What makes older kidneys susceptible to kidney injury

What makes older kidneys susceptible to kidney injury?

Acute kidney injury occurs with 3.5 times greater incidence in those older than 70 years. Approximately one-third of those ≥65 years of age are unable to regain kidney function defined as independence from dialysis therapy, or return of kidney function at or near baseline kidney function after an episode of acute injury. Loss of nephron number and function and decreased vascular response to vasodilation in aging contributes to decreased kidney reserve. Thus any process that further compromises kidney perfusion or loss of nephron function, including pre-renal, intrinsic, or post-renal causes, increases susceptibility to kidney injury. Volume loss, marked vasoconstriction, or decreased cardiac output are frequent pre-renal processes in the elderly with numerous comorbidities such as hypertension, diabetes, heart failure, malignancy, or atherosclerosis. Medications, including angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and nonsteroidal agents or contrast infusion, can exacerbate the prerenal process, thereby requiring careful volume assessment before use. Intrinsic kidney processes such as toxin-associated tubular dysfunction (i.e., aminoglycosides), interstitial inflammation (i.e., antibiotic or other drug-mediated), or manipulation of the arterial tree leading to cholesterol embolization are often evident in the older individuals undergoing diagnoses and treatment for comorbid illnesses. Urinary tract obstruction can present with acute decline in kidney function in the elderly given laxity or overgrowth of pelvic structures with age and enlarged or prolapsed uterus in females and prostatic hypertrophy in male patients.

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