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Autopsy study examining non-chronic kidney disease versus chronic kidney disease caused by hypertensive-nephrosclerosis in elderly subjects

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Abstract

Background

The aim of this autopsy study was to clarify the differences of renal histopathology between non-chronic kidney disease (CKD) and CKD caused by hypertensive-nephrosclerosis in the elderly and during the aging process.

Methods

We examined autopsy specimens from 105 elderly patients (53 male subjects; mean age, 86.2 years) including 44 patients with CKD as a result of nephrosclerosis. The analysis was divided into two groups depending on whether they had CKD.

Results

The incidences of arterial intimal thickening (AIT), obsolescent-type global glomerulosclerosis (OB), and interstitial fibrosis and tubular atrophy (IF/TA) were higher in the CKD group than in the non-CKD group (all p < 0.01). These factors were all correlated with each other (AIT vs. OB, r = 0.43; AIT vs. IF/TA, r = 0.25; OB vs. IF/TA, r = 0.53). IF/TA had the strongest association with hypertension and decreased eGFR. In the non-CKD group, the frequency of OB was more than 20% in subjects aged 90 years or older. However, the individuals in the non-CKD group tended to have compensatory glomerular hypertrophy with increasing age and a retained eGFR, while the CKD group was unable to obtain compensatory hypertrophy and had a lower eGFR. We also found that AIT, OB and IF/TA occurred independently of systemic atherosclerosis.

Conclusions

Non-CKD in the elderly refers to the so-called aging kidney. The progression from aging kidney to CKD caused by nephrosclerosis was influenced by increases in AIT, OB and IF/TA. IF/TA was thought to be the most important downstream factor in the progression of aging kidney to CKD.

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Acknowledgements

We would like to express our sincere appreciation to all related parties at the pathological examinations who cooperated in this study.

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Authors and Affiliations

  1. Department of Analytic Human Pathology, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-0022, Japan

    Yasuko Yamaguchi & Akira Shimizu

  2. Department of Nephrology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan

    Yasuko Yamaguchi, Takashi Takei, Wako Yumura & Mitsuyo Itabashi

  3. Department of Pathology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan

    Yoko Matsuda & Tomio Arai

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  1. Yasuko Yamaguchi
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  2. Takashi Takei
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  3. Yoko Matsuda
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  4. Wako Yumura
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  5. Mitsuyo Itabashi
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  7. Akira Shimizu
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Correspondence to Yasuko Yamaguchi.

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Yamaguchi, Y., Takei, T., Matsuda, Y. et al. Autopsy study examining non-chronic kidney disease versus chronic kidney disease caused by hypertensive-nephrosclerosis in elderly subjects. Clin Exp Nephrol 26, 530–539 (2022). https://doi.org/10.1007/s10157-022-02189-x

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  • DOI: https://doi.org/10.1007/s10157-022-02189-x

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