性别与性别在肾脏疾病发生发展中的关系

Marcora Mandreoli
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引用次数: 1

摘要

肾脏学中基于性别的差异一直是一个历史上研究不足的领域。在肾脏病学中,在慢性肾脏疾病(CKD)的流行病学、演变和预后方面存在性别差异。在某些情况下,这些差异与一般人口趋势相反。我们讨论了这种性别和性别差异,包括传统和新型风险因素的不同影响,以及激素因素,所有这些因素都可能影响慢性肾病的倾向、进展以及生化和心理方面。造成这种性别差异的因素可能包括饮食、肾脏和肾小球的大小、肾小球血流动力学的差异以及性激素的直接影响。许多肾脏疾病的进展速度受性别影响。在多囊肾病、膜性肾病、免疫球蛋白A肾病和“病因不明的慢性肾病”中,男性进展到终末期肾衰竭的速度比女性快。在许多,但不是全部,肾脏疾病的动物模型中,雌激素延缓了进展速度。动物和实验研究试图为疾病进展中的性别差异提供进一步的机制解释。有人认为,CKD进展的性别二态性可能代表了循环类固醇与特定肾脏受体相互作用的影响。一般认为内源性雌激素对肾脏具有抗纤维化和抗细胞凋亡的作用。另一方面,男性肾功能的快速下降归因于雄激素的特异性促凋亡和促纤维化特性。
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Gender and sex in the development and progression of renal diseases
Sex-based disparities in nephrology have been a historically understudied area. In nephrology, gender differences exist with regard to the epidemiology, evolution and prognosis of chronic kidney disease (CKD). In some cases, these differences run contrary to the general population trends. We discuss such gender and sex disparities, including differing impact of traditional and novel risk factors, as well as hormonal factors, all of them potentially influencing propensity, progression and biochemical and psychological aspects of CKD. The factors involved in this gender disparity may include diet, kidney and glomerular size, differences in glomerular hemodynamics, and the direct effects of sex hormones. The progression rate of many renal diseases is affected by sex. In polycystic kidney disease, membranous nephropathy, immunoglobulin A nephropathy, and “chronic renal disease of unknown etiology”, men progress at a faster rate to end-stage renal failure than women do. In many, but not all, animal models of renal disease, estrogens slow progression rate. Animal and experimental studies have tried to offer further mechanistic explanations for gender differences in disease progression. It has been suggested that the gender dimorphism of CKD progression may represent the effects of the interaction of circulating steroids with specific kidney receptors. Endogenous estrogens have in general been considered to have anti-fibrotic and anti-apoptotic effects on the kidney. On the other hand, the faster decline of kidney function in men has been attributed to the specific pro-apoptotic and pro-fibrotic properties of androgens.
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