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Change in Renal Function, Fluids, and Electrolytes

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Principles and Practice of Geriatric Surgery

Abstract

Renal aging is not a pathological process since the aging kidney is able to maintain the homeostasis of the internal medium in conditions of health despite the fact that its resources and ability to adapt to challenges of restriction or overload are limited. It should be understood by the reader that we have based the findings in this chapter mostly on the relatively few studies carried out in healthy aged persons in whom biochemical and clinical findings, including holistic geriatric evaluation, have been done before inclusion in the study protocol. The majority of published studies have been, unfortunately, performed in “apparently healthy” aged individuals in home care institutions, aged persons attending outpatient clinics, or hospitalized individuals whose baseline status was not well evaluated.

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References

  1. Bruijn JA, Cottran RS (1992) The aging kidney: pathological alterations. In: Martinez-Maldonado M (ed) Hypertension and renal disease in the elderly. Blackwell, Cambridge, MA, pp 1–9

    Google Scholar 

  2. Brenner BM, Meyer GW, Hostetter TH (1982) Dietary protein intake and the progressive nature of kidney disease: the role of hemodynamically mediated glomerular injury in the pathogenesis of progressive glomerular sclerosis in aging, renal ablation, and intrinsic renal disease. N Engl J Med 307:652–659

    Article  PubMed  CAS  Google Scholar 

  3. Adler S, Lindeman RD, Yiengst MJ et al (1968) Effect of acute acid loading on urinary acid excretion by the aging human kidney. J Lab Clin Med 72:278–279

    PubMed  CAS  Google Scholar 

  4. Darmady EM, Offer J, Woodhouse MA (1973) The parameters of the aging kidney. J Pathol 109:195–209

    Article  PubMed  CAS  Google Scholar 

  5. MacCrory WW (1972) Developmental nephrology. Harvard University Press, Cambridge, MA

    Google Scholar 

  6. Lindeman RD (1992) Renal hemodynamics and glomerular filtration and their relationship to aging. In: Martinez-Maldonado M (ed) Hypertension and renal disease in the elderly. Blackwell, Cambridge, MA, pp 10–25

    Google Scholar 

  7. Davies DF, Shock NW (1950) Age changes in glomerular filtration rate, effective renal plasma flow, and tubular excretory capacity in adult males. J Clin Invest 29:490–507

    Google Scholar 

  8. Wesson LG (1969) Renal hemodynamics in physiological states. In: Wesson LG (ed) Physiology of the human kidney. Grune & Stratton, New York, p 96

    Google Scholar 

  9. Fuiano G et al (2001) Renal hemodynamic response to maximal vasodilating stimulus in healthy older subjects. Kidney Int 59:1052–1058

    Article  PubMed  CAS  Google Scholar 

  10. Hollenberg NK, Adams DF, Solomon HS et al (1974) Senescence and the renal vasculature in normal man. Circ Res 34:305–309

    Article  Google Scholar 

  11. Sjostrom PA, Odlind BG, Wolgast M (1988) Extensive tubular secretion and reabsorption of creatinine in humans. Scand J Urol Nephrol 22(2):129–131

    PubMed  CAS  Google Scholar 

  12. Berglund F (1961) Urinary excretion patterns for substances with simultaneous secretion and reabsorption by active transport. Acta Physiol Scand 52:276–290

    Article  PubMed  CAS  Google Scholar 

  13. Musso CG, Michelangelo H, Vilas M, Reynaldi J et al (2009) Creatinine reabsorption by the aged kidney. Int Urol Nephrol 41(3):727–731

    Article  PubMed  CAS  Google Scholar 

  14. Macías-Núñez JF, Garcia-Iglesias C, Tabernero Romo J et al (1981) Estudio del filtrado glomerular en viejos sanos. Rev Esp Geriatr Gerontol 16(2):113–124

    Google Scholar 

  15. Cockroft DW, Gault MN (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16:31–41

    Article  Google Scholar 

  16. Kimmel PL, Lew SQ, Bosch JP (1996) Nutrition, ageing and GFR: is age-associated decline inevitable? Nephrol Dial Transplant 11:85–88

    Article  PubMed  Google Scholar 

  17. Rowe JW, Shock N, De Fronzo RA (1976) The influence of age on the renal response to water deprivation in man. Nephron 17:270–278

    Article  PubMed  CAS  Google Scholar 

  18. Lindeman RD (1990) Overview: renal physiology and pathophysiology of ageing. Am J Kidney Dis 16:275–282

    PubMed  CAS  Google Scholar 

  19. Larsson A, Jagenburg J, Landahl S (2005) Renal function in an elderly population. Scand J Clin Lab Invest 65(4):301–305

    Article  PubMed  CAS  Google Scholar 

  20. Nicholl SR et al (1991) Assessment of creatinine clearance in healthy subjects over 65 years of age. Nephron 59:621–625

    Article  Google Scholar 

  21. Keller F (1987) Kidney function and age (letter). Nephrol Dial Transplant 2:382

    PubMed  CAS  Google Scholar 

  22. Levey AS, Bosch JP, Lewis JB et al (1999) A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Ann Intern Med 130:461–470

    PubMed  CAS  Google Scholar 

  23. Rule AD, Larson TS, Bergstralh EJ et al (2004) Using serum creatinine to estimate glomerular filtration rate: accuracy in good health and in chronic kidney disease. Ann Intern Med 141(12):929–937

    PubMed  CAS  Google Scholar 

  24. Duchin KL (1985) Pharmocodynamics and pharmacokinetics of drugs in the elderly. In: Zawada ET Jr, Sica DA (eds) Geriatric nephrology and urology. PSG, Littleton, MA, pp 215–229

    Google Scholar 

  25. Durakovic Z (1986) Creatinine clearance in the elderly: a comparison of direct measurement and calculation from serum creatinine. Nephron 44:66–69

    Article  PubMed  CAS  Google Scholar 

  26. Macías-Núñez JF, García Iglesias C, Bondía Román A et al (1978) Renal handling of sodium in old people: a functional study. Age Ageing 7:178–181

    Article  PubMed  Google Scholar 

  27. Miller JH, McDonald RK, Shock NW (1952) Age changes in the maximal rate of renal tubular reabsorption of glucose. J Gerontol 7:196–200

    Article  PubMed  CAS  Google Scholar 

  28. Butterfield WJH, Keen H, Whichelow M (1967) Renal glucose threshold variations with age. Br Med J 4:505–507

    Article  PubMed  CAS  Google Scholar 

  29. Musso C, López-Novoa JM, Macías Núñez JF (2005) Handling of water and sodium by the senescent kidney. Interpretation of a clearance technique for functional study. Rev Esp Geriatr Gerontol 40(2):114–119

    Article  Google Scholar 

  30. Musso CG, Macías-Nuñez JF, Musso CA et al (2000) Fractional excretion of sodium in old-old people on low sodium diet. FASEB J 14:A659

    Google Scholar 

  31. Refoyo A, Macías-Ñúñez JF (1991) The maintenance of sodium in healthy aged. Geriatr Nephrol Urol 1:65–68

    Article  Google Scholar 

  32. Macías-Núñez JF, López-Novoa JM, Martínez-Maldonado M (1996) Acute renal failure in the aged. Semin Nephrol 16:330–338

    PubMed  Google Scholar 

  33. Macías-Núñez JF, García-Iglesias C, Tabernero-Romo JM et al (1980) Renal management of sodium under indomethacin and aldosterone in the elderly. Age Ageing 9:165–172

    Article  PubMed  Google Scholar 

  34. Sica DA, Centor RM (1985) Tests of glomerular and tubular function in the elderly. In: Zawada ET Jr, Sica DA (eds) Geriatric Nephrology and Urology. PSG, Littleton, MA, pp 33–47

    Google Scholar 

  35. Weidmann P, De Myttenaere-Bursztein S, Maxwell MH et al (1975) Effect of aging on plasma renin and aldosterone in normal man. Kidney Int 8:325–333

    Article  PubMed  CAS  Google Scholar 

  36. Norris SH, Kurtzman NA (1992) Renal acidification and metabolic acidosis in the elderly. In: Martinez-Maldonado M (ed) Hypertension and renal disease in the elderly. Blackwell, Cambridge, MA, pp 185–199

    Google Scholar 

  37. Rodriguez-Puyol D (1998) The aging kidney. Kidney Int 54:2247–2265

    Article  PubMed  CAS  Google Scholar 

  38. Phillips PA, Rolls BJ, Ledingham JG et al (1984) Reduced thirst after water deprivation in healthy elderly men. N Engl J Med 311:753–759

    Article  PubMed  CAS  Google Scholar 

  39. Shannon RP, Minaker KL, Rowe JW (1984) Aging and water balance in humans. Semin Nephrol 4:346–353

    Google Scholar 

  40. Rowe JW, Minaker KL, Sparrow D et al (1982) Age-related failure of volume-pressure-mediated vasopressin release. J Clin Endocrinol Metab 54:661–664

    Article  PubMed  CAS  Google Scholar 

  41. Robertson GL (1984) Abnormalities of thirst regulation. Kidney Int 25:460–469

    Article  PubMed  CAS  Google Scholar 

  42. Helderman JH, Vestal RE, Rowe JW et al (1978) The response of arginine vasopressin to intravenous ethanol and hypertonic saline in man: the impact of aging. J Gerontol 33:39–47

    Article  PubMed  CAS  Google Scholar 

  43. Edelman IS, Leibman J (1959) Anatomy of body water and electrolytes. Am J Med 27:256–260

    Article  PubMed  CAS  Google Scholar 

  44. Chien S, Usami S, Simmons RL (1966) Blood volume and age: repeated measurements on normal men. J Appl Physiol 21:583–588

    PubMed  CAS  Google Scholar 

  45. Edmonds CJ, Jasani BM, Smith T (1975) Total body potassium and body fat estimation in relationship to height, sex, age, malnutrition and obesity. Clin Sci Mol Med 48:431–440

    PubMed  CAS  Google Scholar 

  46. Macías-Núñez JF, López Novoa JM (2008) Physiology of the healthy aging kidney. In: Macías Núñez JF, Cameron JS, Oreopoulos DG (eds) The aging kidney in health and disease. Springer, New York, pp 93–112

    Chapter  Google Scholar 

  47. Musso CG, Maytin S, Fainstein I, et al (1999) Water metabolism in elderly with immobility syndrome. XV International Congress of Nephrology, Buenos Aires, (abstracts); p 169

    Google Scholar 

  48. Musso CG, Macías-Núñez JF (2008) Renal handling of electrolytes in the old and old-old healthy aged. In: Macías Núñez JF, Cameron JS, Oreopoulos DG (eds) The aging kidney in health and disease. Springer, New York, pp 141–154

    Chapter  Google Scholar 

  49. Dontas AS, Marketos S, Papanayioutou P (1972) Mechanisms of renal tubular defects in old age. Postgrad Med J 48:295–303

    Article  PubMed  CAS  Google Scholar 

  50. Lewis WH, Alving AS (1938) Changes with age in the renal function of adult men. Clearance of urea, amount of urea nitrogen in the blood, concentrating ability of kidneys. Am J Physiol 123:505–515

    Google Scholar 

  51. Takazakura E, Sawabu N, Handa A et al (1972) Intrarenal vascular change with age and disease. Kidney Int 2:224–230

    Article  PubMed  CAS  Google Scholar 

  52. Kirkland JL, Lye M, Levy DW et al (1985) Patterns of urine flow and electrolyte secretion in healthy elderly people. Br Med J 285:1665–1667

    Google Scholar 

  53. Lye M (1981) Distribution of body potassium in healthy elderly subjects. Gerontology 27:286

    Article  PubMed  CAS  Google Scholar 

  54. Burini R, Da Silva CA, Ribeiro MA et al (1973) Concentracão de sodio e de potassio no soro e plasma de individuos normais. Influencia da idade, do sexo e do sistema de colheita do sangue sobre os resultados. Rev Hosp Clin Fac Med S Paulo 28:9–14

    PubMed  CAS  Google Scholar 

  55. Biswas K, Mulkerrin EC (1997) Potassium homoeostasis in the elderly. Q J Med 90:487–492

    Article  CAS  Google Scholar 

  56. Kelepouris E, Agus Z (1998) Hypomagnesemia: renal magnesium handling. Semin Nephrol 18:58–73

    PubMed  CAS  Google Scholar 

  57. Graham LA, Caesar JJ, Burgen ASV (1960) Gastrointestinal absorption and excretion of magnesium in man. Metabolism 9:646–659

    PubMed  CAS  Google Scholar 

  58. Wen SF, Evanson RL, Dirks JH (1970) Micropuncture study of renal magnesium transport in proximal and distal tubule of dog. Am J Physiol 219:570–576

    PubMed  CAS  Google Scholar 

  59. Shareghi GR, Agus ZS (1982) Magnesium transport in the cortical thick ascending limb of Henle’s loop of the rabbit. J Clin Invest 69:759–769

    Article  PubMed  CAS  Google Scholar 

  60. Rude R (1996) Magnesium disorders. In: Kokko J, Tannen R (eds) Fluids and electrolytes. WB Saunders, Philadelphia, pp 421–445

    Google Scholar 

  61. Suki WN, Rouse D (1996) Renal transport of calcium, magnesium and phosphate. In: Brenner BM (ed) The Kidney, vol 1. WB Saunders, Philadelphia, pp 472–515

    Google Scholar 

  62. Friedman PA, Gesek FA (1995) Cellular calcium transport in renal epithelia: measurements, mechanism and regulation. Annu Rev Physiol 75:429–471

    CAS  Google Scholar 

  63. Gallagher JC, Kinyamu K, Fowler S et al (1998) Calciotropic hormones and bone markers in the elderly. J Bone Miner Res 13:475–482

    Article  PubMed  CAS  Google Scholar 

  64. Freaney R, McBrinn Y, McKenna MJ (1993) Secondary hyperparathyroidism in elderly people: combined effect of renal insufficiency and Vit D deficiency. Am J Clin Nutr 58:187–191

    PubMed  CAS  Google Scholar 

  65. Forster IC, Hernando N, Biber J et al (2006) Proximal tubular handling of phosphate: a molecular perspective. Kidney Int 70:1548–1559

    Article  PubMed  CAS  Google Scholar 

  66. Goldfarb S, Westby GR, Goldberg M et al (1977) Renal tubular effects of chronic phosphate depletion. J Clin Invest 59:770–779

    Article  PubMed  CAS  Google Scholar 

  67. Hershfield M (1996) Gout and uric acid metabolism. In: Bennett JC, Plum F (eds) Cecil textbook of medicine. WB Saunders, Philadelphia, pp 1508–1515

    Google Scholar 

  68. Sorensen LB (1980) Gout secondary to chronic renal disease: ­studies on urate metabolism. Ann Rheum Dis 39:424–430

    Article  PubMed  CAS  Google Scholar 

  69. Musso CG, Alvarez Gregori JA, Macias-Nuñez JF (2008) Renal handling of uric acid, magnesium, phosphorus, calcium and acid base in the elderly. In: Macias Nuñez JF, Stewart Cameron JS, Orepoulos DG (eds) The aging kidney in health and disease. Springer, New York, pp 155–172

    Chapter  Google Scholar 

  70. Macias Nuñez JF, Bondía Roman A, Rodriguez Commes JL (1987) Physiology and disorders of water balance and electrolytes in the elderly. In: Macias Nuñez JF, Cameron S (eds) Renal function and disease in the elderly. Butterworths, London, pp 67–93

    Google Scholar 

  71. Kumar R, Hill CM, McGeown MG (1973) Acute renal failure in the elderly. Lancet 1:90–91

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

The authors are grateful to Drs. Joaquin Alvarez Gregori, Paula Scibona, and Carlos Musso for their help in the preparation of the manuscript.

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Correspondence to Juan F. Macías-Núñez .

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Macías-Núñez, J.F., Martínez-Maldonado, M. (2011). Change in Renal Function, Fluids, and Electrolytes. In: Rosenthal, R., Zenilman, M., Katlic, M. (eds) Principles and Practice of Geriatric Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-6999-6_78

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  • DOI: https://doi.org/10.1007/978-1-4419-6999-6_78

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