Hostname: page-component-669899f699-2mbcq Total loading time: 0 Render date: 2025-04-27T05:42:27.395Z Has data issue: false hasContentIssue false
  • English
  • Français

Handling of water and electrolytes in the healthy old

Part of: Bespoke shallow archive Weizmann

Published online by Cambridge University Press:  17 August 2009

Joaquin-A. Alvarez Gregori  and
Juan-F. Macías Núñez
Joaquin-A. Alvarez Gregori
Affiliation:
Faculty of Medicine, University of Salamanca, Spain C.S. Casto Prieto, UDMFYC, SACYL, Salamanca, Spain
Juan-F. Macías Núñez*
Affiliation:
Faculty of Medicine, University of Salamanca, Spain
*
Address for correspondence: Juan-F. Macías Núñez, Medicine Department, Faculty of Medicine, University of Salamanca, C/Alfonso X El Sabio, 37007 Salamanca, Spain. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Summary

This paper reviews the handling of water and electrolytes by the ageing kidney and the clinical consequences in everyday clinical practice. Normal physiology in the adult kidney is discussed, followed by description of the main physiological changes (adaption) that occur as the kidney ages. Clearly, successful management of the elderly patient requires a knowledge of these changes, which result in: (i) increased tendency for volume depletion and dehydration; (ii) decreased ability to tolerate a volume load; (iii) increased propensity for potassium disturbances (hypo- and hyperkalaemia); (iv) diminished production of renin and blunted physiological response to the effects of aldosterone and antidiuretic hormone; (v) increased tendency to lower levels of phosphate; and (vi) tendency for the development of hypocalcaemia and hypomagnesaemia. A brief review of the role of extracellular fluid volume depletion and other factors contributing to acute renal failure in elderly patients is also presented.

Keywords

renal functionelectrolyteshydrationageingelderly
Type
Biological gerontology
Information
Reviews in Clinical Gerontology , Volume 19 , Issue 1 , February 2009 , pp. 1 - 12
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

1Musso, CG. Geriatric nephrology and the ‘nephrogeriatric giants’. Int Urol Nephrol 2002; 34: 255–6.CrossRefGoogle ScholarPubMed
2DeSanto, NG, Anastasio, P, Coppola, S, Barba, G, Jadanza, A, Capasso, G. Age-related changes in renal reserve and renal tubular function in healthy humans. Child Nephrol Urol 1991; 11: 33–40.Google ScholarPubMed
3Durakovic, Z. Creatinine clearance in the elderly: a comparison of direct measurement and calculation from serum creatinine. Nephron 1986; 44: 66–9.CrossRefGoogle ScholarPubMed
4Macias Nunez, JF, Garcia Iglesias, C, Bondia Roman, A, Rodriguez Commes, JL, Corbacho Becerra, L, Tabernero Romo, JM et al. Renal handling of sodium in old people: a functional study. Age Ageing 1978; 7: 178–81.CrossRefGoogle ScholarPubMed
5Musso, C, Lopez Novoa, JM, Macías Núñez, JF. Handling of water and sodium by the senescent kidney. Interpretation of a clearance technique for functional study. Rev Esp Ger 2005; 40: 114–9.Google Scholar
6Musso, CG, Macías, Núñez JF, Musso, CAF et al. Fractional excretion of sodium in old-old people on low sodium diet. FASEB J 2000; 14: A659.Google Scholar
7Refoyo, A, Macías-Núñez, JF. The maintenance of plasma sodium in the healthy aged. Geriatr Nephrol 1991; 1: 65–8.CrossRefGoogle Scholar
8Macias-Nunez, JF, Lopez-Novoa, JM, Martinez-Maldonado, M. Acute renal failure in the aged. Semin Nephrol 1996; 16: 330–8.Google ScholarPubMed
9Macias Nunez, JF, Garcia Iglesias, C, Tabernero Romo, JM, Rodriquez Commes, JL, Corbacho Becerra, L, Sanchez Tomero, JA. Renal management of sodium under indomethacin and aldosterone in the elderly. Age Ageing 1980; 9: 165–72.CrossRefGoogle ScholarPubMed
10Weidmann, P, De Myttenaere-Bursztein, S, Maxwell, MH, de Lima, J. Effect on aging on plasma renin and aldosterone in normal man. Kidney Int 1975; 8: 325–33.CrossRefGoogle ScholarPubMed
11Ceruso, D, Squadrito, G, Quartarone, M, Parisi, M. Renal function and blood and urinary electrolytes after administration of aldosterone in the aged. Gerontol 1970; 18: 862–7.Google ScholarPubMed
12Elias, HHA, Schwartz, DE. Steorology: application to biomedical research. Physiol Rev 1971; 51: 158–200.CrossRefGoogle Scholar
13Musso, CG, Macias Nunez, JF, Oreopoulos, DG. Physiological similarities and differences between renal aging and chronic renal disease. J Nephrol 2007; 20: 586–7.Google ScholarPubMed
14Lye, M. Distribution of body potassium in healthy elderly subjects. Gerontology 1981; 27: 286–92.CrossRefGoogle ScholarPubMed
15Biswas, K, Mulkerrin, EC. Potassium homoeostasis in the elderly. QJM 1997; 90: 487–92.CrossRefGoogle ScholarPubMed
16Mulkerrin, E, Epstein, FH, Clark, BA. Aldosterone responses to hyperkalemia in healthy elderly humans. J Am Soc Nephrol 1995; 6: 1459–62.CrossRefGoogle ScholarPubMed
17Musso, CG, Miguel, R, Algranati, L, Farias Edos, R. Renal potassium excretion: comparison between chronic renal disease patients and old people. Int Urol Nephrol 2005; 37: 167–70.Google ScholarPubMed
18Zuccala, G, Pedone, C, Cocchi, A, Pahor, M, Carosella, L, Carbonin, P et al. Older age and in-hospital development of hypokalemia from loop diuretics: results from a multicenter survey. GIFA Investigators. Multicenter Italian Pharmacoepidemiologic Study Group. J Gerontol A Biol Sci Med Sci 2000; 55: M232–8.CrossRefGoogle ScholarPubMed
19Forster, IC, Hernando, N, Biber, J, Murer, H. Proximal tubular handling of phosphate: A molecular perspective. Kidney Int 2006; 70: 1548–59.CrossRefGoogle ScholarPubMed
20Goldfarb, S, Westby, GR, Goldberg, M, Agus, ZS. Renal tubular effects of chronic phosphate depletion. J Clin Invest 1977; 59: 770–79.CrossRefGoogle ScholarPubMed
21Sorensen, LF. Gout secondary to chronic renal disease: studies on urate metabolism. Ann Rheum Dis 1980; 39: 424–30.CrossRefGoogle ScholarPubMed
22Knochel, JP. The pathophysiology and clinical characteristics of severe hypophosphatemia. Arch Intern Med 1977; 137: 203–20.CrossRefGoogle ScholarPubMed
23Shields, HM. Rapid fall of serum phosphorus secondary to antacid therapy. Gastroenterology 1978; 75: 1137–41.CrossRefGoogle ScholarPubMed
24Suki, WN. Renal handling of calcium. Contrib Nephrol 1980; 23: 1–10.CrossRefGoogle ScholarPubMed
25Dontas, AS, Marketos, SG, Papanayiotou, P. Mechanisms of renal tubular defects in old age. Postgrad Med J 1972; 48: 295–303.CrossRefGoogle ScholarPubMed
26Lewis, WH, Alving, AS. Changes with age in the renal function of adult men. Clearance of urea, amount of urea nitrogen in the blood, concentrating ability of kidneys. Am J Physiol 1938; 123: 505–15.CrossRefGoogle Scholar
27Rowe, JW, Shock, NW, DeFronzo, RA. The influence of age on the renal response to water deprivation in man. Nephron 1976; 17: 270–8.Google ScholarPubMed
28Takazakura, E, Sawabu, N, Handa, A, Takada, A, Shinoda, A, Takeuchi, J. Intrarenal vascular changes with age and disease. Kidney Int 1972; 2: 224–30.CrossRefGoogle ScholarPubMed
29Davies, DF, Shock, NW. Age changes in glomerular filtration rate, effective renal plasma flow, and tubular excretory capacity in adult males. J Clin Invest 1950; 29: 496–507.CrossRefGoogle ScholarPubMed
30Larsson, M, Jagenburg, R, Landahl, S. Renal function in an elderly population. A study of S-creatinine, 51Cr-EDTA clearance, endogenous creatinine clearance and maximal tubular water reabsorption. Scand J Clin Lab Invest 1986; 46: 593–8.CrossRefGoogle Scholar
31Lindeman, RD. The aging kidney. Compr Ther 1986; 12: 43–9.Google ScholarPubMed
32Lindeman, RD, Goldman, R. Anatomic and physiologic age changes in the kidney. Exp Gerontol 1986; 21: 379–406.CrossRefGoogle ScholarPubMed
33Kirkland, JL, Lye, M, Levy, DW, Banerjee, AK. Patterns of urine flow and electrolyte excretion in healthy elderly people. Br Med J 1983; 287: 1665–7.CrossRefGoogle ScholarPubMed
34Rodriguez Soriano, J. Renal tubular acidosis: the clinical entity. J Am Soc Nephrol 2002; 13: 2160–70.CrossRefGoogle ScholarPubMed
35Adrogué, H, Madias, NE. Renal tubular acidosis. In: Davison, AM, Cameron, SJ, Grünfeld, JP et al. . (eds), Oxford Textbook of Clinical Nephrology (3rd edn). Oxford: Oxford University Press; 2005. pp. 975–94.Google Scholar
36Adler, S, Lindeman, RD, Yiengst, MJ, Beard, E, Shock, NW. Effect of acute acid loading on urinary acid excretion by the aging human kidney. J Lab Clin Med 1968; 72: 278–89.Google ScholarPubMed
37Agarwal, BN, Cabebe, FG. Renal acidification in elderly subjects. Nephron 1980; 26: 291–5.CrossRefGoogle ScholarPubMed
38Shock, NW, Yiengst, MJ. Experimental displacement of the acid base equilibrium of the blood in aged males. Fed Proc 1948; 7: 114.Google ScholarPubMed
39Schuck, O, Nadvornikova, H. Short acidification test and its interpretation with respect to age. Nephron 1987; 46: 215–6.CrossRefGoogle ScholarPubMed
40Macías Núnez, JF, García Iglesias, C, Tabernero, JM et al. Comportamiento del riñón del viejo en la sobrecarga de acidos. Nefrología 1983; 3: 11–16.Google Scholar
41Adachi, T, Kawamura, M, Owada, M, Hiramori, K. Effect of age on renal functional and orthostatic vascular response in healthy men. Clin Exp Pharmacol Physiol 2001; 28: 877–80.CrossRefGoogle ScholarPubMed
42Macías, JF, Cameron, JS. The ageing kidney. In: Davison, AM, Cameron, SJ, Grunfeld, JP et al. (eds), Oxford Textbook of Clinical Nephrology (3rd edn). Oxford, Oxford University Press; 2005. pp. 73–85.Google Scholar
43Macias Nuñez, JF, Lopez Novoa, JM. Physiology of the Healthy Aging Kidney. In: Macias Nuñez, JF, Cameron, JS, Oreopoulos, DG (eds), The Aging Kidney in Health and Disease. New York: Springer; 2008. pp. 93–112.CrossRefGoogle Scholar
44Rodriguez-Puyol, D. The aging kidney. Kidney Int 1998; 54: 2247–65.CrossRefGoogle ScholarPubMed
45Macias Nuñez, JF, Bondía Roman, A, Rodriguez Commes, JL. Physiology and disorders of water balance and electrolytes in the elderly. In: Renal Function and Disease in the Elderly. London: Butterworths; 1987. pp. 67–93.CrossRefGoogle Scholar
46Musso, CG, Alvarez Gregori, JA, Macias Nuñez, JF. Renal Handling of Uric Acid, Magnesium, Phosphorus, Calcium, and Acid Base in the Elderly. In: Macias Nuñez, JF, Cameron, JS, Oreopoulos, DG (eds), The Aging Kidney in Health and Disease. New York: Springer; 2008. pp: 155–72.CrossRefGoogle Scholar