More or Less Nephrons...

Written by Meguid El Nahas on Thursday, 22 June 2017. Posted in OLA Blog

More or Less Nephrons...

I read more than once this paper and failed to understand it...

N Engl J Med. 2017 Jun 15;376(24):2349-2357. doi: 10.1056/NEJMoa1614329.

Single-Nephron Glomerular Filtration Rate in Healthy Adults.

 
Total measured GFR doesnt seem to change much with age...
 
Age related reduction in Nephron numbers doesnt seem associated with compensatory growth of remnant nephrons...not surprising, well known in animal models of renal mass reduction that compensatory renal growth is blunted with age!
 
Nephrosclerosis associated reduction in nephron numbers is associated with compensatroy glomerular growth, that maintain total GFR; well thats good news and shows that compensatory growth and hyperfiltration are a good and not a bad thing...physiological rather than pathological as we were led to beleive...
 
Obesity and excessive height are associated with single nephron hyperfiltration...so what...?!
 
Overall, I failed to quite grasp the publication message,

 CAN SOMEBODY EXPLAINS ITS FINDINGS TO ME....?! 

Meguid El Nahas

Professor Meguid El Nahas PhD, FRCP

Chief Editor, OLA Director

Professor El Nahas was born in Cairo, Egypt and undertook his undergraduate medical education in...
Posted: 1 month 1 week ago by elnahas #21564
elnahas's Avatar
So...no SNGFR hyperfiltration with age-related declining renal function if there is no glomerular or vascular scarring...so declining GFR, why? and How? just age-related renal ischemia that leads to glomerular shrinkage and would prevent SN hyperperfusion, thus hyperfiltration...???!!!!

then, there is SNGFR hyperfiltration with age-related decline GFR when there is glomerulosclerosis and vascular sclerosis..."that exceeds what is expected for age"...makes some sense if the primary pathology is not ischemia leading to glomerular shrinkage; so in this case age-related is primarily ischemic, and the additional insult leading to glomerular volume and function increase is something else...most likely glucose intolerance or DM...?!

BUT: this doesnt seem to make any difference to the overall GFR decline with age...as this is the starting definer?!

Also somewhat unclear about the clinical relevance?!

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