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Original Research |

The Association Between Age and Nephrosclerosis on Renal Biopsy Among Healthy Adults

Andrew D. Rule, MD, MSc; Hatem Amer, MD; Lynn D. Cornell, MD; Sandra J. Taler, MD; Fernando G. Cosio, MD; Walter K. Kremers, PhD; Stephen C. Textor, MD; and Mark D. Stegall, MD
[+] Article, Author, and Disclosure Information

From Mayo Clinic, Rochester, Minnesota.

Grant Support: By National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases (grant K23 DK078229).

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M09-2223.

Reproducible Research Statement:Study protocol, statistical code, and data set: Not available.

Requests for Single Reprints: Andrew D. Rule, MD, MSc, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905.

Current Author Addresses: Drs. Rule, Amer, Cornell, Taler, Cosio, Kremers, Textor, and Stegall: Mayo Clinic, 200 1st Street SW, Rochester, MN 55905.

Author Contributions: Conception and design: A.D. Rule, L.D. Cornell, S.J. Taler.

Analysis and interpretation of the data: A.D. Rule, L.D. Cornell, S.J. Taler, F.G. Cosio, W.K. Kremers, S.C. Textor, M.D. Stegall.

Drafting of the article: A.D. Rule, M.D. Stegall.

Critical revision of the article for important intellectual content: A.D. Rule, H. Amer, L.D. Cornell, S.J. Taler, F.G. Cosio, W.K. Kremers, S.C. Textor, M.D. Stegall.

Final approval of the article: A.D. Rule, H. Amer, L.D. Cornell, F.G. Cosio, S.C. Textor, M.D. Stegall.

Provision of study materials or patients: A.D. Rule, H. Amer, S.J. Taler, S.C. Textor, M.D. Stegall.

Statistical expertise: A.D. Rule, W.K. Kremers.

Obtaining of funding: A.D. Rule.

Administrative, technical, or logistic support: A.D. Rule, H. Amer, F.G. Cosio, M.D. Stegall.

Collection and assembly of data: A.D. Rule, H. Amer, L.D. Cornell, F.G. Cosio, S.C. Textor, M.D. Stegall.

Ann Intern Med. 2010;152(9):561-567. doi:10.7326/0003-4819-152-9-201005040-00006
Text Size: A A A

Background: Chronic kidney disease is common with older age and is characterized on renal biopsy by global glomerulosclerosis, tubular atrophy, interstitial fibrosis, and arteriosclerosis.

Objective: To see whether the prevalence of these histologic abnormalities in the kidney increases with age in healthy adults and whether histologic findings are explained by age-related differences in kidney function or chronic kidney disease risk factors.

Design: Cross-sectional study.

Setting: Mayo Clinic, Rochester, Minnesota, from 1999 to 2009.

Patients: 1203 adult living kidney donors.

Measurements: Core-needle biopsy of the renal cortex obtained during surgical implantation of the kidney, and medical record data of kidney function and risk factors obtained before donation.

Results: The prevalence of nephrosclerosis (≥2 chronic histologic abnormalities) was 2.7% (95% CI, 1.1% to 6.7%) for patients aged 18 to 29 years, 16% (CI, 12% to 20%) for patients aged 30 to 39 years, 28% (CI, 24% to 32%) for patients aged 40 to 49 years, 44% (CI, 38% to 50%) for patients aged 50 to 59 years, 58% (CI, 47% to 67%) for patients aged 60 to 69 years, and 73% (CI, 43% to 90%) for patients aged 70 to 77 years. Adjustment for kidney function and risk factor covariates did not explain the age-related increase in the prevalence of nephrosclerosis.

Limitation: Kidney donors are selected for health and lack the spectrum or severity of renal pathologic findings in the general population.

Conclusion: Kidney function and chronic kidney disease risk factors do not explain the strong association between age and nephrosclerosis in healthy adults.

Primary Funding Source: National Institutes of Health, U.S. Public Health Service.


Grahic Jump Location
The relationship between GFR and age in persons with and without nephrosclerosis.

Regression of GFR onto age in persons with nephrosclerosis (solid black line) is similar to that in persons without nephrosclerosis (solid green line). Dashed lines represent the 95% CIs. GFR = glomerular filtration rate.

Grahic Jump Location




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