210, Col. Lomas Segunda Sección, San Luis Potosí, San Luis Potosí, México
| | - Karen Beatriz Méndez-Rodríguez
- Coordination for the Innovation and Application of Science and Technology (CIACYT), Autonomous University of San Luis Potosi, 550 Sierra Leona Av., CP 78210, Col. Lomas Segunda Sección, San Luis Potosí, San Luis Potosí, México
| | | | | | - Fernando Díaz-Barriga
- Coordination for the Innovation and Application of Science and Technology (CIACYT), Autonomous University of San Luis Potosi, 550 Sierra Leona Av., CP 78210, Col. Lomas Segunda Sección, San Luis Potosí, San Luis Potosí, México
| | - Francisco Javier Pérez-Vázquez
- Coordination for the Innovation and Application of Science and Technology (CIACYT), Autonomous University of San Luis Potosi, 550 Sierra Leona Av., CP 78210, Col. Lomas Segunda Sección, San Luis Potosí, San Luis Potosí, México.
| |
Collapse
|
4
|
Deng L, Li W, Xu G. Update on pathogenesis and diagnosis flow of normoalbuminuric diabetes with renal insufficiency. Eur J Med Res 2021; 26:144. [PMID: 34895352 PMCID: PMC8665546 DOI: 10.1186/s40001-021-00612-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/16/2021] [Indexed: 12/11/2022] Open
Abstract
In recent decades, the prevalence of diabetic kidney disease has remained stable and appears to be a wide heterogeneity. Normoalbuminuric diabetes with renal insufficiency, which is characterized by a decline in the glomerular filtration rate in the absence of albuminuria, has been identified as an albuminuria-independent phenotype of diabetic kidney disease. Epidemiological data demonstrate that normoalbuminuric phenotype is prevalent. Compared to albuminuric phenotype, normoalbuminuric phenotype has distinct clinical characteristics and a wide heterogeneity of pathological features. Currently, the pathogenesis of normoalbuminuric phenotype remains unclear. Additionally, the flow of diagnosing normoalbuminuric phenotype is not perfect. In this article, we review the latest studies addressing the epidemiology, clinical characteristics, and pathology of normoalbuminuric phenotype. Based on the studies of clinical features and renal histopathologic changes, we attempt to propose an underlying pathogenesis model and a flow chart for diagnosing normoalbuminuric phenotype.
Collapse
Affiliation(s)
- Le Deng
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, Jiangxi, 330006, People's Republic of China
| | - Wenjie Li
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, Jiangxi, 330006, People's Republic of China
| | - Gaosi Xu
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, Jiangxi, 330006, People's Republic of China.
| |
Collapse
|
5
|
Li T, Yu C, Zhuang S. Histone Methyltransferase EZH2: A Potential Therapeutic Target for Kidney Diseases. Front Physiol 2021; 12:640700. [PMID: 33679454 PMCID: PMC7930071 DOI: 10.3389/fphys.2021.640700] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 01/11/2021] [Indexed: 12/19/2022] Open
Abstract
Enhancer of zeste homolog 2 (EZH2) is a histone-lysine N-methyltransferase enzyme that catalyzes the addition of methyl groups to histone H3 at lysine 27, leading to gene silencing. Mutation or over-expression of EZH2 has been linked to many cancers including renal carcinoma. Recent studies have shown that EZH2 expression and activity are also increased in several animal models of kidney injury, such as acute kidney injury (AKI), renal fibrosis, diabetic nephropathy, lupus nephritis (LN), and renal transplantation rejection. The pharmacological and/or genetic inhibition of EZH2 can alleviate AKI, renal fibrosis, and LN, but potentiate podocyte injury in animal models, suggesting that the functional role of EZH2 varies with renal cell type and disease model. In this article, we summarize the role of EZH2 in the pathology of renal injury and relevant mechanisms and highlight EZH2 as a potential therapeutic target for kidney diseases.
Collapse
Affiliation(s)
- Tingting Li
- Department of Nephrology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chao Yu
- Department of Nephrology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shougang Zhuang
- Department of Nephrology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.,Department of Medicine, Alpert Medical School and Rhode Island Hospital, Brown University, Providence, RI, United States
| |
Collapse
|
6
|
Melchioretto EF, Zeni M, Veronez DADL, Filipak Neto F, Digner IDS, Fraga RD. Stereological study and analysis of oxidative stress during renal aging in rats. Acta Cir Bras 2020; 35:e351106. [PMID: 33331456 PMCID: PMC7748077 DOI: 10.1590/acta351106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 10/21/2020] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate renal histological changes by stereology and morphometry and analyze the main markers of oxidative stress in rats undergoing natural aging. METHODS Seventy two Wistar rats were divided into six groups of 12 rats each, which were euthanized at 3, 6, 9, 12, 18, and 24 months of age. Right kidney was stereologically and morphometrically analyzed to calculate the volumetric density (Vv[glom]), numerical density (Nv[glom]) and glomerular volume (Vol[glom]). Left kidney was used to determine the levels of nonprotein thiols, lipid peroxidation, and protein carbonylation, as well as the activities of superoxide-dismutase and catalase enzymes. RESULTS Both Vv[glom] and Nv[glom] values showed gradual decreases between groups. Activity of superoxide-dismutase was elevated at 24 months of age, and the levels of nonprotein thiols were higher in older animals. Greater catalase activity and protein carbonylation were observed in animals between 6 and 12 months of age but lessened in older rats. Lipid peroxidation decreased in the older groups. CONCLUSIONS Morphometric and stereological analyses revealed a gradual decrease in the volume and density of renal glomeruli during aging, as well as kidney atrophy. These findings related to oxidative stress clarify many changes occurring in kidney tissues during senescence in rats.
Collapse
Affiliation(s)
- Eduardo Felippe Melchioretto
- Fellow PhD degree, Postgraduate Program in Surgical Clinic, Universidade Federal do Paraná, Curitiba - PR, Brazil. Conception and design, manuscript preparation and writing, critical revision
| | - Marcelo Zeni
- Fellow Master degree, Department of Urology, Medical School, Universidade Federal da Fronteira Sul, Chapecó - SC, Brazil. Design
| | - Djanira Aparecida da Luz Veronez
- PhD, Associate Professor, Department of Anatomy, Medical School, Universidade Federal do Paraná, Curitiba - PR, Brazil. Conception and design
| | - Francisco Filipak Neto
- PhD, Associate Professor, Department of Cellular and Molecular Biology, Medical School, Universidade Federal do Paraná, Curitiba - PR, Brazil. Conception and design
| | - Ingridy de Souza Digner
- Graduate student, Little Prince College, Curitiba - PR, Brazil. Design, manuscript preparation and writing, critical revision
| | - Rogerio de Fraga
- PhD, Associate Professor, Department of Urology, Medical School, Universidade Federal do Paraná, Curitiba - PR, Brazil. Conception and design
| |
Collapse
|
7
|
Izumi T, Terauchi M. The Diverse Efficacy of Food-Derived Proanthocyanidins for Middle-Aged and Elderly Women. Nutrients 2020; 12:nu12123833. [PMID: 33334009 PMCID: PMC7765374 DOI: 10.3390/nu12123833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/04/2020] [Accepted: 12/12/2020] [Indexed: 12/21/2022] Open
Abstract
Middle-aged and elderly women are affected by various symptoms and diseases induced by estrogen deficiency. Proanthocyanidins, widely present in many kinds of fruits and berries, have many beneficial effects, such as antioxidative, anti-inflammatory, and antimicrobial activities. We researched the effects of proanthocyanidins for middle-aged and elderly women, finding that it has been revealed in many clinical trials and cohort studies that proanthocyanidins contribute to the prevention of cardiovascular disease, hypertension, obesity, cancer, osteoporosis, and urinary tract infection, as well as the improvement of menopausal symptoms, renal function, and skin damage. Thus, proanthocyanidins can be considered one of the potent representatives of complementary alternative therapy.
Collapse
Affiliation(s)
- Toru Izumi
- Department of Production and Quality Control, Kikkoman Nutricare Japan Incorporation, Nihonbashikoamicho 3-11, Chuo, Tokyo 103-0016, Japan
- Correspondence: ; Tel.: +81-3-5521-5138; Fax: +81-3-3660-9222
| | - Masakazu Terauchi
- Department of Women’s Health, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo, Tokyo 113-8510, Japan;
| |
Collapse
|
8
|
Fang Y, Gong AY, Haller ST, Dworkin LD, Liu Z, Gong R. The ageing kidney: Molecular mechanisms and clinical implications. Ageing Res Rev 2020; 63:101151. [PMID: 32835891 PMCID: PMC7595250 DOI: 10.1016/j.arr.2020.101151] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 08/07/2020] [Accepted: 08/17/2020] [Indexed: 12/11/2022]
Abstract
As human life expectancy keeps increasing, ageing populations present a growing challenge for clinical practices. Human ageing is associated with molecular, structural, and functional changes in a variety of organ systems, including the kidney. During the ageing process, the kidney experiences progressive functional decline as well as macroscopic and microscopic histological alterations, which are accentuated by systemic comorbidities like hypertension and diabetes mellitus, or by preexisting or underlying kidney diseases. Although ageing per se does not cause kidney injury, physiologic changes associated with normal ageing processes are likely to impair the reparative capacity of the kidney and thus predispose older people to acute kidney disease, chronic kidney disease and other renal diseases. Mechanistically, cell senescence plays a key role in renal ageing, involving a number of cellular signaling mechanisms, many of which may be harnessed as international targets for slowing or even reversing kidney ageing. This review summarizes the clinical characteristics of renal ageing, highlights the latest progresses in deciphering the role of cell senescence in renal ageing, and envisages potential interventional strategies and novel therapeutic targets for preventing or improving renal ageing in the hope of maintaining long-term kidney health and function across the life course.
Collapse
Affiliation(s)
- Yudong Fang
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Division of Nephrology, University of Toledo College of Medicine, Toledo, Ohio, USA
| | - Athena Y Gong
- Division of Nephrology, University of Toledo College of Medicine, Toledo, Ohio, USA
| | - Steven T Haller
- Division of Cardiology, University of Toledo College of Medicine, Toledo, Ohio, USA
| | - Lance D Dworkin
- Department of Medicine, University of Toledo College of Medicine, Toledo, Ohio, USA
| | - Zhangsuo Liu
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Rujun Gong
- Division of Nephrology, University of Toledo College of Medicine, Toledo, Ohio, USA; Department of Medicine, University of Toledo College of Medicine, Toledo, Ohio, USA; Department of Physiology and Pharmacology, University of Toledo College of Medicine, Toledo, Ohio, USA.
| |
Collapse
|
9
|
Davani-Davari D, Karimzadeh I, Sagheb MM, Khalili H. The Renal Safety of L-Carnitine, L-Arginine, and Glutamine in Athletes and Bodybuilders. J Ren Nutr 2018; 29:221-234. [PMID: 30341034 DOI: 10.1053/j.jrn.2018.08.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 07/07/2018] [Accepted: 08/27/2018] [Indexed: 02/06/2023] Open
Abstract
One of the major concerns about taking amino acid supplements is their potential adverse effects on the kidney as a major organ involved in the metabolism and excretion of exogenous substances. The aim of this study is to review available data about renal safety of the most prominent amino acid supplements including L-arginine, glutamine and also L-carnitine as well as creatine (as amino acid derivatives) in athletes and bodybuilders. The literature was searched by keywords such as "L-carnitine", "L-arginine", "glutamine", and "kidney injury" in databases such as Scopus, Medline, Embase, and ISI Web of Knowledge. Articles published from 1950 to December 2017 were included. Among 3171, 5740, and 1608 records after primary search in the relevant databases, 8, 7, and 5 studies have been finally included, respectively, for L-carnitine, L-arginine, and glutamine in this review. Arginine appears to have both beneficial and detrimental effects on kidney function. However, adverse effects are unlikely to occur with the routine doses (from 3 to >100 g/day). The risks and benefits of L-carnitine on the athletes' and bodybuilders' kidney have not been evaluated yet. However, L-carnitine up to 6000 mg/day is generally considered to be a safe supplement at least in healthy adults. Both short-term (20-30 g within a few hours) and long-term (0.1 g/kg four times daily for 2 weeks) glutamine supplementation in healthy athletes were associated with no significant adverse effects, but it can cause glomerulosclerosis and serum creatinine level elevation in the setting of diabetic nephropathy. Creatine supplementation (ranged from 5 to 30 g/day) also appears to have no detrimental effects on kidney function of individuals without underlying renal diseases. More clinical data are warranted to determine the optimal daily dose and intake duration of common supplemental amino acids associated with the lowest renal adverse effects in sportsmen and sports women.
Collapse
Affiliation(s)
- Dorna Davani-Davari
- Pharmaceutical Biotechnology Incubator, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Iman Karimzadeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Mohammad Mahdi Sagheb
- Nephrology-Urology Research Center and Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Khalili
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
10
|
Li Z, Wang Z. Aging Kidney and Aging-Related Disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1086:169-187. [PMID: 30232759 DOI: 10.1007/978-981-13-1117-8_11] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
With the development of society and improvement of health care, the life span is much longer than before, which brings serious aging problems. Among all the aging problems, renal aging grows to be nonnegligible issue. The aging process of kidney is always accompanied with structural and functional changes. Molecular changes, including Klotho and Sirtuins, are the basic causes of phenotypical changes. Cell senescence and cell autophagy play fundamental roles in the process of renal aging. To effectively intervene in the process of renal aging, different methods have been tried separately, which could produce different effects. Effective intervention of renal aging could be meaningful for healthy state of the whole body.
Collapse
Affiliation(s)
- Zhongchi Li
- MOE Key Laboratory of Protein Sciences, School of Pharmaceutical Sciences, Tsinghua University, Beijing, China
| | - Zhao Wang
- School of Pharmaceutical Sciences, Tsinghua University, Beijing, China.
| |
Collapse
|
11
|
Melchioretto EF, Zeni M, Veronez DADL, Martins EL, Fraga RD. Quantitative analysis of the renal aging in rats. Stereological study. Acta Cir Bras 2017; 31:346-52. [PMID: 27275857 DOI: 10.1590/s0102-865020160050000009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/11/2016] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To evaluate the renal function and the renal histological alterations through the stereology and morphometrics in rats submitted to the natural process of aging. METHODS Seventy two Wistar rats, divided in six groups. Each group was sacrificed in a different age: 3, 6, 9, 12, 18 and 24 months. It was performed right nephrectomy, stereological and morphometric analysis of the renal tissue (renal volume and weight, density of volume (Vv[glom]) and numerical density (Nv[glom]) of the renal glomeruli and average glomerular volume (Vol[glom])) and also it was evaluated the renal function for the dosage of serum creatinine and urea. RESULTS There was significant decrease of the renal function in the oldest rats. The renal volume presented gradual increase during the development of the rats with the biggest values registered in the group of animals at 12 months of age and significant progressive decrease in older animals. Vv[glom] presented statistically significant gradual reduction between the groups and the Nv[glom] also decreased significantly. CONCLUSIONS The renal function proved to be inferior in senile rats when compared to the young rats. The morphometric and stereological analysis evidenced renal atrophy, gradual reduction of the volume density and numerical density of the renal glomeruli associated to the aging process.
Collapse
Affiliation(s)
- Eduardo Felippe Melchioretto
- Fellow Master degree, Postgraduate Program in Surgical Clinic, Department of Urology, Federal University of Parana (UFPR), Curitiba-PR, Brazil. Scientific, intellectual, conception and design of the study; acquisition, analysis and interpretation of data; technical procedures; histopathological examinations; statitics analysis; manuscript writing; critical revision., Universidade Federal do Paraná, Department of Urology, Federal University of Parana, Curitiba PR , Brazil
| | - Marcelo Zeni
- MD, Volunteer, Department of Urology, UFPR, Curitiba-PR, Brazil. Scientific and intellectual content of the study, acquisition of data, technical procedures., Universidade Federal do Paraná, Department of Urology, UFPR, Curitiba PR , Brazil
| | - Djanira Aparecida da Luz Veronez
- PhD, Associate Professor, Department of Anatomy, School of Medicine, UFPR, Curitiba-PR, Brazil. Scientific, intellectual, conception and design of the study; analysis and interpretation of data; histopathological examinations; critical revision., Universidade Federal do Paraná, Department of Anatomy, School of Medicine, UFPR, Curitiba PR , Brazil
| | - Eduardo Lopes Martins
- Graduate student, School of Medicine, UFPR, Curitiba-PR, Brazil. Acquisition of data, technical procedures, histopathological examinations., Universidade Federal do Paraná, School of Medicine, UFPR, Curitiba PR , Brazil
| | - Rogério de Fraga
- PhD, Associate Professor, Department of Urology, School of Medicine, UFPR, Curitiba-PR, Brazil. Scientific, intellectual, conception and design of the study; analysis and interpretation of data; statistics analysis; critical revision., Universidade Federal do Paraná, Department of Urology, School of Medicine, UFPR, Curitiba PR , Brazil
| |
Collapse
|
12
|
Jia L, Zhang W, Ma J, Chen X, Chen L, Li Z, Cai G, Huang J, Zhang J, Bai X, Feng Z, Sun X, Chen X. Pulse Pressure, Instead of Brachium-Ankle Pulse Wave Velocity, is Associated with Reduced Kidney Function in a Chinese Han Population. Kidney Blood Press Res 2017; 42:43-51. [PMID: 28291958 DOI: 10.1159/000468531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 01/23/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS In this study, we aim to investigate the association between renal function and arterial stiffness in a Chinese Han population, and further to discuss the effects of smoking on renal function. METHODS We collected the data of the brachium-ankle pulse wave velocity (baPWV), blood pressure, blood chemistry and smoking status. Then, the multiple linear regression was done to explore the relationship between estimated glomerular filtration (eGFR) and baPWV. Further, the parameters were compared among the four groups divided according to the quartiles of baPWV. Finally, the baPWV, eGFR and albuminuria values were compared between smokers and non-smokers. RESULTS baPWV is associated with eGFR in the correlation analysis and univariate linear regression model. After adjustment, the pulse pressure (PP) instead of baPWV showed a significant association with eGFR. Nevertheless, the eGFR values differed among the four baPWV groups; the baPWV values were significantly higher in the subjects at the CKD (eGFR<60 mL/min/1.73 m2) and the early CKD stage (eGFR60-80 mL/min/1.73 m2). The baPWV values and the ratio of proteinuria were significantly increased in smokers. CONCLUSION PP but not baPWV is a predictor of declined renal function. Smokers have worse arterial stiffness and worse renal function.
Collapse
Affiliation(s)
- Linpei Jia
- Department of Nephrology, Second Hospital of Jilin University, Changchun, China.,Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Disease, National Clinic Research Center for Kidney Diseases, Beijing, China
| | - Weiguang Zhang
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Disease, National Clinic Research Center for Kidney Diseases, Beijing, China
| | - Jie Ma
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Disease, National Clinic Research Center for Kidney Diseases, Beijing, China
| | - Xizhao Chen
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Disease, National Clinic Research Center for Kidney Diseases, Beijing, China
| | - Lei Chen
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Disease, National Clinic Research Center for Kidney Diseases, Beijing, China
| | - Zuoxiang Li
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Disease, National Clinic Research Center for Kidney Diseases, Beijing, China
| | - Guangyan Cai
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Disease, National Clinic Research Center for Kidney Diseases, Beijing, China
| | - Jing Huang
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Disease, National Clinic Research Center for Kidney Diseases, Beijing, China
| | - Jinping Zhang
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Disease, National Clinic Research Center for Kidney Diseases, Beijing, China
| | - Xiaojuan Bai
- Department of Gerontology and Geriatrics, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Zhe Feng
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Disease, National Clinic Research Center for Kidney Diseases, Beijing, China
| | - Xuefeng Sun
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Disease, National Clinic Research Center for Kidney Diseases, Beijing, China
| | - Xiangmei Chen
- Department of Nephrology, Second Hospital of Jilin University, Changchun, China.,Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Disease, National Clinic Research Center for Kidney Diseases, Beijing, China
| |
Collapse
|
13
|
Bridges CC, Zalups RK. The aging kidney and the nephrotoxic effects of mercury. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2017; 20:55-80. [PMID: 28339347 PMCID: PMC6088787 DOI: 10.1080/10937404.2016.1243501] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Owing to advances in modern medicine, life expectancies are lengthening and leading to an increase in the population of older individuals. The aging process leads to significant alterations in many organ systems, with the kidney being particularly susceptible to age-related changes. Within the kidney, aging leads to ultrastructural changes such as glomerular and tubular hypertrophy, glomerulosclerosis, and tubulointerstitial fibrosis, which may compromise renal plasma flow (RPF) and glomerular filtration rate (GFR). These alterations may reduce the functional reserve of the kidneys, making them more susceptible to pathological events when challenged or stressed, such as following exposure to nephrotoxicants. An important and prevalent environmental toxicant that induces nephrotoxic effects is mercury (Hg). Since exposure of normal kidneys to mercuric ions might induce glomerular and tubular injury, aged kidneys, which may not be functioning at full capacity, may be more sensitive to the effects of Hg than normal kidneys. Age-related renal changes and the effects of Hg in the kidney have been characterized separately. However, little is known regarding the influence of nephrotoxicants, such as Hg, on aged kidneys. The purpose of this review was to summarize known findings related to exposure of aged and diseased kidneys to the environmentally relevant nephrotoxicant Hg.
Collapse
Affiliation(s)
- Christy C Bridges
- a Mercer University School of Medicine , Division of Basic Medical Sciences , Macon , Georgia , USA
| | - Rudolfs K Zalups
- a Mercer University School of Medicine , Division of Basic Medical Sciences , Macon , Georgia , USA
| |
Collapse
|
14
|
Marynissen S, Willems A, Paepe D, Smets P, Picavet P, Duchateau L, Daminet S. Proteinuria in Apparently Healthy Elderly Dogs: Persistency and Comparison Between Free Catch and Cystocentesis Urine. J Vet Intern Med 2017; 31:93-101. [PMID: 28019038 PMCID: PMC5259622 DOI: 10.1111/jvim.14635] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 08/10/2016] [Accepted: 11/15/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Up to 25% of elderly humans have proteinuria, often associated with underlying lesions. Data concerning the presence of proteinuria in elderly dogs is scarce. OBJECTIVES To describe the presence and persistence of proteinuria and to compare urinary protein : creatinine ratio (UPC) between free catch and cystocentesis urine samples in apparently healthy elderly dogs. ANIMALS Hundred apparently healthy elderly dogs. METHODS Prospective study. Owners of 100 elderly dogs were asked to collect 2 free catch urine samples. Dogs were considered healthy based on owner's perception and an age chart, based on ideal bodyweight, was used to define dogs as senior or geriatric. UPC of urine collected by free catch and cystocentesis were compared. Overt proteinuria and borderline proteinuria were defined as UPC >0.5 and between 0.2 and 0.5, respectively, if examination of sediment did not explain proteinuria. Proteinuria was considered persistent if present at both sampling times. RESULTS At baseline, 71 owners succeeded in collecting urine. Eleven percent of dogs had overt proteinuria, 14% were borderline proteinuric, and 75% nonproteinuric. Thirty-seven repeated urine samples, with a median time interval of 31 days (range 10-90), were available. Nineteen percent of dogs had a persistently increased UPC (>0.2), with persistent overt proteinuria present in 8%. A strong correlation (ρ = 0.88) was found between UPC of urine collected by free catch and cystocentesis. CONCLUSIONS AND CLINICAL IMPORTANCE As 19% of study dogs had persistent proteinuria, our findings emphasize that measurement of proteinuria should be part of geriatric health screening. For UPC in dogs, free catch urine provides a good alternative to cystocentesis.
Collapse
Affiliation(s)
- S.J.J. Marynissen
- Department of Medicine and Clinical Biology of Small AnimalsFaculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| | - A.L. Willems
- Department of Medicine and Clinical Biology of Small AnimalsFaculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| | - D. Paepe
- Department of Medicine and Clinical Biology of Small AnimalsFaculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| | - P.M.Y. Smets
- Department of Medicine and Clinical Biology of Small AnimalsFaculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| | - P. Picavet
- Hill's Pet Nutrition, IncMerelbekeBelgium
| | - L. Duchateau
- Department of Comparative Physiology and BiometricsFaculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| | - S. Daminet
- Department of Medicine and Clinical Biology of Small AnimalsFaculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| |
Collapse
|
15
|
Kanki A, Ito K, Yamamoto A, Yasokawa K, Noda Y, Sato T, Tamada T. Evaluation of renal cortical thickness by non-contrast-enhanced MR imaging with spatially selective IR pulses: comparison between cirrhotic and non-cirrhotic patients. Br J Radiol 2016; 89:20150803. [DOI: 10.1259/bjr.20150803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
16
|
Musso CG, Jauregui JR. How to differentiate renal senescence from chronic kidney disease in clinical practice. Postgrad Med 2016; 128:716-21. [DOI: 10.1080/00325481.2016.1209963] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Carlos G. Musso
- Ageing Biology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Jose R. Jauregui
- Ageing Biology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| |
Collapse
|
17
|
Portilla Franco ME, Tornero Molina F, Gil Gregorio P. Frailty in elderly people with chronic kidney disease. Nefrologia 2016; 36:609-615. [PMID: 27242263 DOI: 10.1016/j.nefro.2016.03.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 03/15/2016] [Accepted: 03/28/2016] [Indexed: 01/14/2023] Open
Abstract
In recent years, the concept of frailty as a "state of pre-disability" has been widely accepted by those involved in the care of the elderly. Its importance lies not only in its high prevalence - more than 25% in people over 85 years of age - but it is also considered an independent risk factor of disability, institutionalisation and mortality amongst the elderly. The study of renal function is relevant in patients with major comorbidities. Studies have shown a significant association between chronic kidney disease and the development of adverse clinical outcomes such as heart disease, heart failure, end-stage renal disease, increased susceptibility to infections and greater functional impairment. Frailty can be reversed, which is why a study of frailty in patients with chronic kidney disease is of particular interest. This article aims to describe the association between ageing, frailty and chronic kidney disease in light of the most recent and relevant scientific publications.
Collapse
|
18
|
Abstract
Given the irreversible nature of nephron loss, aging of the kidney is of special interest to diagnostic and toxicologic pathologists. There are many similarities among histologic lesions in aged human and canine kidneys, including increased frequency of glomerulosclerosis, interstitial fibrosis, and tubular atrophy. Unfortunately, there are few studies in which renal tissue from aged healthy dogs was adequately examined with advanced diagnostics—namely, transmission electron microscopy and immunofluorescence—so age-associated changes in canine podocytes and glomerular basement membranes are poorly characterized. An age-associated decrease in the glomerular filtration rate in humans and dogs (specifically small breed dogs) has been documented. Although lesions in aged rats and mice differ somewhat from those of aged dogs and humans, the knowledge gained from rodent models is still vital to elucidating the pathogenesis of age-associated renal disease. Many novel molecules implicated in renal aging have been identified through genetically modified rodent models and transcriptomic and proteomic analysis of human kidneys. These molecules represent intriguing therapeutic targets and diagnostic biomarkers. Likewise, influencing critical pathways of cellular aging, such as telomere shortening, cellular senescence, and autophagy, could improve renal function in the elderly.
Collapse
Affiliation(s)
- R. E. Cianciolo
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | - S. L. Benali
- Dipartimento di Biomedicina comparata e Alimentazione, Università di Padova, Legnaro, Italy
| | - L. Aresu
- Dipartimento di Biomedicina comparata e Alimentazione, Università di Padova, Legnaro, Italy
| |
Collapse
|
19
|
Abstract
Physiology changes at the structural, functional, and molecular levels as people age, and every major organ system experiences physiologic change with time. The changes to the nervous system result mostly in cognitive impairments, the cardiovascular system develops higher blood pressures with lower cardiac output, the respiratory system undergoes a reduction of arterial oxyhemoglobin levels, the gastrointestinal system experiences delayed gastric emptying and reduction of hepatic metabolism, and the renal system experiences a diminished glomerular filtration rate. Combined, these changes create a complex physiologic condition. This unique physiology must be taken into consideration for geriatric patients undergoing general anesthesia.
Collapse
Affiliation(s)
- Bret D Alvis
- Division of Critical Care Medicine, Department of Anesthesiology, Vanderbilt University School of Medicine, 1211 21st Avenue South, 526 MAB, Nashville, TN 37212, USA
| | - Christopher G Hughes
- Division of Critical Care Medicine, Department of Anesthesiology, Vanderbilt University School of Medicine, 1211 21st Avenue South, 526 MAB, Nashville, TN 37212, USA.
| |
Collapse
|
20
|
Cellerino A, Valenzano DR, Reichard M. From the bush to the bench: the annual
Nothobranchius
fishes as a new model system in biology. Biol Rev Camb Philos Soc 2015; 91:511-33. [DOI: 10.1111/brv.12183] [Citation(s) in RCA: 165] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 03/04/2015] [Accepted: 03/13/2015] [Indexed: 02/01/2023]
Affiliation(s)
- Alessandro Cellerino
- Bio@SNS, Scuola Normale Superiore Department of Neurosciences Piazza dei Cavalieri 7 56126 Pisa Italy
- Fritz Lipmann Institute for Age Research, Leibniz Institute Beutenbergstr. 11 D‐07745 Jena Germany
| | - Dario R. Valenzano
- Max Planck Institute for Biology of Ageing Joseph‐Stelzmann‐Str. 9b D‐50931 Cologne Germany
| | - Martin Reichard
- Institute of Vertebrate Biology, Academy of Sciences of the Czech Republic Květná 8 603 65 Brno Czech Republic
| |
Collapse
|
21
|
Kremers WK, Denic A, Lieske JC, Alexander MP, Kaushik V, Elsherbiny HE, Chakkera HA, Poggio ED, Rule AD. Distinguishing age-related from disease-related glomerulosclerosis on kidney biopsy: the Aging Kidney Anatomy study. Nephrol Dial Transplant 2015; 30:2034-9. [PMID: 25888387 DOI: 10.1093/ndt/gfv072] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 02/24/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Global glomerulosclerosis is characteristic of chronic kidney disease and also occurs with normal aging. Our goal was to determine the upper limit of normal for number of globally sclerotic glomeruli. METHODS Core-needle biopsies of the renal cortex were obtained at the time of living kidney transplantation at three centers between 1998 and 2011. The number of globally sclerotic glomeruli was averaged across two biopsy sections. Quantile regression was used to estimate the 95th percentile for globally sclerotic glomeruli as the upper reference limit. There were 2052 donors (mean age 43 years, 41% male, 10% hypertensive), with a mean (SD) of 16.0 (9.7) glomeruli and 0.47 (0.99) globally sclerotic glomeruli on biopsy; only 2.6% had >5% fibrosis. RESULTS In a multivariable model excluding hypertensive donors, independent predictors of the number of globally sclerotic glomeruli were age, total number of glomeruli and cortex area. A simplified model was used to estimate the 95th percentile for number of globally sclerotic glomeruli by total number of glomeruli and age. For a biopsy section with 17-32 total glomeruli, the 95th percentile ranged from 1 for a 20-year old to 5.5 for a 70-year old donor. Hypertensive donors were more likely to have an abnormal number of globally sclerotic glomeruli (OR = 1.79, P = 0.035). CONCLUSIONS We have derived the 95% reference limit for number of globally sclerotic glomeruli in ostensibly healthy individuals accounting for age and the biopsy characteristics. Numbers of globally sclerotic glomeruli in a kidney biopsy that exceed these thresholds suggest chronic pathological injury in excess of that expected with normal aging.
Collapse
Affiliation(s)
- Walter K Kremers
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA William J. von Liebig Transplant Center, Mayo Clinic, Rochester, MN, USA
| | - Aleksandar Denic
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - John C Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Mariam P Alexander
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Vidhu Kaushik
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Harini A Chakkera
- Division of Nephrology and Hypertension, Mayo Clinic, Scottsdale, AZ, USA
| | - Emilio D Poggio
- Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, OH, USA
| | - Andrew D Rule
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
22
|
A correlation study of telomere length in peripheral blood leukocytes and kidney function with age. Mol Med Rep 2015; 11:4359-64. [DOI: 10.3892/mmr.2015.3292] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 01/02/2015] [Indexed: 11/05/2022] Open
|
23
|
Xu X, Liang X, Hu G, Zhang J, Lei H. Renal function and klotho gene polymorphisms among Uygur and Kazak populations in Xinjiang, China. Med Sci Monit 2015; 21:44-51. [PMID: 25556925 PMCID: PMC4292765 DOI: 10.12659/msm.891213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The association of genetic polymorphisms of klotho gene with aging has not been thoroughly examined. Previous studies showed that longevity in the Uygurs was considerably greater than in Kazaks in Xinjiang. This study aimed to investigate the difference of renal function and Klotho gene polymorphisms between Kazak and Uygur normal populations in Xinjiang, China. MATERIAL/METHODS A total of 249 Uygur and 386 Kazak clinically normal subjects were included in this study. Four single-nucleotide polymorphisms (rs1207568, rs564481, rs9527025, and rs9536314) of the klotho gene were genotyped using the ABI SNaPshot method. Estimated glomerular filtration rate (eGFR) was calculated according to the Chinese simplified MDRD equation. RESULTS There were significant differences between Kazak and Uygur healthy populations in both allele frequencies and genotype distributions in rs9527025 and rs9536314 (P<0.05, respectively). When the subjects were divided into 2 groups according to the genotypes of the klotho gene polymorphism, in the GA+AA genotype distributions of the rs1207568, the differences I serum creatinine and estimated glomerular filtration rate between the Kazak and Uygur groups were statistically significant (P<0.05, respectively). In CC genotype of rs564481, serum creatinine was significantly higher in Kazaks compared with Uygurs (P<0.05). In GG genotype of rs9527025, serum creatinine was significantly higher in the Kazak group compared with the Uygur group (P<0.05), as well as in CG+CC genotype of rs9527025 (P<0.05). Serum creatinine was significantly higher in the Kazak group compared with the Uygur group in TT genotype of rs9536314 (P<0.05), as was GT+GG genotype of rs9536314. Haplotype analysis indicated that the frequencies of ACGT, GTGT, and GCCG haplotypes were significantly different between Kazak and Uygur healthy populations (P=0.04, P=0.018, P=0.000, respectively). CONCLUSIONS Significant differences in klotho gene rs9527025 and rs9536314 polymorphisms were found between the Uygur and Kazak populations.
Collapse
Affiliation(s)
- Xinjuan Xu
- Department of Hypertension, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China (mainland)
| | - Xiaohui Liang
- Department of Hypertension, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China (mainland)
| | - Guangmei Hu
- Department of Hypertension, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China (mainland)
| | - Junshi Zhang
- Department of Hypertension, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China (mainland)
| | - Hong Lei
- Department of Hypertension, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China (mainland)
| |
Collapse
|
24
|
Abstract
Several anatomic changes and physiologic alterations occur in the aging kidney, awareness of which is essential for the early recognition of acute kidney injury (AKI) to improve outcomes in hospitalized geriatric patients. There are no unique diagnostic methods or treatment modalities in the care of the geriatric patient with AKI. Therapy is mainly supportive, and the full spectrum of treatment options, including renal replacement therapy (RRT), should not be withheld from a patient based on age. More studies need to be performed to determine the optimal timing, intensity, and modality of RRT in the geriatric population.
Collapse
Affiliation(s)
- Anthony J Baldea
- Division of Trauma, Critical Care and Burns, Loyola University Medical Center, 2160 South First Avenue, EMS Building, Room 3279, Maywood, IL 60153, USA.
| |
Collapse
|
25
|
Noda Y, Ito K, Kanki A, Tamada T, Yamamoto A, Kazuya Y, Higaki A. Measurement of renal cortical thickness using noncontrast-enhanced steady-state free precession MRI with spatially selective inversion recovery pulse: Association with renal function. J Magn Reson Imaging 2014; 41:1615-21. [PMID: 25066504 DOI: 10.1002/jmri.24719] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 07/14/2014] [Accepted: 07/15/2014] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To assess whether noncontrast-enhanced steady-state free precession (SSFP) magnetic resonance imaging (MRI) with a spatially selective inversion recovery (IR) pulse can improve the visibility of renal corticomedullary differentiation in patients showing renal dysfunction, and to investigate the correlation between renal cortical thickness and estimated glomerular filtration rate (eGFR). MATERIALS AND METHODS Sixty-five patients with and without chronic kidney diseases (CKD) were investigated. Based on eGFR, patients were divided into three groups (Group 1, eGFR < 60; Group 2, eGFR = 60-90; and Group 3, eGFR > 90). All patients underwent noncontrast-enhanced SSFP MRI with spatially selective IR pulses and minimal renal cortical thickness was measured. RESULTS The mean corticomedullary contrast ratio was significantly higher in SSFP images with optimal TI than in in-phase images in all three groups (P = 0.001). Positive correlation was seen between the corticomedullary contrast ratio in SSFP images with optimal TI and eGFR (P = 0.011, r = 0.314). A significantly positive correlation was observed between minimal renal cortical thickness and eGFR (P < 0.01, r = 0.495). CONCLUSION Noncontrast-enhanced SSFP MRI with a spatially selective IR pulse using optimal TI can improve the visibility of renal corticomedullary differentiation even in patients with renal insufficiency. The decrease in renal cortical thickness measured using this technique correlated significantly with eGFR.
Collapse
Affiliation(s)
- Yasufumi Noda
- Department of Radiology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Katsuyoshi Ito
- Department of Radiology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Akihiko Kanki
- Department of Radiology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Tsutomu Tamada
- Department of Radiology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Akira Yamamoto
- Department of Radiology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Yasokawa Kazuya
- Department of Radiology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Atsushi Higaki
- Department of Radiology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| |
Collapse
|
26
|
Bao YS, Jia XB, Ji Y, Yang J, Zhao SL, Na SP. High prevalence and risk factors for kidney dysfunction in patients with atherosclerotic cardio-cerebrovascular disease. QJM 2014; 107:443-9. [PMID: 24448380 DOI: 10.1093/qjmed/hcu007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients with atherosclerotic cardio-cerebrovascular disease are at high risk of kidney dysfunction because of the overlap of several risk factors. The purpose of this study is to examine the prevalence and characteristics and risk factors for kidney dysfunction in the cardio-cerebrovascular disease population. METHODS Renal functions of 1012 patients with the cardio-cerebrovascular disease were evaluated with the purpose of evaluating characteristics of the incidence, risk factors for kidney dysfunction in the cardio-cerebrovascular disease population. RESULTS In the univariate analysis, the major risk factors for kidney dysfunction in the patients with the cardio-cerebrovascular disease were age, gender, hypertension, diabetes mellitus, dyslipidemia and serum uric acid. In the patients with both hypertension and diabetes mellitus the percentages of significantly decreased eGFR were 25.6%. Results of multivariable analysis showed that diabetes mellitus (odds ratio (OR) 1.609, 95% confidence intervals (CI) 1.08-2.398, P = 0.019), hypertension (OR 1.547, 95% CI 1.049-2.281, P = 0.028) and serum uric acid (OR 1.009, 95% CI 1.007-1.010, P < 0.001) were independent risk factors for reduced kidney function. CONCLUSIONS In the context of the cardio-cerebrovascular disease kidney dysfunction is common and has a high prevalence. Patients with both cardio-cerebrovascular disease and kidney dysfunction at any stage should be recognized as high-risk population.
Collapse
Affiliation(s)
- Y-S Bao
- From the Department of Nephrology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin 150001, China
| | - X-B Jia
- From the Department of Nephrology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin 150001, China
| | - Y Ji
- From the Department of Nephrology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin 150001, China
| | - J Yang
- From the Department of Nephrology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin 150001, China
| | - S-L Zhao
- From the Department of Nephrology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin 150001, China
| | - S-P Na
- From the Department of Nephrology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin 150001, China
| |
Collapse
|
27
|
Ivey KL, Lewis JR, Lim WH, Lim EM, Hodgson JM, Prince RL. Associations of proanthocyanidin intake with renal function and clinical outcomes in elderly women. PLoS One 2013; 8:e71166. [PMID: 23940710 PMCID: PMC3734096 DOI: 10.1371/journal.pone.0071166] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Accepted: 07/01/2013] [Indexed: 11/19/2022] Open
Abstract
Background Progression to chronic renal failure involves accelerated atherosclerosis and vascular calcification. Oxidative stress and endothelial dysfunction play a role in renal failure pathophysiology. In addition to improving vascular health and function, proanthocyanidins have been shown to exert renoprotective effects in animal models. Thus we hypothesize that proanthocyanidins may contribute to the maintenance of healthy renal function. Objective Determine the association of habitual proanthocyanidin intake with renal function and the risk of clinical renal outcomes in a population of elderly women. Design 948 women aged over 75 y, free of prevalent renal disease at baseline, were randomly selected from ambulant Caucasian women. Proanthocyanidin consumption was determined using a validated food frequency questionnaire and the United States Department of Agriculture proanthocyanidin food content database. Fasting serum cystatin C and creatinine were assessed at baseline. Renal failure hospitalisations and deaths were assessed over 5 years of follow-up through the Western Australia Data Linkage System. Results Compared to participants with low consumption, participants in the highest tertile of proanthocyanidin intake had a 9% lower cystatin C concentration (P<0.001). High proanthocyanidin consumers were at 50% lower risk of moderate chronic kidney insufficiency, and 65% lower risk of experiencing a 5-year renal disease event (P<0.05). These relationships remained significant following adjustment for renal disease risk factors and diet-related potential confounders. Conclusion Increased consumption of proanthocyanidins was associated with better renal function and substantially reduced renal associated events, which has been supported by mechanistic and animal model data. Proanthocyanidin intake should be further examined as a dietary contributor to better renal health.
Collapse
Affiliation(s)
- Kerry L Ivey
- School of Medicine and Pharmacology Sir Charles Gairdner Hospital Unit, University of Western Australia, Perth, Western Australia, Australia.
| | | | | | | | | | | |
Collapse
|
28
|
Noda Y, Kanki A, Yamamoto A, Higashi H, Tanimoto D, Sato T, Higaki A, Tamada T, Ito K. Age-related change in renal corticomedullary differentiation: Evaluation with noncontrast-enhanced steady-state free precession (SSFP) MRI with spatially selective inversion pulse using variable inversion time. J Magn Reson Imaging 2013; 40:79-83. [DOI: 10.1002/jmri.24332] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 07/09/2013] [Indexed: 11/08/2022] Open
Affiliation(s)
- Yasufumi Noda
- Department of Radiology; Kawasaki Medical School; Kurashiki Okayama Japan
| | - Akihiko Kanki
- Department of Radiology; Kawasaki Medical School; Kurashiki Okayama Japan
| | - Akira Yamamoto
- Department of Radiology; Kawasaki Medical School; Kurashiki Okayama Japan
| | - Hiroki Higashi
- Department of Radiology; Kawasaki Medical School; Kurashiki Okayama Japan
| | - Daigo Tanimoto
- Department of Radiology; Kawasaki Medical School; Kurashiki Okayama Japan
| | - Tomohiro Sato
- Department of Radiology; Kawasaki Medical School; Kurashiki Okayama Japan
| | - Atsushi Higaki
- Department of Radiology; Kawasaki Medical School; Kurashiki Okayama Japan
| | - Tsutomu Tamada
- Department of Radiology; Kawasaki Medical School; Kurashiki Okayama Japan
| | - Katsuyoshi Ito
- Department of Radiology; Kawasaki Medical School; Kurashiki Okayama Japan
| |
Collapse
|
29
|
AlZahrani A, Sinnert R, Gernsheimer J. Acute kidney injury, sodium disorders, and hypercalcemia in the aging kidney: diagnostic and therapeutic management strategies in emergency medicine. Clin Geriatr Med 2013. [PMID: 23177611 DOI: 10.1016/j.cger.2012.10.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
This article summarizes the current literature regarding the structural and functional changes of the aging kidney and describes how these changes make the older patient more susceptible to acute kidney injury and fluid and electrolyte disorders. It discusses the clinical manifestations, evaluation, and management of hyponatremia and shows how the management of hypernatremia in geriatric patients involves addressing the underlying cause and safely correcting the hypernatremia. The current literature regarding evaluation and management of hypercalcemia in older patients is summarized. The management of severe hypercalcemia is discussed in detail. The evaluation and management of acute kidney injury is described.
Collapse
Affiliation(s)
- Abdullah AlZahrani
- Department of Emergency Medicine, SUNY Downstate College of Medicine, Brooklyn, NY 11203, USA
| | | | | |
Collapse
|
30
|
|
31
|
|
32
|
Abstract
Chronic kidney disease is a general term for heterogenous disorders with >3 months duration affecting kidney structure and function. Nowadays, involving 10–16% of the adult population worldwide, chronic kidney disease is recognised as a major global public health problem. The number of cases is continuously increasing. In this review, epidemiology, definition, new classification and a conceptual model for development, progression and complications of chronic kidney disease as well as strategies to improve outcome are summarized. Orv. Hetil., 2013, 154, 43–51.
Collapse
Affiliation(s)
- Judit Nagy
- Pécsi Tudományegyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika és Nefrológiai Centrum Pécs Pacsirta u.1. 7624
| |
Collapse
|
33
|
Fu N, Li X, Yang S, Chen Y, Li Q, Jin D, Cong H. Risk score for the prediction of contrast-induced nephropathy in elderly patients undergoing percutaneous coronary intervention. Angiology 2012. [PMID: 23196639 DOI: 10.1177/0003319712467224] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We developed a risk score for contrast-induced nephropathy (CIN) in elderly patients (n = 668) before percutaneous coronary intervention (PCI). Another 277 elderly patients were studied for validation. Based on the odds ratio, risk factors were assigned a weighted integer; the sum of the integers was the risk score. Among the 668 elderly patients, 105 (15.7%) experienced CIN. There were 9 risk factors for CIN (with weighted integer): estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m(2) (4), diabetes (3), left ventricular ejection fraction <45% (3), hypotension (2), age >70 years (2), myocardial infarction (2), emergency PCI (2), anemia (2), and contrast agent volume >200 mL (2). The incidence of CIN was 3.4%, 11.9%, 36.9%, and 69.8% in the low-risk (≤4), moderate risk (5-8), high-risk (9-12), and very-high-risk groups (≥13). The model demonstrated good discriminative power in the validation population (c statistic = 0.79). This score can be used to plan preventative measures.
Collapse
Affiliation(s)
- Naikuan Fu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin Medical University, Tianjin, China
| | | | | | | | | | | | | |
Collapse
|
34
|
Are cystatin C-based equations superior to creatinine-based equations for estimating GFR in Chinese elderly population? Int Urol Nephrol 2012; 44:1877-84. [PMID: 23011734 DOI: 10.1007/s11255-012-0278-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 08/29/2012] [Indexed: 12/25/2022]
Abstract
PURPOSE Cystatin C has been proposed as a surrogate marker of kidney function. The elderly population accounts for the largest proportion of chronic kidney disease (CKD) patients. The aim of this study was to assess the diagnostic value of serum cystatin C and compare the applicability of cystatin C-based equations with serum creatinine (Scr)-based equations for estimating glomerular filtration rate (GFR). METHODS The estimated GFR (eGFR) values from six cystatin C-based equations (Tan, MacIsaac, Ma, Stevens1-3) and three Scr-based equations (CG, MDRD, CKD-EPI) were compared with the reference GFR (rGFR) values from 99mTc-DTPA renal dynamic imaging method. RESULTS A total of 110 elderly Chinese (60-92 year, 71.05±7.62 year) were enrolled. Cystatin C had better diagnostic value than Scr (relationship coefficient with rGFR: cystatin C -0.847 vs. Scr -0.729, P<0.01; sensitivity: cystatin C 0.90 vs. Scr 0.55, P<0.01; AUCROC: cystatin C 0.857 vs. Scr 0.757, P<0.01). All the equations predicted GFR more accurately for rGFR≥60 ml/min/1.73 m2 than for rGFR<60 ml/min/1.73 m2. Most equations had acceptable accuracy. The cystatin C-based equations deviated from rGFR by -12.78 ml/min/1.73 m2 to -2.12 ml/min/1.73 m2, with accuracy varying from 64.6 to 82.7%. The Scr-based equations deviated from rGFR by -5.37 ml/min/1.73 m2 to -0.68 ml/min/1.73 m2, with accuracy varying from 77.3 to 79.1%. The CKD-EPI, MacIsaac and Ma equations predicted no bias with rGFR (P>0.05), with higher accuracy and lower deviation in the total group. The MacIsaac, CKD-EPI and Stevens3 equations could be optimal for those with normal and mildly impaired kidney function, whereas the Ma equation for those with CKD. CONCLUSION Cystatin C is a promising kidney function marker. However, not all cystatin C-based equations could be superior to the Scr-equations.
Collapse
|
35
|
Stojanović VR, Jovanović ID, Ugrenović SZ, Vasović LP, Živković VS, Jocić MV, Kundalić BK, Pavlović MN. Morphometric analysis of nonsclerosed Glomeruli size and connective tissue content during the aging process. ScientificWorldJournal 2012; 2012:845046. [PMID: 22654637 PMCID: PMC3354636 DOI: 10.1100/2012/845046] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 12/21/2011] [Indexed: 11/17/2022] Open
Abstract
Number of sclerotic glomeruli increases during the aging process. Consequently, majority of remained nonsclerosed glomeruli become hypertrophic and some of them sclerotic, too. The aim of this study was to quantify the size and connective tissue content of nonsclerosed glomeruli and to evaluate the percentage of hypertrophic ones in examined human cases during the aging. Material was right kidney's tissue of 30 cadavers obtained during routine autopsies. Cadavers were without previously diagnosed kidney disease, diabetes, hypertension, or any other systemic disease. Tissue specimens were routinely prepared for histological and morphometric analysis. Images of the histological slices were analyzed and captured under 400x magnification with digital camera. Further they were morphometrically and statistically analyzed with ImageJ and NCSS-PASS software. Multiple and linear regression of obtained morphometric parameters showed significant increase of glomerular connective tissue area and percentage. Cluster analysis showed the presence of two types of glomeruli. Second type was characterized with significantly larger size, connective tissue content, and significantly lower cellularity, in relation to the first type. Such glomeruli might be considered as hypertrophic. First type of glomeruli was predominant in younger cases, while second type of glomeruli was predominant in cases older than 55 years.
Collapse
Affiliation(s)
- Vesna R Stojanović
- Department of Anatomy, University of Niš, Faculty of Medicine, Dr Zoran Djindjic Boulevard 81, 18000 Niš, Serbia
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Smets PMY, Lefebvre HP, Aresu L, Croubels S, Haers H, Piron K, Meyer E, Daminet S. Renal function and morphology in aged Beagle dogs before and after hydrocortisone administration. PLoS One 2012; 7:e31702. [PMID: 22393368 PMCID: PMC3290534 DOI: 10.1371/journal.pone.0031702] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Accepted: 01/17/2012] [Indexed: 11/19/2022] Open
Abstract
Objectives of this study were to evaluate glomerular filtration rate (GFR), renal structural changes and proteinuria in aged Beagle dogs before and after hydrocortisone (HC) administration. Eleven Beagle dogs ≥10 years old were treated with either hydrocortisone (HC group, n = 6) or placebo (control group, n = 5). Urinary markers, GFR and kidney biopsies were evaluated before (T0), during (T16 wks) and after discontinuing HC administration (T24 wks). Results indicate that HC administration causes a significant increase in GFR. At all time points except T16 wks, proteinuria was higher in the control group than in the HC group, and there was no significant difference in urinary markers between groups. At T16 wks, proteinuria, urinary albumin-to-creatinine (c) ratio, immunoglobulin G/c and retinol-binding protein/c were higher compared to baseline in the HC group. At T0, rare to mild renal lesions were detected in all HC dogs and rare to moderate changes in all control dogs. Glomerulosclerosis progressed in both groups until T24 wks. Tubular atrophy was detected in three HC dogs at T16 wks and T24 wks, but also in five control dogs throughout the study. At every time point, five HC dogs and all control dogs had rare to moderate interstitial inflammation. Rare to mild interstitial fibrosis was found in up to three HC dogs at T16 wks and T24 wks, and severe fibrosis in one HC dog at T24 wks. Up to four control dogs had rare to mild fibrosis at all time points. These findings indicate that clinically healthy, aged Beagle dogs may have considerable renal lesions and proteinuria, which could have implications for experimental or toxicological studies. Additional research is needed to elucidate glucocorticoid effects on renal structure, but functional changes such as hyperfiltration and proteinuria warrant attention to kidney function of canine patients with Cushing's syndrome or receiving exogenous glucocorticoids.
Collapse
Affiliation(s)
- Pascale M Y Smets
- Department of Small Animal Medicine and Clinical Biology, Faculty of Veterinary Medicine, Ghent University, Salisburylaan, Merelbeke, Belgium.
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Abstract
Chronic kidney disease is a general term for heterogeneous disorders affecting kidney structure and function. The 2002 guidelines for definition and classification of this disease represented an important shift towards its recognition as a worldwide public health problem that should be managed in its early stages by general internists. Disease and management are classified according to stages of disease severity, which are assessed from glomerular filtration rate (GFR) and albuminuria, and clinical diagnosis (cause and pathology). Chronic kidney disease can be detected with routine laboratory tests, and some treatments can prevent development and slow disease progression, reduce complications of decreased GFR and risk of cardiovascular disease, and improve survival and quality of life. In this Seminar we discuss disease burden, recommendations for assessment and management, and future challenges. We emphasise clinical practice guidelines, clinical trials, and areas of uncertainty.
Collapse
Affiliation(s)
- Andrew S Levey
- William B Schwartz Division of Nephrology, Tufts Medical Center, Boston, MA 02111, USA.
| | | |
Collapse
|
38
|
The kidney and the elderly: why does the risk increase? Int Urol Nephrol 2011; 44:625-32. [DOI: 10.1007/s11255-011-0063-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 09/20/2011] [Indexed: 12/19/2022]
|
39
|
Musso CG, Oreopoulos DG. Aging and physiological changes of the kidneys including changes in glomerular filtration rate. Nephron Clin Pract 2011; 119 Suppl 1:p1-5. [PMID: 21832859 DOI: 10.1159/000328010] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
In addition to the structural changes in the kidney associated with aging, physiological changes in renal function are also found in older adults, such as decreased glomerular filtration rate, vascular dysautonomia, altered tubular handling of creatinine, reduction in sodium reabsorption and potassium secretion, and diminished renal reserve. These alterations make aged individuals susceptible to the development of clinical conditions in response to usual stimuli that would otherwise be compensated for in younger individuals, including acute kidney injury, volume depletion and overload, disorders of serum sodium and potassium concentration, and toxic reactions to water-soluble drugs excreted by the kidneys. Additionally, the preservation with aging of a normal urinalysis, normal serum urea and creatinine values, erythropoietin synthesis, and normal phosphorus, calcium and magnesium tubular handling distinguishes decreased GFR due to normal aging from that due to chronic kidney disease.
Collapse
Affiliation(s)
- Carlos G Musso
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | | |
Collapse
|
40
|
Hohenfellner M, Pahernik S, Jaeger D, Zeier M. Renal cell cancer--a multimodal approach to preserving renal function and improving survival. Nephrol Dial Transplant 2011; 26:3086-8. [PMID: 21622992 DOI: 10.1093/ndt/gfr268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
41
|
[Quantification of sclerotic renal glomeruli during the aging process in humans]. ACTA ACUST UNITED AC 2011; 63:775-8. [PMID: 21553453 DOI: 10.2298/mpns1012775s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The aim of our research was to quantify the presence of totally sclerotized glomeruli during the aging process. MATERIAL AND METHODS The study material were kidney tissue samples taken from fifty-six cadavers, their age ranging from 20 to over 70 years. They were classified in six age groups: I (20-29), II (30-39), III (40-49); IV (50-59); V (60-69) and VI (older than 70). The tissue samples were routinely histologically processed and then cut into the slices 5 mm thick, which were then stained and stereologically analyzed under the microscope with a projection screen (Reichert Visopan) with 10 x lens magnification and multipurpose test system M42 application. The analysis was carried out on 20 fields of vision per one sample. The numerical density of completely sclerotic and other glomeruli was measured, and the resulting percentages were obtained from this parameter. RESULTS Completely sclerotic glomeruli were not found in the first group. They were observed in the II aging group (5%) for the first time. Their numerical density and percentage increased during the aging process and was 18% in the IV, 25% in the V and maximally 37.5% in the VI aging group. CONCLUSION Finally, the above cited results pointed to the increase of completely sclerotized and the decreased presence of normal glomeruli during the aging process.
Collapse
|
42
|
Renal creatinine handling in very old patients with chronic renal disease. Int Urol Nephrol 2010; 43:899-902. [DOI: 10.1007/s11255-010-9886-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Accepted: 12/07/2010] [Indexed: 11/26/2022]
|
43
|
Duarte D, Santos-Araújo C, Leite-Moreira AF. Hypertension and angiogenesis in the aging kidney: a review. Arch Gerontol Geriatr 2010; 52:e93-102. [PMID: 21176977 DOI: 10.1016/j.archger.2010.11.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 10/23/2010] [Accepted: 10/26/2010] [Indexed: 01/13/2023]
Abstract
With advanced aging, main components of the kidney are altered, including blood vessels, glomeruli and tubulointerstitium. Disruption in these 3 elements is interconnected and associated with several modifications, such as loss of kidney mass and systemic, metabolic and immunologic diseases. In this review we focus on renal blood vessels, the key role of hypertension and angiogenesis in the elderly kidney, the hemodynamic and molecular mechanisms underlying this aging process and the main factors involved. So far, the present data suggests a strong association between renal disease and hypertension and the impairment of regulatory mechanisms, such as angiogenesis in the aging kidney. The endothelium is a key player in vascular control and appears to be also disrupted in many compensatory functions (i.e., vasodilation). Perspectives for the management of the dysfunctional aging kidney are also addressed.
Collapse
Affiliation(s)
- Delfim Duarte
- Department of Physiology, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | | | | |
Collapse
|
44
|
Mohamed N, John R. Use of renal biopsy in the elderly. Int Urol Nephrol 2010; 43:593-600. [PMID: 21113798 DOI: 10.1007/s11255-010-9874-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 11/04/2010] [Indexed: 12/01/2022]
Abstract
Renal biopsy is an essential tool in the management of kidney disease. A biopsy provides a diagnosis, guides therapy and aids in prognosis, and this is true for persons of all ages. For a variety of reasons, nephrologists are sometimes hesitant to perform a biopsy in an older person. There is the major issue of a lack of perceived benefit that the biopsy will not show a treatable lesion and that therapy may not be possible in an older person. Additionally, concerns of safety may also influence the decision to biopsy. In this review, we will address these issues in the context of clinical renal syndromes and common kidney diseases in the elderly and weigh the benefit of biopsy in various situations. In general, the indications are the same as in the adult population, as is the risk associated with the biopsy procedure. Therapy, as for adults, is often successful, although further assessment of risk-benefit ratio is necessary. Age, by itself, is not a contraindication to biopsy.
Collapse
Affiliation(s)
- Nasreen Mohamed
- Department of Pathology, University Health Network, 200 Elizabeth St., 11 Eaton, Toronto, ON, M5G 2C4, Canada
| | | |
Collapse
|
45
|
Kithas PA, Supiano MA. Hypertension and chronic kidney disease in the elderly. Adv Chronic Kidney Dis 2010; 17:341-7. [PMID: 20610361 DOI: 10.1053/j.ackd.2010.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Revised: 04/15/2010] [Accepted: 04/21/2010] [Indexed: 12/24/2022]
Abstract
Although age-related alterations in the structure and function of the kidney may be inevitable, up to one-third of the older population shows no age-related decline in kidney function. As measured by inulin clearance, the healthy elderly population will be able to maintain a normal, albeit lower than their younger counterparts, glomerular filtration rate. This age-related decline in glomerular filtration rate will remain clinically insignificant in the absence of acute or chronic conditions adversely affecting kidney function or reserve. The contribution of illnesses associated with aging, such as hypertension (HTN) and diabetes mellitus, may accelerate this decline in kidney function with aging and therefore increase the incidence of chronic kidney disease. With the predicted global increase in the elderly population, the effect on health care costs and on society in general will be enormous. This will require intensive efforts at controlling diseases, such as HTN, along with continued efforts at promoting increased aerobic exercise, and a low sodium, low fat diet. The age-related decline in kidney function will, in turn, affect not only the choice of therapeutic agent in the treatment of HTN but the dosing and need for combination therapy as well. Although these approaches will need to be as aggressive as possible, they will also need to be balanced with the individual patient's potential for adverse outcomes such as orthostatic hypotension, worsening kidney function, and hyperkalemia (depending upon the agent chosen).
Collapse
|
46
|
Komplikationen durch Diuretikatherapie bei geriatrischen Patienten. Wien Med Wochenschr 2010; 160:276-280. [DOI: 10.1007/s10354-010-0786-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
47
|
Rule AD, Amer H, Cornell LD, Taler SJ, Cosio FG, Kremers WK, Textor SC, Stegall MD. The association between age and nephrosclerosis on renal biopsy among healthy adults. Ann Intern Med 2010. [PMID: 20439574 DOI: 10.1059/0003-4819-152-9-201005040-00006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Chronic kidney disease is common with older age and is characterized on renal biopsy by global glomerulosclerosis, tubular atrophy, interstitial fibrosis, and arteriosclerosis. OBJECTIVE To see whether the prevalence of these histologic abnormalities in the kidney increases with age in healthy adults and whether histologic findings are explained by age-related differences in kidney function or chronic kidney disease risk factors. DESIGN Cross-sectional study. SETTING Mayo Clinic, Rochester, Minnesota, from 1999 to 2009. PATIENTS 1203 adult living kidney donors. MEASUREMENTS Core-needle biopsy of the renal cortex obtained during surgical implantation of the kidney, and medical record data of kidney function and risk factors obtained before donation. RESULTS The prevalence of nephrosclerosis (> or =2 chronic histologic abnormalities) was 2.7% (95% CI, 1.1% to 6.7%) for patients aged 18 to 29 years, 16% (CI, 12% to 20%) for patients aged 30 to 39 years, 28% (CI, 24% to 32%) for patients aged 40 to 49 years, 44% (CI, 38% to 50%) for patients aged 50 to 59 years, 58% (CI, 47% to 67%) for patients aged 60 to 69 years, and 73% (CI, 43% to 90%) for patients aged 70 to 77 years. Adjustment for kidney function and risk factor covariates did not explain the age-related increase in the prevalence of nephrosclerosis. LIMITATION Kidney donors are selected for health and lack the spectrum or severity of renal pathologic findings in the general population. CONCLUSION Kidney function and chronic kidney disease risk factors do not explain the strong association between age and nephrosclerosis in healthy adults. PRIMARY FUNDING SOURCE National Institutes of Health, U.S. Public Health Service.
Collapse
|
48
|
Kim CJ, Shin DS. Optimal screening cut-off points for renal impairment in rural Korean older adults taking medications. J Gerontol Nurs 2010; 36:20-8; quiz 30-1. [PMID: 20438011 DOI: 10.3928/00989134-20100330-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2009] [Accepted: 01/11/2010] [Indexed: 11/20/2022]
Abstract
The purpose of this descriptive, cross-sectional study was to identify the optimal cut-off point of estimated glomerular filtration rate (eGFR) using the area under the receiver operating characteristic curve to screen for renal impairment among rural Korean older adults taking medications (N = 100). Renal function was assessed by eGFR using the Cockcroft-Gault formula. Nearly half of participants took five or more prescription drugs, and 46% took nephrotoxic medications. Participants' optimal eGFR cut-off points in screening for renal impairment with and without polypharmacy were 54.3 mL/min (area under curve [AUC] = 0.824, p < 0.001) and 61.4 mL/min (AUC = 0.768, p < 0.001), respectively. The incidence of renal impairment was 61.2% and 56.9%, respectively, using 54.3 mL/min and 61.4 mL/min as the new optimal cut-offs of eGFR with and without polypharmacy. More than half of the rural older adults require a reduction in medication dosage or a change to non-nephrotoxic medications. These new optimal cut-off points using eGFR according to polypharmacy may be helpful in screening for renal impairment among rural older adults taking medications.
Collapse
Affiliation(s)
- Chun-Ja Kim
- Ajou University College of Nursing, Suwon, South Korea
| | | |
Collapse
|
49
|
Rule AD, Amer H, Cornell LD, Taler SJ, Cosio FG, Kremers WK, Textor SC, Stegall MD. The association between age and nephrosclerosis on renal biopsy among healthy adults. Ann Intern Med 2010; 152:561-7. [PMID: 20439574 PMCID: PMC2864956 DOI: 10.7326/0003-4819-152-9-201005040-00006] [Citation(s) in RCA: 328] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Chronic kidney disease is common with older age and is characterized on renal biopsy by global glomerulosclerosis, tubular atrophy, interstitial fibrosis, and arteriosclerosis. OBJECTIVE To see whether the prevalence of these histologic abnormalities in the kidney increases with age in healthy adults and whether histologic findings are explained by age-related differences in kidney function or chronic kidney disease risk factors. DESIGN Cross-sectional study. SETTING Mayo Clinic, Rochester, Minnesota, from 1999 to 2009. PATIENTS 1203 adult living kidney donors. MEASUREMENTS Core-needle biopsy of the renal cortex obtained during surgical implantation of the kidney, and medical record data of kidney function and risk factors obtained before donation. RESULTS The prevalence of nephrosclerosis (> or =2 chronic histologic abnormalities) was 2.7% (95% CI, 1.1% to 6.7%) for patients aged 18 to 29 years, 16% (CI, 12% to 20%) for patients aged 30 to 39 years, 28% (CI, 24% to 32%) for patients aged 40 to 49 years, 44% (CI, 38% to 50%) for patients aged 50 to 59 years, 58% (CI, 47% to 67%) for patients aged 60 to 69 years, and 73% (CI, 43% to 90%) for patients aged 70 to 77 years. Adjustment for kidney function and risk factor covariates did not explain the age-related increase in the prevalence of nephrosclerosis. LIMITATION Kidney donors are selected for health and lack the spectrum or severity of renal pathologic findings in the general population. CONCLUSION Kidney function and chronic kidney disease risk factors do not explain the strong association between age and nephrosclerosis in healthy adults. PRIMARY FUNDING SOURCE National Institutes of Health, U.S. Public Health Service.
Collapse
|
50
|
The safety of oral use of l-glutamine in middle-aged and elderly individuals. Nutrition 2010; 26:375-81. [DOI: 10.1016/j.nut.2009.05.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Revised: 05/04/2009] [Accepted: 05/16/2009] [Indexed: 01/10/2023]
|