Skip to main content
SpringerLink
Log in

Renal Arterial Aging

  • Chapter
  • First Online:
Book cover Arterial Disorders

  • 1332 Accesses

Abstract

Renal arterial aging is emerging as a powerful determinant of age-related renal impairment and chronic kidney disease (CKD) in the elderly. Renal arterial aging represents a clinicopathologic entity characterized by progressive loss of renal mass and nephrons, decrease in renal blood flow and glomerular filtration rate, and a wide spectrum of renal vascular lesions involving both the large arteries and microcirculation. The changes in the renal microcirculation which involve mainly the preglomerular and glomerular vessels include intimal fibroplasia, arteriolar hyalinization, and glomerulosclerosis. Atheroembolic changes involve the large renal arteries. Several pathophysiologic mechanisms participate in these vascular lesions, with impairment of renal blood flow autoregulation playing an important role. There is no specific therapy to reverse these processes. Management includes normalization of systemic and glomerular hypertension with antihypertensive agents; lipid-lowering, antiplatelet agents; and lifestyle measures. Revascularization of stenotic renal artery(ies) does not appear to provide any improvement in malfunction and/or cardiovascular outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 149.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Bash LD, Astor BC, Coresh J (2010) Risk of incident ESRD: a comprehensive look at cardiovascular risk factors and 17 years of follow-up in the Arteriosclerosis Risk in Communities (ARIC) study. Am J Kidney Dis 55:31–41

    Article  PubMed  Google Scholar 

  2. Drey N, Roderick P, Mullee M, Rogerson M (2003) A population-based study of the incidence and outcomes of diagnosed chronic kidney disease. Am J Kidney Dis 42:677–684

    Article  PubMed  Google Scholar 

  3. Coresh J, Selvin E, Stevens LA et al (2007) Prevalence of chronic kidney disease in the United States. JAMA 298:2038–2047

    Article  CAS  PubMed  Google Scholar 

  4. United States Renal data System (2007) Annual data report, Bethesda

    Google Scholar 

  5. Silva FG (2005) The aging kidney: a review – part I. Int Urol Nephrol 37:185–205

    Article  PubMed  Google Scholar 

  6. Zhou XJ, Saxenia R, Liu Z, Vaziri ND, Silva FG (2008) Renal senescence in 2008: progress and challenges. Int Urol Nephrol 40:823–839

    Article  PubMed  Google Scholar 

  7. Epstein M (1996) Aging and the kidney. J Am Soc Nephrol 7:1106–1122

    CAS  PubMed  Google Scholar 

  8. Martin JE, Sheaf MJ (2007) Renal ageing. J Pathol 211:198–205

    Article  CAS  PubMed  Google Scholar 

  9. Lopez Novoa JM, Montanes M (1987) Changes in renal function and morphology in aging laboratory animals. In: Macias Nuzez JF, Cameron JS (eds) Renal function and disease in the elderly. Buttersworths, London, pp 162–183

    Chapter  Google Scholar 

  10. Coresh J, Astor BC, Green T et al (2003) Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey. Am J Kidney Dis 41:1–12

    Article  PubMed  Google Scholar 

  11. Presta P, Lucisano G, Fuiano L, Fuisano G (2012) The kidney and the elderly: why does the risk increase. Int Urol Nephrol 44:625–632

    Article  CAS  PubMed  Google Scholar 

  12. Zhou XJ, Laszik ZG, Silva FG (2008) Anatomical changes in the aging kidney. In: Macias Nunez JF, Cameron JS, Oreopoulos DG (eds) The aging kidney in health and disease. Springer, New York, pp 39–54

    Chapter  Google Scholar 

  13. Fliser D (2005) Ren sanus in corpore sano: the myth of the inexorable decline of renal function with senescence. Nephrol Dial Transplant 20:482–485

    Article  PubMed  Google Scholar 

  14. Ljungquist A, Lagergren C (1962) Normal intrarenal arterial pattern in adult and ageing human kidney: a micro-angiographical and histological study. J Anat 96(2):285–300

    Google Scholar 

  15. Tracy RE, Parra D, Eisaguirre W, Torresbalawza RA (2002) Influence of arteriolar hyalinization on arterial intima fibroplasia in the United States, Peru, and Bolivia, applicable also to other population. Am J Hypertens 15:1064–1073

    Article  PubMed  Google Scholar 

  16. Tracy RE, Ishii T (2000) Hypertensive renovasculopathies and the rise of blood pressure with age in Tokyo, Japan. Int Urol Nephrol 32:109–117

    Article  CAS  PubMed  Google Scholar 

  17. Hill GS, Heudes D, Bariety J (2003) Morphometric study of arterioles and glomeruli in the aging kidney suggests focal loss of autoregulation. Kidney Int 63:1027–1036

    Article  PubMed  Google Scholar 

  18. Tracy RE (2007) Age trends of renal arteriolar hyalinization explored with the aid of serial sections. Nephron Clin Pract 105:C171–C177

    Article  PubMed  Google Scholar 

  19. Smith JP (1955) Hyaline arteriolosclerosis in the kidney. J Pathol Bacteriol 69:147–168

    Article  CAS  PubMed  Google Scholar 

  20. Davidson AT, Talner LB, Downs WM (1969) A study of the angiographic appearance of the kidney in an ageing normotensive population. Radiology 92:975–983

    Article  CAS  PubMed  Google Scholar 

  21. Meyrier A (1996) Renal vascular lesions in the elderly: nephrosclerosis or atheromatous renal disease. Nephrol Dial Transplant 11(Suppl 9):45–52

    Article  PubMed  Google Scholar 

  22. Kalra PA, Guo H, Kausz AT et al (2005) Atherosclerotic renovascular disease in United States patients aged 67 years or older: risk factors, revascularization and prognosis. Kidney Int 68:293–301

    Article  PubMed  Google Scholar 

  23. Valderrabano F, Berthoux FC, Jones EH, Mehls O (1996) Report on management of renal failure in Europe, XXV, 1994 end stage renal disease and dialysis report. The EDTA ERA Registry. European Dialysis and Transplant Association-European Renal Association. Nephrol Dial Transplant 11(Suppl 1):2–21

    Article  PubMed  Google Scholar 

  24. Kasiske BL (1987) Relationship between vascular disease and age-associated changes in the human kidney. Kidney Int 31:1153–1159

    Article  CAS  PubMed  Google Scholar 

  25. Wright JR, Duggal A, Thomas R et al (2001) Clinicopathologic correlation in biopsy-proven atherosclerotic renovascular disease: implications for renal functional outcome in atherosclerotic renovascular disease. Nephrol Dial Transplant 16:765–770

    Article  CAS  PubMed  Google Scholar 

  26. Barton M (2005) Ageing as a determinant of renal and vascular disease: role endothelial factors. Nephrol Dial Transplant 20:485–490

    Article  CAS  PubMed  Google Scholar 

  27. Nyengaard JR, Bendtsen TF (1992) Glomerular number and size in relation to age, kidney weight, and body surface in normal man. Anat Rec 232:194–201

    Article  CAS  PubMed  Google Scholar 

  28. Heudes D, Michel O, Chevalier J et al (1994) Effect of chronic ANG I-converting enzyme inhibitor on aging processes-1 kidney structure and function. Am J Physiol 266:R1038–R1051

    CAS  PubMed  Google Scholar 

  29. Anderson S, Brenner BM (1987) The aging kidney: structure, function, mechanisms and therapeutic implications. J Am Geriatr Soc 35:590–593

    CAS  PubMed  Google Scholar 

  30. Fliser D, Ritz E (1996) Renal hemodynamics in the elderly. Nephrol Dial Transplant 11(Suppl 9):2–8

    Article  PubMed  Google Scholar 

  31. Hollenberg NK, Adams DF, Solomon HS et al (1974) Senescence and the renal vasculature in normal man. Circ Res 34:309–316

    Article  CAS  PubMed  Google Scholar 

  32. Kappel B, Olsen S (1980) Cortical interstitial tissue and sclerosed glomeruli in the normal human kidney, related to age and sex. A quantitative study. Virchows Arch A Pathol Anat Histol 387:271–277

    Article  CAS  PubMed  Google Scholar 

  33. Newbold KM, Sandison A, Howie AJ (1992) Comparison of size of juxtamedullary and outer cortical glomeruli in normal adult kidney. Virchows Arch A Pathol Anat Histopathol 420:127–129

    Article  CAS  PubMed  Google Scholar 

  34. Samuel T, Hoy WE, Douglas-Denton R et al (2005) Determinants of glomerular volume in different cortical zones of the human kidney. J Am Soc Nephrol 16:3102–3109

    Article  PubMed  Google Scholar 

  35. Hollenberg NK, Epstein M, Basch RI, Merrill JP (1969) “No Man’s Land” of the renal vasculature an arteriographic and hemodynamic assessment of the interlobar and arcuate arteries in essential and accelerated hypertension. Am J Med 47:845–854

    Article  CAS  PubMed  Google Scholar 

  36. Hill GS, Heudes D, Jacquot C et al (2006) Morphometric evidence for impairment of renal autoregulation in advanced essential hypertension. Kidney Int 69:823–831

    Article  CAS  PubMed  Google Scholar 

  37. Hoang K, Jan JC, Derby G et al (2003) Determinants of glomerular hypofiltration in aging kidneys. Kidney Int 64:1417–1424

    Article  PubMed  Google Scholar 

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

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  39. Tracy RE, Ishii J (2000) What is nephrosclerosis? Lessons from the US, Japan, and Mexico. Nephrol Dial Transplant 15:1357–1366

    Article  CAS  PubMed  Google Scholar 

  40. Luke RG (1999) Hypertensive nephrosclerosis: pathogenesis and prevalence – essential hypertension is an important cause of end-stage renal disease. Nephrol Dial Transplant 14:2271–2278

    Article  CAS  PubMed  Google Scholar 

  41. Freedman BI, Iskandar SS, Appel RG (1995) The link between hypertension and nephrosclerosis. Am J Kidney Dis 25:207–221

    Article  CAS  PubMed  Google Scholar 

  42. Nichols WW, O’Rourke MF, Vlachopoulos C (2011) Special circulations. In: Nichols WW, O’Rourke MF, Vlachopoulos C (eds) McDonald’s blood flow in arteries: theoretical, experimental and clinical principles, 6th edn. Taylor and Francis Ltd, London, pp 397–409

    Google Scholar 

  43. O’Rourke M, Safar M (2005) Relationship between aortic stiffening and microvascular disease in brain and kidney: cause and logic of therapy. Hypertension 46:200–204

    Article  PubMed  Google Scholar 

  44. Bidani AK, Polichnowski AJ, Loutzenhiser R, Griffin KA (2013) Renal microvascular dysfunction, hypertension and CKD progression. Curr Opin Nephrol Hypertens 22:1–9

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  45. Loutzenhiser R, Bidani A, Chilton L (2002) Renal myogenic response: kinetic attributes and psychological role. Circ Res 90:1316–1324

    Article  CAS  PubMed  Google Scholar 

  46. Bidani AK, Griffin KA, Williamson G et al (2009) Protective importance of the myogenic response in the renal circulation. Hypertension 54:393–398

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  47. Palmer BF (2004) Disturbances in renal autoregulation and the susceptibility to hypertension induced chronic kidney disease. Am J Med Sci 328:330–343

    PubMed  Google Scholar 

  48. O’Rourke ME, Hashimoto J (2007) Mechanical factors in arterial ageing: a clinical perspective. J Am Coll Cardiol 5:1–13

    Article  Google Scholar 

  49. Lindeman RD, Tobin J, Schock NW (1985) Longitudinal studies on the rate of decline in renal function with age. J Am Geriatr Soc 33:278–285

    CAS  PubMed  Google Scholar 

  50. Young JH, Klag MJ, Muntner P et al (2002) Blood pressure and decline in kidney function: findings from the Systolic Hypertension in the Elderly program (SHEP). J Am Soc Nephrol 13:2776–2782

    Article  CAS  PubMed  Google Scholar 

  51. Verhave JC, Fesler P, du Cailar G et al (2005) Elevated pulse pressure is associated with low renal function in elderly patients with isolated systolic hypertension. Hypertension 45:586–591

    Article  CAS  PubMed  Google Scholar 

  52. Peralta CA, Jacobs DR Jr, Katz R et al (2012) Association of pulse pressure, arterial elasticity, and endothelial function with kidney function decline among adults with estimated GFR>60 ml/min/1.73m2: the Multi-Ethnic Study of Atherosclerosis (MESA). Am J Kidney Dis 59:41–49

    Article  PubMed Central  PubMed  Google Scholar 

  53. Tomiyama H, Tanaka H, Hashimoto H et al (2010) Arterial stiffness and declines in individuals with normal renal function/early chronic kidney disease. Atherosclerosis 212:345–350

    Article  CAS  PubMed  Google Scholar 

  54. Madero M, Peralta C, Katz R et al (2013) Association of arterial rigidity with incidence kidney disease and kidney function decline: the Health ABC study. Clin J Am Soc Nephrol 8:424–433

    Article  PubMed Central  PubMed  Google Scholar 

  55. Feihl F, Liaudet L, Waeber B (2009) The macrocirculation and microcirculation of hypertension. Curr Hypertens Rep 11:182–189

    Article  PubMed  Google Scholar 

  56. Yannoutsos A, Levy BI, Safar ME et al (2014) Pathophysiology of hypertension: interactions between macro and microvascular alterations through endothelial dysfunction. J Hypertens 32:216–224

    Article  CAS  PubMed  Google Scholar 

  57. Palmer BF (2001) Impaired autoregulation: implications for the genesis of hypertension and hypertension-induced renal injury. Am J Med Sci 321:388–400

    Article  CAS  PubMed  Google Scholar 

  58. James MA, Watt PA, Potter JF et al (1995) Pulse pressure and resistance artery structural in the elderly. Hypertension 26:301–306

    Article  CAS  PubMed  Google Scholar 

  59. Wesson LG Jr (1969) Renal hemodynamics in physiological states. In: Physiology of the human kidney. Grune and Stratton, New York, pp 96–108

    Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  61. Kielstein JJ, Bode-Böger SM, Frölich JC et al (2003) Asymmetric dimethylarginine, blood pressure, and renal perfusion in elderly subjects. Circulation 107:1891–1895

    Article  PubMed  Google Scholar 

  62. Muhlberg W, Platt D (1999) Age-dependent changes of the kidneys: pharmacological implications. Gerontology 45:243–253

    Article  CAS  PubMed  Google Scholar 

  63. Rowe JW, Andres R, Tobin JD (1976) The effect of age on creatinine clearance in men: a cross-sectional and longitudinal study. J Gerontol 31:155–163

    Article  CAS  PubMed  Google Scholar 

  64. Gill J, Malyuk R, Djurdjev O, Levin A (2007) Use of GFR equation to adjust drug doses in an elderly multi-ethnic group – a cautionary tale. Nephrol Dial Transplant 22:2894–2899

    Article  PubMed  Google Scholar 

  65. Fliser D, Zeler M, Nowick R, Ritz E (1993) Renal functional reserve in healthy elderly subjects. J Am Soc Nephrol 3:1371–1377

    CAS  PubMed  Google Scholar 

  66. Ichihara A, Hayashi M, Koura Y et al (2005) Long-term effects of statins on arterial pressure and stiffness of hypertensives. J Hum Hypertens 19:103–109

    Article  CAS  PubMed  Google Scholar 

  67. Maki-Petaja KM, Wilkinson IB (2009) Antiinflammatory drugs and statins for arterial stiffness reduction. Curr Pharm Des 15:290–303

    Article  CAS  PubMed  Google Scholar 

  68. Cooper CJ, Murphy TP, Cutlip DE et al (2014) Stenting and medical therapy for atherosclerotic renal-artery stenosis. N Engl J Med 370:13–22

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine,, American University of Beirut Medical Center, Beirut, Lebanon

    Adel E. Berbari, Najla A. Daouk & Samir G. Mallat

Authors
  1. Adel E. Berbari
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Najla A. Daouk
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Samir G. Mallat
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Adel E. Berbari .

Editor information

Editors and Affiliations

  1. American University of Beirut Medical Center, Beirut, Lebanon

    Adel Berbari

  2. University of Milano Bicocca IRCCS Istituto Auxologico Italiano, Milan, Italy

    Giuseppe Mancia

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Berbari, A.E., Daouk, N.A., Mallat, S.G. (2015). Renal Arterial Aging. In: Berbari, A., Mancia, G. (eds) Arterial Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-14556-3_15

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-14556-3_15

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-14555-6

  • Online ISBN: 978-3-319-14556-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation