Following the occurrence of population aging, we have to grip a clearer picture of what happens to the kidneys in the elderly population. As shown in the highlight of this slide. Kidney function starts to decline after the biological age of 30 to 40 years. Physiologically, renal aging is characterized by a gradual decline in the estimated glomerular filtration rate, with the speed of minus 0.5 to 2% of renal function per year. This relatively low speed of renal function decline is considered purely physiological, and is independent of any comorbid condition. There are also reports suggesting that renal nascence stamps from the alter renal vascular responses to various mediators. But the entire picture seems still elusive. There is also evidence for pathological renal aging. And atomically, the aging kidney occurs microscopically and macroscopically. Microscopically, the fundamental unit of kidneys. The glomerulus becomes glomerulus garodnick, with tube collapse, basement membrane thickening, and intracapsular vibronic. Aging is also accompany microscopically by to atrophy, interstitial fibrosis, arteriosclerosis, and arteriolar heiland noses. The combination of these microscopic changes constitute the microscopic changes of nephrosclerosis, the hardening of the entire kidneys. Indeed, prior studies show that the percentages of nephrosclerosis increase stepwise with higher age. However, there are also exceptions. These anatomical changes are not necessarily associated with changes in renal functions. Another phenomenon of renal aging Is the decrease in gross renal weight. Usually, renal weight starts to decrease since 40 to 50 years of age. Although renal volume does not decrease, due to the relative increase in sinus fat or compensatory, renal hypertrophy. Renal contour and surface changes are frequently the results of associated comorbidities. But not aging per asaht In addition, physiological and pathological random aging increased age is also accompanied by an increased susceptibility to insults. Especially acute kidney injury. The kidneys behave differently as it ages. Aging predisposes individuals to nephrotoxic injuries due to the following reasons. First, the elderly frequently have more team mobility among which multiple components place the affected individuals at the higher risk of developing acute kidney injury. Such as diabetes, mellitus, and hypertension. Second, multi morbidity often necessitates the various interventions or procedures that create further insults to the relatively vulnerable kidneys. Finally, the aging body reacts differently to insults. Immune senescence may alter the responses of kidneys sustaining injuries. With a tendency toward more prominent inflammation and less tendency toward fibrosis. Aging is also associated with the risk of renal outflow obstruction due to prostatic hypertrophy. This is also an important cause of renal injury in the elderly. Rather negalactic changes in the aging kidney is the inaccuracy of existing tools to recognize renal failure, regardless of acute or chronic origin. Historically, the diagnosis of acute kidney injury was based on criteria of magnitude or percentage changes in serum pratunam. Most of these criteria required a defined window during which serum crafting changes. However, several biological phenomena in the elderly interfere with the accurate application of these criteria. First, serum kratom names can be falsely lower in the elderly than they should be in the general population, due to the fact that kratom in production is determined by the volume of muscle mass, and nutritional status. Both of which are often inadequate or even compromised in the elderly. Second, the rate of kratumi increases during acute kidney injury in the elderly, is also lower than that in the general population, due to kratumi kinetic issues. Judging from these physiological differences proven criteria for diagnosing acute kidney injury in the general population, may be this accurate in recognizing acute kidney injury in the elderly. Last but not least, when the same degree of kidney injury occurs in the non elderly and the elderly population, the later group frequently suffers from more complications. And has worse outcomes compared to the former group. This can be due to the fact that elderly patients have this physiological reserve to recover from acute illnesses compared to the non elderly. An important term has been used to describe this age related exquisite, susceptibility to acute insults. That is the frailty. We will talk more about frailty in the section of renal supportive care later. An important analogy of the relationship between chronic kidney disease and end-stage renal disease Is the tip of the iceberg drawing. Although we can only identify the proportion of patients with end stage renal disease from the outset. In fact, they are way more patients with renal or mid stage chronic kidney disease, evading our traditional detection strategy. To counteract this downward spiraling trend of renal function decline, we need to do as we can to reduce the burden of this devastating disease to our fellow citizens in Taiwan.
