Aging Vs. Hypertension: An Autopsy Study of Sclerotic Renal Histopathological Lesions in Adults With Normal Renal Function

BACKGROUND AND AIMS: Arterial hypertension and glomerular ischemia coexist in elderly patients with hypertension. Thus, 2 conflicting therapeutic purposes, i.e., reduction of pressure overload and maintenance of renal arterial perfusion, must be considered in elderly patients with hypertension. This study examined this issue from the perspective of renal histopathology. METHODS: Adult autopsied kidneys without apparent renal disease were analyzed for histopathological features that might be related to aging or hypertension. Mean glomerular volume (GV), global glomerulosclerosis (GGS), arteriosclerotic lesions (AL), arteriolar hyalinosis (AH), and interstitial fibrosis/tubular atrophy (IF/TA) were evaluated. RESULTS: This study included 59 Japanese autopsy patients, of whom 28 (47%) were hypertensive. Overall, GGS, IF/TA, and AL, but not GV or AH, tended to increase with aging. Multivariate analysis revealed that age, but not hypertension, was an independent factor associated with GGS, IF/TA, and AL. In contrast, hypertension was independently associated with GV. AH was not associated with age or hypertension in this autopsy series. Of note, in the late elderly group (≥75 years), GGS was significantly lower in hypertensives than in normotensives. No such trend was found in the non-elderly (<65 years) or early elderly groups (65-74 years). CONCLUSIONS: Normal aging has a major impact on the development of renal sclerotic lesions compared to hypertension in adults with no apparent renal disease. Hypertension may play a role in maintaining downstream glomerular perfusion in the aging kidney.