肾脏结构和功能的变化及其对老年患者心血管风险的影响

娜塔 莉亚, 尤里 ·A
别尔哥罗德国立研究大学

摘要

近年来，全世界的预期寿命都在增加。人类衰老与不同器官系统的分子、结构和功能变化有关。在正常生理衰 老过程中，肾脏功能会下降，同时也会发生宏观和微观组织学的变化。随着年龄的增长，由于肾小球硬化、萎缩和通道纤维 化的增加，功能性颗粒的数量减少。在宏观解剖结构的变化中，皮质体积的减少以及视觉检查发现的囊肿数量和大小的许多 变化是显著的。正常衰老的变化在临床上具有重要意义，在代偿机会被压迫的背景下，老年人更容易发生急性损伤和慢性肾 病，加重慢性肾病的流变性。心脏病是肾病患者死亡的主要原因，也是最常见的病理并发症。老年人肾功能逐渐下降，加上 其他危险因素，导致心室后负荷增加、冠状动脉灌注紊乱和心肌缺血，从而导致心血管疾病的发展。这篇综述确定了老年患 者肾脏最显著的结构和功能变化及其对心血管风险的影响。

关键词

衰老，慢性肾病，心血管风险

参考

[1] Moiseev V.S., Muhin N.A., Smirnov A.V., Kobalava Zh.D., Bobkova I.N., Villeval'de S.V., Efremovceva M.A., Kozlovskaya L.V., Shvecov M.Yu., Shestakova M.V., Arutyunov G.P., Bojcov S.A., Galyavich A.S., Grinshtejn Yu.I., Dobronravov V.A., Drapkina O.M., Ermolenko V.M., Karpov Yu.A., Kayukov I.G., Kotovskaya Yu.V., Kuharchuk V.V., Martynov A.I., Morozova T.E., Oganov R.G., Podzolkov V.I., Rozhinskaya L.Ya., Tereshchenko S.N., Fomin V.V., Hirmanov V.N., Chazova I.E., Shamhalova M.Sh., Shilov E.M., Shlyahto E.V., Shutov A.M. 2014. Serdechno-sosudistyj risk i hronicheskaya bolezn' pochek: strategii kardio-nefroprotekcii [Cardiovascular risk and chronic kidney disease: strategies for cardio-nephroprotection]. Rossijskij kardiologicheskij zhurnal. (8): 7-37. doi: 10.15829/1560-40712014-8-7-37_(in Russian). [2] Osipova O.A., Gosteva E.V., Chefranova Zh.Yu., Zhernakova N.I., Lykov Yu.A., Avdeeva I.V. 2020. Vliyanie farmakoterapii na dinamiku markerov obmena kollagena u bol'nyh hronicheskoj serdechnoj nedostatochnost'yu s promezhutochnoj frakciej vybrosa na fone ishemicheskoj bolezni serdca v starshih vozrastnyh gruppah [The influence of pharmacotherapy on the dynamics of collagen metabolism markers in patients with chronic heart failure with intermediate ejection fraction against the background of coronary heart disease in older age groups]. Kardiovaskulyarnaya terapiya i profilaktika. 19 (5): 188-194 (in Russian). [3] Osipova O.A., Nagibina A.I., Komisov A.A., Petrova G.D., Shekhovcova L.V., Vlasenko M.A., Vlasenko O.A. 2016. Patomorfologicheskie mekhanizmy regulyacii obrazovaniya miokardial'nogo fibroza u bol'nyh hronicheskoj serdechnoj nedostatochnost'yu na fone ishemicheskoj bolezni serdca [Pathomorphological mechanisms of regulation of myocardial fibrosis formation in patients with chronic heart failure on the background of ischemic heart disease]. Zhurnal serdechnaya nedostatochnost'. 5 (98): 357-364 (in Russian). [4] Sviridova M.S., Efremova O.A., Kamyshnikova L.A. 2013. Rasprostranennost' hronicheskoj bolezni pochek I-III stadij v Belgorodskoj oblasti [Prevalence of Stage I-III Chronic Kidney Disease in the Belgorod Region]. Nauchnye vedomosti Belgorodskogogosudarstvennogo universiteta. Seriya: Medicina. Farmaciya. 4 (147): 182-186 (in Russian). [5] Abdulkader R.C.R.M., Burdmann E.A., Lebrão M.L., Duarte Y.A.O., Zanetta D.M.T. 2017. Dec 19. Aging and decreased glomerular filtration rate: An elderly population-based study. PLoS One.; 12 (12): e0189935. doi: 10.1371/journal.pone.0189935. [6] Chagnac A., Zingerman B., Rozen-Zvi B., Herman-Edelstein M. 2019. Consequences of Glomerular Hyperfiltration: The Role of Physical Forces in the Pathogenesis of Chronic Kidney Disease in Diabetes and Obesity. Nephron. 143 (1): 38-42. doi: 10.1159/000499486. [7] Charlton J.R., Xu Y., Wu T., deRonde K.A., Hughes J.L., Dutta S., Oxley G.T., Cwiek A.,Cathro H.P., Charlton N.P., Conaway M.R., Baldelomar E.J., Parvin N., Bennett K.M. 2020. Sep 8. Magnetic resonance imaging accurately tracks kidney pathology and heterogeneity in the transition from acute kidney injury to chronic kidney disease. Kidney Int.: S0085-2538 (20) 31045-0. doi:10.1016/j.kint.2020.08.021. [8] Chevalier R.L. 2019 Jul. Evolution, kidney development, and chronic kidney disease. Semin Cell. Dev. Biol. 91: 119-131. doi: 10.1016/j.semcdb.2018.05.024. [9] Denic A., Alexander M.P., Kaushik V., Lerman L.O., Lieske J.C., Stegall M.D., Larson J.J., Kremers W.K., Vrtiska T.J., Chakkera H.A., Poggio E.D., Rule A.D. 2016. Detection and Clinical Patterns of Nephron Hypertrophy and Nephrosclerosis Among Apparently Healthy Adults. Am. J. Kidney Dis. 68 (1): 58-67. doi: 10.1053/j.ajkd.2015.12.029. [10] Denic A., Glassock R.J., Rule A.D. 2016. Structural and Functional Changes With the Aging Kidney Adv. Chronic. Kidney. Dis. 23 (1): 19-28. doi: 10.1053/j.ackd.2015.08.004. [11] Denic A., Lieske J.C., Chakkera H.A., Poggio E.D., Alexander M.P., Singh P., Kremers W.K., Lerman L.O., Rule A.D. 2017. The Substantial Loss of Nephrons in Healthy Human Kidneys with Aging. J. Am. Soc. Nephrol. 28 (1): 313-320. doi: 10.1681/ASN.2016020154. [12] Elsherbiny H.E., Alexander M.P., Kremers W.K., Park W.D., Poggio E.D., Prieto M., Lieske J.C., Rule A.D. 2014. Nephron hypertrophy and glomerulosclerosis and their association with kidney function and risk factors among living kidney donors. Clin. J. Am. Soc. Nephrol. 9 (11): 1892-902. doi:10.2215/CJN.02560314. [13] Glassock R., Denic A., Rule A.D. 2017. When kidneys get old: an essay on nephrogeriatrics. J. Bras. Nefrol. 39 (1): 59-64. Portuguese, English. doi: 10.5935/0101-2800.20170010. [14] Glassock R.J., Rule A.D. 2016. Aging and the Kidneys: Anatomy, Physiology and Consequences for Defining Chronic Kidney Disease. Nephron. 134 (1): 25-9. doi: 10.1159/000445450. [15] Hodgin J.B., Bitzer M., Wickman L., Afshinnia F., Wang S.Q., O'Connor C., Yang Y., Meadowbrooke C., Chowdhury M., Kikuchi M., Wiggins J.E., Wiggins R.C. 2015. Glomerular Aging and Focal Global Glomerulosclerosis: A Podometric Perspective. J. Am. Soc. Nephrol. 26 (12): 3162-78. doi: 10.1681/ASN.2014080752. [16] Hommos M.S., Glassock R.J., Rule A.D. 2017. Structural and Functional Changes in Human Kidneys with Healthy Aging. J. Am. Soc. Nephrol. 28 (10): 2838-2844. doi: 10.1681/ASN.2017040421. [17] Hughson M.D., Hoy W.E., Bertram J.F. 2020. Progressive Nephron Loss in Aging Kidneys: Clinical-Structural Associations Investigated by Two Anatomical Methods. Anat. Rec. (Hoboken). 303(10): 2526-2536. doi: 10.1002/ar.24249. [18] Humphreys B.D. 2018. Mechanisms of Renal Fibrosis. Annu. Rev. Physiol. 10; 80: [19] 309-326. doi: 10.1146/annurev-physiol-022516-034227. [20] Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2017 Clinical Practice Guideline for the Evaluationand Management of Chronic Kidney Disease. Kidney inter., Suppl. 2013; 3: 1-150. [21] O'Sullivan E.D., Hughes J., Ferenbach D.A. 2017. Renal Aging: Causes and Consequences. J. Am. Soc. Nephrol. 28 (2): 407-420. doi: 10.1681/ASN.2015121308. [22] Okabayashi Y., Tsuboi N., Kanzaki G., Sasaki T., Haruhara K., Koike K., Takahashi H.,Ikegami M., Shimizu A., Yokoo T. Aging Vs. 2019. Hypertension: An Autopsy Study of Sclerotic Renal Histopathological Lesions in Adults With Normal Renal Function. Am. J. Hypertens. 11; 32 (7): [23] 676-683. doi: 10.1093/ajh/hpz040. [24] Osipova O.A., Gosteva E.V., Shepel R.N., Belousova О.N., Tsurikova L.V., Petrichko T.A. 2020. Study of the role of oxidative stress, antioxidant protection and immune inflammation markers in the pathogenesis of chronic heart failure by the middle range ejection fraction in elderly patients depending on gender. Journal of critical reviews (JCR). 7 (15): 14-21. [25] Ozdemir A.A., Kapucu K. 2017. The relationship between simple renal cysts and glomerular filtration rate in the elderly. Int. Urol. Nephrol. 49 (2): 313-317. doi: 10.1007/s11255-016-1414-9. [26] Russo G.T., De Cosmo S., Viazzi F., Mirijello A., Ceriello A., Guida P., Giorda C., Cucinotta D., Pontremoli R., Fioretto P. 2018. AMD-Annals Study Group. Diabetic kidney disease in the elderly: prevalence and clinical correlates. BMC Geriatr. 18 (1): 38. doi: 10.1186/s12877-018-0732-4. [27] Schmitt R., Melk A. 2017. Molecular mechanisms of renal aging. Kidney Int. 92 (3): 28. 569-579. doi: 10.1016/j.kint.2017.02.036. [28] Tan J.C., Busque S., Workeneh B., Ho B., Derby G., Blouch K.L., Sommer F.G., Edwards B., Myers B.D. 2010. Effects of aging on glomerular function and number in living kidney donors. Kidney Int. 78 (7): 686-92. doi.org/10.1038/ki.2010.128.