geriatrРоссийский журнал гериатрической медициныRussian Journal of Geriatric Medicine2686-86362686-8709Сайт издателя10.37586/2686-8636-1-2021-76-81geriatr-120Research ArticleОБЗОРЫREVIEWSСтарение почки. Взгляд гериатраKidney aging.Geriatric viewhttps://orcid.org/0000-0003-2112-9164МеркушеваЛ. И.MerkushevaL. I.

Меркушева Людмила Игоревна, кандидат медицинских наук, нефролог, гериатр, научный сотрудник лаборатории общей гериатрии и нейрогериатрии.

Москва, Телефон: +7(925)027-33-60

Merkusheva Ludmila I., MD, PhD, geriatrician and nephrologist.

Moscow

dr.merkusheva@gmail.comhttps://orcid.org/0000-0001-5272-0454РунихинаН. К.RunikhinaN. K.

Рунихина Надежда Константиновна, доктор медицинских наук, заместитель директора по гериатрической работе.

Москва, телефон: +7(499)187-78-09

Runikhina Nadezhda K., MD, PhD, Deputy Director.

Moscow

nkrunihina@rgnkc.ruhttps://orcid.org/0000-0002-4193-688XТкачеваО. Н.TkachevaO. N.

Ткачева Ольга Николаевна, доктор медицинских наук, профессор, дирек-тор Российского геронтологического научно-клинический центра.

Москва, телефон: +7(499)187-64-67

Tkacheva Olga N., MD, PhD, professor, Director.

Moscow

tkacheva@rgnkc.ruФГАОУ ВО РНИМУ им. Н.И. Пирогова Минздрава России, Российский геронтологический научно-клинический центрРоссияPirogov Russian National Research Medical University, Russian Gerontology Research and Clinical CentreRussian Federation202118042021017681Copyright © Меркушева Л.И., Рунихина Н.К., Ткачева О.Н., 20212021Меркушева Л.И., Рунихина Н.К., Ткачева О.Н.Merkusheva L.I., Runikhina N.K., Tkacheva O.N.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.geriatr-news.com/jour/article/view/120

Люди в возрасте 65 лет и старше являются наиболее быстро растущей по численности демографической популяцией во всем развитом мире. В этом обзоре мы исследуем особенности почки у людей пожилого и старческого возраста и процессы, способствующие изменениям, наблюдаемым при старении. Гистологические структурные возрастные изменения почек включают в себя уменьшение количества функциональных клубочков из-за повышенной распространенности нефросклероза (атеросклероз, гломерулосклероз и атрофия канальцев с интерстициальным фиброзом) и в некоторой степени компенсаторную гипертрофию оставшихся нефронов. Среди макроанатомических структурных изменений пожилой возраст ассоциируется преимущественно с уменьшением объема коры почки. Есть основания полагать, что у пожилых людей хроническая болезнь почек (ХБП) диагностируется некорректно. В дополнение к структурным изменениям почек у пожилых людей также обнаруживаются физиологические изменения, такие как снижение скорости клубочковой фильтрации (СКФ), дисбаланс вазоактивных веществ и гемодинамики, тубулярные изменения, а также уменьшение почечного резерва. Эти изменения делают пожилых людей восприимчивыми к почечному повреждению, в то время как у молодых людей они могли бы быть компенсированы (включая острое повреждение почек, нарушения водного и электролитного баланса, нефротоксичность лекарственных препаратов). Кроме того, сохранение нормального анализа мочи, значений мочевины и креатинина в сыворотке, синтеза эритропоэтина отличает процесс снижения СКФ при старении от такового при ХБП. В данной статье представлены современные взгляды на механизмы почечного старения, анатомические и функциональные возрастные изменения, а также отражены вопросы диагностики и распространенности ХБП у людей пожилого и старческого возраста, рисков развития терминальной почечной недостаточности. Отмечена актуальность проблемы и целесообразность интеграции нефрологии и гериатрии для специалистов, наблюдающих пациентов старшей возрастной группы.

Individuals age >65 years old are the fastest expanding population demographic throughout the developed world. Consequently, more aged patients than before are receiving diagnoses of impaired renal function and nephrosclerosis. In this review, we examine these features of the aged kidney and explore the various validated and putative pathways contributing to the changes observed with aging. Senescence or normal physiologic aging portrays the expected age-related changes in the kidney as compared to chronic kidney disease (CKD) in some individuals. The microanatomical structural changes of the kidney with older age include a decreased number of functional glomeruli from an increased prevalence of nephrosclerosis (arteriosclerosis, glomerulosclerosis, and tubular atrophy with interstitialfibrosis), and to some extent, compensatory hypertrophy of remaining nephrons. Among the macroanatomical structural changes, older age associates with smaller cortical volume. There is reason to be concerned that the elderly are being misdiagnosed with CKD. 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.

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The authors declare that there are no conflicts of interest present.