Is the pulse pressure-associated effect on glomerular filtration rate observed in elderly isolated systolic hypertension a marker of the accelerated renal aging process?
The renal aging process is characterized by a progressive decline in GFR, and a proportional fall in renal blood flow and thus an increase in renal vascular resistance. In cross-sectional studies, it has been generally assumed that the evolution of renal function parameters with time is linear [18]. In a personal study conducted in 443 normotensive (< 140/90 mmHg) subjects a decrease in GFR of 0.52 ml/min per year was found. However, careful analysis of the relationship between GFR and age clearly showed that the relationship is curvilinear and that no correlation exists before the age of 40 years, whereas GFR declines at a rate of 0.94 ml/min per year after the age of 40 years. Similar findings apply to the renal plasma flow, which tends to decrease in parallel. Such observations suggest that the aging process of renal function starts to be significantly operative during the fifth decade of life. This assumption is supported by histological studies of human kidneys obtained at autopsy
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