Effects of aging on glomerular function and number in living kidney donors

To elucidate the pathophysiologic changes in the kidney due to aging, we used physiological, morphometric, and imaging techniques to quantify GFR and its determinants in a group of 24 older (≥55 years) compared to 33 younger (≤45 years) living donors. Mathematical modeling was used to estimate the glomerular filtration coefficients for the whole kidney (Kf) and for single nephrons (SNKf), as well as the number of filtering glomeruli (NFG). Compared to younger donors, older donors had a modest (15%) but significant depression of pre-donation GFR. Mean whole-kidney Kf, renocortical volume, and derived NFG were also significantly decreased in older donors. In contrast, glomerular structure and SNKf were not different in older and younger donors. Derived NFG in the bottom quartile of older donors was less than 27% of median-derived NFG in the two kidneys of younger donors. Nevertheless, the remaining kidney of older donors exhibited adaptive hyperfiltration and renocortical hypertrophy post-donation, comparable to that of younger donors. Thus, our study found the decline of GFR in older donors is due to a reduction in Kf attributable to glomerulopenia. We recommend careful monitoring for and control of post-donation comorbidities that could exacerbate glomerular loss.