Dr Ayman Seddik , Msc , MD

Assistant Professor of Nephrology Ain Shams University , Consultant nephrologist

Dubai Hospital , Dubai Hospital Dubai Health Authority

OUTLINE 1. Prevalence of CKD and other comorbidties with

aging

2. Our kidneys and aging structural and functional changes

Hilary Cronin and Rose Anne Kenny

Part 2: The Aging Kidneys Morphological and Functional Changes

Gross granularity and pitting of the external surface

Loss of Mass & Loss of Function But with preserved homeostasis

Diabetes prevalence in the aging

Hypertension and the aging

High cholesterol and statin use in the aging

Prevalence of Chronic Kidney Disease (CKD) Stages by Age Group in NHANES 1988-1994 and 1999-2004

Effects of CKD on mortality and cardiovascular disease in the elderly - mean 75yr

0

1

2

3

4

5

6

7

8

All cause

death

CV death Non-CV

death

Heart failure MI Stroke

Ev

en

ts/1

00

yrs

Normal kidney function

CKD 1-2

CKD 3-5

Shilpak at al Ann Int Med 2006;145:237

Baseline eGFR threshold below which risk for ESRD exceeded risk for death for each age group

O’Hare 2007 JASN 18: 2758–2765

.,

Sir William Osler, M.D 1849 -1919

The Hallmarks of the Aging Kidney Intimal Thickening

of Interlobular Artery Hyaline Atherosclerosis Reduplication of

Internal Elastica Lamina

Glomerulosclerosis, Tubular Atrophy, Vascular Changes

Hypertrophic Glomerulus, Compensating for Obsolete Ones

KI (2008) 74, 710–720

Global glomerulosclerosis

Moderate IF/TA

Arteriolar reveal hyalinosis

• Age‐associated

decrease in GFR

is due to

reduction in RPF

and in Kf (UF

coef)

Factors that mediate and moderate age-related

glomerulosclerosis and tubulointerstitial fibrosis.

Brenner and Rector's The Kidney, 9th ed.

CONCLUSION

In conclusion, a large and growing number of elderly people meet criteria for CKD. However, many of these patients are less likely than their younger counterparts with similar levels of renal function to progress to ESRD.

CONCLUSION HOWEVER a subset of older patients with CKD will

EVENTUALLY progress to ESRD and these individuals account for a growing proportion of the ESRD population.

Thus, a major challenge for nephrologists is to somehow identify the small proportion but large and growing number of older patients with CKD who are most likely to experience progressive loss of renal function and benefit from aggressive efforts to slow progression and to prepare for ESRD management .