Acute Kidney Injury in the Elderly

  • Myrto Giannopoulou
  • Stefanos Roumeliotis
  • Theodoros Eleftheriadis
  • Vassilios LiakopoulosEmail author


The elderly represent the fastest growing subgroup of the general population in the developed countries. The incidence of acute kidney injury (AKI) is rising in individuals of all ages; however, elderly patients (older than 65 years) are particularly susceptible to the development of AKI due to aging process, the presence of comorbidities, and the reduced ability to recover. Therefore, it is important to dissect and understand in details the pathways of the aging process on normal physiology, the risk factors and etiology of AKI in this group of patients. In this chapter we are reviewing the histologic and physiologic alterations, as well as the risk factors for acute kidney injury in the elderly.


Acute kidney injury Aging Elderly Epidemiology Obstructive Pathophysiology Prerenal Renal 


  1. 1.
    Van Den Noortgate N, Mouton V, Lamot C, et al. Outcome in a post-cardiac surgery population with acute renal failure requiring dialysis: does age make a difference? Nephrol Dial Transplant. 2003;18:732–6.CrossRefGoogle Scholar
  2. 2.
    Musso CG, Oreopoulos DG. Aging and physiological changes of the kidneys including changes in glomerular filtration rate. Nephron Physiol. 2011;119(Suppl 1):p1–5.CrossRefGoogle Scholar
  3. 3.
    Castellani S, Ungar A, Cantini C, et al. Excessive vasoconstriction after stress by the aging kidney: inadequate prostaglandin modulation of increased endothelin activity. J Lab Clin Med. 1998;132:186–94.CrossRefGoogle Scholar
  4. 4.
    Crane MG, Harris JJ. Effect of aging on renin activity and aldosterone excretion. J Lab Clin Med. 1976;87:947–59.PubMedGoogle Scholar
  5. 5.
    Silva FG. The ageing kidney: a review I. Int Urol Nephrol. 2005;37:185–205.CrossRefGoogle Scholar
  6. 6.
    Silva FG. The ageing kidney: a review II. Int Urol Nephrol. 2005;37:419–32.CrossRefGoogle Scholar
  7. 7.
    Glassock RJ, Rule AD. The implications of anatomical and functional changes of the aging kidney: with an emphasis on the glomeruli. Kidney Int. 2012;82:270–7.CrossRefGoogle Scholar
  8. 8.
    Abdel-Kader K, Palevsky PM. Acute kidney injury in the elderly. Clin Geriatr Med. 2009;25:331–58.CrossRefGoogle Scholar
  9. 9.
    Del Giudice A, Piemontese M, Valente G, et al. Acute kidney injury in the elderly: epidemiology, risk factors and outcomes. J Nephrol Ther. 2012;2:129.Google Scholar
  10. 10.
    Lindeman RD. Overview: renal physiology and pathophysiology of aging. Am J Kidney Dis. 1990;16:275–82.CrossRefGoogle Scholar
  11. 11.
    Musso CG, Liakopoulos V, Ioannidis I, et al. Acute renal failure in the elderly: particular characteristics. Int Urol Nephrol. 2006;38:787–93.CrossRefGoogle Scholar
  12. 12.
    Baylis C, Corman B. The aging kidney: insights from experimental studies. J Am Soc Nephrol. 1998;9:699–709.PubMedGoogle Scholar
  13. 13.
    Pascual J, Liano F, Ortuno J, et al. The elderly patient with acute renal failure. J Am Soc Nephrol. 1995;6:144–53.PubMedGoogle Scholar
  14. 14.
    Musso C, Liakopoulos V, Pangre N, et al. Renal physiology in elderly persons with severe immobility syndrome. Int Urol Nephrol. 2009;41:437–41.CrossRefGoogle Scholar
  15. 15.
    Musso CG. Geriatric nephrology and the ‘nephrogeriatric giants’. Int Urol Nephrol. 2002;34:255–6.CrossRefGoogle Scholar
  16. 16.
    Ali T, Khan I, Simpson W, et al. Incidence and outcomes in acute kidney injury: a comprehensive population-based study. J Am Soc Nephrol. 2007;18:1292–8.CrossRefGoogle Scholar
  17. 17.
    Wen J, Cheng Q, Zhao J, Ma Q, Song T, et al. Hospital-acquired acute kidney injury in Chinese very elderly persons. J Nephrol. 2013;26:572–9.CrossRefGoogle Scholar
  18. 18.
    Ishani A, Xue JL, Himmelfarb J, et al. Acute kidney injury increases risk of ESRD among elderly. J Am Soc Nephrol. 2009;20:223–8.CrossRefGoogle Scholar
  19. 19.
    Groeneveld AB, Tran DD, van der Meulen J, et al. Acute renal failure in the intensive care unit: predisposing, complicating factors affecting outcome. Nephron. 1991;59:602–10.CrossRefGoogle Scholar
  20. 20.
    Schmitt R, Coca S, Kanbay M, et al. Recovery of kidney function after acute kidney injury in the elderly: a systematic review and meta-analysis. Am J Kidney Dis. 2008;52:262–71.CrossRefGoogle Scholar
  21. 21.
    Hsu CY, Ordonez JD, Chertow GM, et al. The risk of acute renal failure in patients with chronic kidney disease. Kidney Int. 2008;74:101–7.CrossRefGoogle Scholar
  22. 22.
    Huang TM, Wu VC, Young GH, et al. National Taiwan University Hospital Study Group of Acute Renal Failure. Preoperative proteinuria predicts adverse renal outcomes after coronary artery bypass grafting. J Am Soc Nephrol. 2011;22:156–63.CrossRefGoogle Scholar
  23. 23.
    Coca SG, Cho KC, Hsu CY. Acute kidney injury in the elderly: predisposition to chronic kidney disease and vice versa. Nephron Clin Pract. 2011;119(Suppl 1):c19–24.CrossRefGoogle Scholar
  24. 24.
    Musso CG, Belloso WH, Scibona P, et al. Impact of renal aging on drug therapy. Postgrad Med. 2015;127:623–9.CrossRefGoogle Scholar
  25. 25.
    Westhoff JH, Schildhorn C, Jacobi C, et al. Telomere shortening reduces regenerative capacity after acute kidney injury. J Am Soc Nephrol. 2010;21:327–36.CrossRefGoogle Scholar
  26. 26.
    Bolisetty S, Traylor AM, Kim J, et al. Heme oxygenase-1 inhibits renal tubular macroautophagy in acute kidney injury. J Am Soc Nephrol. 2010;21:1702–12.CrossRefGoogle Scholar
  27. 27.
    Hu MC, Kuro-o M, Moe OW. The emerging role of Klotho in clinical nephrology. Nephrol Dial Transplant. 2012;27:2650–7.CrossRefGoogle Scholar
  28. 28.
    Anderson S, Eldadah B, Halter JB, et al. Acute kidney injury in older adults. J Am Soc Nephrol. 2011;22:28–38.CrossRefGoogle Scholar
  29. 29.
    Coca SG. Acute kidney injury in elderly persons. Am J Kidney Dis. 2010;56:122–31.CrossRefGoogle Scholar
  30. 30.
    van Kraaij DJ, Jansen RW, Gribnau FW, et al. Diuretic therapy in elderly heart failure patients with and without left ventricular systolic dysfunction. Drugs Aging. 2000;16:289–300.CrossRefGoogle Scholar
  31. 31.
    Pilotto A, Franceschi M, Leandro G, et al. NSAID and aspirin use by the elderly in general practice: effect on gastrointestinal symptoms and therapies. Drugs Aging. 2003;20:701–10.CrossRefGoogle Scholar
  32. 32.
    Gurwitz JH, Avorn J, Ross-Degnan D, et al. Nonsteroidal anti-inflammatory drug associated azotemia in the very old. JAMA. 1990;264:471–5.CrossRefGoogle Scholar
  33. 33.
    Jerkic M, Vojvodic S, Lopez-Novoa JM. The mechanism of increased renal susceptibility to toxic substances in the elderly. Part I. The role of increased vasoconstriction. Int Urol Nephrol. 2001;32:539–47.CrossRefGoogle Scholar
  34. 34.
    Macias-Nunez JF, Lopez-Novoa JM, Martinez-Maldonado M. Acute renal failure in the aged. Semin Nephrol. 1996;16:330–8.PubMedGoogle Scholar
  35. 35.
    Chawla LS, Abell L, Mazhari R, et al. Identifying critically ill patients at high risk for developing acute renal failure: a pilot study. Kidney Int. 2005;68:2274–80.CrossRefGoogle Scholar
  36. 36.
    Mehran R, Aymong ED, Nikolsky E, et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol. 2004;44:1393–9.PubMedGoogle Scholar
  37. 37.
    Rosner MH, Okusa MD. Acute kidney injury associated with cardiac surgery. Clin J Am Soc Nephrol. 2006;1:19–32.CrossRefGoogle Scholar
  38. 38.
    Song W, Zhang T, Pu J, et al. Incidence and risk of developing contrast-induced acute kidney injury following intravascular contrast administration in elderly patients. Clin Interv Aging. 2014;9:85–93.PubMedGoogle Scholar
  39. 39.
    Brenner BM, Rector FC. Brenner & Rector’s the kidney. 8th ed. Philadelphia: Saunders Elsevier; 2008.Google Scholar
  40. 40.
    Davison AM, Jones CH. Acute interstitial nephritis in the elderly: a report from the UK MRC Glomerulonephritis Register and a review of the literature. Nephrol Dial Transplant. 1998;13:12–6.CrossRefGoogle Scholar
  41. 41.
    Moore RD, Smith CR, Lipsky JJ, et al. Risk factors for nephrotoxicity in patients treated with aminoglycosides. Ann Intern Med. 1984;100:352–7.CrossRefGoogle Scholar
  42. 42.
    Scolari F, Ravani P, Pola A, et al. Predictors of renal and patient outcomes in atheroembolic renal disease: a prospective study. J Am Soc Nephrol. 2003;14:1584–90.CrossRefGoogle Scholar
  43. 43.
    de Lind van Wijngaarden RA, Hauer HA, Wolterbeek R, et al. Clinical and histologic determinants of renal outcome in ANCA-associated vasculitis: a prospective analysis of 100 patients with severe renal involvement. J Am Soc Nephrol. 2006;17:2264–74.CrossRefGoogle Scholar
  44. 44.
    Feest TJ, Round A, Hamad S. Incidence of severe acute renal failure in adults: results of a community-based study. BMJ. 1993;306:481–3.CrossRefGoogle Scholar
  45. 45.
    Bellomo R, Ronco C, Kellum JA, et al. Acute renal failure – definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8:R204–12.CrossRefGoogle Scholar
  46. 46.
    Bagshaw SM, George C, Bellomo R, ANZICS Database Management Committe. A comparison of the RIFLE and AKIN criteria for acute kidney injury in critically ill patients. Nephrol Dial Transplant. 2008;23:1569–74.CrossRefGoogle Scholar
  47. 47.
    Perrone RD, Madias NE, Levey AS. Serum creatinine as an index of renal function: new insights into old concepts. Clin Chem. 1992;38:1933–53.PubMedGoogle Scholar
  48. 48.
    Cheung CM, Ponnusamy A, Anderton JG. Management of acute renal failure in the elderly patient: a clinician’s guide. Drugs Aging. 2008;25:455–76.CrossRefGoogle Scholar
  49. 49.
    Palevsky PM, Liu KD, Brophy PD, et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for acute kidney injury. Am J Kidney Dis. 2012;61:649–72.CrossRefGoogle Scholar
  50. 50.
    Joannidis M, Druml W, Forni LG, et al. Critical Care Nephrology Working Group of the European Society of Intensive Care Medicine. Prevention of acute kidney injury and protection of renal function in the intensive care unit. Expert opinion of the Working Group for Nephrology ESICM. Intensive Care Med. 2010;36:392–411.CrossRefGoogle Scholar
  51. 51.
    Lash JP, Gardner C. Effects of aging and drugs on normal renal function. Coron Artery Dis. 1997;8:489–94.PubMedGoogle Scholar
  52. 52.
    Haas M, Spargo BH, Wit EJ, et al. Etiologies and outcome of acute renal insufficiency in older adults: a renal biopsy study of 259 cases. Am J Kidney Dis. 2000;35:433–47.CrossRefGoogle Scholar
  53. 53.
    Onuigbo MA, Onuigbo NT. The syndrome of rapid onset end-stage renal disease – a new mayo clinic dialysis services experience, January 2010-February 2011. In: Di Iorio B, Heidland A, Onuigbo M, Ronco C, editors. Hemodialysis: how, when and why. Hauppauge: NOVA Science Publishers; 2012. p. 443–85.Google Scholar
  54. 54.
    Onuigbo MAC, Onuigbo NT, Musso CG. Syndrome of rapid onset end stage renal disease in incident Mayo Clinic chronic hemodialysis patient. Indian J Nephrol. 2014;24:75–81.CrossRefGoogle Scholar
  55. 55.
    Musso CG, Reynaldi J, Martinez B, et al. Renal reserve in the oldest old. Int Urol Nephrol. 2011;43:253–6.CrossRefGoogle Scholar
  56. 56.
    Uchino S, Kellum JA, Bellomo R, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005;94:813–8.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Myrto Giannopoulou
    • 1
  • Stefanos Roumeliotis
    • 1
  • Theodoros Eleftheriadis
    • 1
  • Vassilios Liakopoulos
    • 1
    Email author
  1. 1.Division of Nephrology and Hypertension, 1st Department of Internal MedicineAHEPA Hospital, Medical School, Aristotle University of ThessalonikiThessalonikiGreece

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